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This is part three of a six-part op-ed series looking at the nursing crisis in Ontario.

“Beds” has become a political buzzword when discussing health care. This year, Ontario’s budget includes plans to fund more beds, an entire new hospital and a series of initiatives to retain nurses. While attractive in theory, it remains unclear how any of these will be operationalized when they rely on a robust nursing workforce that no longer exists.

The causative agent of our current health-care crisis is not a lack of furniture or buildings — it is a lack of people. If beds were actually the problem, we would not be faced with a collapsing health-care system today.

In the basement hallways of Ontario hospitals, a supply of stretchers and beds line the walls. Throughout hospital units, there are more empty beds, also ready for use. These beds are part of Ontario’s physical hospital patient capacity, which has not changed throughout our health-care crisis. What has changed drastically is the usability of our capacity, due to a lack of nurses.

The overcrowding and excessive wait times in our emergency departments (EDs) are unfortunate examples of how insufficient staffing has impaired hospital operations. While beds are available throughout the hospital, the staff necessary to care for patients are not — rendering those beds useless.

The burden to compensate for insufficient staff unjustly falls on nurses, who experience pressure to take on increasingly unsafe patient loads, adding to job dissatisfaction and burnout. Nurse-to-patient ratios are meant to be limited and maintained, as they are acuity-based and necessary for nurses to provide safe and quality patient care. With fewer nurses, however, patient assignments fill up quickly, leaving other admitted patients where they are: in the ED.

This is most worryingly true of intensive care units (ICUs). As explained by an ED charge nurse, “the common issue in ICUs is that they cannot take more patients during the day shift as the following night shift is so severely short-staffed, so all the ICU admits have to be kept in the ED.”

ICU patients typically require a one-to-one level of specialized care that is often impossible to sustain in the ED, depending on ED workflow, availability of ICU-trained nurses, and overall staffing levels. Not having enough nurses in ICUs overburdens EDs, and also has dire effects downstream for incoming ED patients who need acute care and may not be able to receive it.

Beds without nurses to care for the patients in them are useless. The success of Ontario’s plan for hospital expansion relies on increasing the nursing workforce — both through licensing more new and international nurses, and through senior nurses who left the workforce returning to train them.

It seems logical, then, for the government to reconsider its wage-limiting Bill 124, thus incentivizing nurses to return to the bedside so that we can actually use our abundant hospital beds. This incentive is becoming increasingly paramount for nursing retention, both as a token of respect and because the bill’s restrictive effects will continue to be felt by our health-care system well after its expiration in March.

Much like the facade of claiming beds as a factor limiting our health-care system, the fact that Bill 124 does expire distracts from its clause that nurses cannot receive retroactive wage increases. Given how necessary nurses clearly are and how unlivable our wages have become, the opportunity for these retroactive increases is desperately needed to incentivize nurses to return to the bedside. This can only happen if Bill 124 is repealed.

Our government’s mandate is to uphold public health, and if we were not in a staffing crisis, funding more hospital capacity would theoretically do that. Right now, though, staffing needs to be the government’s priority, since “beds” really means “nurses.”

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