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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The Tinder dating app isn't just about sex – it's about friendship, too. And sex

The lines between sex, love and friendship are blurrier than ever, as I found out quickly while using the app.

The first time I met someone using Tinder, the free dating app that requires users to swipe left for “no” and right for “yes” before enabling new “matches” to chat, it was an unqualified success. I should probably qualify that. I was newly single after five years in a committed relationship and wasn’t looking for anything more than fun, friendship and, well, who knows. A few weeks earlier I had tried to give my number to a girl in a cinema café in Brixton. I wrote it on a postcard I’d been using as a bookmark. She said she had a boyfriend, but wanted to keep the postcard. I had no date and I lost my page.

My Tinder date was a master’s student from Valencia called Anna (her name wasn’t really Anna, of course, I’m not a sociopath). When I arrived at the appointed meeting place, she told me I was far more handsome IRL (“in real life”) than my pictures suggested. I was flattered and full of praise for the directness of continental Europeans but also thought sadly to myself: “If only the same could be said about you.”

Anna and I became friends, at least for a while. The date wasn’t a success in the traditional sense of leading us into a contract based on exclusivity, an accumulating cache of resentments and a mortgage, but it had put me back in the game (an appropriate metaphor – people speak regularly of “playing” with the app).

According to Sean Rad, the co-founder who launched Tinder in late 2012, the service was invented for people like me. “It was really a way to overcome my own problems,” he told the editor of Cosmopolitan at an event in London last month. “It was weird to me, to start a conversation [with a stranger]. Once I had an introduction I was fine, but it’s that first step. It’s difficult for a lot of people.” After just one outing, I’d learned two fundamental lessons about the world of online dating: pretty much everyone has at least one decent picture of themselves, and meeting women using a so-called hook-up app is seldom straightforwardly about sex.

Although sometimes it is. My second Tinder date took place in Vienna. I met Louisa (ditto, name) outside some notable church or other one evening while visiting on holiday (Tinder tourism being, in my view, a far more compelling way to get to know a place than a cumbersome Lonely Planet guide). We drank cocktails by the Danube and rambled across the city before making the romantic decision to stay awake all night, as she had to leave early the next day to go hiking with friends. It was just like the Richard Linklater movie Before Sunrise – something I said out loud more than a few times as the Aperol Spritzes took their toll.

When we met up in London a few months later, Louisa and I decided to skip the second part of Linklater’s beautiful triptych and fast-track our relationship straight to the third, Before Midnight, which takes place 18 years after the protagonists’ first meet in Vienna, and have begun to discover that they hate each others’ guts.

Which is one of the many hazards of the swiping life: unlike with older, web-based platforms such as Match.com or OkCupid, which require a substantial written profile, Tinder users know relatively little about their prospective mates. All that’s necessary is a Facebook account and a single photograph. University, occupation, a short bio and mutual Facebook “likes” are optional (my bio is made up entirely of emojis: the pizza slice, the dancing lady, the stack of books).

Worse still, you will see people you know on Tinder – that includes colleagues, neighbours and exes – and they will see you. Far more people swipe out of boredom or curiosity than are ever likely to want to meet up, in part because swiping is so brain-corrosively addictive.

While the company is cagey about its user data, we know that Tinder has been downloaded over 100 million times and has produced upwards of 11 billion matches – though the number of people who have made contact will be far lower. It may sound like a lot but the Tinder user-base remains stuck at around the 50 million mark: a self-selecting coterie of mainly urban, reasonably affluent, generally white men and women, mostly aged between 18 and 34.

A new generation of apps – such as Hey! Vina and Skout – is seeking to capitalise on Tinder’s reputation as a portal for sleaze, a charge Sean Rad was keen to deny at the London event. Tinder is working on a new iteration, Tinder Social, for groups of friends who want to hang out with other groups on a night out, rather than dating. This makes sense for a relatively fresh business determined to keep on growing: more people are in relationships than out of them, after all.

After two years of using Tinder, off and on, last weekend I deleted the app. I had been visiting a friend in Sweden, and took it pretty badly when a Tinder date invited me to a terrible nightclub, only to take a few looks at me and bolt without even bothering to fabricate an excuse. But on the plane back to London the next day, a strange thing happened. Before takeoff, the woman sitting beside me started crying. I assumed something bad had happened but she explained that she was terrified of flying. Almost as terrified, it turned out, as I am. We wound up holding hands through a horrific patch of mid-air turbulence, exchanged anecdotes to distract ourselves and even, when we were safely in sight of the ground, a kiss.

She’s in my phone, but as a contact on Facebook rather than an avatar on a dating app. I’ll probably never see her again but who knows. People connect in strange new ways all the time. The lines between sex, love and friendship are blurrier than ever, but you can be sure that if you look closely at the lines, you’ll almost certainly notice the pixels.

Philip Maughan is Assistant Editor at the New Statesman.

This article first appeared in the 26 May 2016 issue of the New Statesman, The Brexit odd squad