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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Andy Burnham's full speech on attack: "Manchester is waking up to the most difficult of dawns"

"We are grieving today, but we are strong."

Following Monday night's terror attack on an Ariana Grande concert at the Manchester Arena, newly elected mayor of the city Andy Burnham, gave a speech outside Manchester Town Hall on Tuesday morning, the full text of which is below: 

After our darkest of nights, Manchester is today waking up to the most difficult of dawns. 

It’s hard to believe what has happened here in the last few hours and to put into words the shock, anger and hurt that we feel today.

These were children, young people and their families that those responsible chose to terrorise and kill.

This was an evil act. Our first thoughts are with the families of those killed and injured. And we will do whatever we can to support them.

We are grieving today, but we are strong. Today it will be business as usual as far as possible in our great city.

I want to thank the hundreds of police, fire and ambulance staff who worked throughout the night in the most difficult circumstances imaginable.

We have had messages of support from cities around the country and across the world, and we want to thank them for that.

But lastly I wanted to thank the people of Manchester. Even in the minute after the attack, they opened their doors to strangers and drove them away from danger.

They gave the best possible immediate response to those who seek to divide us and it will be that spirit of Manchester that will prevail and hold us together.

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