1. Jones-Berry, Stephanie


Protests mount as economic pressures on nurses increase.


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Nurses in the United Kingdom (UK) have been buffeted in recent years by staffing shortages and restrictive National Health Service (NHS) pay policies that have led to declines in actual income when adjusted for inflation. Moreover, the nurse shortfall-estimated at 22,000 or nearly 10% of the workforce caring for adult patients in 2015-is expected to worsen as a result of a drop in applicants to nursing schools and the impact of the UK's so-called Brexit vote to quit the European Union (EU).

Figure. Royal Colleg... - Click to enlarge in new window Royal College of Nursing members march for better pay in central London. Photo courtesy of RCNi.

The NHS has traditionally relied on international recruitment-primarily from other EU nations-to alleviate nurse shortages in the UK. More than half of NHS organizations identified as vulnerable to workforce problems report post-Brexit declines in the number of EU nurses on their staffs. Alarming new data underscore this trend: between July 2016 and April 2017 the monthly number of EU nurses registering to work in the UK dropped by 96%.


Observers suggest this may be because of a lack of clarity on the right of EU nationals to join or remain in the UK nurse workforce. The uncertainty has been compounded by recent government proposals that fail to offer employment guarantees to EU nurses with less than five years of UK residency. Toughened language proficiency standards are also cited as a barrier for foreign nurses. The minimum score required as well as the academic style of tests from the International English Language Testing System has been criticized by senior nurses who argue for a lower passing grade to facilitate recruitment.


The number of EU students applying for UK nursing degree courses fell by 24% (400 people) between June 2016 and June 2017, and homegrown applications have declined by 19%. Academic leaders believe the latter may be due partly to the government's decision to discontinue NHS scholarships for nursing studies. Students must now cover approximately $11,700 in yearly tuition plus living costs through loans. Another factor possibly influencing nursing school application rates is a new apprenticeship option for those seeking to qualify as nursing associates.


Meanwhile, following a two-year pay freeze in 2010, the government's pay restraint policy for nurses and other public sector workers rumbles on with an unpopular 1% cap on annual pay increases. The Royal College of Nursing (RCN) contends that the cap has translated into a 14% pay cut over its six-year duration, owing to cost of living outpacing 1% salary increases. In July, the chief secretary to the treasury testified before the House of Commons that the government intends to continue the cap in the 2017-18 budget year as the "responsible thing to do" to ensure that recruitment and retention are balanced with sustainability.


In an unprecedented move, the RCN plans to poll members later this year on whether to take industrial action (such as a strike) on the pay issue-giving the government until the fall to lift the cap.


Although it's not a good time for an exodus, nurses are talking with their feet. Staffing and pay issues have sparked a wave of protests across the country this summer, and more UK nurses are leaving the profession than joining it, citing heavy workloads and eroding standards of care. This trend underscores the country's urgent need to retain its 37,400 EU nurses to help address shortfalls.-Stephanie Jones-Berry