mNPR Frequently Asked Questions

“What are minimum nurse-to-patient ratios (mNPRs)?”

• mNPRs are a critical policy solution aimed at creating better working environments for nurses and quality of care for patients. This goes hand in hand with addressing the nurse staffing shortage in BC’s health-care system. mNPRs represent the minimum number of nurses deemed necessary to care for the number of patients on a given unit, and provides a simple, clear formula that transparently indicates staffing requirements for licensed practical nurses, registered psychiatric nurses, and registered nurses throughout the province.

“Who will benefit from mNPRs?”

• We know from other jurisdictions that mNPRs have the potential to drastically improve patient care across the province and will allow nurses to do what they were trained to do: devote time and attention to patients’ needs and provide the health care everyone deserves.

“What effects will mNPRs have?”

• mNPRs reduce patient mortality, as well as nurse occupational injuries, incidents and missed care. They help create the safe, healthy and supportive workplaces required to retain the nurses we have now, return nurses who have left and recruit the new nurses we need to address to improve the health-care system in the province.

“Why are mNPRs necessary?”

• We have heard from nurses that they want to provide the best quality of care possible to patients, and when they feel like they can’t, because of challenging working conditions and short staffing, that leads to high levels of nurse burnout, reduced morale, and an increase in nurses leaving the profession. mNPRs aim to address these barriers.

“What other jurisdictions use mNPRs?”

• BC will be the first jurisdiction in Canada to adopt mNPRs. California, and Australia already have them in place, and Oregon is currently in the implementation stage. Experience in these jurisdictions has shown that mNPRs create safer care and more satisfied nurses. BC has also landed mNPR definitions for care settings much quicker than other jurisdictions, due to the commitment from the BCNU, the Ministry, and health employers to work together and recognize the pressure the health-care system is currently under.
• BC is also the first jurisdiction in the world to implement ratios for many settings 24/7 365 days a year. 
• BC will also be the first jurisdiction to explore ratios in health authority community and non-hospital care settings, long-term care settings, and assisted living settings.

“How did mNPRs come about?”

• In April 2023, the Ministry of Health signed an agreement with the Nurses’ Bargaining Association signed to introduce mNPRs in hospitals, long-term care and assisted living, and health authority community and non-hospital care settings.

“Do mNPRs work?”

• The evidence from California and Australia, where mNPRs are currently in place, clearly demonstrates positive outcomes for patients, nurses and health-care organizations. After the implementation of mNPRs, California hospitals saw nurse turnover and vacancy rates fall below five percent, well below the national average, and nursing vacancies in Sacramento, California, decreased by 69 percent within four years. The results of California’s mNPR mandate show that it has enabled three hours a day more nursing care to each patient. In Victoria, Australia, the number of employed nurses grew by 24 percent, with more than 7,000 inactive nurses returning to the workforce after mNPRs were implemented.

“How much will mNPRs cost?”

• The Province has allocated $200 million in 2023/2024, $250 million in 2024/2025 and $300 million in 2025/2026 to implement mNPRs. To support implementation, the Province announced in March 2024 an investment of $237 million in one-time funding initiatives to help retain, return and recruit new nurses into the health-care system. This includes $169.5 million for the expansion of provincial rural retention incentives and $68.1 million for training and licensing investments.

“Where will the nurses come from to staff units to ratio?”

• Staffing to support the implementation of mNPRs requires measures to train and recruit new nurses, retain the nurses already working in the system and return nurses who have left the profession back to the bedside. These efforts require a multi-pronged approach that includes financial incentives, increased access to training and career opportunities, improvements in working conditions and supports for nurses’ well-being.

“Is there new government funding dedicated to implementing mNPRs?”

• Yes. To support mNPRs, the Province announced in March 2024 an investment of $237 million in one-time funding initiatives to help retain, return and recruit new nurses into the health-care system. This includes $169.5 million for the expansion of provincial rural retention incentives, signing bonuses to participate in GoHealth BC, the province’s travel nursing program, recruitment signing bonuses for rural and remote communities, signing bonuses for difficult-to-fill urban and metro vacancies, and additional funding to support nurses in the areas of recruitment, retention and/or mental wellness.

“How will inactive nurses be convinced to return to work?”

• In the short term, we expect financial incentives, such as signing bonuses, will help address the shortage. Those who commit to returning for two years to fill high needs vacancies are eligible to receive up to $30,000 to work in the North and $20,000 to work in other rural and remote areas.

“How will BC ensure nurses currently practicing do not leave the field?”

• Addressing concerns about nurses’ working conditions is key to retaining them – that includes addressing the staffing shortage, as well as other concerns such as health and safety issues in the workplace. A Provincial Rural Retention Incentive has been introduced to support retaining nurses in rural communities. The program makes nurses working regular positions in 74 rural communities eligible to receive financial incentives of up to $2,000 per quarter (prorated to productive hours) to a maximum of $8,000 per year.
• Additionally, a key element to mNPR, is the development of quality practice learning environments, which helps center everyone from nurses working at sites across the province, to staff in the Ministry and the BCNU, on creating stronger and safer workplace for nurses and more quality patient care. We know these two points—improving safety and empowering nurses to give the best patient care possible—are key pieces of feedback from nurses and crucial to improving morale and retention.

“What role do agency nurses have to play in addressing the need for more nurses?”

• Agency nurses are utilized as a last resort to fill staffing vacancies when no other nurse is available. Recognizing the health-care system’s growing reliance on private agency nursing and the skyrocketing costs associated with it, the BC Government created GoHealth BC as a publicly delivered alternative.

“What is GoHealth BC?”

• GoHealth BC is the province’s travel nursing program, whose staff are made up of members of the BCNU. Its numbers have grown to more than 200 nurses since it began in 2023. The program was established to help reduce health employers’ reliance on expensive nurse staffing agencies. To further reduce reliance on staffing 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 BC’s health-care system, and help prevent churn and competition between employers. Nurses who are currently employed by third-party staffing agencies are encouraged to apply.

“How will the province increase recruitment of nurses to meet the staffing requirements of ratios?”

• Measures in the BC government’s Health Human Resources Strategy are already leading to increased recruitment after a lapse in practice in the province in 2023. BC’s recruitment efforts continue to expand with $68 million, announced on March 1 2024, in investments being introduced for training and licensing to expand the internationally educated nurse bridging program and introduce new post-secondary education tuition credits and bursaries in nursing programs.
• As noted in the September 17^th 2024 announcement, the full suite of minimum nurse-to-patient ratios will be implemented over a four-year period, with the target of hiring over 8,000 nurses.
• As previously indicated, over the coming year, BC will have funding of $300 million to build out the nursing workforce. Additionally, we’re taking action in the following ways immediately:
  • BC Health Careers recently launched an international recruitment campaign targeting internationally educated nurses. The includes a first of its kind integrated BC Health Careers Roadshow in the UK generating multiple leads, with similar events to come.  
  • Expanding recruitment incentives for nurses taking positions in high needs areas, starting with emergency departments, for up to $25,000. 
  • In addition, an allocation from the 2023/24 $100 million mNPR budget will support retention and professional development for nurses, with an early focus on emergency departments in year 1. This is part of our wider commitment to refresh and expand educational programs for nurses to more easily access practice opportunities in complex care environments. A key area of focus is emergency departments, recognizing the challenges the Province is currently facing. 
  • Expanding GoHealthBC nursing to reduce reliance on agency nursing and overtime, with an early focus on recruiting qualified nurses to prevent emergency department closures.  
  • The BCNU and the Ministry will also work together to create resources, beginning with emergency departments, to implement flexible scheduling as part of establishing collaborative and healthy workplaces.  
  • This is in addition to the 70 actions that are underway under the HHR Strategy to support retention, recruitment, and education of nurses.  

“Who is involved in implementing mNPRs?”

• As noted in the governance section, the implementation of mNPRs is guided by a provincial executive steering committee made up of members from the BCNU, the Nurses’ Bargaining Association, health authorities, and the Provincial Government. The committee was established in the fall of 2023. It operates by consensus and provides provincial recommendations to the Ministry of Health on the multiple investments outlined within the memorandum of understanding.
• Five working groups are responsible for the following topics: planning, implementation, monitoring, reporting and evaluation, recruitment and retention, and communications. These groups provide the executive steering committee with mNPR recommendations.
• To support the implementation of minimum nurse-to-patient ratios (mNPRs) across British Columbia, Joint Regional Implementation Committees (JRICs) have been established within each health authority. Each JRIC is composed of six core members, evenly split between representatives from the BC Nurses’ Union and the health authority.
• A policy directive, implementation instruction manual, planning template, and JRIC terms of reference were developed to support standardized implementation across the province.

“When will mNPRs be implemented?”

• In April 2023, the Nurses’ Bargaining Association and the Ministry of Health signed an agreement to support nursing in the province by adopting mNPRs in hospitals, long-term care and assisted living, and community and non-hospital care settings.
• To read more about the implementation of mNPRs, please see the September 2024 announcement.

“How will mNPR outcomes be measured?”

• Performance metrics will be used to measure the expected outcomes of effectiveness, efficiency, safety, and quality environments. The three performance metric categories for the mNPR initiative include: patients, nurses, and the health-care system.

“How will mNPRs be evaluated?”

• The policy will be formally reviewed every three years. Continuous quality improvement will be based on quarterly evaluation reporting and will support the continuous quality improvement process.

“How will the Ministry support health employers to monitor and report on the mNPR implementation?”

• All of the health employers must do quarterly reporting on the status of implementation.
• Each health employer will be establishing a joint committee comprised of equal members between the health employers and the BCNU called the Joint Regional Implementation Committee (JRIC). This will be used to resolve issues as they arise and ensure successful implementation.
• Our commitment to continuous improvement, or “growing as we go,” means that the processes through the JRIC will evolve as we implement and learn more about the progress of mNPR, as we’re the first jurisdiction in Canada to take this action.

“What is the adaptability around patient acuity?”

• Any proposed minimum nurse-to-patient ratio will be considered as minimum baseline staffing, thus allowing local critical decision-making including temporarily assigning staff according to urgent/emergent patient needs. This adaptability is particularly important in complex care environments. 
• Nurses are professionals, who work as part of a team, and mNPR strives to not just maintain that, but embolden the team culture critical to quality and safe patient care. 
• Ratios are a minimum requirement and do not prevent bringing in additional staff beyond the number required by the ratio due to unforeseen changes in patient acuity and/or intensity.
• This requires 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 will play a key role in overseeing this process as they’re responsible for patient assignments.
• Additionally, the policy directive states that every reasonable effort will be made to call in additional nursing staff, including for overtime, to bring the unit back up to the required ratio. 

“How is this part of a larger quality and practice initiative?”

• We’ve heard from nurses that they want to spend more time with their patients, better meet their professional standard, and feel safer at work.  Current workload is a significant barrier.
• A ratio or numeric formula doesn’t solve that. However, mNPR as a wider initiative lays the groundwork for nurses for nurses to have more manageable workload allowing for safe, quality care delivery. 

“Why is implementation by health employers only beginning now, when the MOU was signed in April 2023, and we are about to approach the next season of public sector bargaining?”

• It’s completely understandable that nurses, fellow medical professionals and health-care workers, and patients in the system are keen to see mNPR implemented with the current challenges the health-care system is facing.
• In the first year, we’ve set ratios for the two thirds of the hospital sector, with planning underway for long-term care and community settings.
• We are the first in Canada to issue a policy directive to ensure and guide the implementation of nurse-to-patient ratios.
• And we’ve done this work through deep consultation and joint partnership to imbed the lived experience of nurses working in the system as much as possible.

“What will be done for nurses who have to continue to work below ratio, as these initiatives are implemented and additional roles are recruited into?”

• There is an expectation, which is formalized in the policy directive, that health employers will make every effort to fill every vacant position.

“How long will implementation take?”

• The MOU signed between the Ministry and the Nurse Bargaining Association for mNPR is funded for three years and ends on March 31, 2026.
• We have stated our commitment from the outset to “grow as we go” recognizing the complexity of this initiative, the importance of collaboration and the fact we are the first jurisdiction in Canada, and in some clinical settings the first jurisdiction in the world, to implement nurse-to-patient ratios.
• By this point, we expect to have comprehensive information which will clarify areas for refinement to ensure the success of this clinical solution, for nurses and patients.

"How is mNPR taking into account the unique reality of rural and remote settings?"

• The Ministry and the BCNU have also organized a rural and remote working group. Many rural and remote facilities have unique needs when it comes to implementing mNPR. This is because nurses work as part of a facility-based team, meaning they alternate between areas depending on the patient’s need. The working group will release recommendations shortly which will help ensure nurses and patients reap the benefits of mNPR in their sites, while also recognizing their unique needs. These updates will be communicated publicly.