Intended for healthcare professionals

Education And Debate

Mind the gap: the extent of the NHS nursing shortage

BMJ 2002; 325 doi: (Published 07 September 2002) Cite this as: BMJ 2002;325:538
  1. Belinda Finlayson, research officer (,
  2. Jennifer Dixon, director,
  3. Sandra Meadows, visiting fellow,
  4. George Blair, adviser on workforce issues
  1. Health Care Policy Programme, King's Fund, London W1G 0AN
  1. Correspondence to: B Finlayson
  • Accepted 1 May 2002

The NHS is struggling to recruit and retain nursing and midwifery staff in a time of high turnover rates and low morale. The problems are most acute in inner cities and teaching trusts. The government is tackling the crisis, but the reasons behind the staffing shortages are complex

The government has a mission to “modernise” Britain's NHS. Success will depend on NHS staff—in particular, whether their numbers can be boosted, whether staff can change how they work, and whether they can be motivated to “go the extra mile” for the NHS. Yet the service is struggling to attract and retain staff in crucial areas, particularly in nursing and midwifery. Here we assess the extent of recruitment and retention problems in nursing in England, comparing acute NHS trusts in London with those in other cities. In another article in this same issue we examine the government's initiatives for tackling these problems.1

Summary points

  • The NHS has serious problems in recruiting and retaining nursing and midwifery staff

  • The underlying causes of these problems include pay, the changing nature of jobs, how valued the staff feel, and other employment opportunities

  • The crisis is most acute in inner cities and teaching trusts, particularly in London, where some turnover rates range from 11% to 38%

  • High turnover results in higher costs and lower morale and may affect patient care

  • The government is tackling the crisis but change is slow and the problems are complex

  • Why 34% of new graduate nurses are not registering to practise needs further study

Numbers and trends in nursing and midwifery

The nursing and midwifery workforce comprises two broad groups of staff working in the NHS. The first group comprises registered nurses and registered midwives, who have a diploma or degree and who have registered with the Nursing and Midwifery Council (before 1 April 2002, the UK Central Council …

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