# Nursing in the United Kingdom

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. Over 700,000 registered nurses practice in the UK, working in settings such as hospitals, health centres, nursing homes, hospices, communities, military, prisons, and academia. Most are employed by the National Health Service (NHS).
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. Nurses often work in multi-disciplinary teams, but increasingly 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. Dental Nurses, Nursery nurses and Veterinary nurses are not regulated by the NMC and follow different training, qualifications and career pathways.

## Registration and regulation

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. 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. However the title "nurse" is not legally protected, so anybody can call themselves a nurse. Brent East MP Dawn Butler introduced a bill in Parliament in February 2025 to protect the title of 'nurse'.

### 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 register, which anyone can search. As of March 2024, there were 826,418 registered nurses, midwives and nursing associates on the NMC register.
The powers of the NMC are set out in the Nursing and Midwifery Order 2001.
Membership of the council comprises 6 lay and 6 registrant members appointed by the Privy Council (United Kingdom), 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.
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.

#### Code of conduct

The Professional standards of practice and behaviour for nurses, midwives and nursing associates, known as the Code was revised in 2018 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.

### Legislation

Government legislation governing nursing in the United Kingdom includes:
* Health and Care (Staffing) (Scotland) Act 2019
* Nurse Staffing Levels (Wales) Act 2016
* Nurses, Midwives and Health Visitors Act 1997 (repealed)
* Nurses, Midwives and Health Visitors Act 1992 (repealed 19 June 1997)
* Medicinal Products: Prescription by Nurses etc. Act 1992
* Nurses, Midwives and Health Visitors Act 1979
* Nursing Homes Act 1975
* Nurses Act 1943
* Royal National Pension Fund for Nurses Act 1936
* Nurses Registration Act 1919

## Education
### 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.
Many trusts and health boards create opportunities for these staff members to become qualified nurses. This is termed secondment (whereby the trust/health board continues to pay them for the duration of their training, and often guarantees employment following successful completion).

### Pre-registration degrees

Registered nurses must complete a nursing degree programme recognised by the Nursing and Midwifery Council from an approved provider.
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.
As of September 2013, degree-level nurse training programmes were required, with no option to study for a diploma.

#### 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.

#### Student Bursary

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. In Scotland and Wales, all student nurses (regardless of which course they are undertaking) receive a bursary in line with the English diploma course. 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.
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.

### Post-registration education

Graduate courses require two years. They often require prior learning and relevant experience, often termed Accreditation of Prior and Experiential Learning (APEL).
Registered nurses must update their skills and knowledge at the rate of at least 35 hours every three years, as part of its post-registration education and practice (PREP) requirements.
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.
Many nurses who qualified with a diploma choose to upgrade their qualification to a degree via additional study. Many nurses prefer this to completing a degree initially, as nurses can study in a specialist field as a part of the degree. Financially, in England, it was more lucrative, as diploma students get the full bursary during their initial training, and employers often pay for the degree course as well as the nurse's salary.
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. As of 2012 over 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, due 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. The process includes an English language test, the standards of which have been criticised for being too high.

## Roles
### 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.
Non-registered staff have various job titles such as "clinical support worker", "care assistant", "nursing assistant" and "healthcare assistant" (HCA). Typically they are on pay band 2 or 3, although senior healthcare assistants can be on band 4.

### 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 practioners, sometimes known as advancecd clinical practitioners, normally study a postgraduate qualification and take on a more medical role. They are the equivelant of nurse practitioners elsewhere. As of 2025, the NMC is consulting on how to effectively regulate

## Nursing organisations and trade unions

As of 2024 over 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) Unite the Union, UNISON and GMB. The RCN has a dual role as both a professional body and a trade union .

### Protests and industrial action

Whilst nurses are not known for striking or taking industrial action, there have been many occasions when nurses have gone on strike, often over pay and conditions. The Royal College of Nursing had a no-strike policy for 79 years until 1995, when the policy was dropped due to pay disputes at the time.
* In 1939 rallied together as it was reported in the Daily Mirror that many nurses were leaving the role and were enduring financial hardship.
* In 1948, following the establishment of the NHS, nurses realised that their pay had decreased, which led to strike action.
* In 1962 many nurses marched to Trafalgar Square as part of pay disputes under the banner of "Empty Purses Mean Less Nurses".
* In 1970 many nurses protested at pay and conditions.
* In 1973 it was reported that over 7,000 nurses marched in Sheffield.
* In 1974 several protests took place by nurses over pay and conditions.
* In 1976 many nurses took part in a low pay strike.
* In 1982 there was a National Health Service day of action with 120,000 workers marching at various locations around the country including many nurses.
* In 1988 Nurses went on strike in 1988 over pay and proposed changes to the NHS.
* In 2011 Unison nurses protested and marched over pay.
* In 2014 Midwives and some nurses went on strike over pay.
* In 2015 nursing students protested outside the Department of Health over the removal of the NHS student bursary.
* In 2016 nursing students marched to Downing Street to protest over the removal of the NHS student bursary. The protest was attended by Shadow Health Minister Heidi Alexander MP, Wes Streeting MP, Representatives of UNISON, Unite the Union and Royal College of Midwives.

#### Student protests

In the November 2015 spending review, George Osborne stated that he would remove the NHS Student Bursary from 2017. This prompted several Nursing students to organise a political demonstration with other healthcare students at King's College London outside the Department of Health in December 2015 which was attended by several hundred supporters. Kat Webb also decided to start a petition on the government's e-petition site, which received over 150,000 signatures
The student bursary debate has been raised in parliament at Prime Minister's Questions, and is the subject of the 'Early Day Motion (EDM) 1081 – THE NHS BURSARY', which was sponsored by Wes Streeting MP.
In December 2015, several hundred people protested the recent removal of the NHS student bursary as announced in the November 2015 spending review.
Over 7000 NHS students and supporters marched on Downing Street in January 2016. The protest was attended by Shadow Health Minister Heidi Alexander MP, Wes Streeting MP, Natalie Bennett, Sian Berry, representatives of UNISON, Unite the Union and Royal College of Midwives. The hashtag #bursaryorbust was the top trending Twitter.
In February, NHS students walked out of placement in solidarity with the Junior Doctors strike.

## Workforce
### Demographics

The Nursing and Midwifery Council report on registration data twice a year (April and September).
The majority of the nursing profession are women at around 90% of the total workforce. 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. The increase in the number of 21-40 year olds was partly due to the international joiners to the register, with an increase to 29.1 percent of all registered professionals from Black and minority ethnic backgrounds. 49.9% of new joiners were educated outside the UK
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

### Workforce planning

In England, Health Education England commission undergraduate and postgraduate education. 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". The number of commissioned places for nurses has varied year on year, as follows:
Adult nursing education places commissioned each year
| 2009/10 | 2010/11 | 2011/12 | 2012/13 | 2013/14 | 2014/15 |
| 14,451 | 13,628 | 11,930 | 11,416 | 12,134 | |

### 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.
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% in 2013, 14% in 2014 and 17% in 2015 of all London nursing positions and 10% as an average nationwide. 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. From 2016/17 registered nursing numbers fell 3% along with a 23% rise in de-registrations. 17,000 nurse permanently unfilled vacancies were observed. 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.
School nurses were also in short supply.
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.

### 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. 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.
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.

## Nurse health
### Campaigns

Nursing is subject to regular health campaigns. Scale ranges from nationwide to ward-based.
* Sign up to Safety – National campaign to ensure staff coordinate their efforts and ideas around ensuring and enhancing safety.
* NHS Change Day – Annual 1-day campaign to get staff contributing ideas to improve the NHS.
* Antibiotic Guardian – Gathers pledges to slow antibiotic resistance. European Antibiotic Awareness Day (EAAD) is held on 18 November.

### 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. 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".

## Compensation

Until October 2004, all nurses in the NHS were employed on a scale known as clinical grading (see below). Agenda for Change was developed by the NHS in response to criticisms that the old scale reflected length of service more than knowledge, responsibility and skills.

### Clinical grading

This was known as the Whitley Council system. This placed nurses (and some other hospital staff) on "grades" between A and I (with A being the most junior, and I the most senior). Unregistered staff were employed on grades A and B (occasionally grade C). Second level nurses were employed on various grades (usually between C and E), with first level nurses taking up grades D-I.

### Agenda for Change

This system puts registered staff on bands 5–8, unregistered staff such as Healthcare Assistants take up bands 2–4. Band 9 posts are for the most senior members of NHS management. Each band contains a number of pay points.
The idea of this system is "equal pay for work of equal value". There was a perceived discrepancy, under clinical grading, between ones grade (and therefore pay) and the work which one actually did, which Agenda for Change aimed to fix. Most NHS staff are now on the AfC system which took quite a long time to implement across the UK. A small percentage of staff went through an appeal procedure as they disagreed with the band that they have been placed on.
In 2015–16 the minimum starting salary for a registered nurse will be £21,692 in England, Wales while in Scotland it will be £21,818. As of 4 June 2015 Northern Ireland have yet to announce their pay rates for 2015–16.

### NHS Pay Review Body (NHSPRB)

The NHS Pay Review Body 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.
In 2014 the government rejected the NHSPRB recommendation for a 1% pay rise.
In 2016 the government announced that nurses would receive a 1% pay rise which would take effect from 1 April 2016. The RCN Chief Executive Janet Davies stated that "The fact remains that pay awards for NHS staff have been severely constrained since 2010".

### Pay disputes

There have recently been complaints of Agenda for Change being a sexist system, as nurses, who are mostly female, claim that, as a profession, they are under-valued using this system. In 2015 the RCN stated that Nurses had suffered a drop in pay equivalent to 9.8% in real terms since 2008.

#### Agency Nurse Pay Cap

In 2015 the government announced that there would be a gradual introduction of pay caps for agency nurses working under NHS England. Starting in November 2015, further caps came in February 2016 with the final cuts introduced in April 2016. The aim of the cap was to save £1bn over three years. The implications of the pay cap means that trusts will not be able to pay staff who work for an agency including doctors and nurses, more than 55% more for a shift than a permanent member of staff. Jeremy Hunt in his capacity as the Health Secretary said it would stop agencies "ripping off the NHS". In response a petition started on the government website which received over 10,000 responses.

#### Nurses finance situation

In 2016, several publications appeared in the media, claiming nurses depend on food banks and payday loans to survive. In October 2016, Western Circle published research, claiming that the sector of NHS Nurses are heavily dependent on payday loan. According to the research, the number of nurses using payday loans has doubled in 3 years, since 2013. This research brought the matter of the low wages nurses received in the UK to the attention of media outlets. The claims were that nurses' salaries were frozen for more than 6 years and in some cases, resulted in financial distress, clearly as wages have not kept pace with the cost of living increases in this time. The lack of pay increases for, particularly nurses within the NHS continues to be an important topic of public discussion in the UK.

## NHS pension

The NHS pension is the main pension offered to NHS staff. There have been three distinct changes made to the NHS pension. The type of pension someone is enrolled onto is referred to by the year that it was introduced or changed 1995, 2008 & 2015.

## Journals and publications

There are a number of nursing publications, journals, magazines and blogs published online and in print. As at 2023 British nursing 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 publications

Significant government publications include:
* Athlone Report Ministry of Health and Board of Education Interim Report of the Interdepartmental Committee on Nursing Services – nursing recruitment, retention and skills 1939
* Nurses Salaries Committee or Rushcliffe Report was established in October 1941 and published two reports in 1943.
* 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
* Salmon Report on Senior Nursing Staff Structure 1966
* Mayston Report on Management Structure in the Local Authority Nursing Services 1969
* 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.
* Cumberlege Report 1986 or Neighbourhood nursing: a focus for care was the report of a Department of Health and Social Security (DHSS) committee advocating that community nurses be permitted to prescribe from a restricted list of treatments.
* Front Line Care Report and the government's response were published in 2010. The chair of the commission was Ann Keen MP who trained as a nurse.
In addition there have been a number of non-governmental reports from the Royal College of Nursing, including:
* Horder Committee established in 1941 to consider ways and means of implementing the recommendations of the Athlone Report, especially regarding the proper control of the Assistant Nurse. In July 1941, renamed the Special Reconstruction Committee on the Assistant Nurse and in January 1942 renamed the Nursing Reconstruction Committee, Assistant Nurse Sub-committee. The report was published in 1949.
* Platt Report 1964 on the Reform of Nursing Education
* Judge Report of a Commission on Nursing Education 1985
* Wills Commission on the Future of Nursing Education 2012 Quality with Compassion: the future of nursing education led by Phil Willis
Additional reports relating to nursing in the UK include:
* Lancet Commission on Nursing (1932) – looked at the reasons for the shortages of applicants to nursing
* UKCC for Nursing Midwifery and Health Visiting. The Report of the Post-Registration Education and Practice Project. 1990

## Nursing in culture

Nursing in the UK has been represented across popular books, television and films, including:
* Mrs Gamp – Sarah or Sairey Gamp is a nurse in the novel Martin Chuzzlewit by Charles Dickens, first published as a serial in 1843–1844. Mrs. Gamp, as she is usually referred to, is dissolute, sloppy and generally drunk. She became a notorious stereotype of untrained and incompetent nurses of the early Victorian era, before the reforms of campaigners like Florence Nightingale. The caricature was popular with the British public.
* Sue Barton – a British series of seven career novels aimed at teenage girls, beginning with Sue as a Student Nurse and working through different roles up to the final book as Staff Nurse. The books were written from 1936 to 1952, and republished several times up to 1991, with more recent vintage editions being available.
* Carry On Films – In total there were 31 British comedy films (1958–1992), their humour was in the British comic tradition of music halls and bawdy seaside postcards. Four of these focused on hospital settings; Carry On Nurse (1959), Carry On Doctor (1967), Carry On Again Doctor (1969), and Carry On Matron (1972).
* Casualty–a BBC drama series airing from 1986 to 2023 focusing on a hospital accident and emergency department. Casualty had a spin off Holby City airing from 1999 to 2021.
* 24hrs in A&E – a Channel 4 British documentary airing from 2011 to 2023 focusing on Accident and Emergency department of a hospital. Initially set in King's College Hospital, Camberwell; from the 7th series it was set in St George's Hospital, Tooting and then from Season 30 Queens Medical Centre, Nottingham
* Getting On – a satirical BBC sitcom based on a geriatric ward in an NHS hospital. It is written by its core cast, Jo Brand, Vicki Pepperdine, and Joanna Scanlan. Three series were aired between 2009 and 2012.
* Call the Midwife – a BBC period drama series about a group of nurse midwives working in the East End of London in the late 1950s and 1960s.