The fall in nursing numbers is a complete disaster

Without swift work to rectify this problem, patient care will suffer.

Following recent reports regarding a significant rise in emergency hospital admissions and higher patient mortality rates over the weekend due to a lack of senior doctors, we are now faced with the abysmal fact of fewer training nurses. Research by Nursing Times (NT) earlier this month revealed that nurse training places have been cut by more than 2,500 in the past three years. Professor David Green, Vice Chancellor and Chief Executive of the University of Worcester commented: "We are heading straight for a national disaster in two to three years’ time." Worse still, Strategic Health Authority figures obtained by NT showed that there were over two thousand more nurses opting to work in a community based setting as opposed to acute care.   

During my time in the NHS I have worked in primary and secondary care with the latter including time spent in acute medical, high dependency and intensive care environments. And I have witnessed first-hand the considerable strain placed on the nursing profession. In an acute medical setting for example, a nurse would be typically responsible for at least four to six patients, sometimes even more. And in the acute setting, a patient’s clinical state can change at any moment. As doctors, following initial patient assessment, we put plans in place from a management perspective to ensure recovery. But due to large patient numbers and demands from outpatient clinics it is difficult to be on the shop floor monitoring each patient around the clock - a sad fact but unfortunately true.

In a high dependency or intensive care setting, the situation however is very different. Doctors are always present and patients benefit from one to one nursing allowing for effective patient assessment. You may argue that these types of patients obviously need a more advanced and rigid monitoring regime and you are probably right. But ward patients also rely heavily on nurses to be their eyes and ears, alerting doctors to any concern they or of course the nurse may have.

An afternoon ward based scenario to help illustrate my point; a four patient bay being manned by one nurse.

Patient A has been admitted with chest pain which initially settled but has now recurred and is more severe in nature. The nurse must do a new set of observations, namely blood pressure, heart rate and oxygen saturations, as well as an electrocardiogram (ECG), give pain relief which has been previously prescribed and alert the doctor responsible for that patient about the change in clinical state.

Patient B, a chronic alcoholic admitted following an alcohol binge, starts to vomit large amounts of blood. He feels faint, his blood pressure is falling and he is at risk of cardio respiratory arrest. The nurse, in addition to recording new observations, will need to insert a cannula and start intravenous fluids if the doctor responsible for this patient is busy and unable to reach the patient straight away.

Patient C has been admitted with renal failure due to not eating and drinking. He has a history of severe depression and is refusing to take his medication. He has been referred to the on call psychiatrist but while waiting for a review is threatening to kill himself and other patients on the ward.

And Patient D, who has been admitted following a fall at home but is now suitable for discharge. He is becoming frustrated by the time it has taken to receive his discharge paperwork and medications. It has been two hours now and he wants to make an urgent complaint about the care he has received, or lack of, to the Patient Advice and Liaison Service (PALS).

You may find it hard to believe but the above ward scenario is certainly not far from the truth.

Not only are nurses expected to respond to changing patient conditions they are also responsible for patients’ personal needs, administering appropriate medication, referring patients to other multidisciplinary staff such as a physiotherapist or occupational therapist and for facilitating discharge to name but a few.

With falling nursing numbers, the government should take heed and put concrete plans in place to ensure this situation is rectified and done so quickly. The workforce is already stretched and I for one fail to see how patient care will not be grossly affected.

Neel Sharma is a Medical Doctor and Honorary Clinical Lecturer at the Centre for Medical Education, Barts and the London School of Medicine and Dentistry

Great Ormond Street Hospital nurses perform during the Olympic opening ceremony. Photograph: Getty Images
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This Ada Lovelace Day, let’s celebrate women in tech while confronting its sexist culture

In an industry where men hold most of the jobs and write most of the code, celebrating women's contributions on one day a year isn't enough. 

Ada Lovelace wrote the world’s first computer program. In the 1840s Charles Babbage, now known as the “father of the computer”, designed (though never built) the “Analytical Engine”, a machine which could accurately and reproducibly calculate the answers to maths problems. While translating an article by an Italian mathematician about the machine, Lovelace included a written algorithm for which would allow the engine to calculate a sequence of Bernoulli numbers.

Around 170 years later, Whitney Wolfe, one of the founders of dating app Tinder, was allegedly forced to resign from the company. According to a lawsuit she later filed against the app and its parent company, she had her co-founder title removed because, the male founders argued, it would look “slutty”, and because “Facebook and Snapchat don’t have girl founders. It just makes it look like Tinder was some accident". (They settled out of court.)

Today, 13 October, is Ada Lovelace day – an international celebration of inspirational women in science, technology, engineering and mathematics (STEM). It’s lucky we have this day of remembrance, because, as Wolfe’s story demonstrates, we also spend a lot of time forgetting and sidelining women in tech. In the wash of pale male founders of the tech giants that rule the industry,we don't often think about the women that shaped its foundations: Judith Estrin, one of the designers of TCP/IP, for example, or Radia Perlman, inventor of the spanning-tree protocol. Both inventions sound complicated, and they are – they’re some of the vital building blocks that allow the internet to function. 

And yet David Streitfield, a Pulitzer-prize winning journalist, someow felt it accurate to write in 2012: “Men invented the internet. And not just any men. Men with pocket protectors. Men who idolised Mr Spock and cried when Steve Jobs died.”

Perhaps we forget about tech's founding women because the needle has swung so far into the other direction. A huge proportion – perhaps even 90 per cent - of the world’s code is written by men. At Google, women fill 17 per cent of technical roles. At Facebook, 15 per cent. Over 90 per cent of the code respositories on Github, an online service used throughout the industry, are owned by men. Yet it's also hard to believe that this erasure of women's role in tech is completely accidental. As Elissa Shevinsky writes in the introduction to a collection of essays on gender in tech, Lean Out: “This myth of the nerdy male founder has been perpetuated by men who found this story favourable."

Does it matter? It’s hard to believe that it doesn’t. Our society is increasingly defined and delineated by code and the things it builds. Small slip-ups, like the lack of a period tracker on the original Apple Watch, or fitness trackers too big for some women’s wrists, gesture to the fact that these technologies are built by male-dominated teams, for a male audience.

In Lean Out, one essay written by a Twitter-based “start-up dinosaur” (don’t ask) explains how dangerous it is to allow one small segment of society to built the future for the rest of us:

If you let someone else build tomorrow, tomorrow will belong to someone else. They will build a better tomorrow for everyone like them… For tomorrow to be for everyone, everyone needs to be the one [sic] that build it.

So where did all the women go? How did we get from a rash of female inventors to a situation where the major female presence at an Apple iPhone launch is a model’s face projected onto a screen and photoshopped into a smile by a male demonstrator? 

Photo: Apple.

The toxic culture of many tech workplaces could be a cause or an effect of the lack of women in the industry, but it certainly can’t make make it easy to stay. Behaviours range from the ignorant - Martha Lane-Fox, founder of, often asked “what happens if you get pregnant?” at investors' meetings - to the much more sinister. An essay in Lean Out by Katy Levinson details her experiences of sexual harassment while working in tech: 

I have had interviewers attempt to solicit sexual favors from me mid-interview and discuss in significant detail precisely what they would like to do. All of these things have happened either in Silicon Valley working in tech, in an educational institution to get me there, or in a technical internship.

Others featured in the book joined in with the low-level sexism and racism  of their male colleagues in order to "fit in" and deflect negative attention. Erica Joy writes that while working in IT at the University of Alaska as the only woman (and only black person) on her team, she laughed at colleagues' "terribly racist and sexist jokes" and "co-opted their negative attitudes”. 

The casual culture and allegedly meritocratic hierarchies of tech companies may actually be encouraging this discriminatory atmosphere. HR and the strict reporting procedures of large corporates at least give those suffering from discrimination a place to go. A casual office environment can discourage reporting or calling out prejudiced humour or remarks. Brook Shelley, a woman who transitioned while working in tech, notes: "No one wants to be the office mother". So instead, you join in and hope for the best. 

And, of course, there's no reason why people working in tech would have fewer issues with discrimination than those in other industries. A childhood spent as a "nerd" can also spawn its own brand of misogyny - Katherine Cross writes in Lean Out that “to many of these men [working in these fields] is all too easy to subconciously confound women who say ‘this is sexist’ with the young girls who said… ‘You’re gross and a creep and I’ll never date you'". During GamerGate, Anita Sarkeesian was often called a "prom queen" by trolls. 

When I spoke to Alexa Clay, entrepreneur and co-author of the Misfit Economy, she confirmed that there's a strange, low-lurking sexism in the start-up economy: “They have all very open and free, but underneath it there's still something really patriarchal.” Start-ups, after all, are a culture which celebrates risk-taking, something which women are societally discouraged from doing. As Clay says, 

“Men are allowed to fail in tech. You have these young guys who these old guys adopt and mentor. If his app doesn’t work, the mentor just shrugs it off. I would not be able ot get away with that, and I think women and minorities aren't allowed to take the same amount of risks, particularly in these communities. If you fail, no one's saying that's fine.

The conclusion of Lean Out, and of women in tech I have spoken to, isn’t that more women, over time, will enter these industries and seamlessly integrate – it’s that tech culture needs to change, or its lack of diversity will become even more severe. Shevinsky writes:

The reason why we don't have more women in tech is not because of a lack of STEM education. It's because too many high profile and influential individuals and subcultures within the tech industry have ignored or outright mistreated women applicants and employees. To be succinct—the problem isn't women, it's tech culture.

Software engineer Kate Heddleston has a wonderful and chilling metaphor about the way we treat women in STEM. Women are, she writes, the “canary in the coal mine”. If one dies, surely you should take that as a sign that the mine is uninhabitable – that there’s something toxic in the air. “Instead, the industry is looking at the canary, wondering why it can’t breathe, saying ‘Lean in, canary, lean in!’. When one canary dies they get a new one because getting more canaries is how you fix the lack of canaries, right? Except the problem is that there isn't enough oxygen in the coal mine, not that there are too few canaries.” We need more women in STEM, and, I’d argue, in tech in particular, but we need to make sure the air is breatheable first. 

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.