Ontario’s unsafe nurse staffing is a patient safety crisis – but it’s fixable

The following was written by ONA member Isabel Schilthuis, RN, BScN, MScN, who says she’s passionate about health policy and patient safety.

This isn’t just a nursing issue, but a patient safety crisis. Research shows that each patient added to a nurse’s workload increases the risk of hospital mortality by 7 per cent. That means if a nurse’s workload increases from four to eight patients, mortality risk increases to an astounding 31 per cent.

Yet in Ontario, there continues to be no mandated minimum nurse-to-patient ratio. Unfortunately, staffing decisions are left to individual hospitals’ discretion, creating unreliable and repeatedly unsafe working conditions and negative consequences across the province.

Ontario has encountered the lowest number of registered nurses per capita in Canada for more than 30 years, entering the COVID-19 pandemic 22,000 nurses short.

Currently, nurses are leaving the profession at disturbing rates, with nearly

40 per cent reporting intentions to leave their current nursing jobs or the nursing role altogether in a CFNU report on nurse-patient ratios.

Burnout, moral distress and unsafe workloads resulting from unsafe nurse-to-patient ratios are not isolated problems but truly systemic failures. The clear, evidence-informed solution to this is simple: Ontario must legislate minimum nurse-patient ratios in acute care hospitals.

Regrettably, both patients and nurses are being reduced to monetary value as staffing shortages are often justified as necessary cost-saving measures, treating nursing care as an adjustable expense rather than a fundamental patient safety investment. As hospitals continue to prioritize budgets over safe staffing levels, patient safety concerns increase as nurses are left to carry heavy workloads that compromise good patient care.

Without legislative intervention, hospitals will continue to treat nursing staff as flexible, prioritizing short-term financial pressures over long-term system stability. Who pays the price? Patients do.

Yes, minimum nurse-to-patient ratios are feasible and effective. This is proven in British Columbia, California and Australia, where positive patient outcomes and nurse workforce stability are evident. In fact, California saw a 69 per cent reduction in nursing vacancies within four years of implementing ratios, while Australia witnessed thousands of inactive nurses returning to the workforce.

The result is improved patient outcomes, stronger workforce retention, and an increase in health-care system stability. Ontario has significant untapped nurse workforce potential, with only 64 per cent of nurses currently working full-time, while many others have left the profession or reduced to part-time hours. Implementing safer workloads could improve both nurse recruitment and retention.

Critics will argue that mandating ratios is expensive or difficult to implement. However, research proves otherwise. Chronic understaffing has resulted in high hidden costs, including overtime, agency staffing, turnover and, importantly, preventable patient adverse events.

Investing in safe nurse staffing is not a cost but a long-term, effective strategy for sustainability. Ontario’s Ministry of Health has the responsibility and authority to act to ensure consistent safe standards, improve hospital accountability and, ultimately, protect both patients and the nursing workforce.

The evidence is strong and clear, and the solution is irrefutable. The missing piece is political action. Therefore, Ontario’s Ministry of Health must implement legislation to protect not only the future of our health-care system but the well-being of our nurses and patients. Ontario can’t afford to wait for change.