Nearly 100,000 nurses could be lost to the NHS over the next 10 years, with up to 28% getting axed from a workforce of just over 352,000, a study has claimed.
The Royal College of Nursing (RCN), which commissioned the report, warned that small policy changes could have a big impact in the long run on staff numbers.
Dr Peter Carter, RCN Chief Executive and General Secretary, called for immediate action to prevent the return of chronic shortages seen in the early 1990s.
He said the study highlighted the "truly shocking scale of losses" that could impact on England's nursing workforce during the next decade.
Dr Carter said patient care would be hugely damaged by a loss of more than 25%, adding that the workforce growth in recent years was only just enough to match rising healthcare demands.
The research, carried out by Queen Margaret University, looked at eight possible courses of events while considering nurses and midwives' account training places, retirement rates and overseas recruitment.