Why are nurses facing forced demotion?

Professor Alison Leary MBE is Chair of Healthcare & Workforce Modelling LSBU and lead researcher for a new survey by the Queen’s Institute of Community Nursing (QICN) to determine how registered nurses and nursing support workers are being affected by forced demotions in their career.

Nursing is the lowest paid of all graduate professions in the NHS. Alongside a difference in pay, anecdotally we see issues with nurses and nursing support workers being forced to take lower paid roles despite having years of experience.

Why is this workforce having to effectively face demotion?

Many tell us that this is to be able to work flexibly – to get the hours they need to support roles as informal carers of children, grandchildren or older adults, they leave jobs for lower paid roles.

Despite having the right to ask for flexible working, we still hear that employers are refusing flexible working or that they are implementing a policy such as being told they can’t work part time on the grade they are currently on – “band 7s/ matrons/ Sisters can’t work part time here-it’s policy” is something I frequently hear. It’s a similar story for those who can’t work long days and find a lower-band job that gives them the hours they need or to accommodate their physical and mental health.

Taking a pay cut to get professional development

In some areas of nursing it’s simply accepted that experienced registered nurses and nursing support workers will take a lower grade of pay to get access to professional development. To undertake the District Nursing Specialist Practice Qualification for example, experienced community nurses often must accept a significant cut in pay grade (to a band 5) and there is no guarantee of returning to their previous grade when the course has been completed. District Nursing has seen a decline in numbers of around 50% in the last ten years, yet promises to move care to the community require skilled community workers.

Pay grades reduced through workforce reviews

We are also increasingly being told about workforce reviews or restructuring in which pay grades in the NHS and other sectors are being reduced – effectively, experienced nurses must accept working at a lower pay grade or leave their work. This also results in a lack of opportunity with only lower grade jobs available, if any at all.

One of the earliest projects I worked on was the devaluation of the role of Clinical Nurse Specialist and we have seen this role drift down in banding for the last 20 years. The last time I scraped NHS jobs in 2024 almost 50% of “Sister/ Charge Nurse” jobs were offered at a band 6.

‘Sticky floor’ holds back female workforce

This is a problem for several reasons. The first is that nursing retention is becoming more of an issue. There are jobs in areas such as retail and industry, often with benefits and a more holistic approach to flexible working that mean employers are more appealing.

The second is that the nursing workforce is predominantly female – 89% of registered nurses in the UK are women. This means they are already disadvantaged in terms of pay and progression. This phenomenon is known as the “sticky floor” (as opposed to the glass ceiling) which can hold back part time workers, women and people from the global majority.

Share your experience: take the survey

The QICN are interested in hearing about the experiences of any member of the nursing workforce, working in any setting, in any role in any part of the UK who has experienced this

Have you had to take a job at a lower band/pay to get the hours, opportunities or any other reason? Complete the QICN survey before the end of June 2025.