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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Did Titantic do more for climate change than Leonardo DiCaprio’s new documentary?

Sex, icebergs and individual plight: the actor’s earlier outing teaches us more about vast disasters than his new docufilm about global warming’s impact, Before the Flood.

“Now you know there was a man named Jack Dawson and that he saved me . . . in every way that a person can be saved.” Or did he? For Titanic actor Leonardo DiCaprio, there is one way in which Jack never did rescue Rose: from the threat of climate catastrophe. 

Over the last 15 years, DiCaprio has made the issue a personal mission. Yet even in his role as UN climate ambassador, he stills feels far from heroic:

“If the UN really knew how I feel, how pessimistic I am about our future . . . I mean to be honest, they may have picked the wrong guy.”

So begins his new documentary, Before the Flood. A quest for answers on climate change, the film sees Leo racing around the world, marvelling at the sound of endangered whales, despairing at the destruction caused by tar-sands – “it looks like Mordor” – and interviewing a series of concerned experts, from professors to Barack Obama to the Pope.

There are plenty of naysayers to stand in his way and put him down. “Who better to educate world leaders on made-up climate change and a crisis that doesn't exist, than an actor with zero years of scientific training?” mocks one commentator from Fox News.

But if DiCaprio can gather enough evidence to believe in himself – AND believe that there are viable solutions out there – then so can we. Or so the story arc promises. His journey thus stands as a guide for our own; a self-education that will lead to salvation for all. 

It's all a little messianic. The film is even named after a biblical painting. And will those who don't already know who DiCaprio is even care? 

The sad fact is that, while DiCaprio’s lasting popularity still owes so much Titanic, the 1997 box-office smash that made his name, his new documentary fails to recapture the dramatic wisdom that put him there. It doesn’t even quip about the icebergs.

This is an oversight. Titanic didn’t win 11 academy awards for nothing. As well as a must-see rite of passage (pun intended) and soundtrack for infinite school discos, it taught me something invaluable about storytelling. Though I was not initially a DiCaprio fan, over the years I’ve come to accept that my lasting love of the film is inseparable from my emotional investment in Leo, or at least in his character, Jack. What Titanic showed so brilliantly was that the fastest way to empathise with suffering on a vast scale – be it a sinking ship or a sinking planet – is to learn to care for the fate of one or two individuals involved.

Every part of Jack and Rose's story is thus intimately linked with the story of the ship. Even that famed sex scene gains its erotic force not from the characters alone, but from their race through the blazing engine room (situated as it is between the foreplay of the naked portrait and the famous post-coital ending in the back of the cab).

And such carefully crafted storytelling isn't only essential to great entertainment but to great activism too. It can literally inspire action – as evidenced by fans’ desperate attempts to prove that both Jack and Rose could have climbed to safety aboard the floating piece of wood.

So would Before the Flood have been better if it had been a little bit more like Titanic and less like An Inconvenient Truth? Yes. And does that mean we should make climate films about epic polar bear love stories instead? Not exactly. 

There are many powerful documentaries out there that make you emotionally invested in the lives of those experiencing the consequences of our indirect (fossil fuel-burning) actions. Take Virunga, a heart-wrenching insight into the struggle of those protecting eastern Congo’s national park.

Sadly, Before the Flood is not one of them. Its examples of climate change – from Beijing air pollution to coral reef destruction – are over-familiar and under-explored. Instead of interviewing a Chinese official with a graph on his iPad, I would have preferred visiting a solar-panel factory worker and meeting their family, who are perhaps suffering from the effects of the smog in a way I can't yet imagine.

If you want a whistlestop tour of all things climate change then this necessary and urgent film is the movie for you. But those hoping it will give new depth to climate activism will be disappointed.

DiCaprio's distant relationship with the effects of climate change leave him stranded at the level of a narrator. He makes for a great elderly Rose, but we need a Jack.

Before The Flood is in limited theatres from 21 October and will be shown on National Geographic on Sunday 30 October.

India Bourke is an environment writer and editorial assistant at the New Statesman.