BC moves forward with minimum nurse-to-patient ratios following policy directive endorsement

The provincial Executive Steering Committee (ESC) responsible for overseeing the implementation of minimum nurse-to-patient ratios (mNPR), which includes representatives from the BC Nurses' Union (BCNU), the Nurses' Bargaining Association (NBA), the Health Employers Association of BC (HEABC), and the provincial government, has officially endorsed a policy directive that provides health employers clear direction needed to consistently implement mNPRs across designated hospital-based care settings.

The Ministry of Health has directed employers to begin implementing these ratios this fall, starting with the general adult medical/surgical mNPR, followed by other hospital-based care ratios. The policy directive marks a significant step toward improving patient care and working conditions for nurses.

Key Highlights of the Policy Directive 

• Joint Regional Implementation Committees (JRICs): Each health authority will establish a Joint Regional Implementation Committee (JRIC) responsible for executing the development and implementation of mNPR plans at the health authority level, ensuring that implementation is standardized and consistent across all relevant sites and units. These committees consist of six core members, with equal representation from BCNU and health employers. Health employer representatives include the chief nursing officer, a senior operational leader with a nursing background, and a senior labour relations leader. The three BCNU JRIC representatives consist of two representatives, one of whom is an elected official, along with a senior labour relations leader.
• Implementation Documents: The Ministry has developed an Implementation Instruction Manual and a Planning Template to ensure uniformity across worksites. The manual links to the policy directive, outlines planning and labour relations strategies, and guides plan submission. Health employers are required to complete the template in collaboration with the JRIC, which must meet the manual's standards before being submitted to the health ministry for approval and funding.
• Role of Charge Nurses and Vacancy Replacement: The policy directive specifies the critical responsibilities of charge nurses, who will provide clinical leadership and coordinate patient assignments to ensure that mNPRs are maintained throughout each shift. Charge nurses have the authority to address immediate concerns related to patient safety and workload. In medical/surgical units, there will be a 24/7 charge nurse without assignment. Additionally, when a baseline nursing position becomes vacant, every effort will be made to fill it with a nurse of the same designation and specialty training (e.g., RN with RN, ER-qualified with ER-qualified) to maintain staffing levels and ensure patient safety.
• Additional Staffing Requirements: The directive underlines the importance of maintaining mNPRs by requiring that individual nurse assignments strive to remain in ratio at all times. Health employers must also ensure staffing levels are adjusted to accommodate overcapacity beds, and additional nurses are to be provided for break relief. Furthermore, any changes to the existing distribution of nursing designations (LPNs, RNs, RPNs) at the site level will require agreement at the JRIC level.
• Quality Practice and Learning Environments (QPLE): The directive emphasizes the connection between mNPRs and fostering quality practice and learning environments (QPLE). Adequate staffing ensures patient safety, improves nurse satisfaction, and facilitates mentorship and education, promoting a culture of excellence and continuous improvement in nursing practice.
• Cultural Safety and Quality Care: The implementation of mNPR must prioritize cultural safety and humility, acknowledging the history of colonialism and the experiences of Indigenous peoples in the health-care system. This includes addressing Indigenous-specific racism in alignment with the Declaration on the Rights of Indigenous Peoples Act (DRIPA), In Plain Sight, and BC Cultural Safety and Humility Standard. Additionally, the principles of Diversity, Equity, Inclusion, Accessibility, and Belonging must be incorporated to ensure the unique needs of staff and patients/families are recognized and respected.

Next Steps 

Health employers will receive the mNPR Implementation Instruction Manual, which details the necessary steps for implementation. Employers will then submit their implementation plans to the Ministry for review and approval. Following this, the Ministry will forward the plans to the ESC for review. The details of how the charge nurse model will be implemented are under discussion at the ESC, with more to come in the weeks to follow. JRICs will be expected to execute the implementation plan at the health authority level.

Have Your Say

As the initial implementation phase begins, it is crucial for members to stay informed and actively engaged. Your feedback will help refine the implementation process and ensure the successful application of minimum nurse-to-patient ratios.

Members are encouraged to share their experiences and suggestions, and to actively participate in shaping these ratios by joining monitoring efforts at your worksite. To get involved, submit an expression of interest through the BCNU Member Portal.

Help Spread the Word: Ratios Save Lives! BCNU has launched a province-wide campaign to educate the public about the importance of minimum nurse-to-patient ratios. Check out the latest radio message, on air from Aug. 19 – Sept. 20, and head over to the new microsite ratiossavelives.ca to watch brief, 15-second animations that illustrate some of the key reasons why ratios matter. This ad campaign, running just ahead of the upcoming provincial election, also includes outdoor, social media, and digital ads aimed at encouraging voters to prioritize health care as they head to the polls.