The findings are from the Royal College of Nursing’s (RCN) latest ‘Last Shift’ survey, which asked more than 1,400 nursing staff working in the NHS and independent health and social care in Scotland about their experiences on their most recent shift.

It comes as the College begins its annual Congress in Liverpool, where General Secretary and Chief Executive Professor Nicola Ranger will tell governments across the UK they are “asleep at the wheel” amid “rising, dangerously unmet levels of patient need”.

In Scotland, over eight in ten (82%) say that clinical complexity has increased over the last two years alone, while less than one in ten (8%) say staffing was at the right level for all of a patient’s needs to be met. More than three quarters (76%) say the situation of limited time and resources is now forcing them to regularly need to make difficult decisions about prioritising care.

Nursing staff across the country report the demands of care increasing, while registered nurse staffing continues to fall short of the level required to provide safe and effective care. They say adults, children and those with mental ill health are all presenting with more clinical complexity which is placing unsustainable pressure on staff.

One nurse working in a general acute ward in an NHS Scotland hospital said: “Shifts are usually characterised by multiple competing priorities, including managing deteriorating patients, completing essential observations and medication rounds, responding to urgent clinical changes, liaising with medical teams, answering phone calls, updating documentation, and maintaining accurate handovers. In this environment, nursing care becomes task-driven and reactive. There is little opportunity for comprehensive assessment, preventative care, patient education, or meaningful interaction — all of which are fundamental components of safe and effective nursing practice.”

A community nurse said: “There are regularly not enough staff and, due to this, nurses are moved to other teams or areas on a daily or weekly basis. This adds pressure to home teams and staff don’t get time for completing administrative work or sometimes patient follow up.”

RCN Scotland Executive Director, Colin Poolman, is calling on the new Scottish government to prioritise new and sustained investment to grow the nursing workforce to a level that meets the needs of an ageing, more sick population. He said:

“When NHS nursing staff in Scotland say there is a high risk of harm to patients because staffing is below what is needed, the government must act. Scotland’s population cannot afford for them to be complacent to rising, dangerously unmet levels of patient need.

“The continued gaps in the registered nurse workforce are always unsafe, but the risk is being compounded by the demands of delivering ever more complex care to an ageing, sicker population, with multiple conditions.” 

A quarter of nursing staff said registered nurse staffing levels on their last shift were well below what was needed, with care significantly compromised and a high risk of harm to patients and staff. 

Registered nurses are highly skilled, degree-educated professionals delivering the majority of clinical care. Their skills, knowledge and expertise are crucial in meeting the needs of patients, especially as demands and complexities increase. 

An NHS nurse in acute services said: “Working in a sustained high-stress environment where there is no capacity buffer is not a safe or sustainable model of care. It increases the likelihood of missed care, delayed interventions, and moral distress among staff who are unable to provide the standard of care they are trained to deliver.” 

This damning picture being painted by Scotland’s nursing staff comes as new analysis from the RCN on the nursing workforce in Scotland reveals that, despite a slow and modest increase in staffing levels of 1.1% in the last year (700 staff), at no point have the levels met the planned need of Scotland’s NHS services. 

Colin Poolman continued:

“It is the Scottish government’s first priority to keep its citizens safe, but our analysis and the testimony of nursing staff show ministers are too often failing in this most basic task. Despite Scotland’s safe staffing legislation coming into force in 2024, nursing shortages continue to have a damaging impact, with many nurses caring for unsafe numbers of patients. We continue to have significant concerns that the workforce planning tools, which are supposed to determine the number and skill mix of nursing staff required to provide safe and effective care, remain unfit for purpose and underestimate the staffing establishment needed.”

The findings of the RCN’s survey also show the extent to which having too few registered nurses and nursing support workers is impacting staff wellbeing. More than three in four (80%) felt emotionally exhausted by the end of their last shift.  Reports of exhaustion were highest among those who said their shift was understaffed.

One respondent working in a Scottish hospital said: “The impact on nurses’ physical and psychological health is significant. Continuous exposure to this level of pressure leads to exhaustion, heightened stress, and burnout, ultimately affecting retention and workforce stability. A system that relies on nurses consistently working at maximum capacity without margin for escalation or recovery places both patients and staff at risk.”

While a community mental health nurse said: “It is getting harder and harder to provide excellent mental health care in the community. Morale within the team is at an all-time low. I never look forward to coming into work, continuously feel anxious and have poor sleep due to worrying about work the next day. I am considering leaving nursing altogether due to significant pressures place on me.”

Colin Poolman concluded:

“Nursing staff cannot continue to deliver the care their patients deserve with increasing workload pressures and continued gaps in the workforce. Gaps in the workforce and the adverse effect on staff wellbeing undermines safe and effective care. Safe nurse staffing saves lives, protects exhausted staff and strengthens health and care services. 

“The new Scottish government must prioritise investment which acknowledges and values the vital contribution of nursing to the health of the nation. It has been over a year since the Scottish government’s Nursing and Midwifery Taskforce published its recommendations yet slow progress has been made to deliver the report’s recommendations. Failure to act is now no longer an option as, with increasing risk of harm to patients, inaction will lead to inevitable consequences for patients and staff.”