The occupational status of nurses and midwives in England and Wales
Case study details
| Metadata item | Details |
|---|---|
| Publication date: | 17 September 2026 |
| Owner: | Office for National Statistics (ONS) |
| Contact: | SRS.Impact@ons.gov.uk |
Challenges for the healthcare system
The UK healthcare sector faces considerable sustainability challenges. Although increasing nursing training places is a major workforce priority across the UK, applications have declined in recent years. At the same time, a notable proportion of nursing posts continue to be filled by internationally trained professionals. As NHS England seeks to reduce dependence on overseas recruitment, policymakers will need to explore a wide range of options to secure a sustainable nursing workforce.
Investigating the occupations of registered nurses
This study, undertaken by researchers at Edinburgh Napier University, aimed to examine whether those registered as nurses were actually working in clinical practice. Nursing and midwifery degrees offer broad, transferable skills, which means some graduates may pursue careers outside their profession. These individuals represent a potential source of workforce capacity that could be drawn back into clinical roles.
The team were therefore interested in the gap between being registered to practise and working in a nursing or midwifery occupation. These professions make an essential contribution to health and social care across the UK, and a large workforce is required to sustain these services. Therefore, it is important that we understand this gap to help with workforce planning.
New linked register data
The team at Edinburgh Napier University were guided by stakeholders from the Nursing and Midwifery Council (NMC), the Nuffield Trust (leaders in healthcare workforce policy), and UK policy makers. The team used de-identified data from the Nursing and Midwifery Council Register Linked to Census 2021 to complete their study.
Together, the linked data allowed the researchers to examine who was working as a registered nurse and how this varied according to demographic and professional characteristics including:
- age
- sex
- ethnicity
- country of training
- field of nursing
- length of time on the register
- wider household and health factors
Findings
Analysis of preliminary findings showed that 88.5% of employed registered nurses were working in clinical roles at the time of the 2021 Census. Among the 11.5% of registrants working outside clinical roles, many held roles in health and public health management, higher education, care management, and other health and safety roles.
There was also a difference observed in the proportion of trained staff in clinical roles by place of training. More nurses trained outside the UK and EU/EEA were recorded as working in clinical roles than those trained within the EU or a UK nation.
Policy implications
These findings suggest that workforce planning should not assume that there is a large, untapped pool of registered nurses working in unrelated occupations who could readily return to direct clinical practice. Instead, policymakers will need to consider increasing workforce capacity through recruitment, retention, and support for the existing workforce.
The high proportion of internationally trained nurses working in direct clinical roles demonstrates their importance to the functioning of the healthcare system. These findings provide evidence to inform workforce planning, emphasising the need for policies that support the recruitment, retention, and long-term integration of internationally trained staff.
The study also demonstrates the value of linking professional registration and Census data to provide a more comprehensive picture of the workforce. Using this linked data has enabled the team to provide new insight into the actual occupations in which registered nurses work.
About the ONS Secure Research Service
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About the authors
Iain Atherton
Iain Atherton is a professor of nursing and data science at Edinburgh Napier University. He remains a registered nurse and has previously practiced in neurology and infectious diseases. He is passionate about the nursing profession, and the contribution data can make to workforce policy.
Michelle Jamieson
Michelle Jamieson is a Research Fellow in Data Science at Edinburgh Napier University, working with ADR Scotland. Their research uses linked administrative and population data to investigate the healthcare workforce, population health and inequalities, alongside methodological questions in quantitative and data-intensive research.