Nurse / midwife to patient ratios
Nurse / midwife to patient ratios are the minimum number of registered nurses, midwives, and enrolled nurses working on a particular ward, unit, or department, in relation to the number of patients they care for. Minimum ratios are applied for every shift (morning, afternoon, night).
The implementation of ratios commenced with a successful pilot at the Perth Children’s Hospital (PCH) Emergency Department in July 2023.
Following this, on 7 October 2024, ratios were successfully trialled in medical and surgical areas at North Metropolitan Health Service. From 21 July 2025, ratios were rolled out further across all metropolitan medical and surgical areas at the Child and Adolescent Health Service, East Metropolitan Health Service, and South Metropolitan Health Service as follows
North Metropolitan Health Service
| Hospital |
Ward |
| Osborne Park Hospital |
6 |
| Sir Charles Gairdner Hospital |
C16
C17
G53
G61
G66
G73
G74
Woods |
South Metropolitan Health Service
| Hospital |
Ward |
| Fiona Stanley Hospital |
4A
6D
M6
M7 |
| Fremantle Hospital |
B8S
D5 |
| Rockingham General Hospital |
Medical
Multi Stay Surgical
Moordibirdup |
East Metropolitan Health Service
| Hospital |
Ward |
| Armadale Health Service |
Campbell
Canning
Colyer |
| Royal Perth Hospital |
3H
5G
6G
7A
8A
9A
10C |
Child and Adolescent Health Service
| Hospital |
Ward |
| Perth Children’s Hospital |
1B
2A
2B
4A
4B
Emergency Department |
What are the minimum nurse / midwife to patient ratios?
The minimum ratio in medical and surgical wards/units are:
- 1:4 + 1 hands-free shift coordinator on morning and afternoon shifts.
- 1:7 on night shifts. A shift co-ordinator is not required for the purposes of ratios compliance on night shifts, but one may be rostered if clinically required.
Ratios exclude all supernumerary roles and apply only to nurses/midwives providing direct care to patients. Assistants in nursing are excluded from ratios.
Why is WA moving to ratios?
WA Health is committed to maintaining a contemporary workload management methodology that strongly aligns with the principles of evidence-based safe staffing.
Under the WA Health System – Australian Nursing Federation – Registered Nurses, Midwives, Enrolled (Mental Health) and Enrolled (Mothercraft) Nurses – Industrial Agreement 2024 (agreement) WA Health is committed to introducing ratios via a phased approach over a minimum of 2 years. Clause 10 of the agreement pertains to ratios.
What will happen to Nursing Hours per Patient Day?
Nursing Hours per Patient Day (NHpPD) was implemented in WA in 2002. Wards/units/departments will continue to operate under the NHpPD methodology until ratios are implemented. Once ratios are implemented across all wards/units, NHpPD will no longer be used as a workload methodology for nurses/midwives in the WA health system.
Day to day operations
The way patients are cared for will remain unchanged, with patient care and staff wellbeing remaining the priority. In areas where the NHpPD classification level is higher than the minimum ratio, the higher staffing level will be retained.
The number of patients assigned to each nurse/midwife can differ depending on clinical need, as long as the overall minimum ratio for that ward/unit is met.
Patient allocations will continue to be based on acuity and remain responsive to the activity of the ward/unit/department.
More information
The Nurse / Midwife to Patient Ratios Policy outlines requirements for implementing ratios.
Last reviewed: 24-07-2025