Nursing Hours per Patient Day

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.

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.

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)

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.

• NHpPD application manual - Guiding principles (2019 revised edition) (PDF 517KB)

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.

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. 

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).

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:

• Classification-Reclassification Request (Word 90KB)
• Prepare a Business Case of Classification-Reclassification of NHpPD (PDF 291KB)

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.

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.

• Annual report NHpPD July 2022-June 2023 (PDF 1MB)
• Interim report NHpPD July 2022-December 2022 (PDF 1MB)
• Annual report NHpPD July 2021-June 2022 (PDF 1MB)
• Interim report NHpPD July 2021-December 2021 (PDF 1.3MB)
• Annual report: NHpPD July 2020-June 2021 (PDF 1MB)
• Interim report NHpPD July 2020-December 2020 (1MB) 
• Annual report: NHpPD July 2019-June 2020 (PDF 1MB)
• Interim report: NHpPD July 2019-December 2019 (PDF 1MB)
• Annual report: NHpPD July 2018 - June 2019 (PDF 1MB)
• Interim report: NHpPD July 2018-December 2018 (PDF 1MB)
• Annual report: NHpPD July2017-June2018 (PDF 1MB)
• Interim report NHpPD July 2017-December 2017 (PDF 862KB)
• Annual report: NHpPD July 2016-June 2017 (PDF 265KB)
• Interim report: NHpPD July 2016-December 2016 (PDF 869)
• Annual report: NHpPD July 2015-June 2016 (PDF 854KB)
• Annual report: NHpPD July 2014-June 2015 (PDF 995KB)
• Annual report: NHpPD July 2013-June 2014 (PDF 983KB)

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.