B.C.’s nurse-patient ratio policy expects to boost nurse job satisfaction, retention

It’s no secret that Canada is facing a healthcare crisis, with 63 per cent of Canadians believing that the biggest weakness in today’s healthcare system is a lack of staff, per data platform Statista.

This belief is backed up by numbers, with a 2021 study finding a 16 per cent increase in patient mortality for every additional patient added to a nurse’s assignment. All this means hospitals committed to nurse recruitment and retention can better ensure comprehensive and high-quality care.

A B.C. government investment of $750-million will see a push toward a new minimum nurse-to-patient ratio (mNPR) policy in hospitals province-wide — a significant change from the 10 to 12 patients that nurses were previously responsible for per shift, says Adriane Gear, president of the British Columbia Nurses Union (BCNU).

Gear highlights the importance of adequate staffing, stating, “You can’t fly a plane if you don’t have a sufficient number of pilots [and] flight attendants.”

Since the pandemic, hospitals have been forced to run with record-low numbers of nurses. In the final months of 2023, B.C. saw more than 5,000 nurse vacancies — four times higher than in 2015.

While the stresses of the pandemic made it more difficult to retain nurses, nurse retention isn’t a new challenge for Canada. As a nurse for more than 30 years, Gear has first-hand experience with the job’s high demands, which can include high-stress shifts that can last over 24 hours in some extreme cases.

Just like in any other job, chronic workplace stress leads to severe fatigue and poor work-life balance. In a hospital setting, these factors can have serious consequences for patients, from medication mismanagement to a lack of early detection of health problems.

“The [healthcare] system has been held up on the backs of nurses,” Gear says, which puts nurses in strenuous situations. “How do you prioritize care? How do I know if [one patient’s] pain that’s out of control is worse than [another] person’s?” she asks. “Having to make those choices, that’s what we have to do as nurses. But doing that for four or five patients versus 10 to 12 is a totally different experience.”

It’s also an experience that can lead to moral distress for nurses — especially in situations where they know what they must do for their patients, but are unable to because of lack of time. This can sometimes undermine nurses’ own professional integrity.

Gear says it’s a horrible feeling. “That’s what’s driving people away [from the profession],” she says.

According to a study, 445,268 nurses were licensed to practice in Canada in 2021. Despite this, 41,715 regulated nurse positions stood vacant as of Q4 2022, according to Statistics Canada.

Over the decades, attempts have been made to fill the nursing gap using for-profit nurse staffing agencies. These agencies assign regulated nurses to work temporary contracts at hospital facilities. From 2016 to 2024, Canada’s healthcare sector saw a 24-fold increase in agency spending.

Not only is this expensive, costing healthcare employers tens of millions of dollars — it’s also been proven to negatively affect patient care and increase staff turnover due to unequal working conditions and salaries. For instance, a private nursing agency can charge up to $300 per hour, whereas a publicly-employed nurse is more likely to make between $28 to $50 per hour.

Controlled ratios will change that. B.C.’s mNPR is the first polity of its kind in Canada. The government investment includes one-time funding initiatives to help retain and recruit new nurses into the healthcare system. As well, the funding aims to encourage the return of nurses who left the profession early.

The government investment includes one-time funding initiatives to help retain and recruit new nurses into the healthcare system. Controlled ratios will change that. As well, the funding aims to encourage the return of nurses who left the profession early.

According to a 2023 poll, four in 10 Canadian nurses are either intending to “retire, leave their jobs, or leave the nursing profession entirely.”

However, BCNU says the new mNPR policy will make B.C. “the best place in the country to be a nurse.” The change will provide nurses with proper working conditions, which will lead to quality healthcare for patients.

Gear says it shouldn’t be difficult to create an environment where nurses feel recognized and valued for their work, and B.C.’s mNPR policy will support its nurses no matter where they’re located in the province.

As of 2021, 17.8 per cent of B.C.’s population live in rural areas, a significant portion of which are Indigenous communities. Despite this, only 7.2 per cent of the province’s 46,665 nurses worked in rural settings as of 2016.

Attracting nurses and retaining them in rural areas is an ongoing challenge due to a lack of resources. Smaller healthcare teams in remote hospitals means higher workloads for nurses to juggle. Plus, there’s the added variable of low financial incentives.

That’s why $169.5-million of the additional government funding will go toward the expansion of provincial rural retention incentives. Through the Provincial Rural Retention Incentive, nurses working across 74 rural B.C. communities will be eligible for financial incentives of up to $2,000 per quarter and a maximum of $8,000 per year.

With mNPR policies in place, B.C. is poised to transform healthcare for both its nurses and patients to better serve its population of five million — from the bustling metropolitan centre of Vancouver to the remote coasts of Tofino.

“Things don’t always go so well in someone’s healthcare journey, but for [nurses to] know that they’ve been able to do everything that was needed for that patient — everyone wants to do a good job,” Gear says.

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