A hospital trust in Staffordshire has become the latest to announce job cuts in an effort to save costs.
Morale among nurses is "plummeting" says a professional body
Mid Staffordshire General Hospitals NHS Trust is to cut more than 150 jobs to make savings of £10m next year.
A spokesman said most of the job losses would come from managerial and support services to try to minimise the impact on patient care.
The trust is expected to make a small surplus this year, but needs to make savings in the next financial year.
It runs two hospitals - the 404-bed Staffordshire General Hospital in Stafford and the 107-bed Cannock Chase Hospital.
Between them they also serve people in Cannock, east Staffordshire, Sutton Coldfield and north Birmingham.
The spokesman said staff interested in early and voluntary retirement would be asked to come forward, but that some compulsory redundancies may be required.
Chief executive Martin Yeates said the trust had instigated changes, including a ban on the use of agency staff, over the past 12 months.
Mr Yeates said: "In order to move to achieve our commitment of excellent, accessible and sustainable services, tough decisions need to be taken now rather than reacting half way through next year.
"Our proactive position will ensure that we continue to develop services whilst maintaining financial balance."
More than 4,000 job losses have been announced at hospitals across the country over the past few weeks.
Healthy union Unison has said the cuts are bound to have an effect on patient care while the Royal College of Nursing has said morale in the profession is "plummeting".
Earlier this month, North Staffordshire NHS Trust said it needed to shed 1,000 jobs to clear a £30m deficit, while Wolverhampton's New Cross Hospital announced 300 jobs would be axed to balance the books.
Similar cuts have also been announced in Shropshire and across England.