B.C.’s minimum nurse-patient ratios expected to improve patient outcomes, save lives

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After months of campaigning for better nurse-patient ratios, BCNU members will see their efforts finally become a reality in hospitals across the province.bcnu

If you have to go to the emergency room in British Columbia these days, chances are you’ll wait hours to be seen.

In the last several years, wait times for important medical procedures have increased. In 2023, the median wait time for MRI scans took seven days longer than in 2019, while CAT scans took four days longer during that same time period.

This doesn’t account for the delays in vital procedures, like cancer surgeries. A study found that between April and September 2022, 50 per cent of cancer patients waited one to three days longer on average for their breast, bladder, colorectal and lung cancer surgeries. For prostate cancer, wait times shot up to 12 days.

One reason for the long wait times and delayed procedures is the plummeting staff levels in hospitals. The healthcare demands of the COVID-19 pandemic exacerbated staffing issues. From 2021 to 2022, Canada saw a record 95,800 vacant nursing, personal support and healthcare worker jobs. More than 5,000 of these nurse vacancies were in B.C.

By 2023, nurse vacancies increased more than four-fold since 2015. The rising vacancy rate has the potential to negatively affect patient outcomes, which is why the British Columbia Nurses’ Union (BCNU) has been campaigning to introduce a minimum nurse-to-patient ratio (mNPR) policy for years. Now, the BCNU’s work will finally become a reality, with the B.C. government recently committing $750-million toward the implementation of an mNPR policy that requires one nurse for every four patients in medical and surgical units.

The new policy is important because fewer hospital staff means more work falls onto the already-overflowing plates of nurses. Heavy workloads can lead to severe fatigue and burnout, which can have a host of ripple effects on patient care.

From 2021 to 2022, nurses and other healthcare providers working in hospitals logged over 14 million overtime hours, up by half from the previous year. A recent study also found that Canadian hospitals with inadequate staffing saw rates of patients’ urinary tract infections and pneumonia rise by around 20 per cent, while aspiration pneumonia rose by 25 per cent, and pressure ulcers by more than 50 per cent. The same study, conducted between 2022 and 2023, also revealed that one in 17 patients were unintentionally harmed during their hospital stay.

Karen Lasater, an associate nursing professor at the University of Pennsylvania, conducted a study in New York and Illinois just before the pandemic hit. Even before COVID-19, she and her team found 50 per cent of nurses were tackling high burnout.

A pre-pandemic survey of Canadian healthcare workers, conducted between 2018 and 2019, found similar results. With respect to the U.S. study, Lasater says the driver of nurse burnout is the understaffing of nurses. “That tells us that when there are staffing policies, they are actually effective at moving the needle on [retention and recruitment].”

She adds that nurse retention is less of a pipeline issue and more of a “leaky bucket,” meaning more nurses are graduating from schools — they’re just not staying with their employers. “There seems to be a logical narrative that nurses are burning out, so there’s not enough nurses, and no one wants to become a nurse,” Lasater says. But despite this, she says, the U.S. has seen record-breaking numbers of new nurses entering the profession.

While it’s a desirable career, Lasater says nurses don’t stay in the same job for long. A recent study by her team found that the biggest reasons for nurses leaving their employers is planned retirement, followed by burnout and insufficient staffing.

“It’s a vicious cycle,” Lasater says.

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mNPRs will ensure that nurses have more manageable workloads, which will help them avoid burnout and lead to better patient care.

Similar policies are already showing promising results in Australia and the U.S.; BCNU has been working with sister unions in these jurisdictions to monitor progress.

mNPRs were first implemented in Australia’s state of Victoria in 2000. After the policy was implemented, Victoria saw a 24 per cent uptick in employed nurses, with more than 7,000 inactive nurses — those who either left the profession or retired — rejoining the workforce.

In 2016, Australia’s Queensland state followed suit. A major study of 231,902 patients found that removing just one patient from a nurses’ roster significantly reduced rates of mortality, readmission and length of stay.

“That’s probably one of the most significant studies showing that staffing policies are not only effective at changing staffing in hospitals, but they are associated with better patient outcomes,” Lasater says.

Meanwhile, mNPRs have been a California-wide requirement in hospitals since 2004, and Oregon is currently working on their implementation. In California, the results have been positive, with the policy allowing nurses to spend three more hours per day with each patient. After implementation, the state’s hospitals also saw a big increase in nurse retention, with vacancy rates falling below five per cent.

In Illinois, mNPRs are going through state legislation. A study by Lasater and her team found that for each patient added to a nurse’s workload, the odds of 30-day mortality increased by 16 per cent in one Illinois hospital.

“Patients who go to hospitals and expect to be able to walk out alive, that’s not a reality when hospitals don’t have safe staffing,” Lasater says. “For some people, it’s life and death [based on] whether or not they have a nurse who can be there to surveil the little changes that happen in their vital signs.”

According to the Illinois study, thousands of deaths would be avoided, patient hospital stays would be reduced and hospitals would save significant costs if nurses in medical-surgical units cared for no more than four patients each.

In California, hospitals that improved the most from the staffing ratio policy were safety-net hospitals, Lasater says. “It really brought the hospitals that were at the bottom up toward the middle, so that’s one hope for British Columbia,” she adds.

While the U.S. healthcare system is different from Canada’s, BCNU president Adriane Gear says the patients are the same. “The care that’s required isn’t different, so that’s definitely been very helpful,” she says.

Gear is watching Australia and California closely to learn how these jurisdictions got the mNPRs into legislation. “A lot of that was educating the public,” Gear says. “We have [mNPRs], but to ensure that they’re implemented fully, and to make sure that there’s some type of accountability, we need to inform and engage the public of their importance.”

Through education, she hopes that more people will understand how critical mNPRs are to their safety.

Plus, for Gear, hospitals are just the start.

“We [BCNU] are unique and really trailblazing in that. Not only are we establishing ratios in hospital settings but also in home and community, and in long-term care,” Gear says. “It’s never been done before.”


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

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