Poor mental health and career progression issues driving nurses out of NHS

Poor mental health and a lack of career progression opportunities are strong drivers for nurses leaving the NHS, a new analysis has suggested.

A new report by the Nuffield Trust set out to unpick what happened to the nursing workforce prior to and after the previous government’s efforts to boost the number of nurses by 50,000.

The government confirmed in 2023 that there were 51,245 additional nurses working in the NHS compared to September 2019 – though less than 1% of these were general practice nurses.

Despite the big recruitment drive to the NHS, the Nuffield Trust’s analysis has revealed concerns about the number of nurses likely to leave their roles – largely because of poor mental health or because they felt ‘stuck’ at the top of their pay bands.

Nuffield Trust analysed around 31 million monthly staff HR and payroll data (Electronic Staff Records) as part of their research.

Analysis showed that between April 2015 and June 2023, nurses with more than 84 days of mental health related sickness absence in a three-month period faced over six and a half times the risk of leaving their role compared with those with zero to four days of mental health sickness absence.

Nurses with five to14 days of mental health sickness absence in a three-month period were over twice as likely to leave than those with little-to-no mental health sickness absence.

It also showed that nurses at the top of their pay band were more likely to choose to leave their role, with the study finding that nurses at the top of NHS Band 7 were 25% more likely to leave than those at the bottom of Band 7.

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Chief nursing officer for the Royal College of Nursing said the study highlights ‘the urgency’ to deliver ‘wider nursing pay and career reform’.

Professor Lynn Wooley said: ‘This analysis provides some welcome lessons from the near past about what happens when you fail to focus and invest in retaining nursing staff.

‘It is no surprise that it identifies a lack of career progression as being key in pushing experienced nursing staff out the door.

The government has started to turn the dial on this issue, but this research highlights the urgency with which we need to deliver wider nursing pay and career reform.

‘It’s a tragedy to see how nursing staff suffering mental ill health are so much more likely to leave the profession. These are highly skilled and safety-critical professionals and losing one from the NHS is one too many.

‘It benefits nobody, certainly not patients, our health service or government, to educate and recruit nursing staff, only to see them leave.

‘Ministers need to acknowledge and address the impact of service pressures on staff retention and employers need to deliver better support.’

She added: ‘Retaining more of our brilliant nurses must be a priority in the upcoming workforce plan. It must centre nursing as the largest workforce delivering the vast majority of care, setting out in detail and with funding how the profession will be valued, both in how they are recruited and retained.

‘Failing to do so will see the mistakes of the past repeated, more pressure placed on an already exhausted workforce and hopes of transforming care at even greater risk.’

The analysis also revealed that the efforts to boost nurses between 2020 and 2023 did not benefit England’s regions equally, with the North East and Yorkshire faring the worst.

In the South East there were 7,145 more nurses (15.7%) while North East and Yorkshire saw 5,894 more nurses (10.2%).

Nuffield Trust fellow Lucina Rolewicz said all regions should ‘reap the benefits’ from a recruitment drive.

‘The details behind headline nurse recruitment figures cannot be ignored,’ she said.

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‘Efforts to get more nurses working in the NHS should not just be about increasing the overall number but ensuring that different regions and services can reap the benefits.

‘Policies aimed at nurses have often neglected retention, with not enough done to understand why they leave the NHS and what could encourage them to stay.

‘As the government works on its plans to bolster the nursing workforce, this new evidence gives clear reasons to focus on career progression opportunities, support with sickness absence and mental health, and issues particularly affecting overseas nurses’ decisions to leave.’

Head of health at Unison, Helga Pile said ‘clear career paths with pay progression to match’ are needed for nurses to continue working in the NHS, including those from overseas ‘who are vital to the service’.

‘Nurses are delivering ever more complex care, making tougher decisions and supervising higher numbers of junior staff,’ she said.

‘The pressures created by understaffing mean many face burnout and receive little support.

‘Health workers across the NHS team have to know they’re properly valued and have long-term career prospects.

‘Better access to flexible working at more senior levels and improved support for health and well-being are essential.

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‘For the NHS to deliver the quality care patients need, staff must also be paid fairly. Ministers must back the forthcoming structural talks with serious funding.’

Meanwhile, the government announced earlier this year that it plans to review Band 5 roles.

It confirmed in February that NHS nurses on Agenda for Change (AfC) contracts will receive a ‘career boost’ under plans agreed with health unions that include increased graduate nurse pay and a review of Band 5 nurse roles.

However, the news sparked disappointment among primary care nurses who say an ‘essential’ part of the nursing workforce has been excluded, and that doing so could damage recruitment and retention efforts in general practice.