On June 29, the B.C. Nurses’ Bargaining Association gave a 72-hour strike notice. The three days came and went without a new offer from the employers’ association, and the nurses began their strike on July 2 by restricting overtime and withdrawing non-nursing services. These include activities that could be performed by other health care workers, such as cleaning or answering phones. 

In early May, over 50,000 nurses participated in a province-wide strike vote, voting 98 per cent in favour of job action. Strike votes send a powerful message to health care employers and the government that workers are willing to withdraw labour in order to reach a settlement that addresses their concerns, including compensation and working conditions.

In May, the multi-union Nurses’ Bargaining Association, led by the B.C. Nurses’ Union, reached a tentative agreement with the Health Employers Associations of B.C. Then, in June, 67 of voting nurses rejected the tentative agreement, which set the stage for job action. 

Under the B.C. Labour Relations Code, health care is designated as an “essential service,” which requires that minimum staffing levels are instituted during job action. This prevents a full withdrawal of nursing care, but if job action escalates, it will most certainly impact health care services for patients.

With this context, it is important to examine some of the underlying system-level issues that have led B.C. nurses to reject the tentative agreement and begin job action.

B.C. hospital capacity has been shrinking

The majority of B.C. nurses work in public hospitals. An aging population with increasing medical complexity, coupled with shrinking hospital capacity, translates into heavier workloads and more challenging working conditions for frontline nurses. 

As Table 1 shows, the number of staffed hospital beds dropped from 293 to 234 per 100,000 people between 2014-15 and 2023-24—a decline of 20 per cent. Over this period, B.C. experienced the largest decline in staffed hospital beds among the three most-populous provinces (Ontario, Quebec, and B.C.). 

Although Ontario and Quebec had much lower hospital bed rates in 2014-15 compared to B.C., B.C. nurses are experiencing a precipitous decline in the ability of public hospitals to meet the needs of the population. 

Fewer hospital beds relative to the growing and aging population contributes to congestion in emergency departments where patients may wait longer to be admitted into hospital because there are no available beds. Surgical patients wait longer for surgeries if there are no recovery beds available. Occupancy rates climb.

This creates challenging working conditions and moral distress—as the gap widens between the level of care nurses want to provide and the institutional constraints they face on a daily basis. Burnout follows and nurses leave the profession.

Emergency department wait times are a canary in the coal mine for health care system performance. B.C. hospital capacity appears insufficient to meet the needs of the population. This is evident when we look at the time it takes to be admitted to an inpatient bed from the emergency department. 

In 2020-21, 90 per cent of patients waited 32.8 hours for an inpatient bed, which increased to 64.7 hours in 2024-25—a wait time that has nearly doubled (Figure 1). This is a significant increase in wait times for patients who require inpatient care, but must wait due to a lack of available inpatient beds.

Declining access to public seniors’ care is making problems worse

Increasing hospital capacity alone will not solve acute care capacity challenges. Too often, patients remain in hospital because there are no community alternatives with an appropriate intensity of clinical care and support. The lack of access to appropriate seniors’ home and community care is widely recognized as one of the main barriers to reducing hospital strain and wait times. 

But on this front, B.C. has been losing ground. In a recent report, the B.C. Seniors Advocate found that B.C. has a shortage of 2,000 long-term care beds today, which increases to 16,000 beds over the next decade.

Instead of fast-tracking new long-term care beds, the provincial government, in its February budget, put the brakes on previously planned public long-term care expansion. The consequence is that more seniors, especially with lower incomes, do not have access to seniors’ long-term care and may end up in a hospital bed because there are no alternatives. 

Previous CCPA analysis found that increasing private, out-of-pocket spending on seniors’ care is also a reflection that the publicly funded system is not meeting the needs of British Columbians. Our analysis found that per capita private long-term care spending increased by 112 per cent while public spending increased by 50 per cent from 2014 to 2023. Private spending comes in the form of out-of-pocket household and private insurance payments. 

Targeting health care investments where it’s needed

Hospitals and regional health authority services make up about 70 per cent of the health budget, followed by physician services and B.C. Pharmacare. Although the health care budget has received decent annual increases over the last decade, the 2026-27 provincial budget fails to maintain existing health care service levels, and this fiscal context contributes to what nurses are experiencing on the frontlines.

According to the most recent data available, B.C. funded its hospitals at the second-lowest rate, per capita, at $2,111, only ahead of Ontario at $1,967 in 2023. B.C. public hospital funding, on a per-person basis, was below the Canadian average of $2,132.

Renewed investment does not appear forthcoming. Regional services, including hospitals and community services, are forecast to only see a teeny 0.7 per cent increase in the fiscal year ending March 2026. The budget for 2026-27 only offers a 2.5 per cent funding lift to regional services—far below what is needed to maintain service levels and account for inflation and population growth and aging. An increase of five to six per cent is required to maintain existing service levels, when accounting for inflation, population growth, and aging.

But at the same time that the B.C.budget brings real spending cuts to health care, which will make it virtually impossible to address severe capacity challenges, the government has not always targeted public funding where it is most needed—and most effective.

The rapid growth of provincial spending on physicians risks crowding out other health care spending priorities. According to data from the Canadian Institute for Health Information, provincial spending growth on physicians of 17 per cent in 2023 (the most recent year available) outpaced spending growth in long-term care (nine per cent), hospitals (15 per cent), and home and community care (16 per cent). This comes as B.C. reports more family physicians per capita between 2020 and 2024—increasing from 133 to 138 per 100,000 people—and yet access to a family doctor has been on the decline since 2015.

From the standpoint of public finances, it is not fiscally prudent for the provincial government to continue such large spending increases on physician services while receiving less access to primary care in return. A recent CCPA report offered evidence-based approaches, such as an expansion of community health centres, with their focus on taking pressure off hospitals by ensuring access to low-income and equity-seeking groups who struggle accessing primary care.

Another frustration for nurses is the misallocation of public dollars to for-profit staffing agencies when those dollars should support recruitment and retention of the long-term nursing workforce. 

For-profit staffing agencies were intended to provide temporary staffing relief, but have become widespread in B.C.’s health system in order to address vacancies and staffing shortages. Health authorities contract these for-profit corporations to supply nurses, medical lab technologists, care aides, and other professions to fill staffing gaps. 

The use of private, for-profit staffing agencies is a financial drain on publicly funded health care organizations. The cost to health authorities can be more than two to three times the cost of hiring regular employed staff. It is also highly corrosive to morale within the health system because regular employees are working alongside agency staff, making upwards of 50 per cent more.

According to government data obtained by CTV News, public spending on for-profit staffing has totalled more than $800 million between 2018-19 and 2024-25—an astonishing 31-fold increase over seven years.

As B.C. Nurses Union president Adrian Gear puts it, “Nurses want to know why the health authorities continue to spend millions of dollars on costly short-term staffing solutions, while the nurses who are here for the long-term struggling with workload pressures, unsafe working conditions, and staffing shortages are being told the cupboards are empty.”

All of this comes at a time of growing economic inequality and cost of living challenges facing nurses just like others in society. As these frustrations and system-level pressures build for B.C.’s frontline nurses, it is not surprising that they want conditions to change. A strike is one of the most visible and powerful tools available to health care workers to demand public health care improvements.

About the author

Andrew Longhurst

Andrew Longhurst is a senior researcher and political economist, with a focus on health policy, at the Canadian Centre for Policy Alternatives. His work has been published in academic journals and by research institutes, including Canadian Journal on Aging, Political Geography, the CCPA, and the Parkland Institute.