VANCOUVER – Patients will experience improved care and nurses will experience a stronger health-care system as the Province and BC Nurses’ Union (BCNU) have now established nurse-to-patient ratios for the majority of hospital settings.

A new recruitment strategy, along with expanded education opportunities and supports for nurses, will enable the implementation of ratios and make B.C. a leader in Canada in terms of places to practise as a nurse.

“Nurses in B.C. do an incredible job taking care of us in our time of need – whether in the community, a hospital or in a care home,” said Premier David Eby. “Setting a minimum nurse staffing standard means more time to deliver the life-saving care. This is one of the actions we’re taking to recruit and retain nurses with better pay, safer working conditions and more training opportunities.”

New nurse-to-patient ratios have been determined for more hospital settings, such as in emergency departments, neo-natal intensive care units (NICU), post-anaesthesia care units (PACU), maternity units, operating rooms and alternative level of care areas. Implementation of these additional ratios will begin in fall 2024. Planning is underway to establish ratios in long-term care, assisted living and other health-authority-operated community settings. The full suite of minimum nurse-to-patient ratios, including the ones announced in March 2024, will be implemented over a four-year period, with the target of hiring more than 8,000 nurses.

“Nurses are essential to the health-care system, and we have worked diligently to address deficiencies in their workplace and improve retention,” said Adrian Dix, B.C. Minister of Health. “Earlier this year, we became the first province in Canada to establish minimum nurse-to-patient ratios and have made significant progress. Now, with ratios for the majority of hospital settings agreed upon with the BCNU, we have a firm commitment to work together to deliver ratios over the next four years, fortified by new recruitment programs for workplaces that benefit both nurses and patients.”

As previously indicated, over the coming year, B.C. will have funding of $300 million to build out the nursing workforce. Additionally, the Province is taking actions in the following ways immediately:

• BC Health Careers recently launched an international recruitment campaign targeting internationally educated nurses. This includes a first-of-its-kind integrated BC Health Careers Roadshow in the U.K., with similar events to come.
• Nurses accepting positions in high-needs areas, starting with emergency departments will receive as much as $25,000 as a recruitment incentive.
• In addition, there is $100 million, allocated from the 2023-24 minimum nurse-to-patient ratio budget, which will support retention and professional development for nurses, with an early focus on emergency departments in Year 1. This is part of the Province’s wider commitment to refresh and expand educational programs for nurses to more easily access practice opportunities in complex care environments. A key area of focus is emergency departments, recognizing the challenges the Province is currently facing.
• Expanding GoHealthBC nursing, the Province’s public travel nurses program, to reduce reliance on agency nursing and overtime, with an early focus on recruiting ER-qualified nurses to prevent emergency department closures.
• The BCNU and Ministry of Health will also work together to create resources, beginning with emergency departments, to implement flexible scheduling as part of establishing collaborative and healthy workplaces.

“Today’s announcement is yet another milestone toward achieving minimum nurse-to-patient ratios in B.C. and represents an unprecedented collaboration between nursing leaders within the Ministry of Health, health authorities and the BC Nurses’ Union,” said Adriane Gear, president, BC Nurses’ Union. “Ratios will improve the quality of patient care and conditions of work. Determining the ratios could not have been done without the feedback provided by thousands of nurses, who are dedicated to improving the experience of both patients and their fellow nurse colleagues.”

Funding for the nurse-to-patient ratios is supported by the Province allocating funding from the Working Together bilateral agreement.

This work also builds on the 602 new nurse training seats announced in 2022, which brings the total number of nursing seats in B.C. to more than 2,700. Investing in the retention and recruitment of nurses is part of B.C.’s Health Human Resources Strategy. The strategy advances 70 actions to retain, recruit and train health-care workers in B.C. while supporting innovative health-system redesign and optimization.

Quotes:

Jim Gould, interim CEO, BC Nurses’ Union –

“Ratios have been proven to transform the delivery of patient care in other parts of the world and it is exciting to know that B.C. is the first province in Canada to implement this as a staffing solution. This is a critical policy decision that nurses have been advocating for and we applaud the government for advancing this work in consultation with the nurses of B.C.”

Mark Holland, federal Minister of Health –

"Ensuring we have enough nurses to take care of patients is critical, not only for the safety and well-being of patients, but for the health and welfare of nurses themselves. Through the Working Together agreement with B.C., federal investments will improve nurse-to-patient ratios, aid the recruitment and retention of nurses, and improve the delivery of care. This is an important milestone for B.C. and will ensure a more supportive environment for nurses provincewide”

Quick Facts:

• Minimum nurse-to-patient ratios can improve patient safety and hospital stay lengths.
• Minimum nurse-to-patient ratios represent the minimum number of nurses deemed necessary to care for a maximum number of patients on a unit.
• The new ratios are the first of their kind in Canada and anchor the delivery of patient care to a simple, clear formula that transparently indicates nurse staffing requirements throughout the province.
• Implementation of ratios has been demonstrated to decrease nurse occupational injuries, return nurses to the bedside and significantly reduce nurse turnover and vacancy rates. This means nurses will be able to spend more time with their patients.
• B.C. is welcoming more nurses faster than other provinces. There have been 14,212 new nurses registered since January 2023, bringing the total nurses registered (in all categories) to 72,082 – the second fastest overall nursing workforce growth in Canada. This includes 1,319 internationally educated nurses (IENs) who have received full or provisional registration, with an additional 1,624 IENs who have been referred to receive additional training for which they can also access bursaries.

Learn More:

To learn more about minimum nurse-to-patient rations in B.C., visit:
https://news.gov.bc.ca/releases/2024HLTH0025-000272

To learn about the latest update on B.C.’s Health Human Resources Strategy, visit:
https://news.gov.bc.ca/releases/2023HLTH0150-001930

To learn more about supports for nurses, visit:
https://news.gov.bc.ca/releases/2023HLTH0019-000446

Three backgrounders follow.

Implementing minimum nurse-to-patient ratios (mNPRs) is critical to ensuring healthy and safe workplaces for nurses. It also supports stronger workplace culture, and quality and practice learning environments, which, in turn, will foster better health-care settings for patients.

• mNPR are shown to decrease patient safety events and reduce hospital stay lengths, improving patient outcomes.
• Supporting nursing workforces by balancing workloads and staffing levels will help reduce risk of burnout and improve retention.
• Staffing minimums aim to guarantee the quality of care and allow nurses to spend the time needed to provide care to patients.
• mNPRs are setting-dependent, meaning some units will require more or less nurses depending on the care setting.

The following new ratios announced today will begin implementation this fall 2024:

• Emergency department:       
  • General emergency: one nurse to three patients (1:3)
  • Short-stay observation: one nurse to four patients (1:4)
  • Medical/surgical short stay: one nurse to four patients (1:4)
  • Trauma: one nurse to one patient (1:1)
  • Critical care: one nurse to one patient (1:1)
  • Fast track: one nurse to four patients (1:4)
  • Waiting/triage: Visits per year
    • NOTE: For Emergency department and maternity ratios a nurse may alternate between clinical areas (for example, trauma and fast track) in line with patient need; ratios here define the number of nurses to be scheduled per shift but not to a specific area of the department.
• NICU: 1:3 for Tier 3 sites, 1:2 for Tier 2 sites, use of historical average patient levels of care for Tiers 5 and 6 sites 
• PACU: following the National Association of PeriAnestheisa Nurses of Canada (NAPAN) standards, two nurses to one patient, or one patient to two nurses (2:1 or 1:2)
• Maternity, based on the Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN) standards:
  • Antepartum: one nurse to three patients (1:3)
  • Labour and delivery: one nurse to one patient (1:1 active; 2:1 birth)
  • Postpartum: one nurse to three dyads (birth parent and newborn) 1:3
    • One nurse to four birth parents only (1:4)
  • Newborn care nursery: one nurse to three newborns (1:3)
• Operating Room (OR): two-and-a-half nurses to one patient (2.5:1)
• Alternative Level of Care: one nurse to seven patients (1:7). Alternate level of care is specific to patients assessed and awaiting placement for senior’s long-term care or discharge to community services.  

The Ministry of Health and BC Nurses’ Union have also organized a rural and remote working group. Many rural and remote facilities have unique needs when it comes to implementing mNPR. This is because nurses work as part of a facility-based team, meaning they alternate between areas depending on patient need. The working group will release recommendations shortly, which will help ensure nurses and patients reap the benefits of mNPR in their sites, while also recognizing their unique needs. These updates will be communicated publicly.

To continue supporting retention and recruitment efforts, the Province has invested $237 million to help retain the nurses B.C. has now, return nurses back to the bedside, and recruit the nurses B.C. needs for the future.

This includes $100 million targeted from the 2023-24 minimum nurse-to-patient ratios (mNPR) budget to support the retention of nurses in the province, with an early focus on emergency departments.

Immediately the Province and BC Nurses’ Union (BCNU) will work to:

• continue to work with health authorities and the British Columbia Institute of Technology to streamline education for emergency room nurses;
• continue to support specialty education through paid work programs for nurses wishing to advance their careers, including in emergency and critical care;
• expand opportunities to support bachelor of science in nursing (BSN) specialty nursing (SN) Learning Pathways in emergency departments;
• expand opportunities for nurses to shadow existing specialty nurses to support advancing their career to the best practice setting;
• expand clinical mentors in emergency departments with chronic vacancies to provide enhanced support to nurses joining these teams;
• fund all course costs (tuition and books) for all pre-requisites for specialty education, including emergency and critical care courses for nurses; and
• provide every nurse enrolled in pre-requisite courses as many as 15 paid shifts to study and complete the required course work;

From April 1, 2024, until March 31, 2025 (fiscal year 2024-25), $69.5 million will support:

• The expanded Provincial Rural Retention Incentive (PRRI) for nurses:
  • As much as $2,000 per quarter for all health-care workers under a Grid 11 (prorated to productive hours worked in regular positions in eligible communities).
  • A prototype PRRI was introduced in 2021 – supporting workforce stabilization in the Northeast, Prince Rupert, Hazelton, Haida Gwaii, Grand Forks, and Mount Waddington.
  • This incentive has expanded to 79 rural and remote communities across B.C. for fiscal year 2024-25.
  • In the first quarter of fiscal year 2024-25 (April 1 to June 30, 2024), 3,444 nurses in 79 communities received PRRI.

• New targeted provincial recruitment incentives with a return of service agreement to eligible nurses who fill eligible positions:
  • The GoHealth BC Signing Bonus – as much as $15,000 for health-care workers who are new to B.C.’s health-care system (new graduates, new entrants and former agency staff) and accept a position with GoHealth BC, the provincial travel resource program that offers flexible scheduling for short-term deployments to rural and remote communities. 
    • As of Aug. 30, 2024: 27 nurses have received the GoHealth BC Signing Bonus, representing 16 FTEs.
  • The Northern Signing Bonus – up to $30,000 for health-care workers who accept regular roles in rural and remote communities in the Northern Health region.
    • As of Aug. 30, 2024: 44 nurses have received the Northern Signing Bonus, representing 43 FTEs.
  • The Rural/Remote Signing Bonus – up to $20,000 for health-care workers who accept regular roles in rural and remote communities outside of Northern Health.
    • As of Aug. 30, 2024: 86 nurses have received the Rural/Remote Signing Bonus, representing 76 FTEs.
  • The Urban/Metro Difficult to Fill Signing Bonus – as much as $15,000 for health-care workers who fill regular difficult-to-fill and high-needs vacancies in urban and metro communities.
    • As of Aug. 30, 2024: 555 nurses have received the Urban/Metro Signing Bonus, representing 490 FTEs.

Also, $68.1 million has been invested in nurse training and licensing initiatives, including:

• $2,000 per year in tuition credits for nursing students enrolled in bachelor of science in nursing, bachelor of science in psychiatric nursing and practical nursing programs at a public post-secondary institution
  • Currently, every student enrolled in an eligible program is receiving this incentive.
• $5,000 per year in tuition credits for Indigenous nursing students enrolled in bachelor of science in nursing at a public post-secondary institution; HHR Strategy Action 57 provides this credit to Indigenous students in bachelor of science in psychiatric nursing, and practical nursing programs
  • Every Indigenous student enrolled in an eligible program is receiving this incentive.
• A $500 bursary for new graduate nurses to offset costs associated with licensure exams and attract new graduates to the public-health sector in B.C
  • In Apil 2024, 2,556 nurses who started work between Jan. 1, 2023, and March 31, 2024, received the bursary.
• Funding to Kwantlen Polytechnic University for the licensed practical nurse to registered nurse bridging pilot program
  • Cohort 1 will include up to 24 students, graduating in October 2025.
  • Cohort 2 will include up to 42 students, graduating in February 2026.
• Funding to post-secondary institutions to increase seats for Internationally Educated Nurses (IENs) in transitional and remedial education programs so they can complete required courses and begin practising in B.C.
  • IENs already have access to bursaries for these programs through Action 37 of the HHR Strategy.
  • From Jan. 1, 2023, to Aug. 31, 2024, 1,624 IENs have been referred to targeted or broad training for which they can access bursaries.

The following ratios were announced in March 2024 and work is being done in health authorities to continue implementing these ratios throughout fall 2024:

• Adult medical and surgical units operating 24/7, 365 days/year (excluding surgical daycare): one nurse to four patients (1:4)
• Palliative care units: one nurse to three patients (1:3)
• Rehabilitation units: one nurse to five patients on day/evening shifts; one nurse to seven patients on night shifts (1:5 days/evenings, 1:7 nights)
• Focused (Special) Care units (Adult Care): one nurse to three patients (1:3)
• High Acuity/Step Down units: one nurse to two patients (1:2)
• Intensive Care (Adult/Child) units: one nurse to one patient (1:1)
• Pediatric medical and surgical units operating 24/7, 365 days a year: one nurse to four patients (1:4)
• Pediatric Focused (Special) Care units: one nurse to three patients (1:3)
• Pediatric High Acuity Units (HAUs): one nurse to two patients (1:2)
• Pediatric Intensive Care units (PICUs): one nurse to one patient (1:1)

The Ministry of Health provided an implementation package to the health employers this year, which includes:

• A policy directive
  • This is to ensure the decisions made by the Ministry of Health are implemented by the health employers.
  • The core of this policy directive is the implementation of the first 10 hospital-based ratios, announced in March 2024.
  • The policy directive is the outcome of deep collaboration between the ministry, the BC Nurses’ Union and health employers, notably through governance structures such as the Executive Steering Committees (ESC) and the Working Groups (WGs).
  • The policy also outlines how, temporarily, a ratio may be applied in an adaptable way to evenly distribute workload having regard for the level of care required by patients on the unit.
• Implementation planning templates
  • This sets out key considerations and details that need to be provided by each health employer to the ministry.
  • This process of validating submitted planning templates will assist the Ministry in ensuring health employers work as consistently as possible with one another throughout implementation and adds to the overall monitoring and reporting measures for the employer.
• Implementation instruction manual
  • This complements the policy directive by laying out the mandatory requirements for each health employer as they implement minimum nurse-to-patient ratio (mNPR), overall enabling nurses to provide safe, including culturally safe, quality patient care within strengthened quality practice and learning environments. 
• Terms of reference for each health authority’s Joint Regional Implementation Committee (JRIC)
  • As implementation by the health employer progresses, JRICs ensure shared ownership of outcomes and milestones as much as possible.
  • The purpose of the JRIC is through collaboration, a combination of expertise and lived experience, to provide guidance, expert advice, and solve issues or barriers as the health employers develop and executes the implementation plan
  • JRICs will have six (6) core members, with equal representation from the BCNU and the health employers.

To learn more about new policy directives to health employers, visit: https://news.gov.bc.ca/files/mNPR_Hospital-Based_Care_Setting_Policy_Directive.pdf