Nova Scotia's largest health district says meeting the staffing levels demanded by 2,600 unionized registered nurses in the Halifax area would require hiring 800 more registered nurses at a cost of more than $60 million per year.
John Gillis, a senior strategy adviser for the Capital District Health Authority, said the increased staffing levels requested by the union are "without evidence that this would improve quality and safety."
"If Nova Scotia were to invest this amount of additional resources in care, we should be sure this is in line with the values of Nova Scotians," said Gillis.
"Do we wish to better support people in the community and in their homes versus focusing on hospital-based care?"
The price tag estimate comes as talks between the Capital District Health Authority and the Nova Scotia Government and General Employees Union head to conciliation.
"There is no contract without mandated ratios. There's no contract," said Joan Jessome, the president of the Nova Scotia Government and General Employees Union.
Jessome said the $60-million figure has been released to scare the public "into believing they can't afford to do it." She said the Capital District Health Authority has not yet sat down to negotiate staffing levels or which units where they may apply.
'We don't have evidence about the impact'
Ginger Hampton, a registered nurse in the intensive care unit, is adamant on the issue. She wants a staffing ratio of one nurse for every four patients.
"Those four patients are guaranteed to be safe," Hampton told CBC News.
"We don't want to work understaffed all the time."
But Kathleen MacMillan, the director Dalhousie University's School of Nursing, said it's not that simple.
"We don't have evidence about the impact on patients," she said.
While acknowledging the importance of nurse workloads and stress, MacMillan said rigid thresholds sometimes do not give managers the flexibility needed to address patient needs.
She said in other places where set ratios have been tried, it has caused unintended consequences.
"These kind of things happen. Surgeries get cancelled, staffing is either inadequate or over what's required when other units need more," MacMillan said.
Hampton dismissed MacMillan as out of touch.
"Each nurse is taking care of more patients. They have an increased workload. They get to spend less and less time with each patient," said Hampton.
"She is very far removed form the bedside."