Province announces minimum nurse-to-patient ratios, retention and recruitment investments

Press Release

VANCOUVER – To continue building on the commitments made at the signing of the Nurses’ Bargaining Association (NBA) collective agreement in April 2023, the Province and BC Nurses’ Union (BCNU) have made significant progress determining minimum nurse-to-patient ratios.

This progress is supported by a $237-million investment 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.

“Nurses play an important and pivotal role in providing quality patient care,” said Adrian Dix, Minister of Health. “Through our collaborative work with the BCNU, we are taking critical steps to address staffing challenges around the province. To meet these ratios, we’re making significant investments to retain our existing nurse workforce, support student nurses wanting to have a rich and rewarding career in BC’s health-care system and recruit more nurses. Building and strengthening our health workforce means a better workplace for health-care workers, quality care for patients and a stronger health-care system for everyone in B.C.”

Together with the BCNU, the Ministry of Health has established minimum nurse-to-patient ratios for six health-care settings in acute care facilities. Examples include most adult medical and surgical units, where the ratio will be one nurse to every four patients, and high-acuity units where it will be one nurse to two patients.

This work, the first in Canadian history, is part of the Province’s efforts to improve the delivery of quality patient care, better working conditions for nurses and a stronger health-care system throughout B.C.

Effective immediately, the Ministry of Health and BCNU will work with health authorities to implement a policy directive issued in support of this first phase to establish these minimum nurse-to-patient ratios. Next, the minimum nurse-to-patient ratios in remaining hospital settings and non-hospital settings, such as long-term care and health authority community settings, will be determined. Another update about the remaining ratios will occur by June 2024.

“This is an important announcement for nurses and patients in B.C.,” said Adriane Gear, president, BCNU. “This commitment is a bold step for government to take and we commend its willingness to listen, learn and invest in nurses. We know that minimum nurse-to-patient ratios improve job satisfaction, create safe and healthy workplaces for nurses and improve patient care. We look forward to working closely with the Ministry of Health and our health authorities to ensure successful implementation every step of the way.”

To support the implementation of minimum nurse-to-patient ratios, the Province is investing $237 million in initiatives that will retain, encourage the return of, and recruit new nurses into the health-care system, such as:

  • $169.5 million in one-time funding for the expansion of provincewide rural-retention incentives, GoHealth BC signing bonuses, recruitment signing bonuses for rural and remote communities, signing bonuses for difficult-to-fill urban and metro vacancies, and consistent with the agreement reached with the NBA in April of 2023, additional funding to support nurses in the areas of recruitment, retention and/or mental wellness.
  • $68.1 million in one-time funding for training and licensing investments, which will go toward expanding the internationally educated nurse (IEN) bridging program, implementing a licensed practical nurse (LPN) to registered nurse (RN) bridging pilot program at Kwantlen Polytechnic University, a nursing student tuition credit, an Indigenous nursing student tuition credit and new graduate transition program bursaries.

“It is important that we continue to take the time to get this right. Incentives that recognize and respect our nurses today and recruit the new nurses we need for tomorrow are critical,” said Jim Gould, interim CEO, BCNU. “Minimum nurse-to-patient ratios are the single most-important policy solution available to address the staffing crisis in this province. After years of advocacy, today’s announcement is an encouraging step in the right direction toward transforming the delivery of health care in this province.”

This work will build on the Province’s strong recruitment and retention results. In 2023, 6,567 nurses were newly registered in B.C.

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.

Quick Facts:

  • Minimum nurse-to-patient ratios represent the minimum number of nurses deemed necessary to care for a maximum number of patients on a given 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’s occupational injuries, return nurses to the bedside and significantly reduce nurse turnover and vacancy rates.
  • Minimum nurse-to-patient ratios can improve patient safety and hospital stay lengths.
  • GoHealth BC is the province’s travel nursing program, whose staff are made up of members of the BCNU.

Learn More:

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

Four backgrounders follow.

Contacts:

Ministry of Health
Communications
250 952-1887 (media line

BC Nurses’ Union
media@bcnu.org


BACKGROUNDER 1

What to know about minimum nurse-to-patient ratios mNPRs

Implementing minimum nurse-to-patient ratios (mNPRs) is crucial to ensuring a healthy, safe and inspired workplace, which will foster a better health-care setting for patients.

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

The following ratios have begun implementation in health authorities, and the ministry expects nurses working in these units will begin to see changes in staffing allocations reflective of mNPRs by fall 2024:

  • Adult medical and surgical units operating 24/7, 365 days a 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)

Contacts:

Ministry of Health
Communications
250 952-1887 (media line)

BC Nurses’ Union
media@bcnu.org


BACKGROUNDER 2

What to know about the retention and recruitment incentives

To continue supporting retention and recruitment efforts, the Province is investing $169.5 million in one-time funding that will help with the unique staffing challenges faced in rural communities, as well as staffing difficult-to-fill vacancies in urban and metro communities. The incentives will become available as of April 1, 2024, and are focused on:

  • Expanding the Provincial Rural Retention Incentive (PRRI):
    • This provides up to $2,000 per quarter (prorated to productive hours) to a maximum of $8,000 per year, from April 1, 2024, until March 31, 2025, to eligible nurses.
    • This incentive was previously introduced by the Province in a number of rural communities in the North in 2021. Since then, it has seen further stabilization and success in those communities.
    • Now, this incentive will be expanded to include 48 new communities, bringing the total number of communities supported to 63.
    • All nurses working in these expanded communities in regular positions will be eligible for this incentive beginning April 1, 2024.
    • This incentive will also be expanded to support other occupations in eligible communities.
  • Providing signing bonuses for nurses who join GoHealth BC:
    • GoHealth BC is the province’s travel nursing program, whose staff are made up of members of the BCNU.
    • In 2023, GoHealth’s staffing numbers increased by 54% (from 103 to 169 nurses).
    • To further reduce reliance on nursing agencies, some nurses will be eligible to receive up to $15,000 in signing bonuses if they choose to take a regular position with GoHealth BC.
    • This incentive will focus on net-new entrants to the B.C. health system, to prevent churn and competition between employers. Nurses who are employed by third party staffing agencies are encouraged to apply.
  • Offering signing bonuses to work in certain rural and remote communities:
    • To support the unique needs and challenges of working in remote communities, the Province will provide as much as $30,000 to eligible nurses who fill identified high needs vacancies in rural and remote communities.
      • Starting April 1, eligible nurses filling eligible positions will receive as much as $30,000 in the North and as much as $20,000 in other rural and remote areas.
    • Eligible nurses will be required to sign a two-year return-of-service agreement.
  • Offering signing bonuses for difficult-to-fill vacancies in urban and metro communities.
    • In addition to implementing mNPRs, the Province is focused on staffing difficult-to-fill vacancies.
    • Eligible nurses may receive as much as $15,000 should they choose to accept a permanent position in eligible difficult-to-fill/high needs vacancies, starting April 1, 2024.
    • Eligibility for the incentive focuses on nurses that are new to B.C.’s public-health system and nurses who may be returning to the system.
    • Eligible nurses will be required to sign a two-year return-of-service agreement.
  • Consistent with the agreement reached with the Nurses’ Bargaining Association in April 2023, to support the Nurse Support Fund for supporting nurses in the areas of recruitment, retention and/or mental wellness.

Contacts:

Ministry of Health
Communications
250 952-1887 (media line)

BC Nurses’ Union
media@bcnu.org


BACKGROUNDER 3

What to know about training and licensing investment

To bolster and support the growth of new nurses in B.C., the Province is investing $68.1 million to:

  • Offer a nursing-student tuition credit:
    • Nursing students in bachelor of science in nursing (BSN), bachelor of psychiatric nursing (BPN) and practical nursing (PN) programs will receive a tuition credit of $2,000 each year.
    • Indigenous students in BSN programs will receive an additional tuition credit of $5,000 per year. This funding is already available to Indigenous students enrolled in BPN and PN programs.
    • These credits will be available to students enrolled in nursing programs in public post-secondary institutions between September 2023 and August 2026.
  • Expand access to bridging education for internationally educated nurses (IENs):
    • IENs will have increased access to transitional or remedial education programs, helping them complete their required courses and begin practising in B.C.
  • Increase the availability of bursaries for nursing students, including bursaries for Indigenous students.
  • Launch a Kwantlen Polytechnic University (KPU) Licensed Practical Nurse (LPN) to Registered Nurse (RN) Bridging Pilot Program:
    • With KPU, LPNs practising in Fraser Health will have a streamlined pathway to enter KPU’s Bachelor of Nursing (BSN) program.
      • This means, LPNs with a minimum of three years of work experience as an LPN, and current registration as an LPN, will be granted credit for their prior learning and experience, and enable them to complete the BSN in a shorter period of time.
      • Students will be required to retain their employment during the program but will be given the flexibility of a reduced work schedule.
  • Provide new graduates with bursaries for their licensing exams:
    • New graduate nurses will be provided with a $500 bursary to help cover the costs associated with their licensing exams.
    • This funding will be made available on an ongoing basis, retroactively applied to Jan. 1, 2023.

Contacts:

Ministry of Health
Communications
250 952-1887 (media line)

BC Nurses’ Union
media@bcnu.org


BACKGROUNDER 4

What to know about progress on nursing recruitment in the province

Since 2017, the government has been working hard to increase the supply of nurses in the province. A key component of these efforts is the development and implementation of the Health Human Resources (HHR) Strategy.

In 2023, action taken under the HHR Strategy resulted in important growth in the nursing workforce.

  • From Jan. 1 until Dec. 31, 2023, 6,567 nurses were newly registered in B.C. across all classes and occupations.
  • From Jan. 1, 2023, until Jan. 31, 2024, 1,774 internationally educated nurses (IENs) received a registration decision from BC College of Nurses and Midwives (BCCNM):
    • 806 IENs received full registration as a registered nurse (RN) or licensed practical nurse (LPN), up from only 288 in 2022.
    • 828 IENs were referred to additional education for which they can access bursaries.
    • 140 IENs registered as health-care assistants.
  • In 2023-24, post-secondary institutions in B.C. graduated approximately 1,500 RNs, 120 RPNs and 500 LPNs.

The Canadian Institute of Health Information (CIHI), which measures the province’s progress against other provinces in the country, released their report, State of the Health Workforce in Canada, 2022, on Feb. 29, 2024. It reports:

  • From 2021 until 2022, B.C. was third among the provinces in RN workforce growth (+1.7%), compared with 1% in Ontario and 0.1% in Alberta.
  • From 2020 until 2022, B.C. was second among the provinces in total nursing workforce growth (+2.2%), including RNs, RPNs, LPNs and Nurse Practitioners (NPs), compared with 1.8% in Ontario and 0.8% in Alberta.
  • From 2017 until 2022, B.C. was:
    • first among the provinces in RN workforce growth (+10.6%), compared with 5.2% in Ontario and 0.1% in Alberta.
    • third among the provinces in LPN workforce growth (+23.3%), compared with 19.3% in Ontario and 26.4% in Alberta.
    • first among the provinces in nursing-workforce growth (+14.7%), including RNs, RPNs, LPNs and NPs, compared with 10.1% in Ontario and 7.3% in Alberta.

Contacts:

Ministry of Health
Communications
250 952-1887 (media line)

BC Nurses’ Union
media@bcnu.org

IHT4

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