Ontario nurses have launched a constitutional challenge over an arbitration system they say puts healthcare workers and patients at risk – in part by refusing to cap the number of people nurses care for at a time.
The ONA is targeting the Hospital Labour Disputes Arbitration Act which is used to adjudicate complaints by hospital workers. The law forces collective bargaining between health care workers and employers into a binding arbitration process.
The Ontario Nurses Association’s (ONA) says the law lets hospitals dodge meaningful negotiation. The ONA’s new challenge was triggered by a September 2025 arbitration decision which denied its top demand – to implement mandatory minimum nurse-to-patient ratios.
Months earlier, a two-year IJB investigation had exposed how nurses are reporting being overburdened by unregulated nurse-to-patient ratios.
In workload reports obtained by the IJB under freedom of information legislation, Niagara Region nurses in acute surgical and medical wards could be seen outlining how they had to care for as many as 10 patients at a time.
Hospital managers consistently dismissed complaints filed by nurses about the ratios, the internal records showed.
A Niagara Health spokesperson said at the time that the hospital network “follows internal staffing guideline levels across medical and surgical wards.” The spokesperson declined to say what those guidelines are.
Announcing its new challenge, the ONA said the crisis over patient ratios had become its “tipping point.” The ONA says it wants to see legislated nurse-to-patient ratios capped at one to four (1:4) for medical and surgical wards.
“This is our members’ top demand because it’s a proven way to improve workloads and burnout, as well as ensure high-quality care for patients,” ONA provincial president Erin Ariss said in a written statement to the IJB.
Ontario has the lowest number of nurses per capita in Canada, at 126 per 10,000 people last year. Ontario’s ministries of Health and Labour did not immediately respond to requests for comment.
British Columbia, Oregon, California and states in Australia have mandated minimum patient ratios ranging from 1:4 to 1:5 for general medical wards.
“I have watched staffing conditions steadily deteriorate to the point where unsafe workloads have become normalized,” Jenn Miller, a critical care nurse in the GTA who wants to see mandatory ratios, told the IJB in an email.
“Many of us leave shifts physically exhausted and emotionally devastated, knowing we were forced to divide our attention between too many critically ill patients.”
The Ontario Hospital Association, which represents the province’s 134 public hospitals, declined to provide an interview, directing the IJB to previously published press releases that have warned that labour disruptions by nurses would risk patient care.
In a statement last year, the OHA said mandated ratios could limit a hospital’s flexibility to “tailor staffing levels” and represent “antiquated 20th century thinking at a time when Ontario’s hospitals are innovating to respond to the demands and complexities of the 21st century.”
Studies have repeatedly shown that hospitals with lower nurse-to-patient ratios have better outcomes for patients.
“Hospitals with better nurse staffing have fewer deaths, fewer readmissions, fewer adverse events, and higher patient safety ratings,” said Karen Lasater, a nursing and health policy chair at the University of Pennsylvania School of Nursing, who previously studied the effect of patient safety outcomes following mandated ratios in B.C.
Miller, the critical care nurse, told the IJB that if nothing changes, “the healthcare system will continue losing experienced bedside nurses at an alarming rate.
“Hospitals cannot continue functioning on chronic short staffing, overtime, and the goodwill of exhausted healthcare workers forever,” she said. “There is simply no way to provide the level of care our patients deserve when nurses are stretched this thin.”
