'Bold' action needed over deepening nurse workforce crisis, union warns
Student numbers and vacancies adding to problems across sector
An exodus of younger nurses and a shortage of students entering the profession has created a “pressure cooker situation,” with the staffing crisis sparking growing concerns for the safety and wellbeing of patients.
The Royal College of Nursing Scotland (RCN Scotland) said that without “bold” action from the new administration at Holyrood, the gap between the number of registered nurses needed and the number entering the workforce will continue to widen, with the problem set to “worsen quickly” as existing staff retire.
In a damning new report, the nursing union said its overworked members were increasingly suffering from stress, anxiety and depression, with the absence rate standing more than double the NHS Scotland target, as workers endure “high levels” of burnout.
The situation, the union said, was being compounded by thousands of vacancies across the country, which it said meant that registered nurses and support workers were effectively “missing” from health and care teams around Scotland.
Opposition parties said the report exposed the “years of neglect” around workforce planning under the SNP, describing it as an “urgent wake-up call” for First Minister John Swinney.
RCN Scotland said a series of interconnected issues were having a major impact on the intake of new staff, with over 1,000 fewer students applying to undergraduate nursing courses last year compared to 2019.
Of those students who were due to graduate in 2024, meanwhile, almost 20 per cent did not complete their course, with surveys of the union’s student members indicating financial hardship is among the issues impacting completion rates.
Fewer nursing students have started university than planned each year since 2022, with a new low set this academic year. The RCN said such year-on-year decreases meant there would be an “ongoing reduction” in the availability of newly registered nurses to replace those who are retiring.
“Scotland clearly needs more nurses, yet over the last four years thousands fewer students have begun nursing degrees than were originally planned in the targets set by the Scottish government,” it stated. “This means the gap between the number of registered nurses that are needed and the number entering the workforce will continue to widen. Meanwhile, Scotland’s nursing workforce is aging and so this problem will worsen quickly.”
The union’s fifth annual workforce report pointed to “worrying” data detailing an exodus of younger staff from the profession. In the year to March 2025, it noted, nearly one fifth of registered nurse leavers in the NHS were in their twenties (16.9 per cent), more than one in five were in their thirties (20.8 per cent), and 16.7 per cent were in their forties, compared to 14 per cent, 15 per cent and 13.8 per cent respectively just five years ago.
“Focusing on retention and improving the working environment for existing nursing staff would be the cost-effective solution to these problems,” the report advised. “It would reduce the pressure on the need to increase student intake numbers to a level that currently appears unachievable.”
The RCN also said the issues around staffing levels had an impact on patient safety, noting that preventable complications from inadequate staffing include higher rates of falls, medication errors, and hospital readmissions.
It said it had "significant concerns” that the workforce planning tools, mandated for use by Scotland’s safe staffing legislation,” remain “unfit for purpose”.
It pointed to 2025 research by the Nursing and Midwifery Council (NMC) which reported that 37 per cent of nurses and midwives in Scotland had witnessed a patient safety incident over the previous year in which they believed an individual’s safety or care had been “compromised.”
On the issue of staff burnout, the report pointed out that sickness absence continues to have a “significant impact” with the NMC reporting “high levels of burnout” amongst registered nurses. The absence rate stood at 8.3 per cent between April and December 2025, although across three NHS boards, it exceeded 10 per cent.
The report also said that the ongoing crisis around so-called corridor care in overcrowded hospitals had been “normalised,” and stressed that the “true scale and impact” of the issue was unknown due to a lack of data.
“When patients are put on trolleys and chairs in corridors and additional beds are added to wards, nursing staff are unable to provide high quality care, they are without access to vital lifesaving equipment and protecting a patient’s dignity is impossible,” it said.
Colin Poolman, executive director of RCN Scotland, said: “This is a moment for bold government action on health and care, built around a strong nursing workforce. We need a grown-up discussion about the future of our health and care services, one that is not simply based on the political point scoring and politicisation of our health and care services that has characterised the past.
“Scotland cannot build the sustainable nursing workforce it urgently needs by asking staff to continue to work short-staffed and under relentless pressure while feeling demoralised and undervalued.”
Scottish Conservative deputy leader Rachael Hamilton MSP said: “This scathing report should be an urgent wake-up call for John Swinney.
“The SNP’s dire workforce planning has led to a huge shortfall in the number of nurses needed in our NHS - and those that are left are beyond breaking point. We know this failure to support them leads to waiting times skyrocketing and operations being cancelled at the last minute.”
Scottish Liberal Democrat leader Alex Cole-Hamilton said: “This report hammers home the scale of the challenge that Scotland's nurses are facing on every shift as a result of years of SNP neglect of workforce planning.
“The rise in early and mid-career staff leaving is especially worrying. This is a pressure cooker situation and it is getting worse.”
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