The Royal College of Nursing’s (RCN) biggest survey of its membership shows that ten years of worsening work pressures have caused morale among nursing staff to collapse, as staff shortages and low pay combine to create a crisis among the profession.
In a survey of more than 11,000 nursing staff across the UK’s NHS, social care and independent settings, more than seven in ten say the pressure has become too much to stand, while two thirds (65.6%) say their pay level or band fails to match their level of responsibility, skills and contribution. Now, almost half (45%) say they are planning or considering quitting.
The survey shows that pressures on staff have increased significantly over the last decade and across all settings. The RCN says the findings must ‘concentrate the minds’ of politicians as a general election approaches.
Between 2013 and 2023, the number of nursing staff reporting being under too much pressure at work increased from 59.3% to 71.1%. The same period saw the number of nursing staff saying they are too busy to provide the level of care they would like to increase from 56% to 65.9%.
One nurse working in the NHS in the North West of England who responded to the survey, said: “I’ve been a nurse for 16 years. I can’t remember a worse time in the NHS. Poor staffing, stress, burnout, and morale are apparent on a daily basis - camaraderie gets us through most days. I hope for a future where my children and the next generations have a safe NHS.”
A health visitor working in general practice in Scotland, said: “I am considering leaving nursing all together to find a job I can leave on time and not have to worry about work.”
Over a decade of pay restraint has driven an explosion in pay-related mental ill health among nursing staff. Almost seven in ten (68.7%) say money worries are causing anxiety and depression. One in four (25.2%) say they are regularly losing sleep, with youngest staff aged between 18-24 feeling most impacted.
Across every health and care setting in the UK, nursing staff feel demoralised by pay that fails to match their levels of training, education, skills and responsibilities. A deep dissatisfaction with pay among nursing staff has intensified. Just two in ten (22%) think their pay level or band is appropriate, halving from four in ten (44%) in 2015.
A community nurse in Northern Ireland, said: "Responsibility of the job is not reflected in the pay. Experienced nurses are leaving the profession for jobs such as sales assistants, where they are better paid.”
A healthcare assistant working in an independent sector care home, said: “The amount of work we do for patients, families, and the nurses themselves makes our rate of pay shockingly low and almost unliveable. We are on the lowest pay possible, and many people quit and would rather work at Tesco for higher pay and easier work.”
Two thirds (64%) of staff still consider nursing a rewarding career, with many emphasising their passion for care. However, this figure is falling as more nursing staff say they feel chronically undervalued. For those nursing staff planning or considering quitting nursing, the main reason was feeling undervalued. Being under too much pressure and feeling exhausted are the two other biggest drivers.
A district nurse in Wales, said: “I have been qualified 8 months and I’m already feeling burnt out and dread going to work because of the workload and have been starting to think about leaving.”
Working under pressure is impacting on personal lives. More than eight in ten (85%) admit to working while sick during 2023 and fewer than a third (28.6%) report being happy with their work-life balance – the lowest score recorded since 2013.
A senior nurse, working in an Acute Trust in the South of England, said: “Sometimes I arrive home depleted without energy to even look after myself and I wonder if this is normal.”
A senior nurse working in an NHS mental health setting in the South West of England, said: “Excessive hours and stress, nursing has affected my home life and parenting. There is no work-life balance and the pay does not reflect the self-sacrifice. However, after 35 years, I still love caring for my patients everyday.”
The RCN is calling for investment in the nursing profession and substantially lift pay over the coming years to boost recruitment and retention across all health and care settings.
Professor Pat Cullen, RCN General Secretary and Chief Executive, said: “Over the last ten years, nursing staff have become increasingly demoralised by the level of care they are able to provide. The stress and anxiety from trying to meet the needs of patients is forcing them to work whilst sick and now many want to quit entirely. It is a terrible state of affairs.
“This last decade has seen nursing staff grapple with devastating workforce shortages as successive governments fail to invest in the profession. In every setting from the NHS to social care, patients are suffering. Huge losses in staff pay only add to a feeling of disrespect for dedicated professionals who are sacrificing their own welfare to care for patients.
“The picture for nursing may look bleak, but as a general election approaches, politicians have a chance to chart a better course. Our profession is fundamental to building a healthy society and economy, but it cannot do that with its hands tied behind its back.
“For those wishing to form the next government, this report should concentrate minds. Patients and nursing staff should not have to keep suffering for politicians to pay attention and take action. The next decade must be better than the last.”
