Two Truths

For the first time, minimum nurse-to-patient ratios are no longer just a goal on paper in British Columbia. They are beginning to take shape on the floor. 

Phase one of ratio implementation is now underway in selected settings across the province, including medical and surgical inpatient units, rehabilitation, palliative care, focused and high-acuity care, intensive care and pediatric services.

“Nurses have fought hard for ratios, but securing them was only the first step.”

- BCNU President Adriane Gear

In a small but growing number of worksites, nurses are beginning to see early signs of change. These include more manageable assignments, stronger team stability and more time to focus on patient care. For some members, these early shifts have brought a cautious sense of relief.

But the story of ratios in BC is not a simple one.

Implementation of ratios has been uneven. In many Phase One settings, ratios are only partially in place, inconsistently applied, or not yet implemented at all. Staffing shortages, uneven site-level decision-making and the routine redeployment of nurses have made early gains unstable and, in some cases, quickly undone.

For every unit beginning to feel some of the benefits of ratios, there are many more still waiting to experience them. Many nurses see improvements on some days, only to lose them on others.

“Nurses have fought hard to secure minimum nurse-to-patient ratios, but securing them was only the first step,” says BCNU President Adriane Gear. “What members are telling us is that implementation is uneven and fragile. Where ratios are in place, nurses are seeing what’s possible. Where they aren’t, the risks to patients and nurses remain.”

For BCNU members, this tension between early progress and persistent gaps defines the current reality of ratio implementation in British Columbia.

These stories come from nurses across the province who are beginning to see signs of positive change in their day-to-day work. They offer a glimpse of what safer staffing can make possible when ratios are in place. While these experiences represent only a fraction of members and are not yet the norm across BC, they point to what is possible as this work continues.

Kacy Hu
Richmond Hospital
RN

When ratios are in place on Kacy Hu’s unit, the difference is noticeable. 

“With a higher nurse-patient ratio now, I think that it’s really benefited patient care. When you have a lesser assignment, you’re able to really focus on your specific patients,” Hu says. “You’re able to spend more time with assessments. You’re able to spend more time with things like implementations, wound care and you can just spend more time with the patient in general. So, with ratios, you’re able to really build that patient-nurse connection and provide person-centered care.”

For Hu, the impact is felt not only by patients, but by staff as well.

“In addition to benefiting the patients, I think staff are just a lot more relaxed,” she says. “When ratios are implemented, they’re much happier to come to work because they know that they’ll have a fair assignment. They also know that they’re being supported by other nurses and that they can spend their day focusing just on their assignments and tasks.”

Having ratios in place helps Hu focus on what’s important at work, she says, without having to constantly overexert herself. “There’s not so much short staffing or missing breaks or having to stay for overtime, which used to happen a lot, before ratios were implemented.”

Kennedy Love
Victoria General Hospital
RN

Kennedy Love has been working at Victoria General Hospital for eight months. Originally from Edmonton, she came to BC as part of a ratio hiring initiative and says she has already seen how safer assignments can change patient care when they are in place.

“When I’ve got a ratio assignment, which on my unit is four patients, I’ve got way more time to spend with each individual patient,” Love says. “I’m in there with them a lot more. I have much more time to look over their charts and make sure nothing is being missed.”

That additional time, she explains, directly affects patient safety. 

“When we’re at ratio, there’s no way for these patients to fall through the cracks,” Love says. “There’s so much more time to look over lab results and make sure there are no errors.”

Love works on an acute unit caring for patients recovering from surgery. When staffing drops below ratio, she notices the difference immediately.

“Working short is definitely challenging,” she says. “When we’re short, I feel like I spend a lot of my time just running around, and I have less time to be comprehensive in my assessments because I know I’ve got five more to do.”

She describes the responsibility of caring for post-surgical patients in simple terms.

“It’s already a big responsibility to have four lives that you’re in charge of – keeping people alive and well for 12 hours,” Love says. “When you’ve got six instead, or even seven, it can be overwhelming.”

But perhaps the biggest difference for Love is how her patients react when her unit is at ratio “It makes my patients feel better cared for.”

Corinne Loitz
Nanaimo Regional General Hospital
RN

Corinne Loitz says the difference is clear on days when her unit is staffed to ratio.

“It has been much better when we are at ratio,” Loitz says. “We’re much better able to manage our four-patient load. Just in general, there’s more time available to spend with each patient.”

That time, she explains, shows up in small but meaningful ways.

“It could be little things,” Loitz says. “Having more time means someone gets to brush their teeth that day, or they get to go for a shower. It might not seem like much, but for me, it would be awful if I didn’t get to brush my teeth in the morning.”

When staffing drops below ratio, those intricate moments of care are often the first to disappear.

“When we’re not at ratio, there’s definitely a risk of missing little things because you’re trying to make sure everyone’s taken care of all at the same time,” she says.

Even when ratios are in place, Loitz notes that high patient acuity can still create pressure – and that pressure is made worse by working short.

“Things can get missed depending on the acuity of patients,” Loitz says. “That gets magnified more when we’re over-capacity.”

For Loitz, the consequences are clear.

“When we’re not at ratio, even basic things – important things – get left behind,” she says. “And that can have pretty bad consequences.”

Shannon Wiekenkamp
Eagle Ridge Hospital
RN

For Shannon Wiekenkamp, ratios change not just how much care nurses can provide, but their ability to actually practise nursing at all.

“Ratios make all the difference, because you can actually do your job in the way that you were trained to do it,” Wiekenkamp says. “When you’re at ratio, you should be able to do the tasks and care for your patients in a manner which meets your practice standards and actually acknowledges the patient, as opposed to just doing skills.”

Wiekenkamp works with patients across a wide range of clinical needs, including palliative care. She says having the time to be present with patients matters deeply.

“We have patients of all different kinds,” she says. “Palliative patients that deserve to be heard and to be cared for and not just be ‘okay’.”

When staffing falls below ratio, the strain is immediate.

“If you’re not at ratio, your day can just be a disaster,” Wiekenkamp says. “If you have six patients you’re in charge of, you’re constantly trying to help other people instead of just the patient in front of you.”

The impact of working below ratio doesn’t end when the shift does – if the shift even ends on time.

“You go home after an overtime shift,” she says. “How do you have time to care for yourself? How can you care for your family? We work a lot of 16-hour shifts on our unit.”

Two Truths, One Way Forward

These stories highlight the promise of ratio implementation in BC, showing what becomes possible when nurses have the staffing they need to do their jobs well. When ratios are in place, nurses describe having the time to provide safer, more attentive care, to support one another and to work in ways that are sustainable.

At the same time, these experiences represent only a fraction of members’ experiences. Many nurses across the province have yet to see ratios implemented consistently, and others experience them intermittently or not at all. Staffing shortages, redeployment pressures and uneven site-level decisions continue to undermine progress in many settings.

Phase One has shown what ratios can begin to deliver, but it has also made clear that implementation alone is not enough. Health employers must consistently apply ratios, properly staff workplaces and protect ratios in practice, not just on paper.

The work to fully implement and protect minimum nurse-to-patient ratios in British Columbia is ongoing. BCNU will continue to push for consistent, effective implementation so that the conditions described in these stories become the standard for nurses and patients across the province, not the exception.

UPDATE (Spring 2026)