Ontario's nursing crisis has reached a critical point, with nurses in the Niagara Health System grappling with overwhelming patient loads that jeopardize patient care and contribute to staff burnout. The situation has raised alarms as nurses report being unable to provide adequate and timely care due to high nurse-to-patient ratios, leading to unsafe conditions for both patients and healthcare providers.
On September 17, 2024, three patients fell within less than three hours of a shift's start, highlighting the dangers of excessive patient loads. The nurses were ratioed at 1:8 and 1:7, starkly contrasting with legislative mandates in California and Oregon, where the required nurse-to-patient ratio is 1:5, and in Victoria and Queensland in Australia, where it is 1:4. These standards are far more favorable compared to what Ontario nurses are facing, revealing a significant gap in patient care protocols.
The problem extends beyond the Niagara Health System, as hospitals across Ontario struggle with similar issues. Nurses report that high patient ratios lead to rushed healthcare delivery, delayed medication administration, and patients being treated in hallways without access to essential life-saving equipment such as oxygen tanks and suction machines. A Niagara nurse report noted the dire circumstances: "rushing with vitals so we can try to give meds on time … Multiple confused patients (trying to crawl out of bed), some of them needing 1:1 (attention)."
"You are definitely not encouraged to fill them out," – Niagara nurse interviewed by the IJB
This sentiment from a Niagara nurse reflects the pressure staff face in documenting these critical incidents. On a night shift on September 11, nurses had to treat patients in hallways because the ward was overcapacity by four patients. These conditions are exacerbated by the lack of a call bell system, further endangering patient safety.
British Columbia has taken steps to address similar issues by establishing new guidelines that set a maximum nurse-to-patient ratio of 1:4 in emergency rooms, acute medical wards, and surgical wards. Yet, Ontario Health, responsible for managing hospital funding on behalf of the Ministry of Health, has not responded to inquiries about these challenges from the IJB.
"Eight, nine, ten (patients to one nurse) is an extreme number," – Karen Lasater, chair in nursing and health policy at the University of Pennsylvania School of Nursing
Karen Lasater's expertise underscores the severity of Ontario's nursing crisis. She explains that each additional patient a nurse cares for increases that patient's odds of dying by 7% and raises the nurse's risk of burnout by 23%.
"When a nurse cares for one additional patient, that patient has a 7-percent higher odds of dying. That nurse has a 23-percent higher odds of experiencing burnout." – Karen Lasater
Research by nursing professor Linda Aiken supports these concerns. Her study found that in California, where legislation mandates better ratios, patients receive three times more nursing care hours per day compared to states without such laws. This evidence suggests a direct correlation between legislated nurse-to-patient ratios and improved patient outcomes.
“Multiple (medications) delayed due to high patient ratios,” – Niagara nurse report
The delays in medication and care delivery are not isolated incidents but rather systemic issues that are now commonplace in Ontario hospitals. Many nurses throughout the province share similar experiences, further emphasizing the widespread nature of this crisis.
The IJB has filed formal freedom of information requests for nurse workload reports across Ontario hospitals to shed light on these pressing issues. The goal is to gather comprehensive data that could drive policy changes similar to those seen in other jurisdictions such as British Columbia, several U.S., and Australian states.
