Hospitals and care homes in the UK are so short-staffed that nursing staff are continuing to work while unwell, with stress the leading cause of illness hitting an eight-year high, new research reveals today.

It comes as the Royal College of Nursing (RCN) separately reveals it is receiving dozens of calls a week to its advice line from burnt out staff seeking help over understaffing and spiraling pressures at work, and is set to receive its highest number of calls since 2022.

The landmark survey by the College, of more than 20,000 UK nursing staff about their employment conditions, paints a stark picture of the reality of modern nursing in our NHS and care system with nursing staff being made stressed and sick as a result of the pressure they are under.

The survey found that two thirds (66%) admit to working when they should be on sick leave multiple times a year, up from fewer than half (49%) in 2017. Stress is the biggest cause of illness given by staff in the survey (65.1%), up from 50% in 2017.  The numbers reporting working whilst sick and citing stress as the leading cause both hit eight-year highs.

Meanwhile, seven in ten (70.4%) are working in excess of their contracted hours at least once a week, around half (52.1%) of whom do so unpaid. 

The survey reveals unsustainable pressures on staff that are being felt across the UK and in all settings. An NHS nurse in an older peoples’ ward in England said staff “go home sick with anxiety” when asked to cover staff shortages in other areas where they cannot provide the standard of care they would like. [NOTES]

An NHS staff nurse in England said they developed a chronic illness related to stress but could not leave work “due to the department being overwhelmed and overstretched and [...] not wanting to add to that.” Meanwhile, a staff nurse in an independent care home said they are “dreading going to work knowing we'd be short staffed” and will “inevitably have to work over my hours, unpaid, just to get everything done.”

An NHS community nurse in England said dealing with the amount of patients and paperwork was like “fighting fire with my hands tied behind my back”, while a social care nurse in Northern Ireland said they managed 18 residents with complex needs, and that “nurses are spread too thinly with potential for disaster.”

The College says that the findings highlight the “impossible task” of working in health and care services where there are too few nursing staff to meet demand. It says the situation is not only harmful to patients but also detrimental to the mental and physical health of nursing staff.

The College has separately revealed it is receiving an average of six calls a day from members over staffing levels in their place of work, with nursing staff saying they are having panic attacks and nightmares, unable to safely take toilet or lunch breaks or even annual leave and suffering exhaustion and burnout. The number of calls is expected to reach 2,175 from members related to staffing issues by the end of this year, up from 2,026 in 2024 and 1,837 in 2023. The RCN says the real figures are likely much higher, with often only the most serious cases getting reported to trade unions when members seek legal advice or support.

Burnout is a common theme among the testimonies provided to the RCN’s advice line. An NHS nurse in England took sick leave due to the stress of understaffing, but continued to have nightmares, while another said shortages led to them hyperventilating at work and taking stress-related sick leave.

Another nurse in England said her ward was so unsafe she felt scared to go to work, while another reported the High Dependency Stroke Unit they worked on was short of almost half its registered nurses. A nurse working in social care in England said staffing levels were so low that they couldn’t leave to use the toilet, with only themselves and one healthcare assistant on shift to look after over 100 residents.

A trainee NHS district nurse in Scotland contacted the RCN to report that there was only one staff nurse responsible for up to 100 patients in her area. As a result, a patient developed a serious pressure ulcer which was recorded as a Serious Adverse Event - a potentially life-threatening medical occurrence.

The RCN says responses to its landmark survey and calls to its advice line are “yet more cold, hard evidence” that there are too few nursing staff to safely care for patients.

There are currently more than 25,000 nursing vacancies across England in the NHS alone.

The College says staff are “broken” from being forced to work while unwell in the face of inadequate staffing levels and spiralling demand. It is reiterating its call for new investment to grow the nursing workforce, alongside the introduction of safety-critical nurse-patient ratios for all health and care settings.

The full findings from the RCN’s Employment Survey, the largest national survey into the nursing profession, will be released next month.

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

“Nursing staff are being driven to ill health from working in understaffed and under resourced services. And what’s worse, many feel they cannot take time off for fear of leaving their colleagues at the mercy of brutal pressures. This simply isn’t sustainable. 

“Nursing staff strive to do their best for every patient on every shift, but they are left with the impossible task of caring for dozens and sometimes over a hundred at a time. This is hugely detrimental to patient outcomes, but there also needs to be action to address the devastating impact on staff themselves. The reality is they’re not breaking; many are already broken.

“These findings are yet more cold, hard evidence that there are simply too few nursing staff to meet growing demand. New and urgent investment is desperately needed to grow the nursing workforce, ensuring staff are able to work in a safe environment and that patients get the best care. This must be accompanied by the introduction of safety-critical nurse-patient ratios in all health and care settings."

Ends 

Notes to editors

The RCN’s Employment Survey 2025 is the largest survey of the nursing profession about their employment conditions in the UK. This year, the survey had over 20,000 responses, which included testimonies from nursing staff.

The survey found 66% reported having worked when they should be on sick leave at least twice over the previous 12 months. The main reason for feeling unwell is stress (65.1%), after virus/cold infection (52.5%).

The number of respondents who report working when they should be on sick leave at least twice has increased over time:

• 2017: 49%
• 2019: 62.5%
• 2021: 60.8%
• 2023: 65.4%
• 025: 66%

The proportion who gave stress as a cause of illness has also increased over time:

• 2017: 50%
• 2019: 57%
• 2021: 56.7%
• 2023: 63.1%

• 2025: 65.1%

An NHS staff nurse in an acute hospital unit in England said: “I have developed a chronic illness and doctors think that this is related stress over a long period of time. I should have left work earlier but did not due to the department being overwhelmed and overstretched and me not wanting to add to that.”

A staff nurse in an independent sector care home in England said: “[I am] just dreading going to work knowing we'd be short staffed, I would have a mountain of things to do with no support from management and not enough time so would inevitably have to work over my hours unpaid just to get everything done.”

A staff nurse in an NHS older people’s ward in North West England said: “It is common practice to re-deploy members of staff from their usual area of work to cover staff shortage in other areas, leaving your usual place of work short staffed. Nurses are moved to wards they are not familiar with without any induction. I have known staff members have to go home sick with anxiety rather than go to a new area.”

An NHS community nurse in the South East of England said: “Extra hours, long hours. Never away from work. Always being contacted and having to catch up at home with notes. Always feeling stressed and always feeling guilty about not having enough time to do the job I was trained and loved doing. It is like fighting fire with your hands tied behind your back. You just can’t make a difference.”  

A staff nurse from an independent sector care home in Northern Ireland, said: “I care for between 16 and 18 patients, managing their care, along with their complex needs. With no set ratio for private companies such as nursing homes, it leaves nurses spread too thin with potential for disaster, for example unable to identify the deteriorating patient in a timely manner, due to the workload or attending the needs of other residents.”   

Meanwhile, as of 30 October 2025 there have been 1,813 calls to RCN Direct, that involve issues with staffing in health and social care workplaces across the UK. With a monthly average of 181 calls, this year is on track to reach 2,175 by the end of December, which would make it the highest number since 2022. 

The totals for issues with staffing in health and social care workplaces across the UK) for the past five years are as follows:

The totals (for issues with staffing in health and social care workplaces across the UK) for the past five years are as follows:

Year	Total Calls	Monthly Average
2021	2,009	167
2022	2,232	186
2023	1,837	153
2024	2,026	169
2025 [as of 30 October]	1,813	181

RCND enquiry data regarding staffing issues goes back to 2021.