The depleted nursing workforce in adult social care is so burnt out from caring for too many people that one in three are looking to leave, with the crisis in the sector so deep that the needs of some of the most vulnerable are going unmet, including missing vital medication

In a stark new analysis published on the 4th day of its annual Congress in Liverpool, an RCN report reveals deep-seated issues in the sector, with the College calling for a long-term funding settlement, including action to address registered nurse shortages and for better pay, terms and conditions.

The scale of the challenge is laid out in a survey of RCN members working in social care finding that around one in three (34%) are considering leaving or are already actively planning to leave their jobs. Feeling undervalued (66%), too much pressure (59%) and exhausted (54%) were the top reasons for those considering leaving.

It comes as the RCN also releases analysis which shows that, in England alone, around 16,000 registered nurses in adult social care have been lost since 2012.  Equivalent to losing 1 in 3 of the registered nurses working in the sector. Just restoring those levels would cost an estimated £780 million.

Registered nurses are highly skilled, degree-educated professionals. Their skills, knowledge and expertise are crucial in meeting the increasingly complex care demands in social care.  Office for National Statistics (ONS) figures show the number of people aged over 85 will increase by nearly half (45%) by 2034.

The College says social care has been consistently neglected, kicked down the road through reviews and consultations, with the sector now paying the price for a lack of leadership. It is widely recognised that when adult social care does not work the impact is felt right across health and care, yet the necessary reform has never been delivered, nor has the required investment.

A registered nurse working in a care home in England said: “I work in a care home setting, where we have just two care staff at night with one nurse to 31 to 32 residents. This has a significant impact on the residents and staff. Even during the day we cannot deliver the care we want to.”

When it comes to attracting more people into the profession, more than a third (38%) said pay and terms and conditions did not compare well with other sectors, with a similar proportion (36%) saying that social care carried negative perceptions.

A registered nurse working in a care home in England said: “During my last shift, there were two registered nurses on duty caring for 59 residents across four floors, three of which accommodate residents with nursing needs. Each nurse was responsible for a high number of residents (28 and 32, respectively), including individuals requiring complex care, regular monitoring, and timely medication administration.”

A registered nurse working in Scotland said: “Due to the high level of responsibility and accountability we are not paid properly for the job we do. Sometimes I am the only nurse for between 74 -80 residents.”

A mental health nurse working in social care in Wales said: “I am the only nurse in the building on a day shift for 39 residents. I have to work autonomously … All decisions regarding care are mine as is accountability.”

Of those surveyed by the RCN, a majority said their top priority in the sector was ‘a legal requirement for safe staffing levels, setting a minimum number of registered nurses per resident’. Second to that was a call for a national approach to ensure nurses working in adult social care are paid in accordance with their job’s unique level of professional responsibility, expertise, knowledge, skills and working conditions.

Insufficient capacity in social care also hits services elsewhere with increased avoidable attendance and admission to hospital, and people stuck in beds for longer due to delayed discharges.

The RCN says governments across the UK must now take vital steps to reform commissioning and funding arrangements for social care and ensure they allow for services to meet future needs.

RCN General Secretary and Chief Executive Professor Nicola Ranger said:

“In all parts of the UK we need to see new urgency to address the crisis in social care. Everywhere you look, the lack of political leadership has left the sector neglected, and its workforce depleted and exhausted. As a result, the needs of vulnerable people are going unmet, with staff caring for a totally unsafe number of people. That is dangerous and a tragedy.

“It’s also incredibly worrying that we have seen such a fall in the number of registered nurses in the sector. These highly-skilled clinicians are crucial to delivering safe and effective care to people with complex needs.

“At the heart of this is a workforce that has not been given the value it deserves. With an ageing population, the scale of the challenge for governments across the UK has never been clearer. We need new long-term investment and a plan to build a strong nursing workforce, with swift action across the board to improve pay, terms and conditions.”

Ends

Notes to editors

Note 1 - Figures are based on analysis of nurse retention by London Economics in 2025:  Quantifying retention benefits for public sector nurses in England - March 2025 - London Economics. Government costs of training a domestic nurse total £48,986. Analysis by Skills for Care concludes that restoration to 2012 staffing levels would require the training of around 16,000 nurses, meaning an overall investment of £783,776,000.

With demand for adult social care projected to increase, estimates suggest that just meeting the expected growth from an ageing population would require an additional £9.1bn in 2034/35 in England alone. (The Health Foundation, 2025).

In England, we also conducted a survey of RCN members working in adult social care, to explore issues relating to funding, workforce pressures, integration and reforms. We also conducted informal discussions with a small number of RCN members in England working in acute sector discharge roles and Integrated Care Board (ICB) ongoing care roles. These were helpful to understand the perspective of funding challenges and how they impact upon other parts of the health and care sector.