INSIGHTS: Is poor planning the real problem in hospitals?

By Guest Opinion

Recent IJB reporting has renewed public attention on unacceptably high workloads faced by Canadian nurses. The reporting exposed systemic challenges within the healthcare system that threaten quality care and drive nurses away from hospitals.  

Evidence from jurisdictions outside Canada highlights the importance of safe staffing ratios in achieving better outcomes for patients and less attrition of nurses. In places that mandate staffing ratios, such as California and parts of Australia, we have seen demonstrable improvements in patient safety, reduced mortality, and enhanced nurse retention. In South Korea, shifting from nurse-to-bed to nurse-to-patient ratios led to significant improvements in staffing, with adopting institutions improving by as much as 66% compared to only 23% in non-adopting facilities. Canada must follow suit; there is an urgent necessity to reimagine Canada’s nurse workforce to support retention and enhance health outcomes.

But ratios are only one part of the solution to the supply-demand mismatch. While ratios establish a benchmark for staffing adequacy, actual workloads are dynamic; patient complexity and acuity can drastically affect how much nursing a patient needs. Needs-based planning offers an adaptive and data-driven alternative; unlike traditional models, which rely on historical utilization or budget-based headcounts, needs-based planning anticipates demographic trends, disease burdens, and the actual services populations require.

In Nova Scotia, we applied this approach by using pandemic modelling to link service needs across illness severity levels with workforce supply, identifying critical shortages. By incorporating competency mapping and productivity estimates across multidisciplinary teams, we generated a clearer view of how workforce capabilities can be more strategically aligned with the supply and demand for care.

Elsewhere in Canada, needs-based workforce planning tools are rarely used, despite this year’s report by the World Health Organization which identified 33 such tools. The missed opportunity cannot be overstated. Adopting some of the WHO tools could help Canada catch up. 

Innovations in team-based care models

In addition to planning models, novel team-based care structures can alleviate overworked nurses. Evidence from Canadian and international examples, such as nurse-led primary care clinics and integrated cancer care models, illustrates how collaborative staffing can distribute responsibilities more equitably. A quality improvement initiative in the United States introduced a hybrid staffing model combining bedside nurses, nursing assistants, and virtual nurses; it allowed senior nurses to concentrate on complex care and improved team function.

Team dynamics research highlights shared cognition, consistent communication, and team cohesion are critical to implementing workforce innovations successfully Not surprisingly, poor communication and unstable staffing hinders progress.

Technology innovations like the Nursing Activities Score (NAS) and Safe Nursing Care Tool (SNCT) have been used to estimate workload. Machine learning algorithms and artificial intelligence, especially those co-designed with nurses, have shown promise in optimizing scheduling to balance workloads, reduce burnout, and guide real-time staffing decisions.

Canada can catch up

Despite these advances, implementation across Canadian health systems remains uneven and poorly measured. Where innovative models have been adopted, these efforts are often siloed, underfunded, or short-lived. Sustained national investment in implementation infrastructure, stronger regional policy alignment, and deliberate partnerships with nurses and other key stakeholders are essential to impactful adoption and testing of high-impact innovations. Federal programs must provide catalytic funding accompanied by operational support and strategies for scale-up. Federal, provincial, and territorial governments must work collaboratively, not in isolation, to co-invest in solutions that are scalable and sustainable. In this context, strategic engagement with private industry, particularly in areas such as AI and digital health, can accelerate innovation and amplify system capacity.

Retaining and strengthening the nursing workforce requires a shift toward needs-based, team-enabled, and technology-supported planning. This is not just a policy imperative; it is a clinical and economic necessity. As aging populations and rising care complexity continue to pressure systems, leveraging integrated strategies will be essential to ensuring safe, sustainable, and high-quality care for all Canadians.