GLOBAL – A damning report from the United Kingdom's Royal College of Nursing (RCN) has exposed a deepening crisis within the National Health Service (NHS), with two-thirds of nursing staff reporting they have worked while unwell. The findings, released on Monday, 17 November 2025, EAT, have significant implications for the thousands of Kenyan nurses who have relocated to the UK, many under a bilateral labour agreement, only to find themselves in an overstretched and under-resourced system.

The RCN survey of over 20,000 nursing staff across the UK found that 66% had worked when they should have taken sick leave, a sharp increase from 49% in 2017. Stress was cited as the primary cause of illness by 65% of respondents, up from 50% eight years ago, marking an eight-year high for both metrics. The report paints a grim picture of a workforce at its breaking point, with seven out of ten nurses working beyond their contracted hours weekly, and over half of them doing so unpaid.

Professor Nicola Ranger, the RCN Chief Executive, stated that nursing staff are being "driven to ill health" by systemic understaffing. "Nursing staff strive to do their best for every patient on every shift, but they are left with the impossible task of caring for dozens and sometimes over a hundred at a time… the reality is they’re not breaking; many are already broken," Ranger said. The NHS in England is currently grappling with more than 25,000 nursing vacancies.

The Kenyan Connection: A Deal Under Strain

These revelations are particularly resonant in Kenya, which signed a bilateral agreement with the UK in July 2021 to facilitate the recruitment of unemployed Kenyan health professionals into the NHS. The deal was presented as a "win-win," aiming to address the UK's critical nursing shortages while providing Kenyan nurses with employment and international experience. The agreement is specifically open to Kenya's surplus of qualified but unemployed health workers.

As of October 2024, at least 307 Kenyan nurses had been deployed to the UK under this framework. However, the RCN's findings suggest these nurses have entered a system where immense pressure is the norm. The bilateral agreement stipulates that Kenyan recruits should receive the same employment conditions as their UK counterparts, which includes exposure to these challenging workplace realities. The strain is further compounded by previous RCN reports highlighting a 55% rise in racist incidents against nurses, raising additional safety and wellbeing concerns for foreign staff.

A Global Crisis with Local Roots

The migration of Kenyan nurses is driven by a complex mix of factors. In Kenya, nurses often face high patient-to-nurse ratios and lower pay. While the World Health Organization recommends a ratio of 83 nurses per 10,000 people, Kenya's ratio has been reported to be as low as 25 per 10,000, and in some cases even lower. One nurse recounted working in a Kenyan ward with a 1:40 nurse-to-patient ratio, compared to a typical 1:8 ratio in the UK. This stark contrast in staffing, alongside the prospect of higher remuneration, makes opportunities abroad highly attractive.

However, the RCN report suggests the trade-off may be more complex than anticipated. While escaping local challenges, Kenyan nurses are entering a system where workforce shortages are causing burnout, panic attacks, and nightmares among staff, according to calls received by the RCN's support lines. The pressure to work while ill stems from a desire not to leave colleagues even more short-staffed in overwhelmed departments.

The UK government and NHS continue to rely heavily on international recruitment to fill workforce gaps, with nearly half of all new nursing registrations in 2022/23 coming from outside the UK. For Kenya, this dynamic fuels the ongoing "brain drain" debate, where the country invests in training healthcare professionals only to see them depart for more developed nations. The long-term solution, as advocated by the RCN, is urgent and substantial investment to grow the domestic nursing workforce in the UK, ensuring a safe environment for both staff and patients. For the Kenyan nurses caught in the interim, the promise of a better career abroad is being tested by the harsh realities of a health service in crisis.