Summary#

Bill 192, the Patient-to-Nurse Ratios for Hospitals Act, 2024, would amend Ontario’s Health Protection and Promotion Act. Its stated goal, reflected in its title, is to set maximum patient-to-nurse ratios in hospitals. The Ministry of Health would have to ensure the limits are met; the bill would take effect 12 months after Royal Assent.

• The maximum would be 1 patient per nurse for critical care patients on ventilators; 2 for other critical care patients and highly dependent patients needing mental health care; 3 for specialized care; and 4 for inpatient and palliative care.
• For rehabilitative care, the maximum would be 5 patients per nurse except on night shifts, when it would be 7.
• Regulations would set the mix of nurse practitioners, registered nurses and registered practical nurses.
• The bill assigns the duty to the Ministry. It does not set out a separate duty, penalty or enforcement process for hospitals.

What it means for you#

• Patients: If the bill became law, the Ministry would have to ensure the listed limits are not exceeded. The bill does not say how an individual patient could enforce a ratio or make a complaint.
• Nurses and hospitals: The Ministry’s duty could mean changes to staffing are needed to meet the limits. That is an inference; the bill does not directly assign hospitals a staffing duty or set staffing procedures.
• Ministry of Health: It would have to ensure the ratios are met. Regulations would determine the required mix of the three named types of nurses.
• General public: The bill does not change taxes, fees or benefits in the text provided. It also does not specify how the ratios would be checked or enforced.

Money#

No publicly available information on estimated public cost.

• The Ministry would have to ensure the ratios are met, which may require staffing or other changes. The bill gives no cost estimate or staffing numbers.
• The bill does not state whether hospitals or the Ministry would pay for any changes.

What is unclear#

• The supplied material does not include the current Health Protection and Promotion Act, so I could not verify whether similar ratios already apply under current law.
• The bill does not define “specialized care,” “highly dependent,” “nurse,” or “night shifts,” or explain how patients and nurses would be counted.
• The bill’s title refers to hospitals, but the added section does not define which facilities or care settings it covers.
• The bill does not set rules for monitoring compliance, handling exceptions, reporting breaches, or enforcing the ratios.
• The required nurse mix depends on regulations, whose contents are not supplied.

Case for#

• A possible argument for the bill is that maximum ratios would set clear limits on how many patients nurses may be responsible for in the listed care settings.
• Different limits for different types of care could account for differences in patient needs.
• Giving the Ministry a duty to ensure the limits are met could make the ratios more than guidance alone.

Case against#

• The bill does not explain how the Ministry would ensure compliance, or what would happen if a ratio were exceeded.
• The required mix of nurse types is left to regulations, and the bill does not provide those rules.
• One concern is that the bill creates a duty without specifying staffing resources or a cost estimate.
• The terms and coverage are not fully defined, which could leave uncertainty about how the limits apply in practice.