Health care settings in the UK, including hospitals and care homes, are so short-staffed that nursing staff are continuing to work while unwell; with stress as the leading cause of illness hitting an eight-year high, an RCN survey reveals.

Recent phone calls to the RCN advice line also show that nursing staff are suffering nightmares, panic attacks and exhaustion because of unsafe staffing levels, with the advice line set to receive its highest number of calls about staffing issues since 2022.

We’re reiterating our demands for new investment to grow the nursing workforce, alongside the introduction of minimum, safety-critical nurse-to-patient ratios across all health and care settings.

Our landmark employment survey – which will be released in full next month – asked more than 20,000 nursing staff across the UK about their employment conditions. It 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 while sick and citing stress as the leading cause both hit eight-year highs.

The survey also revealed unsustainable pressures on staff that are being felt across the UK and in all settings. Seven in ten (70.4%) are working in excess of their contracted hours at least once a week, with around half (52.1%) doing so unpaid.

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.”

We believe it is unacceptable that staff are working unpaid overtime to keep patients safe, but the findings highlight the “impossible task” of working in health and care services where there are too few nursing staff to meet demand. The situation is not only harmful to patients but also detrimental to the mental and physical health of nursing staff.

Our advice line receives 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 to the RCN related to staffing issues is projected to reach 2,175 this year – up from 2,026 in 2024 and 1,837 in 2023. They reveal the harrowing impact of understaffing on nursing staff and patients as they work to the point of exhaustion. There are currently more than 29,000 registered nursing vacancies across the UK in the NHS alone.

Nicola continued: “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-to-patient ratios in all health and care settings."

We’re urging members to raise concerns about unsafe care – we cannot let this become normalised.

Find support and guidance on the RCN website about what to do if you see poor care or feel you are being prevented from providing safe, compassionate care.

As an RCN member you can also get advice and support to help you deal with challenging, emotional issues at work or personally. Find out more here.