Low remuneration and nurse turnover in the NHS in England: a critical analysis

Abstract

There is a shortfall of nurses and growing nurse attrition globally, which have been attributed to a range of systemic factors, including inadequate pay. In the UK NHS, the effectiveness of the Agenda for Change (AfC) pay structure in resolving historical and persistent nursing income challenges is increasingly being questioned. This article provides a critical examination of the literature, NHS workforce data, economic analyses and policy documents to explore the extent to which low remuneration drives nurse turnover in England. The author discusses pay inequities in nursing in the context of comparable professions, diversity and equality, and examines how AfC reforms in Scotland and international healthcare funding structures could inform policy change in the NHS in England. Finally, the author considers some implications for nurse managers in relation to translating workforce research into practical strategies for improving nurses' pay and working conditions.