Nursing Hours per Patient Day

Nursing Hours per Patient Day (NHPPD) is the workload monitoring system used throughout the WA public health system since its introduction in 2002.

Hospitals and health services are committed to maintaining a comprehensive workload management system for nurses and midwives in Western Australia under its application of the Nurses (WA Government Health Services) Exceptional Matters Order (EMO) 2001 which is in effect via Part 12, Section 74, Schedule A and Schedule B of the WA Health System – Australian Nursing Federation – Registered Nurses, Midwives, Enrolled (Mental Health) and Enrolled (Mothercraft) Nurses – Industrial Agreement 2018 (PDF 16MB).

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.
  • Is used in the inpatient setting (wards), including haemodialysis, short stay, day surgery settings.
  • Measures and reports on the direct clinical care hours required and provided by nurses and midwives.

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.

What other information is important 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).

NHpPD Guiding Principles

How are categories determined?

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 2018; and, Schedule A – Workload Management, Exceptional Matters Order, of the WA Health System – United Voice – Enrolled Nurses, Assistants in Nursing, Aboriginal and Ethnic Health Workers 2018 – Industrial Agreement stipulate the NHPPD Guiding Principles in determining a ward or department’s category. The category is based on criteria for measuring diversity, complexity and nursing tasks required.

How were the benchmarks 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.

Is the NHPPD benchmark the minimum or maximum hours required?

The NHPPD benchmarks 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.

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 clinical area.

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 leader to roster staff in order to safely staff his/her ward/department.

Example roster 1

 Headcount number of nurses or midwives
   AM shift PM shift ND shift FTE
Mon 8 8 6 4.70
Tue 9 8 6 4.90
Wed 8 8 6 4.70
Thu 8 8 6 4.70
Fri 8 8 6 4.70
Sat 8 7 5 4.25
Sun 7 7 5 4.05
        32.00 FTE

Example roster 2

Headcount number of nurses or midwives
   AM shift PM shift ND shift FTE
Mon 8 8 5 4.45
Tue 8 10 7 5.35
Wed 8 10 7 5.35
Thu 8 10 7 5.35
Fri 8 9 5 4.65
Sat 6 7 5 3.85
Sun 6 4 4 3.00
        32.00 FTE

Reclassification review process

Where the complexity of the ward/department has changed, the NHPPD model incorporates a review process. This allows sites to submit a business case to have their category formally reviewed and updated against criteria.

All business case applications are reviewed and re-classified by the Statewide Workload Review Committee. Sites can use the Prepare a Business Case of Classification-Reclassification of NHpPD (PDF 291KB) to assist them to complete the Classification-Reclassification Request (Word 90KB) document

Reporting

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 Voice 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.

Database

The WA Health NHpPD database (secure site) can be accessed by registered users to report for Small Country Hospitals.

Registered users from each site enter their ward/unit data into this database. Data includes occupied bed days and rostered nursing/midwifery hours. The data is then used to calculate and compare the ward/unit against their target hours.

The Nursing Hours per Patient Day (NHpPD) HSS tool for WA is an automated electronic application and can be accessed by registered users here (external site).

To gain access to either the WA Health NHpPD data base or the automated NHpPD, users need to complete an eHFN30 Form and must be authorised by their manager.

Factsheets

For enquiries about Workload Monitoring please contact us.

Last reviewed: 30-03-2020