For the NHS to function well and grow careful future workforce planning is essential to ensure that the right people are there to provide good, safe and quality-assured care. Health care is changing rapidly: user expectations, where and how health care is delivered, pioneering new treatments, development of technology and changes in how professionals work all contribute to the complexities around future workforce planning.
The nursing workforce is the largest professional group within the NHS and has seen numerous changes over the past few decades. The nursing role is rapidly diversifying and historic changes in practice – through extended or expanded clinical practice – have led to a greater focus on advanced nursing practice.
Entrance options
There was great concern that the introduction of Project 2000 and moving nursing education into universities would present a barrier, but fast forward 30 years and nursing education has never been so accessible to such a wide range of potential applicants.
There are now many different routes to access pre-registration nursing, leading to a career as a registered nurse. Some embark on their journey into nursing via a nursing associate apprenticeship that leads to other apprenticeship routes, others start on a degree programme. A variety of shorter courses have now emerged that are studied at a higher academic level, such as postgraduate diploma/master's level programmes. Each of these routes have their own unique appeal, attracting a range of people, which is exactly what is needed to ensure that the NHS grows a truly diverse nursing workforce.
Although the apprenticeship routes allow people to earn and learn, the more traditional BSc route gives students the full university experience, which is still seen as important for many school-leavers. In contrast, the master's pathway often attracts people who are considering a second degree or to switch to different career.
The variety of routes to access pre-registration nursing education can be described as the A and B roads and motorways of nurse education: although the destination is the same, the journey is vastly different. The authors think that this is a nice way to describe these unique journeys into nursing.
The roads leading to registered nurse registration can take anything from 2 years to 6 years. This highlights that the supply and demand of nursing is the tricky part of workforce development. Long-term sustainable planning is therefore needed to ensure that the NHS does have the right people in place. A good example of such forward planning is the previous government's pledge to recruit 50000 additional nurses. Although universities were asked to increase the number of pre-registration nursing places rapidly, the target was unachievable, with the result that the only way to meet this target within the time frame was to increase overseas recruitment.
Falling interest
Following the COVID-19 pandemic, universities saw a surge of applicants wanting to start a career in nursing, one of the few positives of living through a global pandemic. This surge was short lived, however, and over the past 2 years, university nursing applications have seen a sharp decrease nationally. For the 2024–2025 academic year there were 21% fewer nursing students starting courses at universities across the UK than 3 years ago, according to the Royal College of Nursing (RCN) (2024). The north-east of England saw one of the highest drops in interest, with applications falling by a massive 40% (RCN, 2024).
Admissions service UCAS (2024) observed a notable decrease in applications from mature students to nursing courses, which has had a notable impact on the take-up of the MSc/PGDip route in the 2024–2025 academic year. The RCN said that the drop in applications across all nursing courses is ‘critical’ and ‘as bad as it's ever been’ (Johnson, 2024).
The authors are concerned and we agree with the RCN's view that the shortage of nursing students is at a critical level and will have many consequences for future workforce planning.
Potential solutions
There may be several reasons for this dramatic decrease in applications to nursing courses. Negative reporting around NHS pay, the scrapping of student bursary payments, rising university course fees and the increased cost of living could be among the reasons contributing to the decline.
Some potential solutions centre around NHS pay reform, placing the spotlight on the variety of possible routes into nursing, better publicity about the modern image of nursing and the vast career opportunities open to nurses.
With the increase in course fees and the rise in the cost of living, action needs to be taken by government around the sustainability and flow of nursing students, to ensure that the profession is seen as an attractive option and worth studying. Even so, it is a difficult choice to make in times of national austerity.
It takes time to grow a high-quality nursing workforce and a regular supply chain of nurses is needed to meet the demands of the NHS. Nursing needs to stand loud and proud: together and as a profession we need to continue to lobby ministers so we can make the necessary changes and ensure that nursing is always seen as an important career choice to all. As a professional nursing group, we need to ensure that all roads into nursing are busy and keep moving forward.