Nursing and midwifery: reluctant leavers, uncertain starters.

Why registered nurses and midwives leave

Registered nursing and midwifery is one of the largest groups in our December 2024 – December 2025 exit data, and the share who left unhappy is often above the dataset average. Their reasons fall into four clusters.

Leavers put the progression point plainly: to progress clinically they had to look elsewhere, because there was no clear path where they were. Report 1 of the series makes the wider point that band ceilings, competition for posts and limited development budgets create bottlenecks in clinical roles. When the next step is only available at another trust, the next step is a resignation.

Not leaving the profession, leaving the conditions

What stands out is how many of these departures are reluctant. Nursing leavers still describe pride in the care they give and commitment to their patients and teams, and advocacy among nursing leavers is one of the most striking findings in the staff-group analysis: a majority would consider returning. That is the profile of people who would have stayed if the conditions had been different – which makes the conditions the thing to work on.

Gender and caring responsibilities run through the same story. Report 4 finds women over-represented in frontline roles where workload pressure is high, and more likely to carry primary caring responsibilities outside work. Many of the carers most affected are full-time staff whose need is predictability and modest flexibility – which in nursing means rotas.

The newest nurses: where the risk starts

Our new-starter data adds an earlier warning. Report 2 groups nursing new starters into two categories, and they look quite different:

• 33% at risk in the ‘Nursing and Midwifery Qualified’ group, the highest rate of any staff group
• About one in five at risk across all NHS new starters, with the larger ‘Nursing and Midwifery Registered’ group closer to that average

Compared with administrative and clerical starters, the qualified nursing group was one of the three with the widest gaps on a single item: regular feedback from their line manager. Capability is not the issue. Clarity and reinforcement in the first months are.

Support workers on the way up

Nursing support workers and additional clinical services staff share much of the workload and physical strain, and more often mention pay against responsibility. Some leave specifically to start nurse training they could not access in their own organisation. Our new-starter data suggests this is a group that arrives intending to stay: additional clinical services starters show a strongly anchored profile, with a majority expecting to stay three years or more. A trust that offers a structured route from support worker to registered nurse is keeping people who already want to stay.

What the data points to

• Safe staffing, workload and rota design, with predictability for staff with caring responsibilities treated as a retention measure rather than a favour.
• Clinical career pathways that people can see – specialist, advanced and leadership roles, with the criteria and the route written down and shared.
• Supportive, visible line management in nursing leadership structures, starting with regular feedback for every new starter.
• Structured routes into registered training for support staff, and recognition of the complexity of support roles.
• A returner offer for the many nursing leavers who would consider coming back: see Would they come back?

For the full staff-group comparison, see Who is leaving the NHS, and from which roles?. For the manager rhythm that protects new starters, see What NHS line managers can do in a new starter’s first 12 weeks.