Thousands of UK-trained NHS nurses are quitting every year despite efforts to boost recruitment, a union has warned.
The RCN cites a number of reasons for nurses leaving
Reasons for leaving included violence by patients and rigid working hours, the Royal College of Nursing said.
If the trend continues, the number of annual new recruits will need to double to 66,000 by 2014, its report says.
About 50,000 UK trained nurses have left or retired in the past year, with just over 20,000 recruits joining and another 12,000 coming in from abroad.
The RCN report, entitled UK Nursing Labour Market Commentary 2004/05, was published before the college's annual congress in Harrogate.
It quoted data from the NHS National Workforce Projects team which said the number of nurses retiring each year would increase from 15,000 in 2004 to 25,000 in 2014.
In addition, the RCN estimated 35,000 nurses left the profession last year for other reasons, such as starting a family, and predicted that number would increase each year over the next decade.
The college said increasing numbers of nurses were leaving the profession because of inflexible working hours, fear of violence in the workplace and dissatisfaction with changes to the pension scheme.
It said only 20,588 UK trained nurses joined the register in 2004/05, with another 12,692 nurses from overseas.
As a result, the number entering the profession annually would need to almost double from just under 33,000 in 2004 - to reach 66,000 - by 2014, the RCN said.
Dr Beverly Malone, RCN general secretary, said nurses "are coming in the front door" but "falling out the back".
"The government has not only got to pay attention to bringing them in but keeping them in," she said.
The report said overseas recruitment has accounted for 45% of all NHS intake over the past four years.
But Dr Malone said the UK's overseas nurses could easily be snapped up by another country with staff shortages in the future.
"We have to pay more attention to students and issues such as bursaries," she said.
She also called for more flexible working hours, better childcare and guaranteed pension arrangements.
A Labour Party spokesman defended the government's record saying there are 77,000 more working nurses now than there were in 1997.
"There are also more nurses in training than ever before," he said.
But Shadow Health Secretary Andrew Lansley said nurses must be given more responsibility for the NHS to retain them.
Paul Burstow, Liberal Democrat health spokesman, said: "We will sustain extra investment in the NHS and work to improve morale by a smooth implementation of the new pay deal for nurses."
How should nurses be encouraged to stay in the NHS? Have you been affected by the falling numbers of recruits? Are you a nurse, and if so, have you thought about leaving?
I can't wait to get out of nursing. I trained in the 1960s and as a result of government targets and initiatives the job satisfaction has almost completely gone. The pressure on nurses on a day to day basis is enormous and most of us just simply cannot sustain that type of pressure. At the end of a day most of us have worked unpaid overtime and without meal breaks and our family lives and personal health is affected. It is just not worth it at the end of the day.
Jan Howieson, Cambridge
Nurses are leaving the profession due to poor pay which fails to reflect the level of responsibility, abnormally high levels of work related stress and frequent verbal and physical attacks on front-line staff (such as acute admission psychiatric wards).
Peter Hyland, Sittingbourne, Kent
As a third year student nurse I've found it almost impossible to survive on less then £5,000 a year, while my outgoings are the same as any other person. Due to course commitments such as essays, dissertations and placements it is too much to expect a student to get a part time job to supplement their studies and lifestyle. This pressure is only increased if students have children. Once qualified I do not expect much of an improvement, and if this is the image portrayed, then how can it be expected to attract people to become nurses, or to stay in the profession?
Anon, Cardiff, UK
Having started my training in January of this year. I agree with Dr Beverly Malone (RCN general secretary), there is a need to pay more attention to students and issues such as bursaries. Not only to encourage new nursing students but to retain those that have started their training.
Cheryl Hunter, Canvey Island, Essex
I have always wanted to train to be a nurse but financially it has been impossible for me since the introduction of project 2000. Nurses should be paid a fair wage to train thus encouraging more people into the profession other that school and college leavers.
Is it just my imagination or do we hear about this at least once a year? Usually around RCN conference time? It's like a broken record. The net number of nurses working in the NHS has increased by tens of thousands over the past five years, in terms of both numbers of nurses, and full time equivalents. In other words, taking both the number of nurses joining the NHS and the number leaving, the overall figure has increased massively.
Tim Jones, Putney, London