The report found that despite the clear evidence of harm caused by too few registered nurses, the number of doctors has grown nearly twice as fast. Had nurse numbers grown at the same rate as doctors since 2009, England's NHS would have more than 77,000 additional nurses today. 

Overall, the analysis found that based on the increase in NHS activity since 2009, including admissions, attendances and appointments, the health service is actually short by an estimated 55,000 registered nurses to deliver care safely, more than double the official number of NHS vacancies, which stands at 23,046 as of August.

Nursing leader Professor Nicola Ranger says the new analysis from the Royal College of Nursing (RCN) is "more undeniable evidence" about the link between registered nurse numbers and patient safety.

Included in the report is an audit of recent trust board papers which shows that some hospitals are reporting hundreds of “red flag” patient safety incidents a month. These are safety reports arising from staff shortages including delays to pain relief, essential medication and missed care. 

NHS Trusts are encouraged by the National Institute for Health and Care Excellence (NICE) to publicly report staffing-related quality and safety risks, called "nursing red flags", including medication errors, delayed pain relief, missed patient checks and fewer than two registered nurses on shift. The RCN’s analysis reveals monthly numbers in the hundreds at some trusts.

573 red flags were recorded in a single month at Mid and South Essex NHS Foundation Trust, 206 of which were raised regarding missed intentional care, while 138 were raised alerting delays in recording vital signs, both due to staffing shortfalls. 

Meanwhile, 159 red flags were reported in June at Princess Alexandra Hospital NHS Foundation Trust in Harlow and over 100 in June at University Hospitals of Derby and Burton NHS Foundation Trust.  

University Hospital Southampton NHS Foundation Trust reported 19 red flags and 126 "staffing-related incident reports" in July, including five moderate or severe medication errors. 

Other trusts reported safety issues outside the "red flag" system. For example, Torbay and South Devon NHS Foundation Trust reported seven "severe harm incidents" in July 2026, including two unwitnessed falls resulting in hip fractures. 

Meanwhile, Kingston Hospital NHS Foundation Trust reported skin lesions and assisted falls had increased, as well as longer stays in A&E due to overcrowding. 

The RCN says that the true number of patient safety incidents linked to nurse shortages is likely to be high across the NHS, but due to inconsistent reporting by trusts is unable to determine exact figures. 

One Registered Nurse in a hospital in the East of England told the RCN that pressure ulcers from patients not being turned and unwitnessed falls were all common occurrences in her trust. 

She said: “On my unit, an elderly patient fell out of bed and suffered a brain bleed. Night staff were short and there was no one outside the bay to witness the fall and help for at least ten minutes. Everyone was so worried about the brain injury that it took seven days to realise she actually had a broken hip as well. There just weren’t enough staff to cover every area and the impact it’s had on the nursing team has been huge.  

“On every single shift, there’s at least one thing that doesn’t get done. This includes pain medication, particularly at night when staff have bigger caseloads, and the delays can be hours at a time. Patients who wear pads can also go for hours without being checked or turned, and this leads to their skin breaking down.

“Patients are staying in hospital for far longer because the quality of care they receive is worse.  Nurses barely even have time to talk to our patients. We’re so busy, you can only deal with the immediate task in front of you. That means you can’t do any prevention work and they are less prepared for going back into the community and more likely to be re-admitted. 

“Nursing is desperate for safe staffing. For the first time in eight years, I’ve looked at jobs outside of nursing, because it’s difficult to see how it’s going to get any better.”

A Charge Nurse in an Acute Medical Unit in the West Midlands said: "A shift that has enough staff is considered 'green' and we haven't had one in over six months. You just cannot give quality care if you're looking after ten acutely sick patients each. Pain medication is delayed on a daily basis because it takes staff so much longer to get round all their patients. Certain patients, for example those with Parkison's or Sepsis, need to have medication administered at very strict times otherwise their condition deteriorates, yet we see delays to this type of life saving treatment too because of stretched staff-to-patient ratios. 

"In this profession, we're dealing with human beings. You should never say 'we're just coping', there should be safe staffing as a minimum. What we're seeing is a lot of staff burnout, which then makes staffing pressures even worse. 

"We've been told the trust needs to cut spending by tens of millions of pounds, and last year one of the wards was closed. Over the last two years especially, all staff ever hear about are financial cuts. It's getting to the point now where wards can't order pens, let alone employ more staff." 

An RCN rep supporting concerned staff at a hospital in the East Midlands said: “Just this month, one of our night shifts only had one registered nurse for 15 patients. There are real patient safety risks when registered staffing numbers are low. Pressure area care suffers, patients don’t get enough fluids, medication and pain relief get delayed. Staff themselves are really worried about falling foul of the NMC and are exhausted and demoralised coming to work every day knowing that patients are at risk.  

“We are stacked to the hilt and have hundreds of patients in our Emergency Department who can’t be moved through the system quickly because there just aren’t enough staff.” 
The RCN says the upcoming NHS 10 Year Workforce Plan in England must deliver growth in the nursing workforce to a level that will meet patients’ needs now and in the future. NHS trusts must also be properly funded now to recruit the right number of staff in the right places, it says. 

RCN General Secretary and Chief Executive, Professor Nicola Ranger, said: 

"This report is more undeniable evidence of the clear link between registered nurse staffing levels and patient harm. It's utterly shocking that sick patients should wait hours for pain relief or vital medication, while some are falling, breaking bones and deteriorating needlessly. The truth is patient safety incidents aren’t isolated and trusts are recording hundreds each month due to registered nurse shortages.  

"The numbers are clear: we would have tens of thousands more nurses working in our NHS if we’d had the necessary investment to keep up with demand. Instead, our numbers have been held down, in contrast to other staff. When you have too few registered nurses, you get longer hospital stays, worse outcomes and more pressure on an already burned out and exhausted workforce.

"The government has a great opportunity in the upcoming workforce plan to correct course. That means recognising that registered nurse shortages are the engine of patient harm in the NHS. Patients need investment in nursing, with a detailed plan to boot, that delivers the right number of nurses to meet demand now, and in the future.” 

Ends 

Notes to editors 

The full report, In Short Supply: Estimating the shortfall of registered nurses in the NHS in England | Publications | Royal College of Nursing, is available to read online.

The RCN’s latest briefing on patient ratios, Why Registered Nurse-to-Patient Ratios are Needed: The rationale and evidence base | Publications | Royal College of Nursing, is available to read online.