Go to whole of WA Government Search
Nursing and midwifery workloads

Nursing and midwifery workloads

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

Hospitals and health services will continue managing nursing and midwifery 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 Australian Nursing Federation and United Workers Union industrial agreements.

Nurse / Midwife to Patient Ratios

A nurse / midwife to patient ratio is the minimum number of nurses or midwives working on a particular ward/unit, in relation to the number of patients they care for. Mandated ratios will provide a determined minimum number of nurses or midwives in relation to the number of patients on a ward/unit. Minimum ratios are applied for every shift (morning, afternoon, night).

As per the 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 2 years (WA Ratio Model). The WA Ratio Model aims to ensure safe and sustainable workloads for nurses and midwives.

For further information:

Nursing Hours per Patient Day (NHpPD)

The NHpPD 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 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 required to staff a ward.

The NHpPD HSS Application (external site) for WA is an automated electronic application and can be accessed by registered users. The NHpPD HSS Application assists the WA health system to identify, track and report on NHpPD variances. To gain access to the NHpPD application tool, users must log an IT request by completing an eHFN-030 Form. 

Reporting

As part of WA Health’s commitment to industrial legislation, a 6-monthly 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.

Classification and reclassification of NHpPD category and target hours

Where a new ward/unit is created, the complexity or the relative proportion of ward/unit activity changes or the ward/unit has changed, the NHpPD model incorporates a classification or reclassification review process. Through this process, sites submit a Business Case to 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/units (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. 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 provider’s 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 6-monthly NHpPD Report.

The process of classification and reclassification of NHpPD category and target hours will be maintained while WA Health transition to the NMTPR model. The process for reclassification of wards under the NMTPR model is in development.

Considerations in delivering safe nursing and midwifery care

The following factors should also be considered when managing nursing and midwifery workloads to ensure safe 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).

More information

For enquiries about nursing and midwifery workloads please contact the Chief Nursing and Midwifery Office.

Last reviewed: 24-07-2025
wa.gov.au