The Royal College of Nursing says the incoming Scottish government must prioritise workforce planning as nursing shortages and a surge in the complexity of the people being cared for are coming together to create “a high risk of harm” shift after shift.

On the day that the RCN UK annual congress in Liverpool has been hearing governments across the UK are "asleep at the wheel amid rising, dangerously unmet levels of patient need", the RCN in Scotland says ministers here have to address the fact that they have not been doing enough to keep citizens safe.

The organisation’s latest 'last shift' survey asked more than 1,400 nursing staff in NHS and independent health and social care settings across Scotland about their experience on the most recent occasion they'd been at work.

Fewer than one in 10 (8%) said that staffing had been at the right level for the needs of all their patients to be met, while 76% said limited time and resources had forced them to make "difficult decisions about prioritising care".

One nurse working in a general acute NHS Scotland hospital ward described "multiple competing priorities” that had included supporting deteriorating patients and responding to urgent clinical changes, while ensuring paperwork was completed, medication dispensed and the phone answered.

The nurse said:

“In this environment, nursing care becomes task-driven and reactive. There is little opportunity for comprehensive assessment, preventative care, patient education, or meaningful interaction — all of which are fundamental components of safe and effective nursing practice.”

In their survey response, a community nurse said:

“There are regularly not enough staff and, due to this, nurses are moved to other teams or areas on a daily or weekly basis. This adds pressure to home teams and staff don’t get time for completing administrative work or sometimes patient follow up.”

More than eight in 10 (82%) told the survey that, over the last two years alone, adults, children and those with mental ill-health have all been presenting with more complex clinical needs.

RCN Scotland Executive Director, Colin Poolman, is calling on the new Scottish government to prioritise investment to grow the nursing workforce to a level that meets the needs of an ageing, more sick population:

“When NHS nursing staff in Scotland say there is a high risk of harm to patients because staffing is below what is needed, the government must act. Scotland’s population cannot afford for them to be complacent to rising, dangerously unmet levels of patient need.

“The continued gaps in the registered nurse workforce are always unsafe, but the risk is being compounded by the demands of delivering ever more complex care to an ageing, sicker population, with multiple conditions.”

More demand, fewer nurses

Last week RCN Scotland published its Nursing Workforce in Scotland 2026 report pointing to a series of factors that justify their repeated calls for investment in health and care staffing – including the reduction in the NHS working week to 36 hours, sickness absence rates that are more than double the NHS Scotland absence target, and a significant number of nursing staff nearing retirement age.

The report also shows an increase in numbers leaving the profession early. In the year to March 2025, over 50% of registered nurses who left the NHS did so before the age of 50.

                         Colin Poolman, RCN Scotland

Colin Poolman says, despite safe staffing legislation that came into force in 2024, many nurses continue to look after more patients at any one time than they should:

“We continue to have significant concerns that the workforce planning tools, which are supposed to determine the number and skill mix of nursing staff required to provide safe and effective care, remain unfit for purpose and underestimate the staffing establishment needed.”

Colin Poolman adds:

“Nursing staff cannot continue to deliver the care their patients deserve with increasing workload pressures and continued gaps in the workforce. Gaps in the workforce, and the adverse effect on staff wellbeing, undermine safe and effective care.

“Safe nurse staffing saves lives, protects exhausted staff and strengthens health and care services.

“The new Scottish government must prioritise investment which acknowledges and values the vital contribution of nursing to the health of the nation.

“It has been over a year since the Scottish government’s Nursing and Midwifery Taskforce published its recommendations yet slow progress has been made to deliver the report’s recommendations.

“Failure to act is now no longer an option as, with increasing risk of harm to patients, inaction will lead to inevitable consequences for patients and staff.”

 

Read more: Call for care home nurses to be given pay parity; Staff express concern over latest NHS reform plans; Nurse pay upgrade programme stalls

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