Introduction

This week’s blog is by Rebecca Garcia and Irtiza Qureshi.

The nursing workforce in the United Kingdom (UK) has been under capacity for a long time [1]. According to the latest published figures from NHS Digital (2024) [2], there are currently 34,709 qualified nursing vacancies in England. Worryingly, UCAS figures for 2024 demonstrate a decline over the last three years in people applying and being accepted to nursing courses (and while there are regional differences across the UK), since 2022, there has been a 19% decline in nursing applications. In addition to declining numbers of people seeking to train to become nurses, newly qualified nurses are leaving the profession in the first 12 months, citing lack of support among the reasons for their departure [3]. Additionally, NMC data shows that 20% of people leaving the register have been registered less than 10 years, indicative that retention of qualified nurses is poor [4].

In response to the nursing workforce crisis, various UK governments have a long history of engaging in cycles of international recruitment, which has had detrimental impacts on the individuals involved and the health and social care sector(s), for both the UK and the nurses’ countries of origin [5]. Consequently, The World Health Organisation (WHO) and the International Council for Nurses (ICN) have criticised the UK Government for persistently recruiting international nurses [6,7]. However, the previous UK government stated explicitly that it wanted to lessen its reliance on international recruitment and develop its own workforce [8].

The NHS Workforce (aspirational) Plan

In 2023, the NHS published the ‘NHS Long Term Workforce Plan’ (LTWP) [9], detailing an ambitious strategic plan to address the ongoing recruitment issues in Nursing (and other professions). As a consequence of political change in the UK, there is an ongoing period of uncertainty regarding the funding, delivery and operationalisation of the LTWP. Moreover, the LTWP details the need to reduce reliance on international recruitment and recruit and train local people, intending to increase the nursing workforce by 80% to over 53,500, and nursing associates by 40% to 10,500 by 2031/32 [9]. The LTWP is ambitious and focuses on the operationalisation of training or upscaling, without due consideration to make Nursing an attractive career option for people. Critically, the LTWP has an implicit expectation that people will apply to become nurses, assuming the LTWP is supported and funded as suggested, to increase the nursing workforce numbers. What is needed is a workforce plan that also encompasses explicit strategies to make Nursing an attractive career option, with a clear career trajectory and positive media portrayal.

How to meet these aspirations?

Currently, there are few clear strategies for how the LTWP aspirations will be achieved at scale. From an attraction perspective, nursing is negatively misrepresented in the media with the public image of the profession erroneous. For example, the media portrayal of [often female] nurses being doctors’ handmaidens persists, despite this being far from reality [10]. Additionally, the current discourse of nursing excludes men and people from the global majority, with male global majority individuals being especially invisible [11].    Therefore, it is essential that nurses be proactive with stakeholders and the media to change the public profile of Nursing, and correct misinformation, meaning that the nurse voice needs to be central to future strategic level, government, policy research, education and workforce planning. Utilising new technologies and platforms such as YouTube/Snapchat /TikTok and other social media may reach younger audiences and present nursing as an attractive career option. While it is not within the scope of this paper to properly discuss salary, however, to note that pay and conditions also need to be commensurate with the responsibility given to posts, and nursing is woefully lacking in this regard. Therefore, job compensation also needs to be properly considered to make nursing a viable career for the future and to attract and retain a future workforce. Finally, utilisation of the global evidence base may help inform strategies to develop a nursing workforce from local populations.

Conclusion

We need to move away from short-term solutions to resolve the nursing workforce deficit and look to a more strategic approach to successfully increasing and sustaining our nursing workforce from within the UK. This includes the revision and promotion of an accurate professional nursing profile, which is evidenced (or shared) through the media, and this will go some way to making Nursing an attractive career option and help achieve the growth figures suggested in the aspirational NHS LTWP. To put it more succinctly, with the growing numbers of the UK population, and declining numbers of nursing staff, the nursing profession and the current government must act now to increase the attraction of nursing, or governments will need to significantly rethink health and social care structures and deliverables in the future. This will be a huge challenge, given the pace of change, quality assurance and governance in healthcare.

Author details

Rebecca Garcia¹ PhD RN(A) CPsychol

Irtiza Qureshi^{2, 3} PhD

 ¹Faculty of Wellbeing, Education and Language Studies, The Open University. Walton Drive, Milton Keynes, Buckinghamshire, UK

² Nottingham Centre for Public Health and Epidemiology, University of Nottingham, Hucknall Road

Nottingham, UK

³ Development Centre for Population Health, University of Leicester, University Road, Leicester, UK

RG: Rebecca.Garcia@open.ac.uk *corresponding author

IQ: Irtiza.Qureshi@nottingham.ac.uk

References

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3. The House of Commons. The nursing workforce. [Internet]. London: 2018. Available from: http://ezproxy.stir.ac.uk/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=1988080607&site=eds-live
4. Argyrides A, Castro-Ayala A, Borneo A, Hadden C, Hayford E, Holden J, et al. Valuing Nursing in the UK Staffing for safe and effective care in the UK: interventions to mitigate risks to nursing retention. 2023;
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6. Church Edd. WHO calls for ‘fair and ethical’ international nurse recruitment | Nursing Times. Nurs Times [Internet] 2024 [cited 2024 Aug 16];Available from: https://www.nursingtimes.net/news/global-nursing/who-calls-for-fair-and-ethical-international-nurse-recruitment-03-04-2024/
7. International Council of Nurses. The Guardian article highlights ICN’s concerns about international nurse recruitment and its drastic effects in low-income nations | ICN – International Council of Nurses [Internet]. 2024 [cited 2024 Aug 16];Available from: https://www.icn.ch/news/guardian-article-highlights-icns-concerns-about-international-nurse-recruitment-and-its
8. NHS England. NHS Long Term Workforce Plan. 2023.
9. NHS England. NHS Long Term Workforce Plan. NHS England [Internet] 2023;Available from: https://www.england.nhs.uk/long-read/nhs-long-term-workforce-plan-2/#references
10. Garcia R, Qureshi I. Nurse identity: Reality and media portrayal. Evid Based Nurs [Internet] 2022;25:1–5. Available from: https://ebn.bmj.com/content/25/1/1.long
11. Qureshi I, Ali N, Randhawa G. British South Asian male nurses’ views on the barriers and enablers to entering and progressing in nursing careers. J Nurs Manag 2020;28:892–902.