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Issues of Staffing, Salary, and Educational
Funding Challenge UK Nurses
Protests mount as economic pressures on nurses increase.
Royal College of Nursing members march for better pay in central London. Photo courtesy of RCNi.
urses in the United Kingdom (UK) have been buffeted in recent years by
staffing shortages and restrictive
National Health Service (NHS)
pay policies that have led to declines in actual income when adjusted for inflation. Moreover,
the nurse shortfall—estimated at
22,000 or nearly 10% of the
workforce caring for adult patients in 2015—is expected to
worsen as a result of a drop in
applicants to nursing schools
and the impact of the UK’s socalled Brexit vote to quit the European Union (EU).
The NHS has traditionally
­relied on international recruitment—primarily from other EU
nations—to alleviate nurse shortages in the UK. More than half of
NHS organizations identified as
vulnerable to workforce problems
report post-Brexit declines in the
number of EU nurses on their
staffs. Alarming new data underscore this trend: between July 2016
and April 2017 the monthly number of EU nurses registering to
work in the UK dropped by 96%.
AJN ▼ October 2017
Vol. 117, No. 10
Observers suggest this may be
because of a lack of clarity on the
right of EU nationals to join or
remain in the UK nurse workforce. The uncertainty has been
compounded by recent government proposals that fail to offer
employment guarantees to EU
nurses with less than five years of
UK residency. Toughened language
proficiency standards are also cited
as a barrier for foreign nurses. The
minimum score required as well
as the academic style of tests from
the International English Language
Testing System has been criticized
by senior nurses who argue for a
lower passing grade to facilitate recruitment.
The number of EU students
applying for UK nursing degree
courses fell by 24% (400 people)
between June 2016 and June
2017, and homegrown applications have declined by 19%. Ac­
ademic leaders believe the latter
may be due partly to the government’s decision to discontinue
NHS scholarships for nursing
studies. Students must now cover
approximately $11,700 in yearly
tuition plus living costs through
loans. Another factor possibly influencing nursing school application rates is a new apprenticeship
option for those seeking to qualify as nursing associates.
Meanwhile, following a twoyear pay freeze in 2010, the government’s pay restraint policy
for nurses and other public sector workers rumbles on with an
unpopular 1% cap on annual pay
increases. The Royal College of
Nursing (RCN) contends that the
cap has translated into a 14% pay
cut over its six-year ­duration, owing to cost of living outpacing 1%
salary increases. In July, the chief
secretary to the treasury testified
before the House of Commons
that the government intends to
continue the cap in the 2017–18
budget year as the “responsible
thing to do” to ensure that recruitment and retention are balanced with sustainability.
In an unprecedented move, the
RCN plans to poll members later
this year on whether to take industrial action (such as a strike)
on the pay issue—giving the government until the fall to lift the
Although it’s not a good time
for an exodus, nurses are talking
with their feet. Staffing and pay
­issues have sparked a wave of
protests across the country this
summer, and more UK nurses
are leaving the profession than
joining it, citing heavy workloads
and eroding standards of care.
This trend underscores the country’s urgent need to retain its
37,400 EU nurses to help address shortfalls.—Stephanie
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