Nurse-to-Patient Ratios Save Lives and Reduce Staff Burnout, Says New Academic Study

Authors urge Ontario hospitals to implement safe staffing ratios

TORONTO--(BUSINESS WIRE)--A new academic study says mandating nurse-to-patient ratios would save lives, improve overall outcomes for patients, and alleviate the staffing crisis in Ontario’s hospitals.

Based on an extensive review of existing research on staffing levels in hospitals, in-depth interviews with many Ontario hospital nurses, and an examination of mandated nursing staffing standards in places like California, British Columbia, Nova Scotia and Australia, the researchers recommend Ontario’s hospitals adopt a similar policy to ensure safe staffing levels at all times.

“The evidence shows that nurse-patient ratios save lives,” said Dr. Jim Brophy, co-author of the study and a researcher affiliated with the University of Windsor. “Assigning nurses a manageable workload ensures patients receive appropriate care, which in a high-stakes hospital environment can mean the difference between life and death.”

Dr. Brophy said the evidence was overwhelming on the issue, with one study showing a seven per cent rise in death rates for every additional patient assigned to a nurse. He said another study from the U.K. showed that hospitals with the worst nurse staffing levels had 26 per cent higher death rates. Conversely, death rates declined in California’s hospitals after nursing ratios came into effect in 2004.

Nurse-patient ratios are generally associated with a positive impact on patient care, he said, being associated with “lower levels of medical errors, decreased risk of infections, and lower readmission rates.”

Dr. Margaret Keith, co-author of the study, said mandating nurse-patient ratios would address Ontario’s nursing shortage. Between 2022 and 2024, nurse vacancy rates in the province shot up by 43 per cent.

“Ratios equate to safe staffing levels for nurses,” she said. “Mandated ratios reduce injury rates and burnout, reduce the moral distress of not being able to provide optimum care, and thereby improve staff satisfaction and morale. Addressing these factors would tremendously improve the retention and recruitment problem in Ontario’s hospitals.”

Based on August 2025 data from The College of Nurses of Ontario, there are 16,437 licensed but non-practicing nurses in the province. Keith said Ontario would do well to emulate the Australian province of Victoria, where mandated staffing ratios resulted in a 24 per cent increase in the nursing workforce with more than 7,000 inactive nurses resuming practice.

“It’s an incredible story that shows it is possible to fix the health care staffing crisis,” she said. “We know that attrition rates are very high in Ontario, and this solution could help stem the bleeding.”

Recently, other provincial governments in Canada have taken initiative on minimum nurse staffing levels with employers in British Columbia and Nova Scotia obligated to adhere to newly enforced standards. In Manitoba, the government, employers, and the unions have signed a letter of intent to study the matter.

Rachel Fleming, a registered practical nurse and member of the Canadian Union of Public Employees’ (CUPE) Ontario Council of Hospital Unions (OCHU-CUPE), says inadequate staffing ratios are taking a devastating toll — not only on patient care but also on the emotional well-being of nurses.

“Every day, we’re being forced to make choices that go against everything we believe as caregivers,” said Fleming. “When you can’t give medication on time, when a patient goes without a bath or the comfort of someone simply listening to them, when you can’t even answer a call bell because you're torn between other patients in desperate need—it breaks your spirit. I know so many incredible nurses who walked away not because they stopped caring, but because the pain of not being able to care properly became unbearable.”

According to the authors of the report, nursing ratios also have the potential to save costs by decreasing reliance on private agency staff, reducing avoidable readmissions, as well as workplace injuries and illnesses.

In California, workplace injuries reduced by 32 per cent after the introduction of nursing ratios while hospitals in Pennsylvania with lower staff burnout rates had 6,200 fewer infections for annual cost-savings of up to $68 million.

OCHU-CUPE will be proposing nurse-patient ratios for 50,000 hospital workers in central bargaining with the Ontario Hospital Association next month. However, the union is wary of the hospitals’ opposition to the idea.

“Hospital management in the past rejected nurse-patient ratios, despite evidence that these ratios save lives and improve health outcomes for patients, because they restrict their ability to understaff – a reality forced on them by Ontario’s chronic underfunding of our hospitals,” said Michael Hurley, president of OCHU-CUPE.

“Ratios will bring thousands of nurses who have left the profession in despair back to work. Adopting ratios in bargaining will push the provincial government to fund and staff its hospitals properly. For patients and for nurses, it is time for this fundamental change.”

Last year, the Ontario PC MPPs voted against an NDP bill to legislate nurse-to-patient ratios in hospitals. The bill was reintroduced by the NDP in May 2025 but has yet to be debated.

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