A report from the Royal College of Nursing (RCN) looking at career progression of nurses working directly for the NHS across the UK nations shows the scale of the problem of career progression facing NHS nurses. The Left Behind report shows that too many nurses remain as a band 5 for years, with implications for staff morale, patient care and the sustainability of the health service.
In England, 44% of nurses are employed at band 5, with similarly high figures in Scotland (53%), Wales (44%) and Northern Ireland (49%). Compared to other health professions, nurses are more than twice as likely to remain at band 5 than allied health professionals. This is despite many current nurses reporting that their role should be at a higher band – 68% of respondents to the RCN’s 2025 employment survey said their band or pay level was either inappropriate or very inappropriate and many respondents explained that they often had the same responsibilities as band 6 nurses.
As well as this variation between nations, there is unexplained variation between regions, local areas and even across similar types of providers. For example, across acute teaching NHS trusts in England, the proportion of nurses at band 5 varies from 62% in Hull University Teaching Trust to 36% at Guy’s and St Thomas’ NHS Foundation Trust.
The report also found that nurses from certain ethnic groups, including Asian or Asian British and black or black British, are twice as likely to be at band 5 than those reporting white ethnicity.
This has an impact on patient care – research published in 2023 found that employing higher banded nurses saves lives: an extra one percentage point of planned registered nurse hours filled by a band 5 nurse is associated with a 1.1% reduction in the odds of patient death, compared to 1.6% and 2.4% reductions for a band 6 and 7 nurse respectively.
Improving career progression can also reduce the rate of nurses leaving the profession which is associated with higher productivity, lower costs, improved team knowledge, and retention of other staff groups. Analysis performed by the authors estimates that band 5 nurses are around 17% more likely to leave NHS hospital and community services or the staff group than those at band 6, even after standardising for age.
The report was primarily authored by Dr William Palmer, RCN Director of Research and Emily Maynard, RCN Senior Research and Innovation Analyst, with significant contributions from Professor Jane Ball, Director of RCN Institute of Nursing Excellence, Michelle Woods, RCN NI Senior National Officer, and Wendy Preston, RCN Head of Nursing Workforce.
In England, 44% of nurses are employed at band 5, with similarly high figures in Scotland (53%), Wales (44%) and Northern Ireland (49%). Compared to other health professions, nurses are more than twice as likely to remain at band 5 than allied health professionals. This is despite many current nurses reporting that their role should be at a higher band – 68% of respondents to the RCN’s 2025 employment survey said their band or pay level was either inappropriate or very inappropriate and many respondents explained that they often had the same responsibilities as band 6 nurses.
As well as this variation between nations, there is unexplained variation between regions, local areas and even across similar types of providers. For example, across acute teaching NHS trusts in England, the proportion of nurses at band 5 varies from 62% in Hull University Teaching Trust to 36% at Guy’s and St Thomas’ NHS Foundation Trust.
The report also found that nurses from certain ethnic groups, including Asian or Asian British and black or black British, are twice as likely to be at band 5 than those reporting white ethnicity.
This has an impact on patient care – research published in 2023 found that employing higher banded nurses saves lives: an extra one percentage point of planned registered nurse hours filled by a band 5 nurse is associated with a 1.1% reduction in the odds of patient death, compared to 1.6% and 2.4% reductions for a band 6 and 7 nurse respectively.
Improving career progression can also reduce the rate of nurses leaving the profession which is associated with higher productivity, lower costs, improved team knowledge, and retention of other staff groups. Analysis performed by the authors estimates that band 5 nurses are around 17% more likely to leave NHS hospital and community services or the staff group than those at band 6, even after standardising for age.
The report was primarily authored by Dr William Palmer, RCN Director of Research and Emily Maynard, RCN Senior Research and Innovation Analyst, with significant contributions from Professor Jane Ball, Director of RCN Institute of Nursing Excellence, Michelle Woods, RCN NI Senior National Officer, and Wendy Preston, RCN Head of Nursing Workforce.
