Understanding the impact of nursing shortages

With more than 46,000 nursing vacancies across the NHS in England as of June 2023, nursing shortages have become an increasingly critical issue for the UK's healthcare system.

“Workforce shortages are one of the biggest challenges facing the NHS and adult social care in England,” says The Health Foundation, an independent, healthcare-focused think tank. “Nursing remains a key area of shortfall: in NHS trusts, while registered nurses and health visitors make up around a quarter (26%) of FTE (full-time equivalent) roles, nurse vacancies accounted for more than a third (35%, around 43,600 FTE) of all vacancies in the quarter to December 2022.”

To help address this challenge, though, it’s important to first understand the causes of the nursing practice shortfall, as well as the impact the shortfall is having on healthcare – and beyond.

The UK’s nursing shortage: contributing factors

There are several factors that have contributed to a lack of nurses in the UK. These include:

• The COVID-19 pandemic. Healthcare services already under strain prior to 2020 were further sapped during the coronavirus pandemic – and this immense pressure on healthcare workers created an overworked and exhausted nursing population, with many leaving the profession as a result.
• An ageing nursing workforce. According to 2023 figures from the Nursing and Midwifery Council, the second-largest age demographic among UK Registered Nurses (RNs) is the 41-55 bracket (285,199 registered professionals), while the number of nurses aged 56 or older – including RNs at NHS retirement age – has risen to 167,002. 
• Limited capacity to train new nurses. There is an ever-growing need to recruit and train new nurses, both to address increasing demands on the healthcare industry – such as caring for the ageing population of baby boomers – as well as to backfill the gaps created by nurses leaving the profession due to retirement, burnout, or job dissatisfaction. But these turnover rates have proven difficult to address, with fewer nursing students due to graduate in England in the coming years. According to the Royal College of Nursing, there will be 2,000 fewer nursing students graduating from nursing education in 2025 than there will be 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.”

How nursing shortages impact patient care

The shortage of nurses – from nurse practitioners to nurse managers – directly affects patient safety and care in multiple ways. 

For example, inadequate nurse staffing levels lead to higher nurse-to-patient ratios, making it challenging for nurses to provide the necessary attention and nursing care to each patient. Many nurses work in difficult situations on a regular basis, and these staffing ratios can result in delayed responses to patient needs, which in turn compromises the quality of patient care. This can have adverse effects on patient satisfaction – and, more importantly, on patient outcomes and patient mortality rates. 

Another example of the impact to patient care is the link between hospital nurse shortages and medication errors. According to the Royal College of Nursing, medication errors “become far more likely when staff are overstretched and unable to give their patients the attention they deserve.”

A recent RCN review of NHS England and NHS Digital data also found:

• There are a record number of patients on waiting lists, with the NHS elective care waiting list growing by 169% between 2011 and 2022. And this increase was growing even before the pandemic.
• During the same time frame, the number of people waiting more than four hours in A&E has grown by more than 1.5 million people.
• More than 7 million people in England were waiting to start routine hospital treatment at the end of March 2023, which is the highest number since 2007 when records began.

On the flip side, the American Association of Colleges of Nursing (AACN) – which is also grappling with a nursing shortage – notes that higher nurse staffing levels are associated with “fewer deaths, lower failure-to-rescue incidents, lower rates of infection, and shorter hospital stays.”

How nursing shortages impact the wider healthcare system

Nursing shortages have ripple effects throughout the health system.

For example, inefficient staffing and lower quality of care can lead to increased healthcare costs because patients will often require longer hospital stays, readmission to hospitals and other care facilities, or additional treatments to address complications. 

There is also a knock-on effect to workforce well-being: fewer nurses puts additional strain on existing nurses and other healthcare staff, stretching everyone too thin and creating burnout, further turnover, and a perpetuating cycle of shortages.

How nursing shortages impact the economy

Nursing shortages also have broader economic implications outside of healthcare costs. 

For example, where the nursing shortage means people struggle to access healthcare treatment – due to fewer available appointments, longer waitlists, and so on – this can extend or worsen their illnesses and keep them off work for longer periods of time.

Filling all of the existing nursing vacancies currently available with the NHS would also employ tens of thousands of people, stimulating new economic growth.

How nursing shortages impact the nursing profession 

Nursing shortages have a profound impact on the nursing profession itself. There are links between shortages of nurses and:

• Decreased job satisfaction for nurses. Nurses working in understaffed environments, from inpatient critical care to community healthcare facilities – often find it challenging to practice at the highest level of their abilities.
• Increased turnover. Nurses – particularly younger nurses, but advanced nursing staff, too – are leaving the NHS at alarming rates. A report in early 2023 found that between 2018 and 2022, nearly 43,000 people between the ages of 21 and 50 left the Nursing and Midwifery Council register. The number of nurses leaving the register increased by 9% from 2020-21 on the previous year, and increased by a further 3% in 2022.
• Difficulties recruiting new nurses. The NHS continues to struggle hiring nurses into the health service. There is decreased enrolment in domestic nursing programmes, and in recent years the NHS has heavily relied on recruiting nurses from abroad.

The UK’s nursing shortage: potential solutions

Many experts agree that addressing the UK’s nursing shortage requires a multifaceted approach. Some potential solutions include:

• Increasing nursing education capacity. This could include investing in nursing education programmes and nursing schools to enrol and graduate more students, and offering bursaries or relief for nursing student debt in order to expand the pool of qualified nurses. 
• Offering competitive salaries and benefits. Paying nurses competitive salaries can help attract nursing staff, and also help with staff retention. 
• Providing enhanced support for well-being. Support programmes and resources that effectively promote the well-being and mental health of healthcare professionals can help reduce nurse burnout.
• Further integrating technology in healthcare. Investing in new healthcare technology to streamline administrative tasks would reduce the burdens on nurses and give them more time to focus on high-quality patient care.
• Expanding telehealth services. Offering telehealth and remote monitoring services extends the reach of nurses, especially in under-served areas, particularly rural and remote areas.

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