A “deadly mix” of collapsing growth in the registered nurse workforce and increasingly complex patient needs is leaving staff “struggling to keep people safe,” the Royal College of Nursing (RCN) warned at its annual congress in Liverpool.
Professor Nicola Ranger, RCN general secretary and chief executive, told the 3000-strong audience at the college’s annual conference in Liverpool that most respondents to its latest survey said that staffing levels were too low, with just 1 in 10 describing nurse numbers as at the right level for all patient needs to be met.
Ranger said: “Widespread vacancies of registered nurses are always unsafe, but the risk is being compounded by the demands of delivering ever more complex care to an ageing, sicker population, with multiple conditions. It is a deadly mix.”
The college’s Last Shift Survey asked all RCN members delivering direct patient care across the UK in all health and care settings about staffing levels the last time they were at work, and how those levels impacted them and the care they were able to provide. The online survey was open between 2 March and 7 April, and received over 13,000 responses.
Staffing Levels Insufficient
Key findings were:
- 79% of nurses said that clinical complexity had increased over the last 2 years
- 64% reported that registered nurse staffing levels were “below” or “well below” what was needed
- 69% said the situation forced them to make “difficult decisions” about prioritising care
- 76% felt emotionally exhausted on their last shift, particularly those who said their shift was understaffed
Staff shortages were reported as significantly compromising care across both hospital and community settings. District nurses and others in crucial community nursing roles, who typically care for older people and those with long-term conditions, consistently highlighted being unable to meet surging patient need.
NHS workforce figures showed that as at 31 December 2025 there were 372,515 full-time equivalent nurses. While this was an increase of 6127 in a year, it represented the lowest annual growth since 2018. The RCN said in the previous decade the nursing workforce increased by 31%, but this compared with 47% more doctors. If nurses had seen a similar growth to doctors then there would have been an additional 45,100 more nurses.
Dramatic Fall in International Recruitment
The situation has been exacerbated by a dramatic fall in international nurse and midwife recruitment and retention, in advance of tightening immigration policies coming into force, according to a report from the King’s Fund in December last year. Domestic recruitment was not filling the gaps fast enough.
Suzie Bailey, director of leadership and organisational development at the King’s Fund, said in a press release that the changes could deepen workforce shortages and put patient safety at risk. The numbers “should sound alarm bells for politicians, health and care leaders, and people who rely on health and care services.”
The NHS Alliance, formed from the merger of NHS Providers and the NHS Confederation, has also released results of its survey and interview feedback from local NHS leaders.
It highlighted pressures from rising demand for healthcare, constrained finances, and industrial action, with 76% expecting finances to be even tougher in 2026-2027 than last year.
Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.
