How nursing shortages impact patient care

Nurses are the backbone of any healthcare system, playing a crucial role in providing quality care to patients. The United Kingdom however, is facing a severe nursing shortage, which is having a significant impact on patient care, healthcare providers and the wider healthcare system across the country.

Addressing the availability of nurses requires a multi-faceted approach to ensure the healthcare system has enough nurses to provide high-quality care to patients. To fully understand the problem in the UK, it’s helpful to consider the current state of nursing, the impacts of nursing shortages, and – perhaps most importantly – some of the solutions to help address the problem.

The current state of nursing in the UK

Official NHS vacancy statistics published in May 2023 show that as of 31 March 2023, there were almost 40,096 vacant posts for Registered Nurses (RNs) within NHS England and NHS Improvement. This is a vacancy rate of 9.9%.

There are several issues contributing to the current staffing challenges in nursing. 

An increase in nurses leaving the field

A 2022 analysis conducted by the King’s Fund found a significant increase in nurses leaving the NHS – and this trend is being driven by younger workers. According to data from June 2021 to June 2022:

• There has been a 25% increase in the number of nurses leaving the NHS. The actual figure is more than 34,000 nurses.
• This percentage means an additional 7,000 nurses left the NHS when compared to the previous year.
• The largest increase in leavers was among younger nurses with two thirds (nearly 23,000) aged younger than 45 years.

“This is not an isolated or incidental increase,” the analysis states. “If we look at the data over successive quarters, we find that a clear trend is emerging where a steadily growing number are choosing to leave. Throughout the pandemic and its peaks during 2020 and 2021, the number of nurses leaving remained at a similar level to that seen pre-pandemic, which suggests this is a new trend of nurses leaving who otherwise would not have done, rather than a backlog of resignations.”

As to the cause of these resignations, the King’s Fund points to the NHS Staff Survey, which found that:

• 34% of nurses often thought about leaving
• 52% had felt unwell as a result of work-related stress
• 40% felt burned out because of their work.

An ageing workforce

A 2022 article in the Nursing Times, about a recent World Health Organization (WHO) report, highlighted that at 23% the proportion of nurses over the age of 55 is higher in the UK when compared to other European countries, such as France and Spain.

The WHO report noted additional workforce “must be recruited within the next 10 years to replace these staff when they retire” and the number of healthcare workers will actually need to increase as the European population ages and their healthcare needs become more complex.

An ever-growing demand for recruitment

There have been several efforts and campaigns to recruit more nurses in the UK, and some have been very successful in increasing nurse numbers. However, growing demand means that while these campaigns have increased community and hospital nurses, they have not reduced the number of vacancies.

For example, there is a target to recruit 50,000 new nurses into the NHS by 2023/24, which appears likely to be met. However, projections from the Health Foundation indicate there will still be a shortfall of around 38,000 full-time hospital and community health service (HCHS) and general practice nurses.

“Workforce shortages were the single biggest challenge facing the NHS well before COVID-19,” the Health Foundation states. “But the pandemic has driven increased demand for health care, growing waiting lists and a substantial elective care backlog, while impacting negatively on staff well-being and absence. This makes workforce planning all the more urgent, particularly in light of ongoing cost-of-living pressures, and in terms of patient safety and satisfaction.”

Fewer nurses in training

The Royal College of Nurses reported at the end of 2022 that there will be thousands fewer nursing students graduating in England over the coming years. For example, there will be 2,000 fewer nursing students graduating in 2025 than there were in 2024:

“Recent estimates show that without additional policy intervention and workforce planning, the nursing workforce will grow more slowly than it is currently or will decline, with a projected supply-demand gap of 140,600 nurses in the NHS in England by 2030/31.”

The impacts of nursing shortages

Inadequate nurse staffing levels can lead to a host of challenges.

• Reduced quality of care. A shortage of nurses can significantly increase the workload of existing nursing staff. It can necessitate increased nurse-to-patient ratios, that mean nurses need to take on more inpatient assessments, interventions, and so on. This extra pressure on working nurses can also lead to burnout, stress, and exhaustion, and a negative impact on the overall quality of care provided to patients.
• Longer wait times. Fewer working nurses providing patient care can lead to longer wait times for appointments, procedures, and treatments. This can cause delays in diagnosis and treatment, with significant consequences to patients’ health outcomes.
• Increased costs. With fewer nurses available to provide care, healthcare providers may need to rely on temporary or agency staff, which can be more expensive and increase costs for the healthcare system. 
• Poor patient satisfaction and outcomes. Understaffing in nursing care can negatively impact how patients experience healthcare. A lack of nurses within health services can also have dire repercussions, including (sometimes serious) medical errors and increased patient mortality rates.
• Decreased job satisfaction. Staff shortages can lead to decreased employee satisfaction across the nursing profession, from nurse practitioners to nurse leaders. They can also lead to high turnover rates as well as difficulty retaining staff.

Solutions for nursing shortages

There are many ways  nursing shortages in the UK can be addressed including improvements in important areas such as:

• Funding. Funding can take a variety of forms. For example, the UK government can increase funding for nursing school, education, and training programmes to attract more people to the profession. This can also provide financial support for existing nurses to continue their education and training. Increased funding could also pay for increased wages, helping to boost employee job satisfaction and morale among existing nurses.
• Working conditions. Improving working conditions for nurses, such as reducing workload and providing enhanced resources and support, can help retain existing nursing staff and attract new nurses.
• Recruitment. Healthcare providers can increase their recruitment efforts by offering attractive incentives such as competitive salaries, sign-on bonuses, flexible work arrangements, and career advancement opportunities.
• Nurse retention. Providing career development opportunities can help retain experienced nurses. 
• Diversity. Systemic reviews show diverse representation in nursing can help address nursing shortages by increasing the pool of potential nurses and bringing new perspectives and experiences to nursing practice.

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