Ontario nurses eye B.C.'s plan to cap nurse-to-patient ratio, ease workload

Nurses in Ontario and British Columbia say the western province's plan to set minimum nurse-to-patient ratios could help burnt-out nurses elsewhere in Canada by encouraging more provinces to adopt similar measures expected to reduce workloads and increase patient safety.

Angela Preocanin, who was among dozens of rain-soaked nurses who gathered near Queen's Park this week to protest "unsafe working conditions," said she would not be surprised if Ontario lost nurses to British Columbia.

"But I am hopeful, very hopeful, that this negotiated (plan) is going to be helpful to all of us across the country," said Preocanin, first vice-president of the Ontario Nurses' Association.

British Columbia has outlined a plan to become the first province to adopt minimum nurse-to-patient ratios and better retain and recruit nurses, all backed by $750-million in funding over three years.

The BC Nurses' Union said it worked alongside the government to come up with the proposal.

Preocanin said what would be a "great win" for nurses in the western province could influence demands by unionized nurses in Ontario seeking better working conditions as they head to arbitration next month after contract talks broke down in March.

Across the country, many nurses who were hailed as heroes early in the pandemic have continued to care for more patients than what is considered safe practice, said Linda Silas, president of the Canadian Federation of Nurses Unions.

That includes many who work in intensive care units, where the critical-care standard ratio is one nurse to one patient, said Silas.

She said the standard often cannot be followed during chronic staff shortages, and that can create unsafe conditions for nurses and patients.

"This shortage is creating chaos in critical care units," said Silas, who would like to see minimum ratios across the country.

"We will continue to push that (ratios) are legislated. B.C. still made major progress that they're working toward in the next three years."

British Columbia's efforts come as other provinces offer incentives to keep and attract nurses. Last month, Nova Scotia Premier Tim Houston announced nurses who worked full time in that province last year would receive $10,000 this year and another $10,000 next year if they sign an agreement to stay on the job until 2026.

Nova Scotia also offered $10,000 to nurses who left the public system if they return full time for two years. A spokeswoman for Nova Scotia Health said information on how many of those nurses signed agreements by the March 31 deadline is not yet available.

Jim Gould, interim CEO of the BC Nurses' Union, said the union is part of a committee that will work with the government to have the ratios implemented across the province.

In hospitals, the proposed ratios would be set at one-to-one for critical-care patients on ventilators, one-to-two for unventilated critical-care patients or those needing high-dependency mental-health care, one-to-three for specialized care, one-to-four for in-patient and palliative care and one-to-five for rehabilitative care.

Ratios could be added in areas such as pediatrics and spinal cord rehabilitation, for example, Gould said.

"The beauty of this is that it provides an opportunity for the public to understand how many nurses should be there," he said. "The simplicity of that accountability is what will make the system safer and better."

"We've been pushing for this for more than 25 years," he said of a plan that is modelled after California, where nurse-to-patient ratios began in 1999, and parts of Australia, which introduced similar measures two years later.

Those jurisdictions have had fewer work-related injuries, while quality of care has improved, said Gould, adding the B.C. plan would go further by also adopting minimum ratios in long-term and community-care facilities.

Gould said it's not yet known how many nurses the province would need to make the ratios possible. And neither he nor the health ministry could say when they would take effect.

In January, Premier David Eby said B.C. will pay fees for international nurses, help finance former nurses who want to return to health care, and spend $1.3 million to set up a new pathway for internationally trained nurses and fast track assessment of applications.

"This has to work," Gould said of the proposal. "It's a historic time for health care in British Columbia, and I believe in Canada."

"We hope that we serve as a role model for the rest of Canada."

But Gould is worried about whether British Columbia can attract more nurses as all provinces compete for the professionals.

"I am concerned. There's no doubt about that. And government is concerned," he said, adding he's hoping nurses that left their jobs will return to workplaces that will be safer and offer better job satisfaction.

He described "a crisis situation" in which ratios might be as high as "eight or nine or 10 patients to one nurse."

"That creates a moral fatigue and psychological injury for that nurse who cannot provide proper care."

Peggy Holton, an emergency room nurse and site leader at a hospital in Metro Vancouver, said families have been frustrated by a lack of nurses, especially as patients come in sicker during the pandemic.

"Who knows what the future will bring as far as acuteness of our patients? But (caring for) seven patients that are acutely sick, delirious, confused, is not doable."

Minimum ratios allow nurses to spend valuable time with patients to ask how they will fare at home and whether they need rehabilitation or other supports, she said.

"Now, it's hard to do that when you have one-to-seven (ratios) and you have some patients that are so acutely sick but you just do your basics."

Silas called ratios a "blunt tool" that has been considered around the country for at least 20 years but had not materialized anywhere beyond a few pilot projects, including in Quebec and New Brunswick, she said.

"California has no recruitment issues at all, and no retention issues because they were the first state to have legislated nurse-patient ratios. It has proven to be the best recruitment and retention model for nurses."

This report by The Canadian Press was first published April 7, 2023.

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