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Nursing in the United Kingdom
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Nursing in the United Kingdom is the profession of registered nurses and nursing associates in the primary and secondary care of patients. It has evolved from assisting physicians to encompass a variety of professional roles. More than 780,000 registered nurses practise in the UK, working in settings such as hospitals, health centres, nursing homes, hospices, communities, military, prisons, and academia. Many are employed by the National Health Service (NHS).[1]
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Nursing is split into four fields: adults, children, mental health, and learning disability. Within these nurses may work within specialties such as medical care or theatres, and may specialise further in areas such as cardiac care.[2] Nurses often work in multi-disciplinary teams, but equally work independently, and may work in supporting sectors such as education or research.
The UK-wide regulator for nursing is the Nursing and Midwifery Council (NMC), and all nurses and nursing associates must be registered to practise.[3][4] Dental Nurses, nursery nurses and veterinary nurses are not regulated by the NMC and follow different training, qualifications and career pathways.
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History
The history of nursing in the United Kingdom from the 1850s, showing the lobbying for, establishment and development of the state regulated profession of nursing.
Registration and regulation
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There are currently two levels of nursing registration in the UK: registered nurses and nursing associates. To practise lawfully as a registered nurse, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council.
Nursing and Midwifery Council
The core function of the NMC is to establish and improve standards of nursing and midwifery care to protect the public. It achieves this by placing registered nurses on a state register, which anyone can search. As of March 2024, there were 826,418 registered nurses, midwives and nursing associates on the NMC register.[5]
The powers of the NMC are set out in the Nursing and Midwifery Order 2001.[6]
Membership of the council comprises 6 lay and 6 registrant members appointed by the Privy Council, including at least one member from each of the four UK countries. The registrant members consist of nurses, midwives and nursing associates. The lay members currently include people with diplomatic, legal and business backgrounds.
Register
The NMC register is split into three main parts: Nurses, Midwives and Specialist Community Public Health Nurses (SCPHN). Within the registration it contains several "sub-parts" and qualifications e.g. sub part 1, sub part 2.[7]
Revalidation is a requirement for all NMC registered members to revalidate every three years in order to ensure their registration can be renewed. Revalidation was introduced in April 2016.[8][9]
Code of conduct
The Professional standards of practice and behaviour for nurses, midwives and nursing associates, known as the Code, was revised in 2018,[10] replacing earlier publications in 2015 and 2008. The NMC code presents the professional standards that nurses, midwives and nursing associates must uphold in order to be registered to practise in the UK.
Nurse title
The title "registered nurse" can only be granted to those holding such registration; this protected title is laid down in the Nurses, Midwives and Health Visitors Act 1979.[11]
However, until recently the title "nurse" was not legally protected, so anybody can call themselves a nurse. In response to a campaign led by Alison Leary and Paul Trevatt, the Brent East MP Dawn Butler successfully introduced a bill in Parliament in February 2025 to protect the title of 'nurse'.[12] It was agreed it would be introduced via minor changes to the Nursing and Midwifery Order 2001.[13][6]
Legislation
Government legislation governing nursing in the United Kingdom includes:
- Health and Care (Staffing) (Scotland) Act 2019[14]
- Nurse Staffing Levels (Wales) Act 2016[15]
- Nursing and Midwifery Order 2001[6]
- Nurses, Midwives and Health Visitors Act 1997 (repealed)[16]
- Nurses, Midwives and Health Visitors Act 1992 (repealed 19 June 1997)[17]
- Medicinal Products: Prescription by Nurses etc. Act 1992[18]
- Nurses, Midwives and Health Visitors Act 1979[19]
- Nursing Homes Act 1975[20]
- Nurses Act 1943
- Royal National Pension Fund for Nurses Act 1936[21]
- Nurses Registration Act 1919
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Education
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Non-registered staff education
Training is not mandatory for most people undertaking non-registered staff roles such as Healthcare Assistant. But the majority of NHS employers use "in-house" training for such staff, including induction programmes and ongoing education to achieve a recognised qualification. Some collaborate with local education colleges for theoretical input, and may award a recognised qualification. Some NHS employers ask for some type of health or social care qualification for recruits: for example, an SVQ/NVQ or HNC/HND under qualification names including health care, social care, and health & social care.
Pre-registration degrees
Project 2000 began in 1990 and was designed to move nursing education from hospitals into universities. Prior to Project 2000, nurse education was the responsibility of hospitals and was not based in universities; many nurses who qualified prior to these reforms do not hold an academic award.
From 2011, students studying a pre-registration nursing programmes in Scotland were required to complete a degree. Since September 2013 all UK pre-registration nursing programmes are at degree level.[23] Some Higher Education Institutions offer a graduate entry course for nursing. This is for students who have already gained a degree in another subject and want to register as a nurse. It is undertaken over two years.[24] It is also possible to complete nurse registration through the nursing degree apprenticeship route, where students are sponsored by their employer. [25]
Format
Nursing courses adopt a 50/50 split of learning in university (lectures and examinations) and in practice (supervised patient care within a hospital or community setting). Nursing courses usually take three years and 4,600 hours.
The first year is the common foundation program (CFP), which teaches basic knowledge and skills required of all nurses. Skills include communication, taking observations, administering medication, and providing personal care. The remainder of the program consists of training specific to the student's chosen branch of nursing. The four branches of nursing training offered at university level (not including midwifery) are:
- Adult nursing
- Child nursing
- Mental health nursing
- Learning disabilities nursing
Midwifery education
Midwifery training is similar in length and structure, but is sufficiently different that it is not considered a branch of nursing. 18-month programmes allow nurses already qualified in the adult branch to register as both a nurse and a midwife. Two year courses allow graduates of other disciplines to train as nurses. This is achieved by more intense study and a shortening of the common foundation programme.[26]
Student Bursary
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Student nurses in England and Wales receive no bursary from the government to support them during their nurse training. Diploma students in England receive a universal bursary of £6,000–£8,000 per year (with additional allowances for students with dependent children), while degree students may qualify for a means-tested bursary (often a considerably smaller amount). Degree students are, however, eligible for a student loan, unlike diploma students. Wales, all student nurses (regardless of which course they are undertaking) receive a bursary in line with the English diploma course. In Scotland, nursing students receive a bursary of £10,000 per year. All student nurses in Wales study, initially, for a degree, but may choose to remain at Level 2, thereby achieving a diploma rather than a degree.[27]
It was announced in the Chancellor's Spending Review of November 2015 that from 2017 the NHS bursary would be removed for future nursing, midwifery and allied health professionals in England. Welsh and Scottish students remain unaffected.[28]
Post-registration education
In order to remain registered with the Nursing and Midwifery Council nurses in the UK are required to revalidate their registration every three years. Criteria to meet revalidation include having completed 450 hours of practice in the previous three years.[29]
Nurses can add certifications in areas such as cannulation, venepuncture, intravenous drug therapy, and male catheterisation are common among many others, such as Advanced Life Support.
To become specialist nurses (such as nurse consultants, nurse practitioners, etc.) or nurse educators, some nurses undertake further training above bachelor's degree level. Master's degrees exist in various healthcare related topics, and some nurses choose to study for PhDs or other higher academic awards. District nurses and health visitors are also considered specialist nurses, and to become such they must undertake specialist training (often in the form of a top-up degree (see above) or post graduate diploma).
All newly qualifying district nurses and health visitors prescribe from the Nurse Prescribers' Formulary, a list of medications and dressings. Many of these (and other) nurses undertake training in independent and supplementary prescribing, which allows them to prescribe most drugs in the British National Formulary. This has been the subject of debate in medical and nursing circles.[30] As of 2012, more than 25,000 Nurse Prescribers had been qualified.
Overseas nurses
The Nursing and Midwifery Council has a specific process for inducting Registered Nurses trained outside the UK. Prior to October 2016 an outside UK RN would have to undergo an Overseas Nursing Program known in short as the ONP. The ONP had to be undertaken by the candidate after NMC makes necessary checks and issue the candidate with a decision letter stating that the person may join a university to undertake the ONP.
However, owing to a shortage of nurses and increasing standards in nursing a new process was introduced to include two part test of competence, including an OSCE.[31] The process includes an English language test, the standards of which have been criticised for being too high.[32]
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Roles
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Non-registered staff
Non-registered staff typically working in direct patient care (often on wards), performing tasks such as personal care (washing and dressing), social care (feeding, communicating to patients and generally spending time with them) and more specialised tasks such as recording observations or vital signs (such as temperature, pulse and respiratory rate, or TPR) or measuring and assessing blood pressure, urinalysis, blood glucose monitoring, pressure sores (see Waterlow score) and carrying out procedures such as catheterisation and cannulation).
Some unregistered staff work as phlebotomists, ECG technicians, and smoking cessation therapists beyond the hospital. Others expand their ward-based role to include such tasks. Few areas of nursing cannot be legally performed by suitably trained non-registered staff. They legally must be supervised (either directly or indirectly) by a registered nurse.
In 2019, it was reported that mental health support workers were increasingly covering shifts because of the shortage of mental health nurses.[33]
Non-registered staff have various job titles such as "clinical support worker", "care assistant", "nursing assistant" and "healthcare assistant" (HCA). Typically they are on NHS Agenda for Change (AfC) pay band 2 and progress to band 3 pay after further training.
Registered nurses
Registered nurses traditionally qualify as a staff nurse on a ward, although it is increasingly common for newly-qualified nurses to enter an area such as community nursing directly. From there, nurses can progress into leadership and management roles such as ward sisters or matrons, or specialise in areas such as community nursing or advanced practice.
Specialist nurses and advanced practice
Specialist roles can include clinical nurse specialists, who may run clinics and provide specialist nursing support to wards, or specialist community public health nurses (SCPHNs) such as health visitors. SCPHNs form a separate part of the NMC register.
Advanced nursing practitioners, sometimes known as advanced clinical practitioners, normally study a postgraduate qualification and take on a more medical role. They are the equivalent of nurse practitioners elsewhere. As of 2025, the NMC is consulting on how to effectively regulate
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Nursing organisations and trade unions
As of 2024, more than 200 organisations are related to nursing as regulated by the Nursing and Midwifery Council, not including nursing departments in universities or in the NHS. These include professional bodies, nursing specialties, charities, and migrant support networks.
Four trade unions represent nurses: the Royal College of Nursing (RCN),[34] Unite the Union,[35] UNISON[36] and GMB.[37] The RCN has a dual role as both a professional body and a trade union.[34]
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Workforce
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Demographics
The Nursing and Midwifery Council report on registration data twice a year (April and September).[38]
The majority of the nursing profession are women at around 90% of the total workforce.[39][40][41] In September 2023, 43.5 percent of the ~800,000 registered nurses and midwives were aged 21–40; the average age of registrants was 43 years, 10 months.[41] The increase in the number of 21–40 year olds was partly owing to the international joiners to the register, with an increase to 29.1 percent of all registered professionals from Black and minority ethnic backgrounds.[41] 49.9% of new joiners were educated outside the UK[41]
As at September 2023 601,805 of registrants were Adult Nurses; 58,338 were Children's Nurses; 97,530 were Mental Health Nurses; and 16,806 were Learning Disability Nurses[41]
Workforce planning
In England, Health Education England commission undergraduate and postgraduate education.[42] This is an autonomous national body which works to "ensure that healthcare staff are recruited in the right numbers with the right values and behaviours to support the delivery of excellent healthcare and drive improvement".[42] The number of commissioned places for nurses has varied year on year, as follows:
Adult nursing education places commissioned each year[43]
Nursing shortages
More than a third of nurses in training fail to complete the training course, as has been the case for more than a century.[44]
In January 2016 the RCN stated that more than 10,000 nursing posts went unfilled in 2015. This represented a 3% increase year on year from 11%[45] in 2013, 14% in 2014 and 17% in 2015 of all London nursing positions and 10% as an average nationwide.[45] The Department of Health said it did not recognise the figures. The National Audit Office estimated a shortfall of 7% in the supply of nurses.[46] From 2016/17 registered nursing numbers fell 3% along with a 23% rise in de-registrations. 17,000 nurse permanently unfilled vacancies were observed.[47] In 2019, clinical pharmacology, spinal injuries, paediatric surgery, neurosurgery and neurology were the worst-affected specialities. They had an average of less than 90% of their planned nurse staffing levels.[48]
School nurses were also in short supply.[49]
Hospitals in England are required to report the number of nurses employed on each ward each month. After this was established, ward nurses increased by 13,500, although the numbers of community nurses declined.[50]
Migration
A 2015 Organisation for Economic Co-operation and Development survey reported that 21.7% of NHS nurses were born abroad, compared with 26.9% in Ireland, 9.8% in Italy, 14% in Germany and 5.9% in France. The UK was also the highest exporter of nurses, with more than 50,000 working in other OECD nations.[51] The Migration Advisory Committee criticised the Department of Health, Health Education England, and NHS trusts for not recognising obvious warning signs and "reluctantly" agreed to keep nursing on the list of shortage occupations.[52]
An English language test is compulsory for all foreign nurses, even if they are from English-speaking countries. The process of registering as a nurse can take migrants up to a year and cost more than £3,000.
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Nurse health
Obesity and smoking have long been an issue in nurse health. The effect of nursing on nurses' physical and mental health has been a subject of research papers where the effect of shift work and working with chemicals such as in chemotherapy has been explored.[53][54][55][56][57] In 2016, the government announced £600 million was to be spent on "tackling obesity and improving the well-being of its 1.3 million staff".
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Pay and Conditions
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Agenda for Change
Agenda for Change (AfC) is the 'NHS Terms and Conditions of Service' including pay. As the NHS is the largest single employer of nurses in the UK this influences pay rates across the sector. Registered/newly qualified nurses begin their careers as a Band 5 .[58] Pay is set out in nine pay bands, each band has a number of pay points. Staff usually progress to the next pay band after the required number of years until they reach the top of the pay band. In addition to basic pay, there is also extra pay for staff who work in high cost areas such as around London.
By 2025, devolution of health policy and of the NHS to each of the countries of the United Kingdom led to significant differences in pay for the same band. In 2025-26, the starting salary for a Band 5 registered nurse was £33,247 in Scotland[59] £31,516 for Wales,[60] [61] £31,048 in England,[62] and £29,970 in Northern Ireland.[63]
Northern Ireland repeatedly faces issues with delayed public sector pay awards which the unions have campaigned against.[64] The Northern Ireland Executive has faced several power-sharing impasses where no decisions were made by the government due to a boycott from one of the political parties, most recently in 2025.[65][64]
Progression across bands was significantly slower for nurses than for other health professionals. A nine year study by the Institute for Fiscal Studies for 2012-2021 showed over one-third (35%) of nurses were still in Band 5.[66] A Royal College of Nursing report in 2025 showed "44% of the nursing workforce in the NHS in England are working at band 5. This rises to 46% in Wales, 50% in Northern Ireland and 54% in Scotland. By comparison, only 13% of midwives and 25% of paramedics are paid at band 5, despite starting their careers at the same pay band as registered nurses."[67] It was asserted these barriers to career progression have a negative impact on recruition and retention of nurses in the United Kingdom.[67]
NHS Pay Review Body (NHSPRB)
The NHS Pay Review Body (NHSPRB) is an independent body that makes recommendations to the government on the pay of nurses and NHS staff. The government then makes the final decision.[68]
Pay awards and disputes
The United Kingdom government austerity programme (2010-2019) pursued by the Conservative Party (UK) sought to reduce public spending and tax rises. The impact of COVID and a change of government led the Labour Party (UK) to continue awarding modest pay increases. Overall the pay awards in this period did not keep pace with inflation - resulting in pay cut a real terms. In 2015, the RCN stated that Nurses had suffered a drop in pay equivalent to 9.8% in real terms since 2008,[69] in 2025 they stated it was a drop for an experienced nurse of 25%.
According to a Health Foundation report in 2021 "NHS nurses’ basic earnings grew by 13% in nominal terms between March 2011 and March 2021. However, after accounting for consumer price inflation, this amounts to a 5% reduction in real terms."[70] whilst a Royal College of Nursing 2025 report placed the reduction for Band five nurses between 2010 and 2025 at up to 21%[71]
This resulted in a number of pay campaigns and disputes by the unions including the first ever strike action by the Royal College of Nursing in Northern Ireland in 2019.[72] The reasons for the strikes were not simply about pay, but about the ability of nurses to provide 'safe and effective care' with inadequate staffing levels.[73] A study published in BMJ Open in 2017 linked austerity to 120,000 extra deaths in England, primarily as a result of a reduction in the number of nurses.[74][75]
Sexism has been raised as an issue around pay, with complaints in 2016 that Agenda for Change is a sexist system under-valuing nurses.[76] A 2019 report showed a lack of progression for women within the profession with men being over-represented in the senior positions[77] At the Royal College of Nursing Congress in May 2025, their General Secretary Nicola Ranger asserted that 'the nursing profession is undervalued and underpaid due to being a predominantly female field'. [78]
Agency Nurse Pay Cap
In an attempt to reduce spending, the government introduced pay caps for agency nurses working under NHS England from November 2015 with further caps from February 2016 and April 2016. Trusts were not to pay agency staff more than 55% more for a shift than a permanent member of staff.[79] The aim of the cap was to save £1bn over three years. Jeremy Hunt, the then Health Secretary said it would stop agencies "ripping off the NHS".[79] By 2022 the lack of available staff led to trusts routinely braching the cap, paying up to £2,500 to fill shifts.[80]
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Nursing journals
As at 2023 British nursing journal titles included:
- British Journal of Cardiac Nursing
- British Journal of Community Nursing
- British Nursing Index
- Cancer Nursing Practice
- Nursing Times
- Nursing Standard
- Emergency Nurse
- Evidence-Based Nursing (journal)
- Gastrointestinal Nursing
- Learning Disability Practice
- Mental Health Practice
- Nurse Researcher
- Nursing Children and Young People
- Nursing in Practice
- Nursing Management (journal)
- Nursing Older People
- Nursing Standard
- Nursing Times
- Primary Health Care (magazine)
Government reports
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Significant government publications on nursing and midwifery include:
- Front Line Care (Report) into nursing and midwifery was published in 2010.[81] The chair of the commission was Ann Keen MP who trained as a nurse. The government response, led by Anne Milton, was published in April 2011.[82]
- Cumberlege Report 1986 or Neighbourhood nursing: a focus for care was the report of a Department of Health and Social Security (DHSS) committee recommending that community nurses be permitted to prescribe from a restricted list of treatments.[83]
- Report of the Committee of Enquiry into Mental Handicap Nursing and Care published in 1979. The Committee of Enquiry was chaired by Peggy Jay.[84]
- The Halsbury Report published in 1974 by the Halsbury Committee of Inquiry into the Pay and Related Conditions of Service of Nurses and Midwives which recommended an average 33% pay rise.[85]
- Briggs Report of the Committee on Nursing in the United Kingdom, 1972 which reviewed the role of nurses and midwives in hospitals and in community care. It made recommendations on education, training, and professional regulation. The report was accepted in 1974.[86]
- Mayston Report on Management Structure in the Local Authority Nursing Services 1969
- Salmon Report on Senior Nursing Staff Structure 1966
- Ministry of Health, Department of Health for Scotland, and Ministry of Labour and National Service (Wood Committee) 1947 Report of the Working Party on the Recruitment and Training of Nurses - a government report on the recruitment and training of nurse
- Nurses Salaries Committee or Rushcliffe Report was established in October 1941 and published two reports in 1943. was the first official body to fix salary scales and conditions for nursing in England. [87][88][89]
- Athlone Report Ministry of Health and Board of Education Interim Report of the Interdepartmental Committee on Nursing Services – nursing recruitment, retention and skills 1939[90]
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Significant nursing reports
Significant reports from the Royal College of Nursing include:
- Wills Commission on the Future of Nursing Education 2012 Quality with Compassion: the future of nursing education led by Phil Willis[91]
- Judge Report of a Commission on Nursing Education 1985[92]
- The State of Nursing 1974 submission to the Secretary of State for Social Services which led to the Halsbury Report
- Platt Report 1964 on the Reform of Nursing Education[93]
- Horder Committee (Nursing Reconstruction Committee) 1941–1949 to consider the recommendations of the government's Athlone Report It published four reports.[94][95]
Additional reports relating to nursing in the UK include:
- UKCC for Nursing Midwifery and Health Visiting. The Report of the Post-Registration Education and Practice Project. 1990
- Lancet Commission on Nursing (1932) – looked at the reasons for the shortages of applicants to nursing
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Nurses in the media
Nursing in the UK has been represented across literature, television and film. Portrayals include Mrs Gamp; Sue Barton;[96] Matron in the Carry On films: Carry On Nurse (1959),[97] Carry On Doctor (1967),[98] Carry On Again Doctor (1969)[99] and Carry On Matron (1972);[100] Charlie Fairhead in Casualty[101] and its spin off Holby City;[102] plus characters in Call the Midwife[103] and Getting On.
Documentaries include 24 Hours in A&E.[104]
See also
References
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