A new analysis of NHS Staff Survey data suggests that young nursing staff are the least satisfied with their jobs – and are doing the most paid overtime to supplement their incomes.
The findings, contained in a new report by the Nuffield Trust, have been described as a “ticking time bomb” by the Royal College of Nursing (RCN), which has called on government ministers to step in.
“Young nursing staff are the future of the workforce, but those at the start of their careers are the most unhappy”
Nicola Ranger
Nuffield Trust’s new report, titled ‘What does the NHS Staff Survey tell us about the changing behaviours and motivation of healthcare staff?’, was published today.
It analysed more than one million responses from clinical staff, including nurses, healthcare assistants, midwives and allied health professionals, to NHS Staff Surveys between 2003 and the most recent one from 2023.
Those behind the study said it was the first ever to examine how survey responses have changed over time between different age groups.
The findings suggested that younger and older staff’s relationship with some aspects of work have diverged significantly in the last two decades, and that their experiences in general are very different.
The data showed that stress levels in the youngest age group had increased sharply over the period and were now higher than any other age group.
Stress levels among staff aged 21-30 rose from 38% in 2013 to 52% in 2023, while among workers aged 51-65 they decreased from 43% to 40%.
A major change was observed over time in relation to levels of job satification between the age groups.
In 2013, the proportion of staff saying they “never” or “rarely” looked forward to work was similar regardless of age.
However, by 2023, the percentage of unsatisfied 21-30-year-olds was more than triple that of the oldest age group, increasing from 12.5% of young people to 15% in 10 years.
A similar pattern was seen in relation to staff’s views of their work-life balance and pay.
After starting at a similar point 20 years ago, the percentage of staff in the youngest age group believing they had a good work-life balance has decreased over time, while in the oldest age group it increased.
Around 50% of people aged 21-30 said they strongly agreed, or agreed, that they had a good work-life balance in 2023, compared to around 55% for staff aged 51-65, and 70% for staff aged 66 or older.
Similarly, in 2013, there was very little difference between age groups in terms of satisfaction with pay – with roughly 10% of all ages ticking “strongly disagree” when asked if they are satisfied with pay.
In 2022, more than 30% of people aged 21-30 said they were dissatisfied with pay, compared to around 27% of staff aged 31-40, around 21% of 41-50-year-olds, around 19% of staff aged 51-65, and around 13% for 66+.
Pay satisfaction increased across all age groups between 2022 and 2023, with 22% of people aged 21-30 indicating they were unhappy with pay in the latest staff survey, although this was still much worse than 10% a decade ago.
Nuffield Trust’s report also looked into the rates of staff performing paid and unpaid overtime.
Paid overtime was another area where the age groups have diverged over time. In 2013, the difference between the age groups most commonly undertaking six or more hours of paid overtime was less than 5%.
In 2023, 30% of 21-30-year-old clinicians reported undertaking six or more hours of paid overtime, compared to roughly 20% for staff in the oldest two age groups.
“This may reflect rising financial pressures faced by younger NHS staff, potentially driven by factors like increasing housing costs and wage stagnation,” said the report.
Meanwhile, the difference between age groups for rates of unpaid overtime remained largely the same, challenging assumptions about younger workers not wanting to work longer hours in recent years.
Older workers still reported performing six or more hours without pay far more often: 16% of people aged 51 or older said they did in 2023, compared to around 7% for staff aged 21-30.
Both the RCN and the Nuffield Trust, following the publication of this new data, have called on NHS leaders, employers and the government to do more to improve staff wellbeing and retention.
Nicola Ranger
RCN general secretary and chief executive Professor Nicola Ranger aired her concern at the findings.
“Young nursing staff are the future of the workforce, but those at the start of their careers are the most unhappy,” she said.
“A new nurse today is likely to face extreme pressure in severely understaffed services, with stagnant pay and little prospect of progression.
“In these conditions, it is little wonder so many feel undervalued and overworked.”
The issues facing nurses at the start of their career, who are more likely to be younger, have been brought to light recently by Nursing Times surveys showing gaps in the provision of preceptorship, a key support and wellbeing structure for this staff group.
Meanwhile, nursing staff of all age groups will have been impacted by pay disputes in recent years.
Professor Ranger continued: “The number of people leaving within the first years of their career has skyrocketed, while applications to study nursing are in collapse.
“Ministers need to realise you cannot fix a broken NHS without making nursing a more attractive career, starting with a proper pay rise and new investment to grow the workforce.
“That’s how you support staff to deliver care the way they want to and improve job satisfaction.”
Thea Stein, chief executive of the Nuffield Trust, added: “The traditionally tough start faced by the youngest staff has got even tougher over the past decade, with Gen Z NHS workers now having to manage exams, early career demands and learning the job in potentially overstretched services alongside escalating cost-of-living pressures.
“Our findings raise real concerns around the NHS’s ability to retain its youngest workers, who are just at the start of their careers but are increasingly unhappy.
“The future of the health service depends on these workers. It is vital policy-makers and employers now act on what the NHS’s own staff poll shows us about what the next generation of clinicians need to stay and thrive in the NHS.”
