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Nursing Hours per Patient Day

Nursing Hours per Patient Day

Since 2002, the WA health system has utilised the Nursing Hours per Patient Day (NHpPD) methodology to manage nursing and midwifery workloads. In late 2022, the McGowan government committed to transitioning to the Nurse/Midwife to Patient Ratios (NMTPR) model. This will be implemented in a phased approach across WA health system inpatient services, and NHpPD will be maintained to manage workloads until the completion of the NMTPR roll out. 

Hospitals and health services will continue to manage nursing workloads in accordance with the principles established in the Nurses (WA Government Health Services) Exceptional Matters Order 2001 (PR914193) (the EMO) relating to workloads (Nursing Hours per Patient Day) during the life of the following Agreements.

WA Health System – Australian Nursing Federation – Registered Nurses, Midwives, Enrolled (Mental Health) and Enrolled (Mothercraft) Nurses – Industrial Agreement 2022 (PDF 16MB) (2022 ANF Industrial Agreement)

and 

WA Health System – United Workers Union (WA) – Enrolled Nurses, Assistants in Nursing, Aboriginal and Ethnic Health Workers Industrial Agreement 2022 (PDF 1.5MB) (2022 UWU Industrial Agreement)

The NHpPD workload model:

  • Ensures flexibility in the supply of nursing and/or midwifery hours to meet the variable demands of patient care, with the recommendation of minimum safe staffing levels.
  • Is used only in the inpatient setting (wards)
  • Measures and reports on the direct care hours provided by nurses and midwives, in comparison to the set NHpPD target hours.

The tool can also be used for:

  • Predictive roster and shift planning
  • Bottom up roster building for new or reconfigured services
  • Tracking and reporting on variance across a roster period to help provide better roster management.

WA Ratio Model - Nurse Midwife to Patient Ratio’s (NMTPR)

As per the 2022 ANF Industrial Agreement (signed 14 March 2024) the Employer (WA Health) commits to introducing minimum Nurse/Midwife to Patient Ratios via a phased approach over a minimum of two years (WA Ratio Model). The WA Ratio Model aims to ensure safe and sustainable workloads for nurses and midwives.

The WA Ratio Model will replace Nursing Hours per Patient Day (NHpPD) at Part 2 of the Agreement – a timeline is yet to be established for Part 1 and 2.

How were the NHpPD benchmarks (category and target hours) set?

A benchmarking exercise was conducted across all sites in WA Health during 2000-2001 to establish the initial targets.

All inpatient units are allocated to a benchmark group (Categories A to G) based on a range of defining characteristics including the diversity and complexity of nursing tasks.

Hours represent the total direct clinical care required for each patient in a 24 hour period and ranges from four hours in Category F (sub-acute or rehabilitation) to 31.6 hours in an Intensive Care Unit.

In Intensive Care or Critical Care Units, the NHPPD measures are based on the National Review of the Australian Critical Care Nursing Workforce.

How are the NHpPD category and NHpPD target hours determined?

The nursing and midwifery workload management within the WA public sector is applied through a NHpPD Workload Methodology following an Exceptional Matters Order (EMO) issued by the WA Industrial Relations Commission on 11 February 2002.

The NHpPD model:

  • Ensures flexibility in the supply of nursing and/or midwifery hours to meet the variable demands of patient care, with the recommendation of minimum safe staffing levels.
  • Measures and reports on the direct clinical care hours required and provided by nurses and midwives.

This is in accordance with:

Schedule A – Exceptional Matters Order, of the WA Health System – Australian Nursing Federation – Registered Nurses, Midwives, Enrolled (Mental Health) and Enrolled (Mothercraft) Nurses – Industrial Agreement 2022 (PDF 16MB), and

Schedule A – Workload Management, Exceptional Matters Order, of the WA Health System – United Workers Union (WA) – Enrolled Nurses, Assistants in Nursing, Aboriginal and Ethnic Health Workers Industrial Agreement 2022 (PDF 1.5MB)

Applying the NHpPD Guiding Principles

The NHpPD application manual provides guidance and operational instruction (by way of formulas) for health services to understand the NHpPD Workload Methodology, used within Western Australia, and calculate FTE cover required to staff a ward.

How is NHPPD applied?

The NHHPD model provides a systematic, benchmarked monitoring and measuring system to identify and report the number of direct nursing and/or midwifery hours required and provided to meet patient care needs in a specific inpatient clinical area.

The NHpPD target hours are considered the minimum hours required to provide safe care for patients in that setting. Hours can be averaged over rosters to enable greater hours to be provided at times of higher acuity and fewer hours during times of lower acuity or activity.

General Formula:

Establish the Ward Category and associated hours for that category from Schedule B – NHPPD Guiding Principles

  • Ward Category NHpPD x number of ward beds occupied = nursing hours
  • FTE = nursing hours x 14 days / 76 hours

Example: Ward 4

  • Ward 4 has 30 beds and as per the NHPPD Guiding Principles, is identified as a category B (6.0).
  • Based on the budgeted number of beds, Ward 4’s average patients per day = 29 (96.6% occupancy).
  • To work out the NHpPD, the category is multiplied by the average beds/patients. For Ward 4 it is 6.0 x 29 patients = 174 nursing hours
  • To calculate the FTE required per week for the ward/department, multiply nursing hours by 14 days, divided by 76 hours (standard fulltime nursing/midwifery contract).
  • For Ward 4, the FTE required to cover the roster for a week would be: 174 nursing hours x 14 days ÷ 76 hours = 32.05 FTE
  • This FTE is the minimum target for the frontline nurse/midwife leadership to roster staff in order to safely staff the ward/area. 
Important information to consider in delivering safe nursing and midwifery care

Along with the NHPPD, the following should be considered in managing safe, effective care:

  • Demands on nurse/midwife time that may be considered indirect hours, administrative or non-nurse/midwife functions which impact or distract from providing patient care
  • Inefficient systems and processes which impact or distract from providing direct patient care
  • Effective utilisation of available resources, expertise, knowledge and skill
  • Skill mix of the roster
  • Monitoring of patient outcomes and nurse sensitive outcomes
  • The practice environment for nurses/midwives, staff experience and engagement (with tools to monitor)
  • The patient experience (with tools to monitor).
Classification and reclassification of NHpPD category and target hours

Where there are new units created, the complexity or the relative proportion of ward/department activity changes or the ward/department has changed, the NHpPD model incorporates a classification or reclassification review process.

This allows sites to submit a Business Case and have the NHpPD category and target hours formally reviewed and updated against criteria.

Classification and reclassification Business Cases must include benchmarking data, including comparison of similar specialty wards/areas (locally and/or nationally if it is a new service), average length of stay (ALOS), patient turnover, births, average occupied bed days, emergency admissions, acuity indicators, validation of the of patient complexity and clinical patient cohort/mix. There should also be reference to safety and quality clinical indictors, clinical incidents and/or workforce indicators where relevant.

The Chief Nursing and Midwifery Office facilitates the business case application process and applications are reviewed for decision by the Statewide Workload Review Committee, consisting of the public sector Area Executive Director of Nursing and Midwifery leaders and the Chief Nursing and Midwifery Officer.

To submit a business case application, please refer to:

The completed business case must be endorsed by the health service providers Executive or Area Director of Nursing and Midwifery before being emailed to CNMO.CED@health.wa.gov.au

All approved NHpPD classification and reclassification of wards/areas are publicly listed in the Annual and Interim NHpPD Reports (below).

The process of classification and reclassification of NHpPD category and target hours will be maintained while WA Health transition to the NMTPR model.

NHpPD Reports

As part of WA Health’s commitment to industrial legislation, an annual (financial year) and interim report is published to demonstrate progress against NHpPD benchmark targets. This report is presented to the Director General, Chief Executive Officers, Directors of Nursing/Midwifery of all public health hospitals, the Australian Nursing Federation (WA), United Workers Union and the Hospital Services Union.

All nurses and midwives can access the report, either from this website or from their Director of Nursing and Midwifery.

NHpPD Database

The NHpPD HSS Application (external site) for WA is an automated electronic application and can be accessed by registered users. This application draws nursing hours directly from the WA health rostering system (RoStar) and patient activity from the bed management systems (WebPAS) used across WA Health. The NHpPD program is then able to complete the calculations and provide the actual NHpPD used for each inpatient clinical area classified and on the data base. The NHpPD HSS Application assists the WA health system to identify, track and report on NHpPD variances. To gain access to either the WA Health NHpPD data base or the automated NHpPD, users log and IT request is required by completing an eHFN-030 Form. Noting, this access request must be authorised by the manager.

Specific to the WA Country Health Service (WACHS), the Nursing Workload Monitoring System (NWMS) database (external site) can be accessed by registered users (in WACHS) to report NHpPD for Country Hospitals. Registered users from each site are required to enter their ward/unit data into this database. Data includes occupied bed days and rostered nursing and/or midwifery hours. The data is then used to calculate and compare the actual nursing hours of the ward, unit or area against the set NHpPD target hours.

Last reviewed: 17-07-2024
wa.gov.au