By Rob Hicks, MD

Nurses with prolonged mental health-related sickness absence are far more likely to leave their health system than those without, new analysis indicates, highlighting retention pressures despite recent workforce growth and raising questions about how long recent gains can be sustained.

Researchers at the Nuffield Trust found that nurses with more than 84 days of mental health-related absence over a 3-month period had more than six times the risk of leaving their role compared with those with minimal absence. Even shorter absences were also linked to higher exits, with those taking 5-14 days more than twice as likely to leave.

The findings come despite a net increase of more than 50,000 nurses in England since 2019, meeting a government workforce target in September 2023.

Retention Pressures Behind Workforce Gains

The study examined workforce trends before and during the expansion programme, which increased nurse numbers from about 300,904 in 2019 to more than 352,000 in 2023.

It found that retention challenges persist beneath headline growth, with mental ill health a stronger predictor of leaving than physical health or other factors.

Nurses at the top of NHS pay bands were also more likely to leave, suggesting limited career progression plays a role. Those at the top of Band 7 were around 25% more likely to exit than those at the bottom.

Uneven Regional Growth

Workforce expansion has not been evenly distributed across England.

The North East and Yorkshire saw the smallest increase, gaining 5894 nurses between January 2020 and June 2023, compared with 7145 in the South East.

Lucina Rolewicz, a fellow at the Nuffield Trust, said efforts to expand the workforce should focus not only on overall numbers but also on distribution across regions and services.

Reliance on Overseas Recruitment

International recruitment accounted for most of the increase in nurse numbers, with non-UK staff contributing 88% of net growth between December 2019 and December 2023.

However, the analysis found rising exit rates among nurses from outside the UK and Europe since 2021. Although international nurses were still less likely to leave than UK-trained staff, the gap has narrowed.

The Health Foundation has warned that the UK risks becoming a “stepping stone” for internationally recruited nurses moving on to countries offering better pay or progression.

The Royal College of Nursing has also cautioned that changes to immigration rules could accelerate departures.

The authors said workforce policy has focused heavily on recruitment, with less attention paid to why nurses leave.

They called for greater emphasis on mental health support, management of sickness absence, and clearer career progression pathways, alongside targeted measures for internationally recruited staff.