The Royal College of Nursing (RCN) is calling for urgent investment to expand the UK’s nursing workforce after new figures revealed that stress among nursing staff has risen to an eight-year high, driving many to work while unwell.
A preview of the RCN’s forthcoming employment survey—completed by more than 20,000 nursing staff across the UK—shows that two-thirds (66%) of respondents have worked while sick multiple times in the past year, up from under half (49%) in 2017. Stress was cited as the leading cause of illness by 65% of respondents, compared with 50% eight years ago. Both figures represent the highest levels recorded in the past eight years.
The findings highlight a deepening crisis across health and care services, with hospitals, community services and care homes all struggling under mounting workforce shortages. Nursing staff describe working in environments where there are too few colleagues on shift, too many patients to safely care for, and very little capacity to recover between shifts. The RCN says the situation is leaving staff “already broken” and putting patient safety at risk.
‘Driven to ill health by unsafe staffing’
Professor Nicola Ranger, RCN General Secretary and Chief Executive, warned that nursing staff are being pushed beyond safe limits as they try to compensate for chronic understaffing.
“Nursing staff are being driven to ill health from working in understaffed and under-resourced services,” she said. “Many feel they cannot take time off for fear of leaving their colleagues at the mercy of brutal pressures. This simply isn’t sustainable.”
She added that for many nurses, the decision to work while ill is not simply about dedication, but about a sense of guilt and responsibility in the face of rota gaps and unsafe staffing levels. When a colleague calls in sick, others feel compelled to step in, knowing there may be no replacement available.
The RCN is renewing its call for minimum, safety-critical nurse-to-patient ratios across all health and care settings, alongside long-term investment to grow the nursing workforce. The college argues that without clear, enforceable staffing standards, the pressure on nursing staff will only intensify as demand rises and vacancies remain unfilled.
Overtime, exhaustion and a surge in distress calls
The survey sets out the scale of pressure being felt across the UK. More than seven in ten respondents (70.4%) said they work beyond their contracted hours at least once a week, and around half (52.1%) do so unpaid. Many report exhaustion, burnout and being unable to consistently take rest breaks or annual leave, with some missing meal breaks entirely or regularly staying late after shifts to complete essential tasks.
These experiences are mirrored in calls to the RCN advice line. The service receives an average of six calls a day from members concerned about staffing levels and the impact on their health and their patients. Nursing staff describe panic attacks before shifts, nightmares about work, and extreme fatigue linked to unsafe staffing levels. Some report being unable to safely take toilet breaks, let alone proper rest periods, as they try to cover too many patients with too few staff.
The number of calls to the RCN related to staffing issues is projected to reach 2,175 this year, up from 2,026 in 2024 and 1,837 in 2023, and the highest level since 2022. The RCN says these calls reveal the “harrowing impact” of understaffing on both staff and patients, as nurses and other nursing staff work to the point of exhaustion to keep services running.
There are currently more than 29,000 registered nursing vacancies across the NHS in the UK alone, intensifying workloads for those who remain in post. In practice, this means fewer staff on each shift, more patients per nurse, and less time for each individual’s care, communication and recovery.
‘An impossible task’ for nursing staff
Professor Ranger said nurses are frequently finding themselves responsible for caring for “dozens, and sometimes over a hundred” patients on a single shift because of staffing gaps, particularly in community and care home settings where one nurse may be covering very large caseloads.
“Nursing staff strive to do their best for every patient on every shift, but they are left with the impossible task of caring for far too many at once,” she said. “These findings are yet more cold, hard evidence that there are simply too few nursing staff to meet growing demand.
“New and urgent investment is desperately needed to grow the nursing workforce, ensuring staff are able to work in a safe environment and that patients get the best care. This must be accompanied by the introduction of safety-critical nurse-to-patient ratios in all health and care settings.”
The RCN says it is unacceptable that staff are routinely working unpaid overtime to keep patients safe and warns that this should never be allowed to become normal practice. While many nursing staff willingly “go the extra mile” for their patients, the college argues that goodwill is being exploited to plug systemic gaps in staffing and funding.
Long-term risks for patients and the profession
The college has also warned of the long-term risks if these pressures are not addressed. Persistent overwork and stress can lead to sickness absence, early retirement and nurses leaving the profession entirely, further worsening vacancy rates. That, in turn, risks longer waiting lists, reduced access to services and poorer outcomes for patients.
The survey results suggest a workforce under sustained strain, with little sense that pressures are easing. Many nursing staff report feeling torn between their professional commitment to safe, compassionate care and the reality of working in services where demand far outstrips capacity. The RCN says the repeated message from members is that they cannot continue to absorb the impact of shortages without serious consequences for their own health.
Call to raise concerns about unsafe care
The college is urging members to continue raising concerns where they believe care is unsafe or where they feel unable to provide the standard of safe, compassionate care they were trained to deliver. It emphasises that speaking up about unsafe conditions is both a professional duty and an important safeguard for patients and staff.
Support, advice and guidance on what to do if you see poor care, or feel you are being prevented from providing safe care, are available on the RCN website. Members can access information on how to raise concerns, seek support from RCN representatives and get help if their own health is being affected by work-related stress.
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