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RCN Scotland calls for a nursing retention strategy as workforce crisis shows little sign of improvement

In our third instalment of ‘The Nursing Workforce in Scotland’ report published today (15 May), it is evident that Scotland’s nursing workforce crisis is showing little sign of improvement.


For the second year in a row, the headline recommendations in the report focus on the importance of the ministerial-led Nursing and Midwifery Taskforce and the need for a fully-funded nursing retention strategy.

We’re clear that the Scottish government must publish an agreed set of recommendations and actions from the taskforce and have established an implementation board to oversee the delivery by the end of this year.

In addition, the Scottish government must develop and implement a fully-funded nursing retention strategy that addresses wellbeing, workplace culture, development opportunities, flexible working and career progression.

The report’s 10 recommendations also cover areas such as:

  • fair pay and good employment terms and conditions, including full implementation of the Agenda for Change review recommendations
  • evaluation of the Health and Care (Staffing) (Scotland) Act 2019, including an annual parliamentary debate on safe staffing
  • non-caseload holding status for senior charge nurses and protection of supernumerary status for nursing students.

The new workforce report is published in the lead up to a roundtable of RCN members with Scotland’s politicians and senior nurse leaders today (15 May 2024) focusing on valuing the nursing workforce.
The long-term trends highlighted in the report show that demand continues to outstrip supply. While the number of nursing staff employed by NHS Scotland has increased, crucially, the number of vacancies remains stubbornly high; and staff turnover and absences have increased. Within social care, particularly care homes for adults, the number of registered nurses employed declined further despite increasing clinical need. And for the third year in a row the number of people applying and accepted to study nursing has fallen.

The report provides a detailed analysis of nursing workforce data from across the NHS and independent health and social care services. It highlights the recruitment and retention challenges that employers are facing and the need to improve the quality of data to inform sustainable workforce planning.

A global comparison shows that the number of nurses per 1,000 population in Scotland (7.9) is below the OCED average of 9.2 and significantly below Ireland (15.2), Norway (18.3) and Finland (18.9) who have some of the highest numbers of nurses per 1,000 population.

Commenting on the report’s publication, Julie Lamberth, RCN Scotland Board Chair, said:

“The picture this year’s report paints is simply not sustainable nor is it in the interests of patients and service users.

“At no point has NHS Scotland employed the number of nursing staff it says it needs to deliver safe care and the registered nurse to resident ratio in many care homes makes safe care impossible.

“At the same time, with the squeeze on budgets, we are hearing reports of nursing roles being axed.

“The Scottish government must get serious about the workforce crisis and the long-term implications for the public’s health. Nursing vacancies are having a damaging impact on our members ability to provide safe and effective care. And on their own wellbeing when shift after shift they work extra unpaid hours to cover gaps and go home feeling that they are unable to provide the quality of care they want.”

Colin Poolman, RCN Scotland Director, said:

“Nurses and nursing support workers across Scotland are under paid, under-staffed and many are at breaking point. The current service pressures and staff shortages have resulted in unsafe conditions being normalised.

“We have said it before and we will continue to say it - the future looks bleak if the Scottish government does not grasp with both hands the opportunity for improvement the Ministerial Nursing and Midwifery Taskforce and Agenda for Change review present to alleviate the workforce crisis.

“The taskforce has been progressing and we cannot afford for this essential work to be delayed. We want to work with the Scottish government to ensure the taskforce delivers meaningful and sustainable change. In addition, ministers must now move swiftly to open negotiations for the 2024-25 NHS Scotland pay award.”