In a significant move during recent collective bargaining, the Ontario Nurses’ Association (ONA) has prioritized establishing nurse-to-patient ratios across the province’s hospitals. This national initiative seeks to improve both the workplace environments of nurses and the quality of care delivered to patients. The suggested ratios call for one nurse per four patients in medical and surgical units. In high-acuity units, the ratio is one nurse for every two patients. In intensive care units, a dangerous one-to-one nurse-to-patient ratio is critical.
The push for these ratios comes as the British Columbia Nurses’ Union (BCNU) implements similar measures in their healthcare system. Change is already happening in all health authorities in British Columbia. The emphasis here is to roll these ratios out on medical and surgical wards first. This wave comes on the heels of a new report authored by Professor Karen Lasater which looked at the staffing levels at B.C. hospitals. The study aimed to establish a baseline to measure the impact of a minimum staffing plan, informed by California’s legislation that mandates nurse-to-patient ratios.
Ontario’s nurses are leading the charge on these changes, as patient safety and nurse burnout have become urgent issues in the province. Erin Ariss, president of the ONA, which represents more than 60,000 hospital nurses in Ontario — the most populous of Canada’s provinces. She touched on the role of workloads in creating a safer environment for nurses and patients alike, urging facilities to make them more manageable.
“When was the last time you saw a fire truck rolling to an emergency that is dangerous with one firefighter in the truck?” – Erin Ariss
The ONA’s proposals are part of a growing wave by nursing unions pushing for enforceable minimum staffing standards. In California, where similar regulations have been passed, hospitals are subject to penalties for not achieving required nurse-to-patient ratios. It’s no wonder that this legislative framework has catalyzed conversations about the need for similar measures in Ontario.
And while she understands the difficulties created by the deepening nursing shortage in British Columbia, BCNU president Adriane Gear believes the decision has gone too far. Gear credited the influx of approximately 5,000 new members to the recent Boost Training and Hiring initiatives. As he noted, even once you have these ratios codified it takes time to implement them.
“But my members remain really excited. The feedback where ratios have been implemented has been really, really positive” – Adriane Gear
Critics of the ratios, as proposed, even include those such as the Ontario Hospital Association and the provincial government. They assert that there are more effective solutions to achieve appropriate staffing levels. They contend that requiring certain nurse-to-patient ratios would result in inflexible staffing plans. These models may be less able to adjust to the evolving needs of our hospitals.
Kirk LeMessurier, a spokesperson for the Ontario Hospital Association, stated, “In today’s complex and demanding environment, there isn’t a one-size-fits-all approach to staffing.” This view is in line with worries that inflexible, prescriptive staffing mandates might restrict hospitals’ capacity to respond nimbly to shifting patient demands.
For one, studies demonstrate that not providing adequate staffing is a major factor in pushing many nurses to leave the profession. This makes clear the urgent need for staffing reforms. Professor Lasater’s study reinforces the important life-saving benefits that minimum staffing ratios promise to deliver. These ratios can help get RNs back to full time after they’ve voluntarily decreased their hours or retired from the profession.
“Inadequate staffing is a leading reason why nurses leave the workplace” – Karen Lasater
The continued conversations around nurse-to-patient ratios show that it is a pivotal time for the future of healthcare standards in Ontario and across the nation. Nurses are fighting on the frontlines for safer working conditions and high-quality patient care. We all are too, in hopes that these negotiations will result in the indisputable, needed reforms to our healthcare system.
