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The nursing workforce is critical in the provision of safe, effective, high quality compassionate care. Evidence and experience show that having the right numbers of nursing staff, with the right skills, in the right place, at the right time improves health outcomes, the quality of care delivered and patient safety.

Registered nurses must set the standard for nurse staffing and be assured that the nursing workforce is safe for the acuity and dependency of those they care for. We know that a lack of nursing leadership and relevant support structures within organisations impacts on safety, quality of care and patient mortality, as well as the mental health and general wellbeing of the nursing workforce.

Our members deliver care across a variety of settings, including:

• hospitals
• care homes
• homes
• prisons
• primary care settings  Nursing care is delivered in an increasingly clinically complex environment.

Employers need to pay attention to factors that will aid recruitment and retention of nursing staff. Employment terms and working conditions are key factors in recruiting and retaining nursing staff. Too many good nursing staff are leaving, while potential recruits are reluctant to join the nursing profession and are choosing other careers. To address this there needs to be investment in and attention to working conditions, starting with pay.

These standards set out what we believe nursing staff should expect when they are employed to deliver care in independent health and social care settings.

Employers should have transparent pay, terms and conditions, including pay scales, job evaluation schemes and policies that are applied equitably to all staff.

In addition, the RCN Nursing Workforce Standards explicitly set out what must happen within workplaces to ensure the delivery of safe and effective patient care.

Rates of pay

When employment starts, the minimum starting hourly rate for any employee should at least match the Real Living Wage set by the Living Wage Foundation. Pay scales must be built on the Real Living Wage with nursing support workers receiving higher pay to recognise the enhanced skills they need to deliver care. Registered nurses should also have higher pay rates to recognise the additional autonomy, skills and knowledge they have in their roles.

As of April 2024, the minimum starting salary for nursing staff should be:

• a minimum of £27,500 per year pro rata (£14.10 per hour) for nursing support workers
• a minimum of £35,000 a year pro rata (£17.95 per hour) for registered nurses.

Employers should have a transparent pay policy which sets out pay structures and the criteria for how pay is increased annually to reflect changes in the cost of living.

Pay increases should be decided with the engagement of staff, this could be through recognised trade union representatives where RCN representatives negotiate on behalf of our members. When the rate of inflation is higher than annual pay increases, staff are effectively experiencing a pay cut.

Unsocial and additional hours

Staff should be compensated for the additional costs and inconvenience of working unsocial or additional hours at levels that at least match the below enhanced rates. These enhanced payments are in addition to the pay rate for delivering nursing care:

•  hours worked between 8pm and 7am – time and one third
• overtime – time and a half
• weekend rates – time and a half
• bank holidays – double time.

Some employers offer an enhanced rate of pay, where additional costs for working unsocial hours are incorporated into an employee’s contracted hourly rate for all hours worked. If applicable this should be clearly set out in the member’s offer and contract of employment.

Pay progression

The RCN believes that all employers should have a clear policy and structure relating to pay progression. This is an essential part of recognising the knowledge, skills, and experience of nursing staff. Staff should have their knowledge, skills, experience, development, and training recognised, demonstrating their growth in their role as their length of service increases. The pay progression policy and framework should be additional to annual cost of living increases.

Job evaluation

Job evaluation schemes are used as the basis for fair pay systems. Job evaluation is an objective method of accessing, comparing and evaluating the responsibilities, skills and impact of different roles to determine the appropriate rate of pay. When implemented effectively it ensures that employees are rewarded appropriately for their work, creating a motivated and equitable workplace, promoting equal pay and adding to an employer’s credibility. Any job evaluation scheme should be able to demonstrate that it measures equal pay for work of equal value, meeting equal pay legislative requirements and promoting equity in pay scales and rates.

Employees should also have a fair and transparent process by which to request a pay review or job evaluation if they believe that their role has changed beyond their current job description. Job descriptions should be reviewed whenever changes to the role occur and as part of an appropriate employee appraisal system. Where employees are identified as delivering more than their existing job description, there should be recognition of this.

The job description should be reviewed and reassessed, with pay adjusted to reflect the work being undertaken.

Pension

Providing an enhanced pension package, at least comparable to the NHS pension scheme helps recruit and retain staff. The RCN’s position is that all nursing staff should have access to good quality, sustainable pension provision. Employers who adopt a similar position can see increased employee engagement and retention which improves productivity and can reduce costs associated with recruitment.

Employer contributions should exceed employee contributions. To encourage increased uptake of pension engagement, employers should offer a tiered scheme for employees to increase their pension contributions with corresponding increases in the employer contributions.

A policy allowing staff to retire, access their pension and return to work, perhaps with different working hours or patterns, can support staff to continue to provide excellent nursing care while working fewer hours, without the stress of worrying about how they will cover bills.

Employer liability and insurance cover

Employers have vicarious liability for their nursing staff and therefore require employer indemnity insurance to insure employees’ work.

All employers should display the policy they have at the work base and provide confirmation to nursing staff that the necessary employer and public liability insurance policies insuring nursing staff are in place.

Occupational sick pay

All employees should have contractual sick pay from commencing employment in health and social care. This is not just an employment matter but a matter of infection control.

If staff are unwell and only entitled to statutory sick pay, they are more likely to be under financial pressure to attend work because they cannot afford to live on it. This is a risk for staff, patients and clients.

Providing staff with contractual sick pay reduces presenteeism (working when unwell and/or potentially infectious) and therefore reducing the risk of the spread of a disease, increasing both patient safety and staff wellbeing. Contractual sick pay helps maintain income compared to the low level of statutory sick pay and supports staff with recovery and their return to work.

On commencement of employment, nursing staff should be afforded a minimum of 1 month’s full pay and 1 month’s half pay when off sick, increasing by 1 month’s full and 1 month’s half-pay every year up until 6 years of service.

Parental leave

Provision for time off, more than the statutory minimum requirements, helps employees feel valued by the employer, improves recruitment and retention, staff morale, career satisfaction, the working culture and the employer’s reputation.

The RCN expects that the following occupational/contractual maternity pay is: 8 weeks’ full pay including the relevant statutory pay; 18 weeks’ half pay, plus the relevant statutory pay; then the remaining statutory full pay; 13 weeks of the relevant statutory pay; 13 weeks’ unpaid leave.

If an employee’s baby is stillborn after the end of the 24th week of pregnancy, the expectation is that the employee would be entitled to the same amount of maternity leave and pay as if their baby was born alive.

Upon return from maternity leave a risk assessment should be carried out to ensure the provision of a safe working environment.

Paid time off and flexibility to attend appointments should also be provided for employees going through fertility treatment.

Occupational/contractual adoption pay should match the additional maternity pay. With agreement, occupational adoption pay may be paid in a different way, for example a combination of full pay and half pay, or a fixed amount spread equally over the adoption leave period.

Paternity pay

Staff should also have contractual/occupational entitlement to a minimum of 2 weeks’ paternity leave paid at their normal rate of pay.

Annual leave

The RCN believes that all staff must have an appropriate provision of time off work to support a work-life balance, physical and mental wellbeing.

On commencement of employment, employees should be afforded a minimum of 27 days of annual leave plus 8 bank holidays or more bank holidays if recognised nationally. After 5 years of service, employees should be awarded a minimum of an additional 2 days of annual leave, with a minimum of a further 4 days after 10 years of service.

Flexible working

Flexible working arrangements help employees to balance home and work life. The availability of flexible working can boost morale and encourage longevity of employment as it allows members of staff to feel supported and valued.

Employers should support opportunities for employees to work flexibly where possible, with the criteria for doing so set out in a policy that is applied fairly to everyone. Flexible working, if offered, can also reduce your agency spend, as one of the key drivers for nurses working for agencies is flexibility.

Flexible working should not simply be available but implemented and utilised as a recruitment and retention incentive. All posts should be included for consideration of flexible working including, for example more senior roles.

Domestic leave

Employees should have 5 days (1 working week) of paid special leave for unavoidable domestic situations, this can include but is not limited to bereavements, damage to property, compassionate leave.

Carer/emergency leave

Over 90% of nursing staff are women, many with caring responsibilities. Employees should have 5 days (1 working week) of paid special leave for dealing with emergency caring related situations.

Nursing staff should have easy access to, and be able to self-refer to, free confidential occupational health services and counselling/employee assistance programmes.

Employers must consult with staff or their trade union representatives on matters affecting the health and safety of employees.

Breaks

Breaks are an important contributor to both staff wellbeing and patient safety. As such, staffing, rosters and facilities should allow for staff to have uninterrupted breaks.

Uninterrupted breaks allow for workers to rest, recuperate, rehydrate and refuel. Breaks during the working shift are vital.

Staff working 10 hours or more should be afforded a minimum of 45 minutes of uninterrupted break(s) and at least a 20-minute break if working 6 hours or more (but less than 10 hours). This could be provided as a single break or multiple breaks to provide the best possible rest period. If staff are required to remain at work during their break, the RCN expects that their breaks should be paid breaks. If a staff member’s break is interrupted, they should be afforded a compensatory break later in the shift.

Staffing levels and rosters should allow for staff to have uninterrupted breaks, and there should be facilities in place for them to have their breaks in a separate area which is appropriate for eating, drinking, and rest.

Wellbeing support

All staff should have access to an employee assistance programme and occupational health services, as well as access to physiotherapy and counselling services.

Incident reporting and action

There should be an open, transparent and easy to use reporting system for any incident, error, near miss or accident in the workplace. The system should be able to record all the facts.

There should be an organisation-wide approach to incident reporting that promotes a fair process to uncover the source of errors or mistakes and the appropriate learning from them, rather than seeking to apportion blame. This aids an open and honest reporting environment that results in a quality learning culture, psychologically safe environments, and improved patient safety and care.

Employee voice

Giving employees a voice allows them to express matters that are important to them and can help improve the employer/employee relationship and therefore effectiveness and organisational performance.

Trade union recognition and facility time

Supporting employees to become a trade union representative affords many benefits to employers including being able to address issues swiftly and before they escalate, along with being able to access the RCN’s health and safety and learning resources.

Having trained workplace representatives in place also ensures productive dialogue with members of staff and promotes feelings of being well supported. To undertake this role effectively, any member of staff becoming an RCN rep should be granted paid facility time.

The Health and Safety Executive (HSE) has reported that health and safety representatives are highly effective in improving safe working practice.

Equity, diversity, inclusion and belonging

Employers should be able to demonstrate sustained investment and improvement in ensuring that their workplaces are fully inclusive in culture and are anti-discriminatory in the delivery of outcomes for staff at every level of the organisation.

Employers should ensure that there is visible leadership in this area with high levels of accountability so that staff have complete clarity about who is responsible for this work and how they can be reached should they have concerns about their workplace experience. Employees must also work to create psychologically safe workplace environments that enable the diverse experiences of staff to be shared and appropriately responded to.

RCN members

These standards set out what you should expect from your employer.

Use these standards to discuss and negotiate your starting terms and conditions or to improve your current ones.

Use these standards when meeting with your local MP to ensure they are supportive and include references to our positions in parliamentary meetings.

RCN representatives and staff

These standards set out what you should seek from employers on behalf of members.

Use these standards as a baseline for negotiations about pay, terms and conditions.

Use these standards when meeting with MPs to ensure they are supportive and include references to our positions in parliamentary meetings.

Employers

These standards set out what you should do to provide fair employment standards for your nursing staff. Build these standards into your contracts of employment.

Use these standards when negotiating contracts with commissioners and funders.

Commissioners of nursing services/care

These standards set out the key employment principles and practices that you should be seeking to assure against from service-providing contractors that employ roles within the nursing workforce.

When tendering for services, you should ensure that the successful bidder adheres to these employment standards, as a minimum.

Politicians and decision-makers

These standards set out the key principles that you should ensure are built in to employment practices for nursing services, including providing appropriate funding to deliver these standards.