Nearly a quarter of nurses believe patients are at high risk of harm because dangerously low staffing levels on their last shift left wards and community services unable to cope, according to a major new survey by the Royal College of Nursing. The findings, released as thousands of frontline staff gather in Liverpool for the union’s annual Congress, lay bare what nursing leaders describe as a “deadly mix” of chronic workforce shortages and soaring patient demand that is putting lives at risk across the National Health Service.
The RCN survey of more than 13,000 nursing staff paints a bleak picture of care on the front line. Almost two-thirds (64 per cent) said registered nurse staffing levels on their last shift were “below” or “well below” what was needed, with 22 per cent in both hospital and community settings reporting levels “well below” requirements, leaving care “significantly compromised”. More than two-thirds (69 per cent) of respondents said they were being forced to make difficult decisions about which patients to prioritise, while only one in ten believed staffing levels were adequate for patient needs.
A substantial majority (79 per cent) reported that the clinical complexity of patients had increased over the past two years, driven by an ageing population with multiple chronic conditions, frailty and polypharmacy. One nurse working on an acute adult ward in England said: “The ‘care’ has disappeared in nursing – now it’s just about trying to stay safe, to get through the shift without any harm being done… It’s very, very sad.” Another nurse on an older people’s ward warned: “Managing high-risk fall patients who require 1:1 supervision is simply not achievable with current staffing levels, despite what policy suggests. This gap between theoretical expectations and practical reality places both patients and staff at risk.” A third nurse added: “There is no understanding, insight or awareness of how significantly the dependency, frailty and medical instability of our patient group have changed and increased.”
Community nursing services are also buckling under the strain. One district nurse said: “District nursing is going under with the complexities of care required. We cannot sustain the levels of pressures faced since COVID.” Another community nurse said simply: “Community nursing is on its knees.” The RCN notes that the district nursing workforce has declined by 43 per cent between 2009/10 and 2023/24, even as demand is projected to rise by 34 per cent over the next 15 years due to the ageing population, threatening the government’s ambition to shift more care into the community.
Excess Deaths and Corridor Care
The survey’s stark warning about the risk of harm comes against a backdrop of mounting alarm over excess deaths, record A&E delays and the normalisation of “corridor care”. The Royal College of Emergency Medicine (RCEM) estimates that more than 16,600 excess deaths occurred in England in 2024 associated with patients waiting 12 hours or more in A&E before admission to a hospital bed – an increase of 20 per cent from 2023 and equivalent to around 320 deaths every week. RCEM calculates that one additional death occurs for every 72 patients experiencing an 8-to-12-hour wait, and that patients waiting 12 hours or more are twice as likely to die within 30 days compared with those treated within two hours.
In total, more than 1.7 million patients waited over 12 hours in England’s A&E departments in 2024, including over 1.15 million aged 60 and over. Nearly half a million patients (478,901) endured waits of more than 24 hours. Emergency medicine experts say the risk of death begins rising sharply after patients wait more than five hours.
Corridor care – where patients are treated on trolleys in corridors, waiting rooms, cupboards and other makeshift areas because of bed shortages – has become an increasingly visible symbol of the crisis. An All-Party Parliamentary Group on Emergency Care report backed by emergency medicine experts warned it had become a “defining feature” of the NHS crisis, linked to increased risk of harm. One emergency department nurse in England described the terrifying pressure on a recent shift: “The shift was completely unsafe, and it felt a miracle that avoidable harm was not caused. I’m 11 years into nursing and have never felt so awful about my work.”
Beyond the immediate risks of delays and inappropriate care, the RCN points to wider consequences of understaffing. Earlier RCN surveys found that 62 per cent of nursing staff reported patient care was compromised on their last shift due to insufficient registered nurses, and 43 per cent said they had to leave necessary care undone because of lack of time. Short staffing contributes to medication errors, increased hospital readmissions and longer lengths of stay, as well as higher rates of litigation and complaints due to clinical errors and delayed care.
Workforce Growth Slumps
The RCN warns that growth in the registered nursing workforce in NHS hospital and community services in England has slumped to its slowest level in eight years, with an increase of just 6,127 full-time equivalent nurses in the year ending December 2025. Over the last decade, the nursing workforce grew by 31 per cent compared with 47 per cent for doctors. If nurse numbers had risen at the same pace as doctors, there would now be approximately 45,100 more registered nurses in England – enough to fill NHS vacancies twice over, the union says. Overall, the NHS is facing around 100,000 vacancies across nursing and other roles.
International recruitment has long been a critical mechanism for sustaining service delivery, with overseas staff comprising about 50 per cent of doctors and nearly 27 per cent of nurses in the NHS in 2022. However, the government’s 2023 NHS Long Term Workforce Plan and the subsequent 10-Year Health Plan signal an ambition to reduce reliance on overseas labour, aiming for international recruitment to fall below 10 per cent by 2035. The RCN’s general secretary, Professor Nicola Ranger, has warned that anti-immigration rhetoric risks driving overseas nurses out of Britain. “The truth of the matter is, if we don’t make nursing staff feel welcome here, we shouldn’t be surprised if they decide to leave,” she said.
Staff Wellbeing and Safety
The crisis is also taking a devastating toll on exhausted staff. More than three-quarters (76 per cent) of nursing staff said they felt emotionally exhausted on their last shift, with reports of exhaustion highest among those working understaffed shifts. Stress has reached an eight-year high, with 66 per cent of nursing staff admitting to working while unwell multiple times a year. The percentage of staff who would recommend their organisation as a place to work has dropped to 58.05 per cent, continuing a downward trend.
Violence and abuse against NHS staff are also rising. Almost one in seven (14.47 per cent) experienced physical violence from a patient or member of the public last year, the highest rate in three years. A record percentage of staff reported being subjected to unwanted sexual behaviour from patients or the public, with the figure rising sharply to 31 per cent among ambulance staff. Nearly one in ten (9.26 per cent) experienced discrimination from patients or the public, the highest level on record. The Royal College of Emergency Medicine described the increase in violence and discrimination as “disgraceful, appalling and so much more”.
RCN Leader’s Statement and Government Response
In a speech to more than 3,000 frontline nursing staff at Congress in Liverpool, RCN General Secretary and Chief Executive Professor Nicola Ranger will say that ministers are failing in their “most basic task” of keeping patients safe. She will say: “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. It is a Government’s first priority to keep its citizens safe, but our analysis and the testimony of nursing staff show ministers are too often failing in this most basic task.”
Professor Ranger added: “No matter how far we push ourselves beyond our limits, we can’t make up for having too few staff. That can feel like our failure, and we carry that pain home with us long after our shifts have ended. It’s not our failure. It’s nursing set up to fail.”
The RCN is urging ministers to introduce mandatory minimum safe nurse staffing levels and enforceable registered nurse-to-patient ratios. A Department of Health and Social Care spokesperson said: “Nurses are the backbone of our NHS, and support patients both physically and emotionally in their most vulnerable moments. It is vital that they are equipped with the tools and resources they need to deliver world class care to those who need it. We have recruited 16,000 more nurses and health visitors since we were elected in July 2024, and our upcoming 10 Year Workforce Plan will set out a clear roadmap to improve working lives in the NHS, including better treatment of staff, higher-quality training, and more fulfilling roles. We expect NHS organisations to ensure their staff have the conditions they need to thrive, including well-being support, and our introduction of robust standards will improve staff experience and retention by tackling the issues that really matter to them.”
Yet despite these assurances, NHS trusts are warning of “deep cuts” to services due to insufficient funding, with a significant majority fearing financial constraints will impact planned and emergency care. Patients and carers, meanwhile, find navigating England’s complex health and care system “extremely difficult”, leading to burnout, distress and harm due to coordination failures between NHS and care bodies. The strain on community mental health services has also risen substantially, outpacing workforce growth and raising concerns that patients are “routinely coming to harm”.