Blog | HR |
10 Min Read
October 5, 2023

What is HPPD in Nursing?

by Morris Isaacson

Nurse staffing is a crucial factor in measuring the quality of care patients receive in healthcare facilities. The administrators of the Centers for Medicare and Medicaid Services (CMS) are working to set minimum nurse staffing requirements for healthcare facilities. HPPD is a crucial factor in managing nurse staffing ratios in healthcare. Understanding it can help you ensure your facility maintains optimal staffing levels to comply with the proposed federal staffing requirements.

What is HPPD?


Hours Per Patient Day (HPPD) is used to measure the duration of care patients in a healthcare facility receive in a workday. It is a key measure in qualifying the commitment of healthcare providers to their patients. Healthcare facilities also use it to measure their productivity and efficiency. Monitoring and optimizing your HPPD ratio can help you save costs without compromising quality care. 


An appropriate HPPD ratio means that nurses can give adequate care and time to each patient and cater to their unique needs. This is primarily beneficial to patients who require special care, like disabled individuals or people in nursing homes or hospitals, who often need extra attention and assistance with daily activities. However, HPPD ratios aren’t rigid but depend on patients’ units. 


What is HPPD in nursing homes? 


HPPD in nursing homes will capture the overall time nurses and nursing assistants spend per patient day on the unit. It excludes their sick time, vacation, orientation, or education leave. Nursing homes can use it to manage their staff, offer quality care to residents and keep track of their budget. 

Why are nursing Hours Per Patient Day important? 

You can use HPPD to estimate the number of working staff you will need in your facility per patient. Here are other reasons nursing HPPD is important: 

Positive Patient Outcomes

Positive patient outcomes


It’s no secret that some patients experience delayed care due to poor staffing. Such patients often suffer preventable complications that can result in negative outcomes and even deaths. 


However, the right HPPD ratio ensures that patients receive the required attention and care, leading to better outcomes and reduced mortality rates and complications due to delayed care. 

Healthy Work-Life for Nurses

Healthy work-life for nurses 


Adequate staffing isn’t just beneficial to patients but also to healthcare staff. While healthcare workers care for patients, they also need to care for their health and well-being. Nurse staffing ratios can help ensure nurses are not overworked and have a better work-life balance. 

Improved Financial Health

Improved financial health 


HPPD is a way to measure your staff’s productivity. So, tracking HPPD can help you meet your financial targets while providing quality care. 

How to Calculate Your Facility's HPPD

How to calculate your facility’s HPPD 


You can calculate your HPPD by dividing the hours of work put in within 24 hours by all nursing staff, which includes Registered Nurses, Nursing Assistants and Licensed Practical Nurses by the total number of patients available in the 24-hour workday. 


For example, say your hospital nursing staff provided a total of 3,000 nursing hours and you have 1,000 patients within the same 24-hour duration. To determine your HPPD, divide 3,000 (nursing hours) by 1000 (number of patients). Your hospital’s HPPD for the 24-hour duration is three. 

Why calculating HPPD isn’t always straightforward 


Calculating nursing Hours Per Patient Day provides details of the staffing levels in healthcare facilities. However, it can be a complex exercise, and several factors can affect the process. 

Type of healthcare staff

Type of Healthcare Staff

The quality of healthcare staff like RNs, PNs and NPs available in a facility will impact the HPPD calculation. If your facility has more registered nurses than nursing assistants, your HPPD will be higher. Conversely, if you have more nursing assistants, it will be lower. 

Patient demographics

Patient demographics have an impact on HPPD calculation. Factors like age and gender can influence the results of the HPPD calculation. This is because some patient demographics require more care than others. For example, a study revealed that high-need patients are more than twice as likely to visit the emergency department than other patients in the United States. 

Data collection

Data Collection

Data accuracy is crucial in calculating HPPD, and this is a huge challenge. Another prominent challenge in calculating HPPD is data collection. Collecting accurate data on patient days and nursing hours, especially in busy healthcare settings, can be tough and ineffective. Inaccurate data will result in incorrectly processed HPPD. 



HPPD ratios, when regulated by government bodies, may become more complex to compute because of rigid requirements. Also, healthcare facilities will have to figure out a way to comply with all the set regulations while controlling costs. 

Costs control

Costs Control

Sometimes, to meet the standard HPPD ratio, healthcare facilities may need to increase staffing levels, which can be expensive. Hence, every healthcare facility will have to learn how to balance the need to deliver high-quality healthcare and cost control. 

Impact of proposed nurse staffing requirements on staffing ratios 


In the past two decades, facilities were reported to be understaffed, with fewer nurses available to attend to patients. This impacted the quality of care provided within facilities. Because of that, Congress called for an Institute of Medicine (IOM) to study nurse staffing in clinics and nursing homes. 


After further research, the Agency for Healthcare Research and Quality (AHRQ) concluded there is a clear relationship between nurse staffing and patient outcomes. On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule as a new requirement for nurse staffing levels in facilities. 


The proposed rule will provide mandatory staffing ratios. Therefore, nursing homes may need to start preparing to comply with the rule by developing a more reliable system of tracking their staffing ratios. 

Impact of proposed nurse staffing requirements on staffing ratios

Facilitating nursing scheduling with HR automation 


Creating a more flexible and user-friendly work schedule for your nurses can improve their satisfaction level and enhance the overall efficiency of your operations. Digital solutions, including Human Capital Management (HCM) platforms, can help you simplify nurse scheduling by automating the process. 


Here are a few ways automation can help take the stress out of nurse scheduling: 

Call-outs management

Call-outs management 

Digital HCM solutions allow you to manage caregiver call-outs more proactively and efficiently. Instead of being caught unprepared by an unexpected call-out, an automated HCM system can alert your staff the moment a shift becomes open. The right HCM software will also allow you to notify your caregiver pool of the available shift and help you fill the scheduling gap, preventing any impact to patient care.   

Easy shift swaps 

Easy shift swaps  

With an easily-accessible, user-friendly method of reporting a scheduling conflict, your caregivers can be motivated to report call-outs in advance, giving scheduling staff more time to fill the gap. And be sure to look for HCM platforms that offer a shift-swap feature. Empowering your caregivers to directly exchange shifts with co-workers (with HR approval) can improve morale and reduce the demands on your scheduling and HR staff.   

Effective budget control  

Effective budget control  

HCM software designed for healthcare can help you deliver optimal patient care more reliably. By setting the standard HPPD ratio for your facility and establishing the number of nurses you need on call, you can maintain nurse shift requirements no matter how much the number of patients fluctuates. 

Timely overtime alerts  

Timely overtime alerts  

A digital HCM platform can also help you implement cost controls and payroll rules. An overtime alert feature, for example, can help prevent overworking nurses and maintain payroll guidelines. Currently, Empeon is the only provider with this capability. 

Efficient nurse scheduling made easy 

Embracing HR automation and digital HCM solutions is critical for operators in the home health and long-term care sectors. Remember, to maintain the highest quality of patient care, you need your facility nurses and caregivers to be at their most effective. The right HCM software can empower your caregivers and your healthcare HR team to work smarter not harder through more efficient and collaborative scheduling.  

With Empeon, you can easily organize nurse shifts and maintain required HPPD ratios. Book a demo to learn how our customized solutions can help you improve your HR operations. 

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