The BC Nurses’ Union called the new ratio model 'transformative.' More than 80 per cent of members polled last year had said it was a top priority in improving working and practice conditions.JONATHAN HAYWARD/The Canadian Press
British Columbia will become the first province to adopt minimum nurse-to-patient staffing ratios in an effort to improve nurses’ working conditions and patient care.
Health Minister Adrian Dix announced the plan Tuesday as Canada grapples with a critical nurse shortage that has been exacerbated by the COVID-19 pandemic, and as provinces work to overhaul fragile health care systems.
The BC Nurses’ Union called the new model “transformative.” More than 80 per cent of members polled last year had said it was a top priority in improving working and practice conditions.
“Usually nurses are trying to prioritize whose needs are the most at that time, so this will give that nurse that little bit of time that they can give extra care to those patients that they so deserve and that the nurses are always striving to provide,” said union president Aman Grewal.
Proposed nurse-to-patient ratios, which are subject to change, include 1 to 1 for patients in ventilated critical care; 1 to 2 in non-ventilated critical care, high-dependency mental health, and high-acuity; 1 to 3 in special care; 1 to 4 in inpatient and palliative care; and 1 to 5 in rehabilitation. Ratios are still being developed for other units, including operating rooms and emergency departments.
Neither Mr. Dix nor Ms. Grewal provided comparisons on what current ratios are, but Ms. Grewal said staffing shortages meant one nurse could sometimes be tending to eight patients in some settings.
The ratios will apply to hospitals, long-term and residential care, within the community, and in non-hospital settings. The government and union modelled its nurse-to-patient ratios after those in California and parts of Australia.
To support the model, the province will spend $750-million over three years to recruit and retain nurses. Mr. Dix said targets will be measured in hours, and any funding to support the new nurse-to-patient ratios that is left over each year will remain with nurses, through retention bonuses, training, mental wellness and other such initiatives.
Mr. Dix acknowledged there are “extraordinary challenges” in health care staffing and said he is confident that a suite of recent and coming measures will meet the need.
“It’s ensuring that when people choose the nursing profession, they have the supports that they need, the work-life balance that they need, to make it a career and not a job for a few years,” he said. “Retention is key in terms of what we’re doing, and also bringing, potentially, people back into the profession.”
Mr. Dix also noted recently announced incentives to recruit internationally educated nurses, including bursaries and a streamlined assessment process for new arrivals.
At the end of 2022, British Columbia had about 3,800 nursing vacancies, according to the most recent figures from Statistics Canada.
Linda Silas, president of the Canadian Federation of Nurses Unions, said there is ample research to show that nurse-to-patient ratios have a direct impact on patient care. One study of 87 acute care hospitals in Illinois, published in 2021, found that if nurses in medical-surgical units cared for no more than four patients each, “thousands of deaths could be avoided, and patients would experience shorter lengths of stay, resulting in cost-savings for hospitals.”
Nurse-to-patient ratios “have been proven to be directly linked to retention of nurses, recruitment of nurses, but most importantly, patient safety,” Ms. Silas said. “That’s why nurses unions for the last 20 years have been working with California and Australia on how they got it. The research was done, the evidence was provided to government. I think it’s the crisis of this shortage that got governments saying, ‘I need to do everything I can to keep my nurses.’”
The nurse-to-patient ratios are a key part of the tentative agreement reached last Friday between the Health Employers Association of B.C., the Nurses Bargaining Association and the B.C government. The agreement covers about 51,500 registered, psychiatric and licensed practical nurses across the province.
If ratified, nurses would receive a retroactive raise of 25 cents an hour going back to April 1, 2022, and a total 12-per-cent wage increase over three years, as well as cost of living adjustments. The general wage increases are consistent with the province’s Shared Recovery Mandate. A ratification vote is set to begin April 20.