Minimum Nurse to Patient Ratios (mNPR)

Implementing minimum nurse-to-patient ratios (mNPRs) is critical to ensuring stronger workplaces for nurses. This includes workplace culture, and quality practice and learning environments, which, in turn, will foster better health-care settings for patients.

In April 2023, the Ministry of Health (the Ministry) and the Nurses’ Bargaining Association (NBA) signed a Memorandum of Understanding (MOU), alongside the collective agreement, to support nursing in the province by adopting minimum Nurse-to-Patient Ratios (mNPRs) in hospitals, long-term care and assisted living, and health authority community and non-hospital care settings.

A provincial executive steering committee, comprised of members of the Ministry, BC Nurses’ Union, NBA, Health Employers Association of BC (HEABC) and health authority leaders was established in 2023 to facilitate the introduction of the new staffing model.

British Columbia is the first jurisdiction in Canada to establish nurse-patient ratios.

What is mNPR?

Ratios are part of a larger nursing strategy developed to support nurse well-being, facilitate quality patient outcomes, and increase capacity and efficiency of the health-care system in BC.

Ratios represents a minimum number of nurses deemed necessary to care for the number of patients on a given unit.

The policy directive states: “Ratios are absolute at the unit level and prescribe the total number of nurses to be scheduled per shift. The implementation of mNPRs will strive to ensure that patient assignments are always regularized and in ratio. At times patient assignments will not be in ratio due to unforeseen changes in patient acuity and/or intensity requiring nursing teams to work together to ensure safe patient care while immediate efforts are undertaken to secure additional workload to bring patient assignments on the unit into ratio. The charge nurse plays a key role in coordinating patient assignments."

Learning from other Jurisdictions

In other jurisdictions (Australia and California), nurse-patient ratios have been shown to save lives and improve both patient and nurses’ experiences. For example:

• In Australia and California, ratios are associated with reduced patient mortality.
• In California, the ratios have been associated with improved retention of nursing staff.