The recent headline from the Royal College of Nursing (RCN) and ITV News nails the reality: “Working in an understaffed NHS England is leaving nurses sick and ‘broken’”. That headline encapsulates problems that go far beyond wages or single trusts — they reflect a system under strain, which raises major implications for workforce, governance, oversight and regulatory responsibilities.
Key pressures
Under-staffing and its health impacts
The RCN survey shows two-thirds of nurses (66 %) admitted to working while ill — up from 49 % in 2017. Stress is now cited as the leading cause of sickness absence. Under-resourcing translates directly into burnout, panic attacks, nightmares and fear about going to work. In the words of one nurse: “the ward was so unsafe I felt scared to go to work”. This is not a marginal issue; it is a threat to safe care. Indeed, the Health Services Safety Investigation Body described staff fatigue as a “significant threat to patient safety”.
High expectations of regulatory compliance paired with practical constraints
On one hand, the regulatory landscape is demanding: the Care Quality Commission (CQC) and other regulators expect high levels of compliance, safe staffing, reliable governance, risk management, and consistent standards of care. On the other hand, services are being asked to deliver these under conditions of marked staff shortage, growing demand, and constrained resources. That produces stress, not just for clinical staff but for managers, senior teams and everyone in the chain of accountability.
Industrial action by doctors compounds the pressure
The picture is further complicated by recurring strikes from junior (and senior) doctors. BMA-represented resident doctors have signalled further walk-outs and demand pay restoration (for example a 26 % uplift). These disputes underscore how the whole medical workforce is under tension which puts additional burden on nursing teams, who often pick up the slack when rotas and cover become unstable.
Recruitment and retention barriers
The data on vacancies are stark: more than 25,000 nursing vacancies across England. Without stable pipelines of staff, services remain brittle. In this sense, the government must own a large part of the challenge: training pipelines, retention schemes, career progression, and creating working conditions that make nursing viable, sustainable and safe — not just heroic.
Immigration and overseas recruitment changes affecting workforce supply
The UK government’s immigration policy is tightening in ways that directly impact health and care recruitment. For example: from December 2025 the Immigration Skills Charge for certain health roles will increase by 32 %. The UK government has also indicated that overseas recruitment for new care-worker and senior care-worker roles will be restricted (or ended). And the May 2025 White Paper “Restoring Control over the Immigration System” contained major reforms, including stricter visa rules, higher salary thresholds, and changes to settlement rights. These changes create a challenging paradox: at a time when the workforce is under extreme pressure, restricting the pool of overseas recruits and increasing cost/complexity of sponsorship risks exacerbating recruitment shortfalls. The government needs to address this consciously — unless domestic training and retention improve dramatically, workforce resilience will remain compromised.
Spotlight: The role of the Nursing and Midwifery Council (NMC) and how nursing staff are feeling under pressure
The NMC is the regulatory body that sets professional standards, maintains the register of nurses, midwives and nursing associates, and investigates allegations of impaired fitness to practise. While the regulator’s role in protecting public safety is absolutely valid, there is mounting concern about how the process of referral and investigation is being experienced by nursing staff who are already working in extremely stretched environments.
Some key issues:
There is growing evidence that nurses who raise concerns (or work in extremely pressured services) may be more vulnerable to referral to the NMC. One analysis noted that managers sometimes use the threat of referral to the NMC against staff who speak up about care concerns — effectively weaponising the route of referral.
Data show that nurses from certain protected characteristics (for example black nurses, male nurses, and those trained overseas) are disproportionately referred to fitness to practise proceedings.
The NMC itself has faced criticism: an independent review found concerns about a “dysfunctional culture” at the regulator including delays, the emotional toll on nurses under investigation, and the impact on public safety.
In the context of nursing staff working beyond contracted hours, under extreme stress, with insufficient staffing, the possibility of being held personally accountable — when their working environment was systemically under-resourced — adds a further layer of pressure. A nurse may ask: “I’m doing my best in this ward with half the staff we need, should I still fear being referred if something goes wrong?” The answer for many is yes. The sense of personal liability and potential scapegoating is widespread.
Why leadership and government must accept responsibility
The workforce crisis is not simply a matter of local leadership or poor rostering. It is rooted in structural issues: training capacity, retention, working conditions, pay, career pathways.
Government sets the immigration framework, which directly impacts workforce supply; if the rules make recruitment more difficult at the same time as vacancies are high, that’s a policy contradiction.
The CQC and other regulators rightly expect safe staffing and governance; but where those standards are challenged by workforce shortage, lack of resource, and high demand, the system is at risk of being set up to fail staff as much as patients.
Therefore, rather than only focusing on failures at the point of practise, there needs to be system-level accountability: budgets, workforce strategy, immigration policy, training pipelines, retention mechanisms need to be aligned with delivery expectations.
What this means for nursing managers, Registered Managers, and providers
Given your interest and involvement in cosmetic surgery hospitals, private sector health services, and regulated activity (under CQC etc), the implications are real:
If nursing staff are working in an environment of stretched staffing, with high patient demands, paperwork and regulatory expectations, you will inevitably need to provide strong support: induction, supervision, mentoring, psychological safety.
Be aware that nurses working under duress (short-staffed wards, high expectation) may be more vulnerable to complaints, errors or referrals — not because they are incompetent, but because the system around them is fragile.
Build organisational culture where concerns can be raised safely (Freedom to Speak Up), where managers understand that systemic factors matter, not just individual failings.
Recognise that immigration / overseas recruitment is becoming more complicated: sponsorship costs, visa routes, settlement rights all may affect availability of internationally trained nurses. Trusts/private hospitals should review workforce plans now.
For private hospitals preparing for CQC oversight: ensure that staffing levels, escalation protocols, nursing leadership presence, and regulatory readiness are realistic — not simply aspirational.
Summary
In short: the story of “nurses sick and broken” is a cry not just for individual help, but for systemic reform. The nursing workforce is bearing the brunt of expectations, regulatory pressure, recruitment shortages, staffing crises and immigration changes — and the regulatory burden via the NMC adds further weight. Leadership must respond by recognising the systemic dimension, not simply exhorting staff to be resilient. The government must take serious responsibility for recruitment, training, immigration and workforce policy. And regulators must ensure their systems do not unfairly target nurses who are working in compromised environments.
Reference list
Health Services Safety Investigations Body (2025) The impact of staff fatigue on patient safety. Available at: https://www.hssib.org.uk/patient-safety-investigations/the-impact-of-staff-fatigue-on-patient-safety/investigation-report/
(Accessed: 17 November 2025).
ITV News (2025) ‘Working in understaffed NHS is leaving nurses sick and ‘broken’, leaders warn’, 16 November. Available at: https://www.itv.com/news/2025-11-16/working-in-understaffed-nhs-is-leaving-nurses-sick-and-broken-leaders-warn
(Accessed: 17 November 2025).
Pickup, L. (2025) ‘Healthcare staff fatigue: The unrecognised risk for patient safety’, Journal of Patient Safety and Risk Management, DOI:10.1016/S2514-6645(25)00029-3.
Wikipedia (2024) ‘Nursing and Midwifery Council’, Available at: https://en.wikipedia.org/wiki/Nursing_and_Midwifery_Council
(Accessed: 17 November 2025).