Other Titles
Rapid Presentation Round
Abstract
Researchers and nursing advocates have been advocating for safe staffing for many years; unions and health employers have implemented many different approaches with little success. The nursing shortage was already reaching a critical level when the COVID-19 pandemic dramatically highlighted and worsened the impacts of understaffing, leaving nurses consistently working short in an overstretched system. Shift after shift, nurses find themselves risking their licenses and their own mental and physical health as they do their best to meet their patients’ care needs.
In light of the rapidly worsening nursing shortage, it became clear that a different approach was needed. We found existing research on nurse-patient ratios to be very encouraging – experiences from California and Australia show increases in nursing care hours, better ability to take breaks, increased nurse recruitment, better retention, improved team relationships and job satisfaction, improved quality of care, and decreases in nurse injury rates, readmission rates, missed care, patient complaints, nurse burnout and turnover. Conversations with nursing organizations from California and Australia validated these findings.
Early in 2023, the BC government reached an agreement with the nurses of BC to implement nurse-patient ratios across the healthcare sector, in acute, community and long-term care. The government has committed $750 million towards this work, employing a project governance structure that includes Union, Employer and Government representatives.
Beginning with inpatient medical-surgical wards, the intention is to engage direct care nurses, managers and healthcare leaders to identify appropriate ratios in all care areas, using a continuous learning approach and integrating feedback as the learning evolves. Structures are also being developed to monitor and evaluate this work, including looking at nurse, patient and health systems outcomes in the short-, medium- and long-term.
This oral presentation will walk participants through the development of this ongoing process, give an overview of current status, and describe how the parties continue to work together to resolve issues as they arise.
Notes
References:
McHugh, M.D., Aiken, L.H. et al (2020). Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: An observational study. Nursing, DOI:10.1136/bmjopen-2019-036264
Olley, R. et al (2018). Systematic review of the evidence related to mandated nurse staffing ratios in acute hospitals. Australian Health Review, https://doi.org/10.1071/AH16252
Lasater, K.B., Aiken, L.H. et al (2021). Patient outcomes and cost savings associated hospital safe nurse staffing legislation: An observational study. BMJ Open, DOI:10.1136/bmjopen-2021-052899.
McHugh, MD et al (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. The Lancet, https://doi.org10.1016/S0140-6736(21)00768-6
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Nurse-to-Patient Staffing Ratio, Work Environment Laws, Staffing, Nursing Shortage, Nurse-Patient Ratios, British Columbia
Recommended Citation
Barrowclough, Mycal and Morel, Tarya, "Implementing Mandatory Minimum Nurse-to-Patient-Ratios in British Columbia, Canada" (2026). Creating Healthy Work Environments (CHWE). 12.
https://www.sigmarepository.org/chwe/2024/presentations_2024/12
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-11
Implementing Mandatory Minimum Nurse-to-Patient-Ratios in British Columbia, Canada
Washington, DC, USA
Researchers and nursing advocates have been advocating for safe staffing for many years; unions and health employers have implemented many different approaches with little success. The nursing shortage was already reaching a critical level when the COVID-19 pandemic dramatically highlighted and worsened the impacts of understaffing, leaving nurses consistently working short in an overstretched system. Shift after shift, nurses find themselves risking their licenses and their own mental and physical health as they do their best to meet their patients’ care needs.
In light of the rapidly worsening nursing shortage, it became clear that a different approach was needed. We found existing research on nurse-patient ratios to be very encouraging – experiences from California and Australia show increases in nursing care hours, better ability to take breaks, increased nurse recruitment, better retention, improved team relationships and job satisfaction, improved quality of care, and decreases in nurse injury rates, readmission rates, missed care, patient complaints, nurse burnout and turnover. Conversations with nursing organizations from California and Australia validated these findings.
Early in 2023, the BC government reached an agreement with the nurses of BC to implement nurse-patient ratios across the healthcare sector, in acute, community and long-term care. The government has committed $750 million towards this work, employing a project governance structure that includes Union, Employer and Government representatives.
Beginning with inpatient medical-surgical wards, the intention is to engage direct care nurses, managers and healthcare leaders to identify appropriate ratios in all care areas, using a continuous learning approach and integrating feedback as the learning evolves. Structures are also being developed to monitor and evaluate this work, including looking at nurse, patient and health systems outcomes in the short-, medium- and long-term.
This oral presentation will walk participants through the development of this ongoing process, give an overview of current status, and describe how the parties continue to work together to resolve issues as they arise.
Description
This session will describe British Columbia’s ongoing journey to implement mandatory minimum nurse-to-patient ratios across the healthcare sector, in acute, community, and long-term care, backed by a $750 million commitment from the BC Ministry of Health and a project governance structure that includes union, employer, and government representatives.