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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Would you jump off a cliff if someone told you to? One time, I did

I was walking across the bridge in Matlock park, which is about 12 feet high, with a large group of other kids from my year, in the pouring rain.

Ever heard the phrase, “Would you jump off a cliff if they told you to?” It was the perpetual motif of my young teenage years: my daily escapades, all of which sprang from a need to impress a peer, were distressing and disgusting my parents.

At 13, this tomboyish streak developed further. I wrote urgent, angry poems containing lines like: “Who has desire for something higher than jumping for joy and smashing a light?” I wanted to push everything to its limits, to burst up through the ceiling of the small town I lived in and land in America, or London, or at least Derby. This was coupled with a potent and thumping appetite for attention.

At the height of these feelings, I was walking across the bridge in Matlock park, which is about 12 feet high, with a large group of other kids from my year, in the pouring rain. One of the cool girls started saying that her cousin had jumped off the bridge into the river and had just swum away – and that one of us should do it.

Then someone said that I should do it, because I always did that stuff. More people started saying I should. The group drew to a halt. Someone offered me a pound, which was the clincher. “I’m going to jump!” I yelled, and clambered on to the railing.

There wasn’t a complete hush, which annoyed me. I looked down. It was raining very hard and I couldn’t see the bottom of the riverbed. “It looks really deep because of the rain,” someone said. I told myself it would just be like jumping into a swimming pool. It would be over in a few minutes, and then everyone would know I’d done it. No one could ever take it away from me. Also, somebody would probably buy me some Embassy Filter, and maybe a Chomp.

So, surprising even myself, I jumped.

I was about three seconds in the air. I kept my eyes wide open, and saw the blur of trees, the white sky and my dyed red hair. I landed with my left foot at a 90-degree angle to my left ankle, and all I could see was red. “I’ve gone blind!” I thought, then realised it was my hair, which was plastered on to my eyes with rain.

When I pushed it out of the way and looked around, there was no one to be seen. They must have started running as I jumped. Then I heard a voice from the riverbank – a girl called Erin Condron, who I didn’t know very well. She pushed me home on someone’s skateboard, because my ankle was broken.

When we got to my house, I waited for Mum to say, “Would you jump off another cliff if they told you to?” but she was ashen. I had to lie that Dave McDonald’s brother had pushed me in the duck pond. And that’s when my ankle started to throb. I never got the pound, but I will always be grateful to Erin Condron. 

This article first appeared in the 25 August 2016 issue of the New Statesman, Cameron: the legacy of a loser