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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If only I could wangle a job in the John Lewis menswear department I’d get to say, “Suits you, sir”

I’m afraid I am going to have to stick to writing.

So now that I have made the news public that I am even deeper in the soup than I was when I started this column, various people – in fact, a far greater number than I had dared hope would – have expressed their support. Most notable, as far as I can tell, was Philip Pullman’s. That was decent of him. But the good wishes of people less in the public eye are just as warming to the heart.

Meanwhile, the question is still nagging away at me: what are you going to do now? This was the question my mother’s sisters would always ask her when a show she was in closed, and my gig might have been running for almost as long as The Mousetrap but hitherto the parallels with entertainment had eluded me.

“That’s show business,” she said to me, and for some reason that, too, is a useful comment. (I once saw a picture of a fairly well-known writer for page and screen dressed up, for a fancy-dress party, as a hot dog. The caption ran: “What? And give up show business?”)

Anyway, the funds dwindle, although I am busy enough to find that time does not weigh too heavily on my hands. The problem is that this work has either already been paid for or else is some way off being paid for, if ever, and there is little fat in the bank account. So I am intrigued when word reaches me, via the Estranged Wife, that another family member, who perhaps would prefer not to be identified, suggests that I retrain as a member of the shopfloor staff in the menswear department of John Lewis.

At first I thought something had gone wrong with my hearing. But the E W continued. The person who had made the suggestion had gone on to say that I was fairly dapper, could talk posh, and had the bearing, when it suited me, of a gentleman.

I have now thought rather a lot about this idea and I must admit that it has enormous appeal. I can just see myself. “Not the checked jacket, sir. It does not become sir. May I suggest the heather-mixture with the faint red stripe?”

In the hallowed portals of Jean Louis (to be said in a French accent), as I have learned to call it, my silver locks would add an air of gravitas, instead of being a sign of superannuation, and an invitation to scorn. I would also get an enormous amount of amusement from saying “Walk this way” and “Suits you, sir”.

Then there are the considerable benefits of working for the John Lewis Partnership itself. There is the famed annual bonus; a pension; a discount after three months’ employment; paid holiday leave; et cetera, et cetera, not to mention the camaraderie of my fellow workers. I have worked too long alone, and spend too much time writing in bed, nude, surrounded by empty packets of Frazzles and Dinky Deckers. (For those who are unfamiliar with the latter, a Dinky Decker is a miniature version of a Double Decker, which comes in a bag, cunningly placed by the tills of Sainsbury’s Locals, which is usually priced at a very competitive £1.)

I do some research. I learn from an independent website that a retail sales assistant can expect to make £7.91 an hour on average. This is somewhat less than what is considered the living wage in London, but maybe this is accounted for in the John Lewis flagship store in Oxford Street. It is, though, a full 6p an hour more than the living wage in the rest of the land. Let the good times roll!

At which point a sudden panic assails me: what if employment at that store is only granted to those of long and proven service? God, they might send me out to Brent Cross or somewhere. I don’t think I could stand that. I remember when Brent Cross Shopping Centre opened and thought to myself, even as a child, that this was my idea of hell. (It still is, though my concept of hell has broadened to include Westfield in Shepherd’s Bush.)

But, alas, I fear this tempting change of career is not to be. For one thing, I am probably too old to train now. By the time I will have been taught to everyone’s satisfaction how to operate a till or measure an inside leg, I will be only a few months, if that, from retirement age, and I doubt that even so liberal an employer as John Lewis would be willing to invest in someone so close to the finish line.

Also, I have a nasty feeling that it’s not all heather-mixture suits with (or without) the faint red stripe these days. The public demands other, less tasteful apparel.

So I’m afraid I am going to have to stick to writing.

Nicholas Lezard is a literary critic for the Guardian and also writes for the Independent. He writes the Down and Out in London column for the New Statesman.

This article first appeared in the 22 June 2017 issue of the New Statesman, The zombie PM

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