North Island

Highway 19's northern end is located at the Bear Cove ferry terminal, across the bay from Port Hardy. The highway proceeds southwest from the ferry dock for 5 km (3.1 mi) to a junction with the main road to the centre of Port Hardy, then turns southeast, travelling for 16 km (9.9 mi) to Highway 30, and then further east for 20 km (12 mi) to the main road to Port McNeill. The highway then follows the eastern shore of Nimpkish Lake and the Nimpkish River through a long stretch of dense forest terrain for 64 km (40 mi) southeast, until reaching a junction with the community of Woss, then travelling another 65 km east (40 mi), through the boundary between the Regional Districts of Mount Waddington and Strathcona, to a junction with Sayward, and finally entering the city of Campbell River another 64 km (40 mi) southeast, at a junction with Highways 28 and 19A, just past the river that the city is named for.

The entire stretch of Highway 19 north of Campbell River is an undivided two-lane configuration. Once at the junction with Highways 28 and 19A, Highway 19 separates into an expressway configuration, built between 1996 and 2001. In Campbell River, the highway shares its northbound lanes with Tamarac Street, and its southbound lanes with Willow Street.

Inland Island Highway

The 128 km (80 mi) stretch of Highway 19 between Campbell River and the city of Parksville is known as the Inland Island Highway. The highway completely avoids any residential or urban areas and alternates between a divided four-lane expressway and freeway, with a nominal speed limit of 110 km/h (68 mph) and a 90 km/h (56 mph) speed limit near signal lights.

South from Campbell River, Highway 19 is divided primarily by a concrete wall, and goes through a series of six spaced out at-grade signalized intersections, five of them possessing exit numbers. 52 km (32 mi) south of Campbell River, Highway 19 reaches its first interchange, with a four-lane arterial highway that goes west to the village of Cumberland and east to the communities of Courtenay and Comox. Past the Courtenay Interchange, Highway 19 is divided by a grass median. 16 km (9.9 mi) later, Highway 19 reaches another interchange, this time with a two-lane road that goes a short distance east to the B.C. Ferry terminal at Buckley Bay. There are two small at-grade signalized intersections on Highway 19 in the 41 km (25 mi) between the Buckley Bay Interchange and the interchange with Highway 4, which goes north into Qualicum Beach. 9 km (5.6 mi) later, Highway 19 goes through another interchange, this time with Highway 4A, which goes east into Parksville. The next interchange, at Craig's Crossing, is another 5 km south (3 mi) where Highway 19A (Island Highway) rejoins Highway 19 marking the end of the Freeway and the Inland Island Highway.

Island Highway

Past the Craig's Crossing Interchange, Highway 19 resumes its 1953 Island Highway alignment, which today is a 4-lane, divided arterial highway with a concrete median barrier mostly constructed during the 1970s. It heads mostly southeast through the communities of Nanoose Bay and Lantzville passing 5 signal lights and many at grade intersections along the way before finally entering the north part of Nanaimo. The lower highway standards and signal lights require a lower speed limit of 90 km/h (56 mph) on this section of highway. In Nanoose Bay the presence of a particularly busy signal light, multiple residential properties on the highway, a dense cluster of several intersecting side roads, and the lack of a centre divider results in a 60 km/h (37 mph) speed limit.

Nanaimo Parkway

At the Exit 29 signal lights Highway 19A (Island Highway) once again diverges to follow the 1953 alignment. Highway 19 then veers south onto a 20 km (12 mi) long four-lane expressway known as the "Nanaimo Parkway" which opened in 1997. The alignment has five signalized intersections along its length along with 2 overpasses and 4 underpasses for local roads that do not connect to the highway. The only interchange on the Nanaimo Parkway is at its south terminus where a set of ramps bring Highway 19 onto the Highway 1 alignment where both roads continue south. The parkway's speed limit is 90 km/h (56 mph).

During the planning for the Nanaimo Parkway the Ministry of Transportation opted to construct signal lights instead of interchanges at 5 location as a cost saving measure intending on constructing the interchanges later when needed. At the time of its opening the parkway was a major improvement by allowing long distance traffic to bypass Nanaimo, greatly reducing driving times and eliminating congestion in the city.^[1] However by 2021 the parkway itself was beginning to have serious congestion issues at the signal lights as a result of the highway being flooded with commuter traffic from a growing Nanaimo. With further growth in traffic expected over the next 30 years the Ministry of Transportation has begun to study the implementation of interchanges on the parkway in the near future.^[2]

Highway 1 Concurrency

After the interchange with Highway 1 and Cedar Road, Highway 19 runs in a short concurrency with Highway 1 (the Trans-Canada Highway) for 2 km (1¼ mi) before exiting at a trumpet interchange on to the Duke Point Highway. With 4 southbound lanes and 3 northbound lanes this short section of freeway is the widest road on Vancouver Island.

Duke Point Highway

Opened in 1997 the 7.5 km (4.7 mi) long Duke Point Highway begins as a 4 lane expressway. Highway 19 crosses over the Nanaimo River 2 km (1¼ mi) from Highway 1 and shortly afterwards passes through an interchange at Maughan Rd. The highway then turns northward and narrows to a undivided 3 lane highway (2 lanes westbound and 1 land eastbound) for the last 5 km (3.1 mi) passing two at grade intersections, before finally terminating at the Duke Point Ferry Terminal. There is heavy traffic on the highway for short intervals when ferries are unloading but the rest of the time the Nanaimo bound lanes are virtually empty.

Vancouver Island Highway Project

In the late 1990s and early 2000s, a highway building program called the Vancouver Island Highway Project was initiated to improve the Highway 1 and 19 corridors between Victoria and Campbell River. This project included the construction of the Inland Island Highway, the Nanaimo Parkway and the Duke Point Highway. By early 1996 work was well underway on all sections.^[10]

On October 5, 1996, the first segment of the Inland Island Highway from Mud Bay to Parksville was opened. The Highway 19 designation was soon applied to the new route with the original 1953 highway becoming Highway 19A.^[11]

On May 31, 1997, the Nanaimo Parkway opened, cutting travel times for drivers going though Nanaimo from 40 minutes to 20 minutes and resulting in Highway 19 being realigned away from Nanaimo's downtown, the former route being replaced by another section of Highway 19A.^[1]

Opened in June 1997, the Duke Point Highway connected to BC Ferries' newest terminal as part of a scheme to remove congestion from the Departure Bay ferry terminal and the surrounding surface streets in Nanaimo's core.^[1] As a result of this project, Highway 19 was extended another 9 km to its present terminus, making it the only highway in British Columbia to have ferry terminals at both ends.

The remainder of the Inland Island Highway was built in phases over the next 4 years with the Campbell River Bypass opening on September 24, 1997; the Courtenay-Mud Bay link opening on September 25 1999; and the Courtenay-Campbell River expressway, opening on September 8, 2001, completing the project.^[11] No significant upgrades or extensions to Highway 19 have occurred since.