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.

In hospitals, primary care, public health, home care, long-term care, hospices and in the community, nurses provide the people of Ontario with exceptional care and support when they need it most. Our government recognizes how important nurses are to communities in every corner of this province. We sincerely appreciate their tremendous dedication to patients and families and their integral contributions to our health care system. And under the leadership of Premier Ford and Minister Jones, our government is taking bold action and making innovative changes to grow and support the nursing workforce, now and into the future.

The year 2023 was another record year, adding 17,000 more nurses registered and ready to work in the province, as well as 2,400 new physicians and thousands of personal support workers. Since 2018, nearly 80,000 nurses and more than 12,500 doctors have joined our health care system and another 30,000 nursing students are currently studying at Ontario’s colleges and universities, providing a pipeline of talented health care workers for the future. Our government continues to build on this progress and our actions taken to date.

We are implementing a broad range of initiatives and are making significant investments to ensure Ontario maintains a high-quality nursing workforce. With an investment totalling more than $225 million over four years, our government is expanding nursing education in universities and colleges by increasing enrolment by 2,000 registered nurse, 1,000 registered practical nurse and 150 nurse practitioner seats. With these investments, thousands of additional nurses will join the health care workforce in the years ahead, and this is in addition to our government launching the largest medical school expansion in over 15 years.

In our 2024 budget, Building a Better Ontario, our government invested $743 million over three years to further address immediate health care staffing needs and grow the health care workforce. This is the same budget that the NDP and Liberals voted against.

By making the Supervised Practice Experience Partnership program permanent, up to 1,500 internationally educated nurses each year will become accredited nurses in Ontario. More than 4,200 nurses have participated in this program since its inception in 2022 and over 3,300 internationally trained nurses are already fully registered and practising in Ontario.

Our government has broken down a number of barriers for internationally educated health care professionals, including nurses, to make the process to begin working in Ontario faster and easier. Regulatory changes are allowing internationally educated nurses to register in a temporary class, to begin working sooner while they work towards full registration, and our as-of-right rules allow nurses and other health care workers from other provinces to start working as soon as they arrive in Ontario, without having to first register with a regulatory college. We reduced redundant language proficiency testing as well and are providing financial support to temporarily cover the costs of examination, application and registration fees for internationally educated and retired nurses.

Health regulatory colleges are now required to comply with time limits to make registration decisions, while, in some instances, are prohibited from requiring Canadian work experience for the purpose of registration.

We are also helping to recruit and retain health care workers in smaller, remote and rural communities like my own, through our expanded Learn and Stay grant, where up to 3,700 eligible post-secondary students enrolled in priority health care programs such as nursing are provided with upfront financial support to cover educational costs in exchange for a commitment to work in the region where they studied for a term of service.

Through the Community Commitment Program for Nurses, over 4,000 nurses hired in 2022-23 and 2023-24 will receive incentives of up to $25,000 in exchange for a two-year commitment to work in a hospital, long-term-care home, home and community care agency, primary care service provider, or mental health service provider in a high-need area of Ontario.

The Bridging Educational Grant in Nursing, which is jointly offered by the Ministry of Health and the Registered Practical Nurses Association of Ontario, provides tuition support to registered practical nurses and personal support workers to pursue further education to become registered nurses and registered practical nurses, respectively, in exchange for working in home and community care, acute care or primary care.

Our government also continues to create new pathways to connect more people to high-quality care across the province, including the Clinical Scholar Program, which pairs an experienced front-line nurse as a dedicated mentor with newly graduated nurses, internationally educated nurses, and nurses wanting to upskill. Over 100 hospitals are participating in the Clinical Scholar Program since its launch last year, and 435 experienced front-line nurses have provided more than 17,000 mentorship touch points to new graduate, internationally educated or upskilling nurses. This is another way we’re recruiting and retaining nurses and ensuring that they have the support they need to confidently transition into the nursing profession.

Emergency departments are also being supported through ongoing and increased investments to bolster and stabilize the emergency department nursing workforce through incentives and removing barriers for nurses who are interested in working in emergency nursing, while also focusing on retaining emergency department nurses and nurse leadership. In collaboration with Ontario Health, education and training for the development and standardization of emergency department skills and competencies is being offered to nurses working in smaller, rural and northern hospitals. Through this initiative, over 3,000 training grants were allotted to nurses last year, and we expect that close to 9,000 nurses will access training or grants this year.

We also expanded the scope of practice for registered nurses, as well as for midwives and pharmacists. Registered nurses who complete additional education requirements approved by the council of the College of Nurses of Ontario are now able to prescribe certain medications and to communicate a diagnosis. These registered nurses can prescribe medications for conditions such as immunization, contraception, smoking cessation and topical wound care, as well as prescribe over-the-counter medications.

Our government also invests more than $46 million annually to fund nurse practitioner-led clinics, with Ontario being the first jurisdiction in Canada to implement this innovative model of primary care. These clinics provide comprehensive, accessible and coordinated family health care services, serving more than 80,000 people who might otherwise face challenges in accessing primary care. These clinics are also supported through our government’s recent significant investments in interprofessional primary care teams. This will connect more than 328,000 people to primary care teams in areas where it’s needed the most and add more than 400 new primary care providers and 78 new and expanded primary care teams across the province, which will include family health teams, nurse practitioner-led clinics, community health centres and Indigenous primary care health organizations. In our 2024 budget, we are building on this investment with a $546-million investment over three years to connect approximately 600,000 people to interprofessional primary care. Again, this is the same budget the members opposite voted against.

Speaker, our government has a plan, and it’s working. But we are not stopping there. We are making record investments in health care and building a stronger, patient-centred health care system that is focused on providing people with a better health care experience and better health outcomes. We are growing and supporting our health care workforce, including recruiting, retaining and supporting a strong, stable nursing workforce, to ensure that they have the tools and resources to provide patients with the connected and convenient care they need and deserve, when and where they need it.

This Conservative government must support our Ontario NDP legislation and pass the Patient-to-Nurse Ratios for Hospitals Act. Thank you to our health critic from Nickel Belt. This act is a life-saving piece of legislation. There are simply not enough nurses in our hospitals to take care of patients with often complex needs.

As we once said, we need at least 22,000 more nurses here in this province. This government spoke of nurses as “health care heroes” during the pandemic, yet they didn’t even ensure they had the appropriate PPE to keep all of them alive. Some of our health care professionals died on this government’s watch. In fact, nurses were taken to court by this government. And I don’t need to reiterate the disaster that was this government’s Bill 124 on nurses—racialized and women, predominately, in that sector, I might add—and other public sector workers.

This government has sat idle while over a thousand emergency room closures last year happened. This is simply not good enough. Over 3,200 different studies have been conducted proving that a lower nurse-to-patient ratio is necessary to save lives and prevent burnout of our nurses. This piece of legislation is a win-win. It’s a win for the government, it’s a win for the official opposition, but most importantly, it’s a win for the nurses, their patients and their families.

One such report was WeRPN’s latest survey of over 1,300 registered practical nurses. The 2024 report found that “unsustainable workloads, wage compression, pressured working environments and a lack of support have continued to drive RPNs out” of the profession. The current nurse-to-patient ratio directly impacts patient care. Today, this government can turn the page and do something positive for a change that will directly impact all of our nurses, all of the nurses who have been advocating day in and day out over the last six years, begging this Premier to stop his privatization-of-health-care schemes.

I want to thank Joyce, my local community member and an RPN, for expressing her concerns to me via email. I echo every single one of them:

—introduce nurse-to-patient ratios to reverse deteriorating patient care and ensure workplace safety for nurses and patients;

—pay nurses what they’re worth;

—establish a fair and professional level of compensation for RPNs that reflects their knowledge; and, yes,

—reduce reliance on for-profit nursing agencies that are siphoning out our nurses, yet another way of prompting up this government’s privatization scheme.

So absolutely, we need this patients-to-nurses ratio legislation passed today.