Of all the senior searches we run in healthcare, the hardest to fill right now are not medical director or clinical leadership posts. They are senior nursing roles: Chief Nurses, Directors of Nursing, Deputy Chief Nurses and the divisional heads of nursing who sit beneath them.
Over the last eighteen months we have run 17 of these searches for NHS trusts and private healthcare groups in England and Scotland. They took longer, produced thinner shortlists and fell through more often than any other healthcare leadership work we do.
The size of the gap
A few numbers from our own searches tell the story.
Median time to shortlist was 34 days, against 21 days across the firm as a whole.
Shortlists averaged four candidates, where we would usually present five.
Around 40% of shortlisted candidates were within five years of their expected retirement date.
Three of the 17 searches were re-run after the preferred candidate withdrew, twice because their current employer made a counter-offer.
The pool is not empty. But it is small, it is ageing, and the next generation of nurse leaders is not stepping up at the rate the system needs.
Why it has widened
Candidates and clients gave us broadly the same explanations.
The step from deputy to executive director has become a large one. A Director of Nursing carries board accountability for quality and safety, regulatory exposure, and in many organisations a portfolio that has grown to include patient experience, safeguarding, infection control and workforce. Several deputies we approached told us the pay difference was not worth the risk.
Pay compression is part of it. In some trusts, an experienced deputy with on-call allowances earns within 10% of the executive above them.
And the pipeline thinned during the pandemic years, when development programmes were paused and many senior nurses who might have stepped up chose to stay where they were or retire early.
What NHS trusts are doing differently
The trusts that filled these roles well in the past year did three things consistently.
They split the portfolio. Two trusts we worked with moved workforce and patient experience out of the Director of Nursing role and into separate posts. The resulting roles drew noticeably stronger fields.
They grew their own deputies deliberately. One acute trust in the Midlands paired each divisional head of nursing with a non-executive mentor and gave them a defined board-facing project. Within a year, two were credible external candidates for executive roles, and one was appointed internally.
They widened where they looked. Several boards opened their search to senior nurses from community and mental health services, and from the independent sector, rather than limiting it to acute trust experience.
What private groups are doing differently
Private hospital and care groups face a different problem. They can usually pay more, often 15 to 25% above the equivalent NHS band, but candidates are wary of giving up NHS pension benefits and of a culture they fear will be commercially driven.
The groups that have hired well have addressed those concerns directly:
setting out pension arrangements at first interview, with a like-for-like comparison
putting the Chief Nurse on the executive committee, with a direct line to the board’s quality committee
offering protected clinical time, typically one day a fortnight, so candidates keep their practice current
being explicit about how clinical concerns are escalated and who has the final word
One group we worked with lost two preferred candidates in 2025 on exactly these grounds. After changing its approach, it filled its next two senior nursing roles from the first shortlist.
What we would advise
For any organisation planning a senior nursing appointment in the next year, three practical points.
Allow more time than you would for other executive roles. We now plan for sixteen weeks from brief to offer, not twelve.
Look hard at the portfolio before you go to market. A role that carries everything will attract the people who are willing to carry everything, which is not always the same as the best people.
And invest in the deputies you already have. The shortage is real, but much of the future supply is already working in your organisation, waiting for someone to make the next step look possible.
