A day in the life of an angel: Nurses are leaving Britain in droves. Sarah Strickland joined one during an exhausting day's duty on the wards

IT'S 7.30am on Handfield Jones ward, the transplant unit at St Mary's Hospital in west London.

Senior staff nurse Hilary Fanning has just finished the night shift and is handing over to the morning staff. About eight nurses are gathered round, notepads on knees.

It wasn't a quiet night. One woman bled profusely. Another was incontinent. One man needed to talk, though they were really too busy.

By eight o'clock the breakfast trolley has arrived and it's time to get on. Jutta Herrmann is one of the most junior nurses on the ward. She came to Britain from Germany when she was 18 and qualified in 1983. Last December she finished a conversion course to become a registered general nurse; she began work on the ward in June.

She earns pounds 12,400 a year, including London weighting. She has considered going back to Germany, where she would earn more money, but is going to be married in Britain.

'One friend went to America and saved enough to put down a deposit on a house. But I didn't go into nursing for the money.'

Last week she finished seven 11-hour night-shifts in a row. Yesterday she did overtime, working from 7.30am till 9.15pm. 'The work is physically and mentally exhausting and you have to study at home too to keep yourself up- to-date - I'm in a new job and have a lot to learn.'

Jutta looks after about eight patients. As she begins to give them their breakfast she has to leave a tray at the bottom of a bed and rush off to prepare an insulin injection. Handing out meals is frustrating. 'I'm so busy, it's really a waste of my time,' she says. Yet she does it with care, bending over a patient, buttering and slicing his bread.

One patient stretches out his arms as she approaches. Someone else needs an injection and another patient is unhappy about an operation he is due to have in a few hours. He wants to talk it over. Jutta listens, reassures him, then goes to phone the department concerned - could someone come over to see him? Not having enough time to counsel patients is another frustration. 'It can be quite traumatic for them. The psychological care is so important, but I have too much to do.'

At 9am Jutta starts making beds, chatting with patients as she goes. The newspaper trolley has been and the cleaner is vacuuming, scraping furniture across the floor. A team of doctors is touring the ward.

Jutta gets an elderly patient up and accompanies him to dialysis. He is painfully slowly on his Zimmer frame. Then there's a phone call to answer and another patient to prepare for the theatre: she is scared and doesn't want to go; she asks for the commode. 'I can't wait, I can't hold it in, quick, quick]' Jutta hurries down the corridor.

By 10.30am she has been on her feet for two-and-a-half hours and scrubbed her hands at least eight times. Time for a break.

Down in the canteen, staff nurse Dave Ring is scouring the job adverts in Nursing Times. 'Isn't everyone?' comments another nurse wrily. 'Nursing is a qualification you can take abroad so it's silly not to go, really,' says Dave. But people often say they'll go and don't'

After 20 minutes Jutta is looking at her watch. A patient needs washing and turning. Jutta carefully brushes his hair and eyebrows. He can't speak but she talks to him gently, empties his urine bag, and washes her hands yet again.

Before lunch there are pulses, temperatures and blood pressures to check, another bed to make, another patient to wash. Meals are handed out, then at 12.45 Jutta has to collect a patient from the theatre. She brings him up in the lift, wheels the bed into his room, takes his blood pressure and fills in his chart.

At 1.15 she takes a half-hour lunch break, then it's straight back to check with her team leader, who is going home. An incontinent patient needs changing, washing and turning, then another who has come off dialysis needs an enema - it's the tenth pair of rubber gloves of the day.

A new patient is arriving so the bed needs preparing, then Jutta starts telling the next shift about her patients. But at 2.45 there's an emergency - a young woman has suddenly gone into convulsions.

The ward is galvanized into action, eight doctors and nurses gather around her bed. 'Get suction]' someone cries and Jutta runs to fetch it, rushing off again to look for cot sides to prevent the patient falling out of bed.

Another nurse has got Jutta's patient off the commode but he calls her over, pointing to a mess on the sheets. Another set of sheets, another hand-wash. Then another attempt to brief the next shift. But a patient is leaving and her medicine needs checking. It is 3.30, officially the end of Jutta's shift. But she still has to write a report on each patient.

Just as she starts, she's called to the phone - can she collect a patient from theatre? The new shift is at tea and she can't leave the ward.

She finishes her reports and goes to get changed at 4pm. 'Today hasn't been that busy,' she says.

What on earth is a busy day like, I wonder? I'm feeling shattered, humbled, and extremely thankful that I wasn't shadowing her on an 11-hour late shift.

(Photograph omitted)