New Report Reveals ‘Trap Door’ Causing Career Regression in Nursing
26 November 2025
The Queen’s Institute of Community Nursing (QICN) has published a new report, The Trap Door: Understanding Career Regression in Nursing, revealing a widespread and largely overlooked issue within the profession – the downward movement of highly experienced nurses into lower-paid or less senior roles.
Produced by the QICN’s International Community Nursing Observatory (ICNO) which is led by Professor Alison Leary MBE, the report explores the issue of ‘downbanding’ within the NHS Agenda for Change pay structure. It introduces the concept of the ‘trap door’, where skilled professionals are not only prevented from progressing but are actively pulled back into lower pay bands.
Drawing on 579 survey responses, the study found that over 80% of respondents had experienced career regression, with most having more than 20 years on the Nursing and Midwifery Council register. Many were experienced clinicians – including Clinical Nurse Specialists, District Nurses and General Practice Nurses – whose expertise is vital to patient care and the stability of the health service.
The most common reasons cited for stepping down included:
- Lack of flexible working options – the leading driver of regression.
- Organisational restructuring and redundancies.
- Bullying and toxic workplace culture.
- Burnout and health issues.
- Undervaluing of skills and blocked progression.
The findings expose systemic inequities and cultural barriers within workforce policy, with inflexible management practices and limited recognition of nursing expertise driving experienced professionals out of senior roles.
The report calls for urgent policy reform and cultural change to ensure fair career progression and to retain experienced nurses within the workforce.
We talk a lot about the ‘glass ceiling’ and the ‘sticky floor’, but our research shows there’s also a trap door – and experienced nurses are falling through it. Many are being forced to choose between their health, family life and their professional standing.
Professor Alison Leary MBE, Director of the International Community Nursing ObservatoryWhen our health and care workforce are a cornerstone of high quality safe and effective care, it is tragic to identify significant evidence that suggests our workforce are struggling to find careers that enhance their professional identity and enable them to flourish in their workplace contexts.
Professor Sally Hardy, Director, Norfolk Initiative for Coastal and Rural Health EqualitiesThese findings are very worrying with over 80% of respondents having experienced career regression, and the majority being very experienced clinicians. This included Clinical Nurse Specialists, District Nurses and General Practice Nurses; the expertise of these nurses is critical to safe delivery of care.
The reasons given are not acceptable and very concerning, when we see on a daily basis the results of not having enough nurses in post: the harms to patients due to lack of capacity and the stress and burnout for staff involved. We have to ensure a more flexible approach if we are to retain a skilled and competent nursing workforce.
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