District nursing is ‘going under’, RCN survey warns

Poor staffing levels and increased patient complexity and demand is putting ‘immense pressure’ on community and district nursing services, a survey by the Royal College of Nursing (RCN) has warned.

Kickstarting its annual RCN Congress, the college has today revealed the findings from its ‘Last Shift Survey’ – featuring concerning testimonies from 13,000 nursing staff working across both community and hospital settings.

Almost a quarter of nursing staff across both community (22%) and hospital (22%) settings said registered nurse staffing levels on their last shift were ‘well below what was needed’, with ‘care significantly compromised’ and a ‘high risk of harm to patients and staff’.

Meanwhile, overall, four-fifths (79%) of respondents said clinical complexity has increased over the last two years alone, while just one in 10 said staffing was at the right level for all patient needs to be met.

More than two-thirds (69%) warned the situation is now forcing them to make difficult decisions about prioritising care.

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District nursing ‘cannot sustain levels of pressure’

In responding to the RCN’s survey, district nurses and those working across community nursing services, warned of being unable to meet surging patient need.

A district nurse working in the NHS in England, said: ‘District nursing is going under with the complexities of care required. We cannot sustain the levels of pressures faced since Covid.’

Another said: ‘Patient complexity and acuity is drastically increasing. This is putting immense pressure on registered nursing staff, as visits become too complex for unregistered support workers.’

A community nurse described caseloads increasing ‘significantly’ over the last four years and patients being ‘far more complex with social issues or medical issues’. ‘Community nursing is on its knees,’ they added.

The RCN’s survey also points to concerns over the impact of poor staffing levels and increased pressures on staff wellbeing.

More than three in four (76%) respondents said they felt ‘emotionally exhausted’ on their last shift.

RCN chief executive and general secretary Professor Nicola Ranger is expected to use a keynote address at the congress held in Liverpool today to call for new and sustained investment to grow the nursing workforce.

The RCN wants to see ‘fully costed and funded workforce plans based on robust assessments of patient need’, as well as ‘mandated safe nurse staffing levels across all settings, with enforceable registered nurses-patient ratios’.

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Analysis also released by the RCN today shows that as demand increased, growth in the registered nurse workforce has ‘collapsed in England to an eight-year low’.

‘Ministers are failing to keep patients safe’

Professor Ranger is expected to 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.’

She will also add: ‘We need a new approach, away from the flawed “finger in the wind” workforce planning which led us here.

‘It must be centred on new, sustained investment in the nursing workforce to the level that allows our profession to meet all patients’ needs – now and in the future. Anything else lays the ground for another patient safety disaster.’

Professor Ranger is also expected to warn that nurses ‘continue to bear the brunt of funding restrictions and budgets cuts’ and that this ‘makes a hard job even harder’.

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‘It means 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,’ she will add.

As James Murray was appointed as the new health secretary last week – following the resignation of Wes Streeting – Professor Ranger called for reform of nurse pay and career progression to be on the ‘top of the agenda’.

The RCN’s survey was open for a period of five weeks between 2 March and 7 April 2026 to all RCN members delivering direct patient care across the UK and all health and care settings.