The bill is quite simple. It gives the number of patients that a nurse can be responsible for for one shift. To give you an example, if a patient is in intensive care on a ventilator, the law would say you need one nurse to one patient. On the flipside, if patients are admitted to the rehab unit on a nightshift, then you would have one nurse to seven patients, and there is a list that is given for people in ICUs, specialist care, in-patient, palliative care, rehab etc. that are listed in the bill.

I brought this bill forward because our health care system is in crisis. From Chesley to Wingham, from Marathon to Hawkesbury, from Red Lake to Carleton Place, we have seen over 1,000 emergency room closures in our province. Ontario has never, never seen that before.

If you look at the reason behind the closure of emergency rooms, the closure of important hospital services in different hospitals, up to permanent closures of hospitals, the number one reason why this is happening is always a lack of staff, and the number one reason why we have nursing shortages is burnout. Our nurses are burnt out.

I want to quote quite a few nurses. The nurses are watching right now. They know that I’m bringing this bill forward, and many of them are hoping that things will change, so they sent me quotes.

First: “I believe a legislated ratio is the single most important factor that would improve my own willingness to remain at bedside and within the nursing profession.”

Another quote: “I left a direct-care role in the hospital due to poor patient-to-nurse ratios and constant understaffing. Many times I felt unsafe and overwhelmed due to the short-staffing and increased patient needs.”

Third quote: “Higher wages would attract more nurses and better ratios would stop burnout and address nurses leaving the profession.”

Another quote: “I think wages and better staffing ratios would keep RPNs in Ontario.”

Another quote: “We should be implementing standard ratios. Education has them. Why not health care?”

Another quote: “I left direct patient care due to increase in violence ... and increased patient ratios.”

Another quote: “It’s increasingly difficult to provide quality care for patients when your patient ratio keeps growing.”

Another nurse: “We’re still working in unsafe nurse-patient ratios so often. Our workplace environment impacts the care that the people in the province receive.”

Another nurse: “It’s disappointing, stressful and exhausting. Nurses deserve better than what we have been provided for staffing and for patient ratios currently.”

I could go on, but I know I only have 12 minutes.

I would like to quote from WeRPN. They did a review called The State of Nursing in Ontario. They found out that nearly 48% of their members intend or are considering leaving the profession. When they asked what would sway them to remain, 72% of them said better nurse-to-patient ratios.

It’s not only nurses and RPNs; nurse practitioners also are watching this bill. They said, “The introduction of improved patient-to-nurse ratios is an important step towards addressing the deepening crisis in our health care system, acknowledging the overwhelming evidence seen first-hand by nurse practitioners in the field. Simply put, proper nurse-to-patient ratios improve patient outcomes and reduce nurses’ burnout.” I fully agree with them. Research is showing us that between 34% and 54% of nursing personnel are showing signs of burnout. The number one reason? Workload.

I was able to identify thousands of peer-reviewed publications dealing with the nursing ratios and how they can help address the burnout in our nurses. You do not have to take my word for it, Speaker. Go on your phone. Any of you, go on your phone right now and google articles dealing with nursing ratios in peer-reviewed medical journals, and you will see over 3,000 articles will come up. Let me quote from a few of those.

The National Academy of Medicine—this is a USA journal—looked at nurses’ well-being and found that 54% of nurses exhibited substantial burnout symptoms. The report from the National Academy of Medicine cites higher nurse-to-patient ratios as a factor associated with nursing burnout.

I then looked at some of the reports from Australia. Why not? They published this: Effects of Nurse-to-Patient Ratio Legislation on Nurse Staffing and Patient Mortality, Readmissions, and Length of Stay. Just so you know, Speaker, in 2016, Queensland, which is in Australia, implemented minimum nurse-to-patient ratios in their hospitals. After a few years, they did a study. They looked at 231,902 patients and found that the ratio that they had implemented—in addition to producing better outcomes, the costs avoided due to fewer readmissions and shortened lengths of stay were more than twice the costs of the additional nurse staffing.

The hospitals in Queensland implemented the very same ratios that I have in my bill. In 2016, they did a study. They reviewed 231,000 patients, which was basically every patient who came through, and found that they produced better outcomes, fewer readmissions and shorter lengths of stay—length of stay is how long you stay in the hospital—and it cost them half as much as the cost of having those extra nurses. “Minimum nurse-to-patient ratio policies are a feasible approach to improve nurse staffing and patient outcomes with good return on investment.”

I also looked at The Lancet. How can you look at health care and not look at The Lancet? They have been there since 1832. It is a leading journal in the medical field. They have a landmark study showing that a patient’s risk of dying after surgery varied by the number of patients for whom each nurse had responsibility. They looked at over a million patients in nine European countries. They found that each additional patient added to a nurse’s average workload was associated with 7% higher odds of the patient dying. The evidence showed that better hospital nurse staffing is associated with better patient outcomes, including fewer hospital-acquired infections, shorter lengths of stay, fewer readmissions, higher patient satisfaction and lower nurse burnout. That comes from The Lancet.

Another study, this one for the International Council of Nurses, representing national nursing associations worldwide, “issued their position statement on evidence-based nurse staffing, concluding that plenty of evidence supports taking action now to improve hospital nurse staffing, echoing Nightingale’s”—you all remember Nightingale, one of the first nurses—“call to action over 150 years ago, that if we have evidence and fail to act, we are going backwards.”

Two minutes left; I still have many, many reviews, some of them from the US, where they have staffing ratios. I want to name that Connecticut, Illinois, Minnesota, Nevada, New York, Ohio, Oregon, Texas and Washington have staffing committees. They publicly report in Illinois, in New Jersey, in Rhode Island, in Vermont. Staffing ratios are not new to the States, not new to Australia, not new to the UK.

I have a study here from India, who also implemented staffing ratios, and I want to quickly read their conclusion: “Considering Indian resources”—that’s from India—“best international norms and Indian research evidence, we recommend following nurse-to-patient ratio in each shift for Indian hospitals.”

Same thing with the British journal that’s in the UK—but I won’t have time to share that.

The European Journal of Cardiovascular Nursing says the same thing: If you want to recruit and retain a healthy workforce, the easiest way to do that is to implement nursing ratios.

Anybody who follows health care will know that the NDP in British Columbia is in the process of implementing staffing ratios in the hospital. So yes, I was partly inspired by our colleagues in British Columbia, but also by the hundreds of thousands of nurses here in Ontario who are burnt out, who are on sick leave, who are on long-term disability because they cannot cope with their workload anymore.

The body of evidence is there. It’s a win-win. It is safer for patient outcomes, number of deaths, number of long-term stays. It is better for nurses if you look at the overburden and the burnout of nurses and it is better for hospital budgets. They will actually save money. So it’s a win-win-win: hospitals supported, our nurses supported.

It is time that Ontario takes a serious look at putting in place nursing ratios. It exists throughout the world. There are over 3,000 peer-reviewed papers that looked at the effect of nursing ratios. They all say the same thing: better for patients, better for nurses, better for hospital budgets. I hope people will see fit to support this bill.