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B.C. set to introduce nurse-to-patient ratios, a first in Canada

New model part of signficant funding announced in tentative nursing collective agreement

Nurse-to-patient ratios are coming to B.C. hospitals, community care and long-term care facilities as part of a broader agreement between the provincial government and the union representing nurses. In doing so, B.C. becomes the first province to implement such ratios model after systems in Australia and California.

But if the province is setting a new standard for Canada, questions about key details remain unanswered and the proposed collective agreement still awaits ratification starting April 20 and ending April 27.

The proposed three-year deal between the Health Employers Association of BC, Nurses Bargaining Association and the provincial government proposes two components: one covering wages and other aspects first announced Friday (March 31) as part of a tentative agreement, and a second dealing with nursing workload standards, funding for recruitment and retention and one-time funding for professional development among nurses.

B.C. Nurses Union President Aman Grewal said the tentative agreement goes a long way to solve B.C.’s nursing shortage. Grewal had previously pegged the number of unfilled positions at 5,200 with B.C. needing about 26,000 nurses by 2031. Other sources peg the number higher.

BCNU’s chief negotiator Jim Gould said the deal, combined with the minimum nurse staffing ratios and attached funding, is going to have “an incredibly positive impact” on the recruitment and retention of new nurses as well as the re-hiring of nurses who have left the system. Ratios will improve quality care, he said.

“They will decrease patient mortality. They will increase the job satisfaction for nurses in the province.”

Minister of Health Adrian Dix called the agreement a “singular success” and promised that its effects would be felt everywhere, but especially in the rural parts of the province.

The April 2022 to April 2025 agreement covers approximately 51,500 registered, psychiatric and licensed practical nurses in B.C. About 87 per cent of nurses work in the six provincial health authorities, the rest for affiliated organizations like Providence Health Care.

Nurses will see their wages rise retroactively from April 1, 2022 by 25 cents per hour, then grow by 3.24 per cent until April 2023. From there, nurses’ wages will go up 6.75 per cent to April 2024, and then two per cent to April 2025.

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Other financial aspects include yet-to-be-revealed incentives to recruit, retain and support new-to-practice nurses.

Non-financial incentives include five paid days leave for ceremonial, cultural, spiritual purposes for Indigenous employees and changes permitting employers to preferentially hire Indigenous employees in specific situations, among other measures.

These measures respond to previous findings of anti-Indigenous racism in the provincial health care system.

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The agreement also includes $750 million to implement nurse-to-patient ratios, modeled on similar systems in Australia and California.

Plans call for the ratios to exist uniformly across the province with hospitals being prioritized first starting in the first year of the agreement, followed by community care and long-term care facilities in the subsequent years.

The ratio for treatment in ventilated critical care is 1:1, 1:2 for non-ventilated critical care; 1:3 for special care, 1:4 for in-patient care and palliative care; and 1:5 in rehabilitation. Standards for other areas are still to be developed.

Another $108.6 million in annualized ongoing funding will support recruitment and retention while $100 million in one-time funding will support professional development.

But neither BCNU representatives nor Dix could answer repeated questions about how many new nurses would be necessary to meet the ratios, nor when the ratios would specifically come into effect.

Dix said efforts are already underway to train, recruit and retain more nurses, pointing to expanding training spots for nurses and recruitment of internationally-trained nurses.

Recent years have seen what he called a “significant increase” in the number of recruited nurses. Dix acknowledged that more needs to be done, but expressed confidence that the government would be able to recruit the necessary numbers.


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Wolf Depner

About the Author: Wolf Depner

I joined the national team with Black Press Media in 2023 from the Peninsula News Review, where I had reported on Vancouver Island's Saanich Peninsula since 2019.
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