Mandatory Nurse Ratios in Ontario Hospitals

Summary#

Bill 19, the Patient-to-Nurse Ratios for Hospitals Act, 2025, would amend Ontario’s Health Protection and Promotion Act. Its stated goal is to set maximum patient-to-nurse ratios; the Ministry of Health would have to ensure those limits are met.

  • The limits would be 1 patient per nurse for critical care patients on ventilators; 2 per nurse for other critical care patients and highly dependent patients who need mental health care; and 3 per nurse for specialized care.
  • The limits would be 4 per nurse for inpatient and palliative care, 5 per nurse for rehabilitative care except on night shifts, and 7 per nurse for rehabilitative care on night shifts.
  • Regulations would set the mix of nurse practitioners, registered nurses and registered practical nurses.
  • The Act would start 12 months after it receives Royal Assent. The bill does not state when regulations would be made.

What it means for you#

  • Patients: If the bill became law and its requirements were implemented, the Ministry would have to ensure the listed maximum ratios are not exceeded. The bill does not set out a process for patients to report or appeal a ratio.
  • Nurses and hospitals: The Ministry—not hospitals directly in the text—would have the duty to ensure the limits. Meeting them could require staffing changes, but that is an inference; the bill does not set out how the Ministry would achieve compliance.
  • Ministry of Health: It would have to ensure the listed ratios are met. Regulations would determine the mix of nurse types.
  • Taxpayers: The bill does not specify a tax or fee. Any public cost is unknown.

Money#

No publicly available information on the bill’s cost is included in the supplied material.

  • The Ministry would have to ensure the ratios, which could require staffing changes; the bill gives no staffing numbers or cost estimate.
  • The bill does not state whether or how hospitals would be funded to meet the ratios.

What is unclear#

  • The supplied material does not include the current Health Protection and Promotion Act, so I could not verify how the bill’s requirements would interact with current law.
  • The bill does not define terms such as “highly dependent,” “specialized care” or “inpatient care.”
  • It does not explain how ratios would be measured, monitored or enforced, or what would happen if a ratio were exceeded.
  • The nurse mix depends on regulations, but the regulations are not supplied.
  • The bill does not explain how it would apply when a patient’s care fits more than one listed category.

Case for#

  • A possible argument for the bill is that clear maximum ratios could limit how many patients nurses are responsible for in the listed types of care.
  • The limits differ by care category, including a separate limit for ventilated critical care patients and for rehabilitative care on night shifts.
  • The Ministry would have a duty to ensure the limits are met, rather than the bill merely stating a goal.

Case against#

  • The bill sets limits but does not explain how the Ministry would ensure they are met or what consequences would follow if they are not.
  • It does not include a cost estimate or specify funding for any staffing changes needed.
  • Key care categories are not defined in the bill, and the nurse mix depends on regulations whose content is not provided.
  • The 12-month start date may arrive before the practical details are clear; the bill does not set a deadline for making the regulations.