B.C. becomes first Canadian province to implement minimum nurse-patient ratio policy

British Columbia’s government announced a plan this past March to implement minimum nurse-to-patient ratios, aiming for at least one nurse for every four patients in medical and surgical units at all times. Once fully implemented, this initiative will make B.C. the first jurisdiction in the world to mandate such a low ratio in this specific hospital unit.

It’s a significant breakthrough that can’t come soon enough for both nurses and the people they care for, says Adriane Gear, president of the British Columbia Nurses’ Union (BCNU).

“In many cases, what we have now is the illusion of care,” says Gear, a nurse of over 30 years and a key campaigner of the minimum ratio policy. “The reality is that care every day is being missed, and there are dire consequences.”

Gear paints a troubling picture of B.C.’s current healthcare system. She says B.C. nurses caring for patients recovering from surgery might have 10 or 12 patients under their care – and that’s on a good day. Many units are operating with less than half the staff they need.

“If somebody suffers a complication…after surgery, a nurse should be able to actually observe you and notice subtle changes,” she says. “Right now, nurses are spread so thin that these opportunities for early intervention just don’t exist, or in some cases, are missed.”

The effects overworked nurses have on patient care is well-documented. For example, a 2021 study found that for each additional patient added to a nurse’s workload, there was a 16 per cent increase in the risk of death within 30 days for those patients.

Additionally, what should be therapeutic care can sometimes feel like “factory care,” Gear says, meaning nurses are unable to give patients the time and attention they need. This inevitably translates into worse outcomes for patients. Studies have shown that increasing the number of patients under nurses’ care results in higher mortality, medication errors, longer hospital stays and higher readmission rates.

Without standardized minimum patient ratios, nurses have become demoralized due to the mental and physical burdens that result from the consistent daily care of multiple patients, Gear adds.

“Nurses, to their own detriment, continue to band together and make it work,” Gear says. “It’s not like you can say, ‘Forget this, I’m just leaving.’ Nurses are required to work, in some extreme instances, up to 24-hour shifts, because they can’t abandon their patient if nobody else is coming in.”

The result is a cycle of overwork and burnout, contributing to the worsening nursing shortage. The numbers speak for themselves: There’s an increasing number of unfilled nursing positions in B.C., with Statistics Canada recently reporting over 5,000 nurse job vacancies in the province. That’s a stark jump from the 1,615 vacancies seen at the end of 2018.

“The system has been held up on the backs of nurses, and because we’ve done such a good job of it, the general public isn’t always aware of the issue”, she says. “We have many nurses in the system that are just hanging on for dear life.”

The staffing shortage has led to emergency room closures and employers spending tens of millions of dollars on for-profit staffing agencies as they try to bridge the gap. That’s why the introduction of minimum ratios — which adjust to a lower, better nurse-to-patient ratio for sicker patients, as low as 1:1 in ICUs — will be a gamechanger.

“At the end of the day, it’s a simple proposition: More nurses equal better care,” says Jim Gould, BCNU’s interim CEO and a key player in negotiating the forthcoming policy. “Minimum nurse-patient ratios ensure that nurses have the time they require to provide appropriate and high levels of care.”

He adds that the ratios recognize that patient care is a hands-on job and that nurses have less time for each patient, depending on the number of patients they’re responsible for.

“It really is that simple, but unfortunately somewhere along the way, with budgets and pressures on healthcare, we’ve lost touch,” he says, adding that the ratios present an opportunity to clearly and definitively establish a measure of successful care.

The minimum ratios are a Canadian first, but they have been successfully implemented in other jurisdictions, like Australia and California. That said, B.C. is leading the way globally when it comes to extending the implementation of ratios in community and long-term care.

“[In these other jurisdictions, minimum ratios] reduced nurse injury, it improved quality of care, the quality of the nursing experience, decreased sick leave, increased morale and caused more nurses to come back to work,” Gould says. “It really dug those jurisdictions out of similar situations to what we find ourselves in here in Canada.”

The BCNU has been pushing the provincial government to implement minimum nurse-patient ratios for more than 25 years, Gould adds. While it will take time, he says the government’s commitment is a step in the right direction.

“The fact that it’s taken so long is unfortunate, but it represents a very exciting opportunity for healthcare in this country,” Gould says. “I think everyone is watching, and they should be, because this is going to work.”

Gear says she’s looking forward to the day when nurses might finally have the appropriate conditions and support to do the job they love in the way they were trained to do it. When this does happen, it will be due to the successful implementation of the minimum ratio policy, she says.

“Nurses will no longer have that moral distress that they haven’t provided [the level of care they want] to their patients,” she says. “Nurses will have quality practice environments where they have the conditions of work that improve conditions of care for patients, and [they’ll] know that they’ve been able to do everything that was needed and required for their patients.”

Advertising feature produced by Globe Content Studio with B.C. Nurses’ Union. The Globe’s editorial department was not involved.