Calls for Ontario hospitals to implement nursing ratios

Nurses push for mandated staff-patient ratios amid rising burnout in the industry. A new study shows shortages harm care and boost readmission rates.

The union representing health-care workers in Ontario says establishing minimum nurse-to-patient ratios in hospitals would help with staffing shortages.

A study conducted by Dr. James T. Brophy and Dr. Margaret M. Keith, funded by the Ontario Council of Hospital Canadian Union of Public Employees, paints a dire picture of the state of the health-care system.

Their research found that hospital staffing shortages have led to an increase in workloads, poorer patient outcomes, and loss of public confidence.

They say that the decline in working conditions has driven nurses from the profession – many of whom would come back if working conditions improved.

“We started off looking at violence in the workplace (and found) that health care was one of the most dangerous workplaces in the country,” Brophy said.

Research conducted in 2023 found that 43.6 per cent of 750 health-care workers surveyed said that violence had increased since the beginning of the COVID-19 pandemic.

“We’re here to care for patients, so experiencing violence myself has become more and more difficult because it doesn’t make me want to go back to work the next day,” said nurse Rachel Fleming, who works in acute care.

Decline in working conditions

Brophy said the working conditions make retaining workers a big problem.

“Attrition is a problem,” he said.

“People in their 40s are saying, ‘I can’t wait to retire. If I can get out earlier, I’m going to.’ And then at the same time, there’s this … government report that we’re short -- by 2027 -- 33,000 nurses. So there’s this incredible problem.”

Fleming said she understands the frustration patients feel when they are admitted to hospitals, since they are also feeling the impacts of staffing shortages.

France Gélinas, MPP for Nickel Belt and the NDP’s health critic, said nurses are used to advocating for their patients.

“Very seldom do they ask for things for themselves,” Gélinas said.

“They are speaking up right now. They speak from a place of power. People love nurses and they’re putting forward a solution that is a win for patients, a win for themselves, a win for the hospitals, a win for the government.”

Brophy said the evidence shows that nurse-to-patient ratios save lives.

“It just can’t be ignored any more,” he said.

The Ontario Nurses Association has previously called for a ratio of one nurse to every four patients for acute medical and surgical units and a one-to-one ratio for intensive care units.

“We have to listen to the health-care workers now,” Brophy said.

Ignoring the crisis

“We have to stop ignoring this continuing crisis. That is frustrating everyone -- the public, people who go into the hospital with the long waits and the lack of … proper care. ER closures, hallway medicine -- I mean, we’ve had it. The public is fed up.”

The union is proposing the nurse-patient ratios for 50,000 hospital workers in central bargaining with the Ontario Hospital Association next month.

However, hospital administrations oppose the idea.

Last year, the Conservative government voted against an NDP bill to legislate nurse-to-patient ratios in Ontario hospitals. The NDP reintroduced the bill in May of this year, but it has yet to be debated.

Such ratios already exist in provinces like British Columbia and Nova Scotia, with Manitoba studying the idea.

Flemings said she hopes the ratios will be implemented in Ontario – and soon.

“The devastating part of it is I need to prioritize at that moment who I’m going to care for,” she said.

“And that is where … we’re starting to lose our moral compass, because we’re left and faced with priorities using somebody else’s life.”