Care Under Pressure

Care Under Pressure 2

Caring for the Carers – a realist review of interventions to minimise the incidence of mental ill-health in nurses, midwives and paramedics


The NHS needs healthy, motivated nurses, midwives and paramedics to provide high quality patient care but these jobs are known to be very challenging. Staff shortages, high demand and increasing external scrutiny, is associated with a high prevalence of mental ill-health amongst healthcare staff. In 2015, the King’s Fund declared stress levels among NHS staff as ‘astonishingly high’ suggesting this was a public health issue. Our work builds on a current realist review examining doctors mental ill-health (Care Under Pressure 1).

Our focus on NHS nurses, midwives and paramedics reflects the pressing recruitment and retention issues in these professions and their different experiences compared to doctors (e.g. lack of power/autonomy [nurses]; high litigation [midwives] and physical isolation [paramedics]). Nurses, midwives and paramedics are over 40% of the clinical workforce; have high rates of sickness absence due to mental ill-health with significant attrition and substantial financial implications. Changing the work environment to prevent the development of mental ill-health is preferable to alleviating ‘symptoms’, such as absenteeism and workforce attrition. Thus, strategies are needed that span the spectrum from prevention to treatment, and that target both individual and organisational behaviours.


To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related mental ill-health and determine which high-quality interventions can be implemented to minimise mental ill-health in these staff groups.


An evidence synthesis (realist review) to 1) understand when and why nurses, midwives, and paramedics develop mental ill-health at work, and where and how it is most experienced, 2) identify which strategies and interventions to reduce mental ill-health work best for these staff groups, how these work, and in what circumstances they are most helpful. We will engage with diverse stakeholders throughout (e.g. nurses, midwives and paramedics who have experienced mental ill-health, service managers, policy makers) to 3) design and develop resources for NHS managers/leaders to improve the mental health of nurses, midwives and paramedics in the workplace.

For more information:

Project website

Care Under Pressure 2: workplace psychological ill-health for nurses, midwives and paramedics – University of Surrey (


Delivering healthcare: a complex balancing act.
A guide to understand and tackling psychological ill-health in nurses, midwives and paramedics.
Available here

Key Publications

Taylor C, Maben J, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K (2024). Care Under Pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics. BMJ Qual Saf DOI: 10.1136/bmjqs-2023-016468

Maben J, Taylor C, Jagosh J, Carrieri D, Briscoe S, Klepacz N & Mattick K. Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review. Health and Social Care Delivery 2024;12(9).

Taylor C, Mattick K, Carrieri D, Cox A, Maben J. (2022). ‘The WOW factors’: comparing workforce organization and well-being for doctors, nurses, midwives and paramedics in England. British Medical Bulletin141(1), 60-79.