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March 2024

New evidence for exodus of qualified nurses

New research, from the Health Foundation’s REAL Centre, shows a dramatic increase in the number of nurses requesting a certificate from the Nursing and Midwifery Council in 2022/23, which other countries require for nurses to prove that they are UK-registered.  

Applications for Certificate of Current Professional Status (CCPS) signal interest in moving to practise nursing abroad. 

The Health Foundation says this spike in applications, which indicates that more UK-registered nurses may be looking to move abroad, is likely to be the result of a combination of current conditions in the NHS and improved opportunities abroad. The Foundation is calling on policy makers to do more to understand why these nurses may be moving on and take action to retain them.  

The research highlights that: 

  • In 2022/23, over 12,400 UK-registered nurses applied for a CCPS in order to register outside the UK, more than double the number the year before and 4 times more than in 2018/19.  
  • Overseas-trained nurses, who first qualified outside the UK and the EU, accounted for 7 in 10 of these applicants in 2022/23. The largest increase was for those with 3 years or fewer on the UK register, suggesting that for an increasing number of international nurses, the UK may be a stepping-stone prior to moving to other destinations.   
  • In 2022/23, more than 4 in 5 CCPS applications were for just three countries: Australia, New Zealand and the US. Applications for the US increased ten-fold between 2021/22 and 2022/23 and coincided with the rolling over of unused visas from the pandemic period.   
  • UK nurses earn substantially less than many of their counterparts in these countries, all of which have also recently announced measures to attract more nurses from overseas. Once adjusted for purchasing power, OECD data indicate that a nurse in the UK earns around £36,430 annually, compared to £45,000 in New Zealand, £56,000 in Australia and £66,500 in the US.   

Other factors leading to the spike in applications are likely to include working conditions and the impact of staffing shortages in the UK. Experiences on the front line during the COVID-19 pandemic may have led more nurses to consider their options.  

Elaine Kelly, Assistant Director at the Health Foundation’s REAL Centre, said:  

‘There is a global shortage of nurses, and the UK operates in an international market. In recent years, the NHS has relied heavily on international nurses to plug workforce gaps, yet our research shows that nurses trained overseas are the largest group applying for professional certificates to enable them to practise abroad. If the NHS is to avoid becoming a stepping stone to careers elsewhere, it needs to be a more attractive place to work for all nurses, regardless of where they were trained.  

‘The current environment for nursing in the UK is very challenging – nurses have experienced a decade of real terms decline in pay, while the NHS staff survey shows that less than half feel their organisation values their work.  Against this backdrop, it is not surprising that when other opportunities arise, many nurses are keen to explore them.  

‘Even if we are successful in meeting the ambitious targets to train more nurses in the UK, we can ill afford nurses leaving the profession at such high rates, whether that be for nursing jobs abroad or other opportunities within the UK.’

Bazeer N, et al. Nursing locally, thinking globally: UK-registered nurses and their intentions to leave. The Health Foundation; 24 March 2024.

Practice Nurse 2024;54(2): online only