The Impact of Florence Nightingale

Quite a few years back, a poster made its way into popular culture, titled, "All I really need to know I learned in kindergarten." It reminded us all that the basic rules for life are really very simple - and serve as a foundation for all the more complicated concepts we learn as the years go on.

I would dare say that a similar poster could be done for the field of nursing: "All I really need to know about nursing I learned from Florence Nightingale." Known as "the lady with the lamp" from her nights (and days) caring for injured soldiers in the Crimean War, Florence Nightingale can be credited for creating those basic rules, the foundation, of our profession. And although much has changed in healthcare since her time, no one person has contributed as significantly to nursing since. With 2010 marking the 100th anniversary of Florence's death, examining her life, career and dedication to the field seems to be an appropriate launching point for the Dean's Corner's year-long series focusing on the theme of "Nursing: Then and Now."

Florence Nightingale came from an affluent family and was very well educated, especially for a woman of that era. Her father home-schooled Florence and she received tutoring in advanced mathematics at her own insistence. "The importance of the instruction that she received at her father's hands cannot be overestimated," author Mark Bostridge noted in "Florence Nightingale: The Making of an Icon." "Its breadth and range put her on equal footing with male counterparts, as well as ensured that she would never think twice about engaging in discussion or debate with the opposite sex."¹

It is widely known that Florence Nightingale was strongly drawn to nursing. While you would think that nursing would have been considered a good choice for a young woman, today's opinion of nursing is much different than in the 1800s. As I mentioned in the introductory column in this series, nursing in England was considered "menial employment." So at 25, when Florence declared that she wanted to be a nurse, she lacked both the support of society and her parents. Still, she was determined to follow her dream and studied on her own at night; for eight years! How many students - of nursing or other fields - would show such dedication, feel such a calling, take such initiative?

In 1853, Florence Nightingale spent a month visiting hospitals, almshouses and institutions in Paris. She traveled abroad again, with family friends, to visit another facility, and upon returning home later that year became superintendent of a charitable institution in London that cared for "sick gentlewoman." She even had her parents' blessing - and an allowance of 500 pounds a year. A year later though she became restless for actual hospital work. While volunteering at Middlesex Hospital during a cholera epidemic, Florence heard news about the Crimean War. The Secretary of War wrote to her, asking if she would introduce women nurses into army hospitals in Crimea. This was quite an honor, and she finally gained the approval of her family.

Interestingly enough, Florence Nightingale left London for Scurtari Hospital, where she would care for soldiers from the Crimean War, on October 21, 1854. That's right: Florence set out with her 38 nurses exactly 155 years to the day that West Coast University will officially open the relocated Los Angeles Campus in North Hollywood.

The medicine chest Florence Nightingale took with her to the Crimean War is now at the Florence Nightingale Museum, which is located at St. Thomas Hospital in London. The wooden box contained 13 large bottles, two boxes of pills, scales and measures. Most of the medicines were for the treatment of upset stomachs. Which is not what she found in Crimea. What Florence discovered were injured soldiers who went up to a week without receiving medical attention; a lack of surgeons, dressers and nurses, and linen for bandages; a dirty hospital in serious disrepair. One famous quote from Florence was "Our soldiers enlist to death in the barrack," as soldiers died at more than twice the rate of the general population - yet were supposed to be the healthiest.²

Florence Nightingale certainly had her work cut out for her. She immediately focused on food and hygiene, and fixing the wards. I wonder how many professionals today would so willingly roll up their shirtsleeves to accomplish a task of such enormity? That is truly the work of someone called to a career out of love.

From May through August 1855, Florence Nightingale traveled to Balaclava to inspect hospitals. She became ill a few days after she arrived with "Crimean Fever" and nearly died. Appropriately, she was nursed back to health by a nurse.

Mortality and morbidity rates dropped considerably under Florence Nightingale's direction, and many British soldiers who would have died instead lived to fight another day. When Florence returned to England from Crimea, she was a hero. Songs and poems were written about her. People bought figurines and portraits of her. "Florence" became a popular name for girls, and there was even a Florence Nightingale doll and cradle. How wonderful that a nurse was recognized so warmly by a country that just recently had a much different opinion about women in our field!

But Florence Nightingale did not love the attention. In fact, she shunned it until her death. Still, the British were so thankful for Florence Nightingale's care of their soldiers that they began to send her money, leading to a national appeal that raised 45,000 pounds in just 20 months. (A lot of money back then.) The money was given to Florence to start a permanent school of nursing. The first, which still bears her name, was established in 1860 at St. Thomas Hospital in London. Florence set the curriculum, which consisted of lectures, student diaries and work in the hospital wards. Her students went on to work at hospitals worldwide. Today, we owe her a debt of gratitude for making nursing a respectable field that requires a solid education.

Florence Nightingale continued to dedicate her life to nursing. She reformed military sanitary conditions, planned military and civilian hospitals, and wrote volumes of letters, reports and publications. She followed her love of statistics, became an elected member of the Statistical Society, and used statistics for recommendations to the British Army and the Indian Army, and in civilian hospitals. She studied religions and cultures, and believed that people were entitled to their beliefs. (Not a popular opinion back then.) At her death, she knew five languages.

She also published numerous books and other types of publications and wrote poetry. One of Florence Nightingale's greatest works was "Notes on Nursing," published in 1860 and subsequently published in many languages and distributed around the world. Her goal was to help ordinary people nurse the sick; she realized that these were the people hurting patients because of a lack of understanding of patients' needs. Much of her advice is still relevant to nursing today - remember that poster I mentioned early on? - the manual is still in print today.

In 1907, King Edward VII awarded Florence Nightingale with the Order of  Merit. The British honorary institution recognizes those who have served in the armed forces or distinguished themselves in science, art, literature or the promotion of culture. Florence was the first woman ever to receive the honor, and it would be 1965 before the second woman did.

Florence Nightingale died in 1910 of heart failure. She will always be remembered and credited for the care of the military soldier; improving sanitary conditions through public health measures, both in general and also in hospitals; the development of what today would be the quality improvement (infectious disease or morbidity and mortality tracking); and the development of modern day nursing education. 

I cannot imagine what our field would be like today if Florence Nightingale had not been our pioneer. Perhaps someone else would have stepped up to the task, but I truly believe the end result, which you as student nurses are experiencing today, would not have been as remarkable.

Please remember to submit linkable articles related to the theme of "Nursing: Then and Now," as well as about our founder Florence Nightingale, via our Facebook page, westcoastuniversity.edu/facebook.

¹ Mark Bostridge, "Florence Nightingale: The Making of an Icon" New York, 2008.
² Cecil Woodham-Smith, "Florence Nightingale" New York, 1951.

Unless otherwise noted, the factual information from this article is from displays at the Florence Nightingale Museum at St. Thomas Hospital in London.

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