Ratios Bring Hope

Years of advocacy, collaboration and consultation bring better outcomes for nurses and patients through minimum nurse-to-patient ratios.

Across BC, a years-long effort to improve patient care is beginning to deliver results. Driven by nurses and supported through collaboration across the health-care system, minimum nurse-to-patient ratios are starting to change what care looks and feels like on the front lines.

For nurses on units where minimum nurse-to-patient ratios are in place, the difference is already clear: more time with patients, safer workloads and care that feels sustainable again.

People want to work in a unit where they feel like their workload is manageable, that they can fulfill their standards of practice and not leave in a state of moral distress

Ratio Rep. Kyla Dres

Kyla Dres is a licensed practical nurse working at Nicola Valley Hospital in Merritt who is feeling the early positive impacts of minimum nurse-to-patient ratios. Her workplace is part of the 73 percent of units that are implementing ratios as of March 2026. This first phase of implementation includes medical and surgical inpatient units, rehabilitation, palliative care, focused and high-acuity care, intensive care, rural and remote facilities and some pediatric services.

Dres says the number of nursing vacancies in her unit have noticeably declined as a direct result of ratios coming into effect. Her hospital’s transition liaison, who hears from nurses each day about clients who may need home care, is reporting a significant improvement in their morale.

  
 
 
 
 
 
 
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“Ratios have resulted in increased dignity for the patients,” she says. “They’re able to have things like assistance with their washes, getting up to the bathroom and more involvement in their care planning. We’re able to set them up for success upon discharge. Nurses actually have time to listen to them and treat them holistically.”

Having that time is critical. It improves care across the board but also helps reduce barriers for traditionally marginalized patients – a goal specifically embedded in the policy directive that health authorities use to implement ratios. With more manageable workloads, nurses have more time to provide culturally safe, trauma-informed care grounded in trust, attention and respect. Ratios can also help offset fatigue, information overload and overcrowding – factors that can worsen implicit bias and compassion fatigue. 

The story of ratios in BC thus far, however, is an uneven one. Even in activated units, there are still days where staffing levels fall short. And in settings that are not part of phase one, the contrast is stark.

Where ratios are in place, nurses can deliver the kind of care they were trained to provide – safe, focused and patient-centred.

BCNU President Adriane Gear

"Where ratios are in place, nurses can deliver the kind of care they were trained to provide – safe, focused and patient-centred. Where they’re not, we’re still seeing the strain: unsafe workloads, rising injuries and nurses leaving the profession,” says BCNU President Adriane Gear. “That contrast makes it clear. That’s why BCNU continues to push for implementation, because ratios aren’t a luxury, they’re essential.”

Phase two includes emergency departments, operating rooms, alternative level of care units, maternity care, post-anesthesia care and neonatal intensive care, where implementation is about to begin. Community and long-term care will follow, though implementation in those settings requires a different level of planning. BC will be the first jurisdiction in the world to extend ratios into those areas, a milestone that will require the same level of collaboration that has driven progress so far.

Dres says phase two can’t come soon enough.

“Not having ratios is actually causing people to leave those departments because they don’t want to work in such a chaotic environment and not feel good about the care that they’re able to provide,” she says. “And there are increased injuries in those departments compared to the units at ratio.”

More recent research close to home points in the same direction. A peer-reviewed study by Dr. Karen Lasater, Dr. Linda H. Aiken and colleagues at the University of Pennsylvania looked at the links between staffing conditions, patient outcomes, quality of care, patient safety and nurse job outcomes in BC hospitals. It confirmed that unsafe workloads are the number one reason nurses plan to leave their jobs – with 66.6 percent of those considering leaving citing inadequate staffing, followed by 61.9 percent for burnout and 50.2 percent for dissatisfaction with management.

“Given the variability in staffing, quality and patient outcomes across BC hospitals, the implementation of a minimum nurse-patient ratio policy has the potential to improve patient care safety and retention of nurses,” the authors concluded.

Atkinson says that shift is already beginning. 

“Even retired nurses are coming back, as are international nurses. People are moving from the mainland,” she says. “Nurses that were part time are wanting to increase to full time, and casuals are wanting to work more.”

While many units are still awaiting ratios, early results point to what is possible, and have many nurses, patients and communities eager to reap the benefits Atkinson sees.

“It’s really everything we hoped for.”