Angela Hodgson is the president of CUPE 1974 and chair of the RPN Committee of the Ontario Council of Hospital Unions (OCHU-CUPE).
Over the past two decades, she has been intimately familiar with the long-festering staffing crisis in Ontario’s hospitals. As a registered practical nurse (RPN), Angela has witnessed first-hand the decline in working conditions, characterized by high rates of injuries and workplace violence, poorer patient outcomes, and worsening morale.
Ontario’s low level of nurse staffing – the lowest in Canada – comes with a heavy price tag: every additional patient added to a nurse’s workload is linked to a 7% increase in patient deaths. Conversely, appropriate ratios save lives.
As Angela notes, safe staffing also protects workers. In a 2023 CUPE survey, 75% of nurses said they had high stress levels, 61% reported trouble sleeping, and 55% dreaded going to work. Good nurse-to-patient ratios are associated with reasonable workloads, lower injury rates, higher job satisfaction and better retention.
But is that enough to convince governments across Canada, wedded to austerity, to invest in higher staffing levels?
There have been encouraging signs in recent years. The British Columbia government has already begun implementing nurse-to-patient ratios. Nurses in Nova Scotia have successfully negotiated a staffing standard with the health authority. In Manitoba, employers, unions and the government have signed a letter of intent to establish ratios.
In Ontario, nurses are bound to face an uphill battle with a Conservative government in charge. Furthermore, in the last round of central bargaining, the employer – the Ontario Hospital Association – refused to discuss the issue with the common front composed of CUPE’s hospital division, the Ontario Council of Hospital Unions (OCHU), representing nearly 50,000 staff; SEIU, representing 20,000; and Unifor, representing 15,000.
As chair of OCHU-CUPE’s RPN Committee, Angela plays a key role in the union’s campaign for safe nurse staffing levels. The campaign began with a media tour in August 2025, releasing findings of a major new academic study endorsing nursing ratios.
Question 1
What motivated you to become a nurse?
From a young age, I had a strong desire to help people, especially those who were unwell. I found comfort in caring for sick family members and always felt a deep sense of purpose in being there for them. Visiting loved ones in hospital sparked something in me. I was fascinated by the environment, the compassion of the caregivers, and the resilience of the patients.
I believe that being present for someone during their most vulnerable moments is a privilege. No one should feel alone or afraid when they’re sick, and sometimes, simply offering comfort and companionship can make all the difference. Nursing gives me the opportunity to do just that, to provide care, support, and a sense of humanity when it’s needed most.
Question 2
You have been working as a hospital nurse for over 20 years. How have your working conditions evolved during that period and what drew you to union activism?
Working conditions for nurses have declined considerably over the past 20 years. I wouldn’t say they were ideal before, but 10 to 15 years ago, our workloads were far more manageable. You might have been assigned five or six patients in an acute care unit, which allowed for timely and effective care. Those ratios weren’t perfect, and you might have had to stay late, skip lunch, or forgo a break, but you felt like you could do your job to a reasonable level of satisfaction. You didn’t leave your shift questioning if the care provided was compromised.
Today, it’s so much more challenging. The number of patients per nurse has increased. It’s far more common to be assigned six to eight patients during your shift. It becomes virtually impossible to provide the kind of care that we were trained to deliver. It’s not fair to patients.
Over the years, I became increasingly aware of the ongoing challenges in our profession, particularly around workload, lack of support for RPNs, and the absence of strong advocacy for our role in health care. I knew I needed to better understand the root causes of these issues and find a way to make a difference.
The combination of rising patient acuity, reduced staffing, and limited resources pushed me to act. I realized that the same compassion and commitment I bring to caring for patients could be used to advocate for colleagues. My goal became clear: to help improve working conditions, secure proper support for health care workers, and create a healthier, more respectful workplace for all.
Question 3
We hear a lot about nurses and other health care workers facing moral distress as a result of not being able to deliver the care that patients need. Can you explain what that feels like for you?
We go into nursing because of our compassion and desire to help people and improve their well-being.
But when you’re unable to provide the level of care your patients truly need, when call bells go unanswered, medications are delayed, and there’s no time to sit with someone, understand their condition, or simply offer comfort, you start to question yourself. You doubt the quality of care you’ve delivered and carry the weight of feeling like it wasn’t enough. These moments stay with you. It’s very demoralizing.
Question 4
Our 2023 survey revealed that working conditions keep many nurses up at night, which helps explain why so many are leaving the job they love. OCHU-CUPE is campaigning for nurse-to-patient ratios. How would that help?
The constant sense of letting your patients down doesn’t just fade. It settles deep in your mind and begins to weigh on your emotional well-being. Over time, that emotional toll becomes physical, too. It’s the reason so many nurses lie awake at night, burdened by the “what ifs” and “what could have been.” There’s only so much you can endure before you reach a breaking point and decide to quit, so it’s no surprise that so many nurses have left the profession.
Mandating nurse-to-patient ratios is extremely important. Evidence from the U.S. and Australia shows that nursing ratios are linked to lower death rates, improvement in patient satisfaction and decline in workplace injuries.
Ratios will guarantee that staffing levels never dip below an established threshold. We will have the time to properly assess our patients, provide treatments, and teach patients how to better care for themselves. It will mean less rushed care which decreases the potential for error. It will allow for the therapeutic relationships that nurses should be building with their patients to reduce their anxiety. Overall, it will mean better working conditions for us as nurses so we can fully take care of our patients.
Question 5
Would it be possible to implement nursing ratios in a province like Ontario where there is a significant shortage of nurses and employers are struggling to fill vacancies?
Mandating ratios isn’t a magic bullet solution, but evidence shows they boost recruitment and retention. I think it sends a clear signal to staff that the system cares about their well-being and is taking concrete steps to improve working conditions.
We have proof that ratios have been greatly beneficial elsewhere. In 2015, after ratios came into effect in the Australian state of Victoria, the number of nurses increased by 24%, with more than 7,000 inactive nurses rejoining the workforce. Imagine if we tried that in Ontario, where 15,000 nurses are registered but not currently practicing, it could be an incredible success story.
Question 6
Nurses in other jurisdictions like British Columbia and Nova Scotia have already won ratios or equivalent staffing standards. What campaign has OCHU-CUPE launched in Ontario, and how do you expect the employer to respond in central bargaining?
OCHU-CUPE released an academic study in August, which explores nurse-to-patient ratios and concludes we absolutely need them. We will be touring the province, holding media conferences as part of an awareness and education campaign in an effort to win the public over. We’ll also organize rallies, run educationals for CUPE members, and lobby members of the provincial parliament. We’ll host virtual briefings for all the nurses we represent and a nursing conference on December 1 to approve an action plan to achieve ratios.
The demand for nurse-to-patient ratios is also going to be tabled as a bargaining proposal in central bargaining. Unfortunately, in the last round of bargaining, the Ontario Hospital Association was unwilling to even have a conversation about it. There is no reason to expect a different attitude this time around, but that makes it even more important to have a strong campaign and compel them to seriously engage with us on this issue.
Nursing ratios save lives. If the employer truly cares about improving patient care, we need to be talking about how best to implement them here in Ontario. People’s lives depend on it. This issue won’t go away. We will achieve these ratios in Ontario and, eventually, in every province.
