The Royal College of Nursing (RCN) has warned that unwell patients are waiting hours for pain relief and others are deteriorating needlessly because of a lack of nurses. A new report from the college highlights how nurse shortages can have serious implications for patient safety, including falls from hospital beds resulting in broken bones or brain bleeds.
The report examines NHS hospital board papers on "nursing red flags" – safety reports linked to staff shortages, including delays to pain relief, essential medication and missed care. It found reporting of these incidents is inconsistent across hospitals, but in some cases, these safety-critical incidents are widespread, with monthly trust numbers in the hundreds.
West Midlands Nurse Describes Overstretched Shifts
A nurse in the West Midlands said: "A shift that has enough staff is considered 'green' and we haven't had one in over six months. You just cannot give quality care if you're looking after 10 acutely sick patients each."
Another nurse in the East of England told the RCN: "On my unit, an elderly patient fell out of bed and suffered a brain bleed. Night staff were short and there was no-one outside the bay to witness the fall and help for at least ten minutes. Everyone was so worried about the brain injury that it took seven days to realise she actually had a broken hip as well. On every single shift, there's at least one thing that doesn't get done. This includes pain medication, particularly at night when staff have bigger caseloads, and the delays can be hours at a time."
Thousands of Nursing Vacancies Across England
The report reveals there were approximately 23,000 nursing vacancies across England, yet these figures "understate the true shortfall" as they fail to account for frozen or unfunded posts. The authors caution that staffing is "unevenly distributed across England" and draw attention to how the growth in doctor numbers has not been mirrored by an equivalent rise in nursing staff.
Since 2009, nurse numbers have risen by 33 per cent, compared with 60 per cent for doctors, according to the report. It further states that had nurse numbers expanded at the same rate as doctors, England would currently have in excess of 77,000 additional nurses. The report also highlights that nurse numbers have "failed to keep up with overall hospital workload", with the authors estimating that had nursing figures kept pace with the increase in hospital activity, there would be 55,000 more nurses since 2009/10.
RCN Calls for Sustained Workforce Investment
The report concludes: "Whichever approach is used, the conclusion is the same: England has a substantial shortfall in registered nursing labour, requiring at least tens of thousands more nurses and sustained long-term workforce investment."
Professor Nicola Ranger, RCN general secretary and chief executive, said: "It's utterly shocking that sick patients should wait hours for pain relief or vital medication while some are falling, breaking bones and deteriorating needlessly. The truth is patient safety incidents aren't isolated and trusts are recording hundreds each month due to registered nurse shortages. The numbers are clear: we would have tens of thousands more nurses working in our NHS if we'd had the necessary investment to keep up with demand. Instead, our numbers have been held down, in contrast to other staff. When you have too few registered nurses, you get longer hospital stays, worse outcomes and more pressure on an already burned-out and exhausted workforce."
A Department of Health and Social Care spokesperson said: "This Government is putting more staff on the frontline, with 14,000 more nurses employed by the NHS now compared with July 2024. Alongside this, we are continuing to drive forward key patient safety reform, and from Tuesday, Martha's Rule will be extended to hospital A&E departments in England, making it easier for staff and patients to ask for a second opinion. Our 10-Year Workforce Plan will put the NHS workforce on a sustainable footing and ensure the NHS has the staff it needs to deliver for patients, both now and in the future."
