The Timeless Wisdom of Florence Nightingale
in Canadian Nurse, Vol. 109, No.2 (February 2013), p.36.
Forget about the 28-bed wards, the starched aprons and that lamp of hers (the one she used in the Scutari Barrack Hospital was actually of the Home Hardware variety) – all long relegated to nursing history. It’s time to reboot the perception of Florence Nightingale as a visionary whose ideas are valid today.
Most Canadian nurses simply do not know what she did, apart from vague awareness that she founded nursing in the distant past. Nor do they know that there was scarcely any nursing, as patient care, before her, apart from devoted but not well trained nuns. Those who were called nurses before her were mainly low-paid, disreputable hospital cleaners, notorious for demanding bribes from patients and stealing their gin.
Nightingale opened the first secular nurse training school in the world, and Nightingale nurses were sent to Canada, the U.S., Australia, Europe and India and influenced nursing practice in Japan and China. She herself mentored two generations of nursing leaders.
She was the first to study the occupational health of nurses, at a time when the occupation was even more dangerous than it is now. She promoted a pavilion style of hospital construction, an innovation that effectively reduced the potential for cross infection (when the mortality rate in top London teaching hospitals was 10 per cent of all patients admitted).
Nightingale worked with a multidisciplinary team of doctors, statisticians, engineers and architects on her reform agenda. As a woman with little formal education, she deferred to them for their technical expertise. That they deferred to her for the boldness of her vision is evident in their letters to her. She articulated the vision and the steps to achieve it.
That she was an expert researcher – the first woman to become a fellow of the Royal Statistical Society – gave her clout. What she wrote could be depended upon, yet she typically asked colleagues to review her material prepublication, in the days before peer review was the norm.
To me, her most significant reform was to create real hospitals out of the dreaded workhouse infirmaries. The infirmaries were the recourse for the vast majority of people, who could not afford hospital fees. Think shared beds, no nurses, no doctors on call and no budget for drugs. Her religious faith prompted her to demand more; surely, a benevolent God wanted quality care for all. She declared that the care of the poor in these places should be as good as in the best-staffed, fee-charging hospitals. Moreover, she believed the goal was achievable, by employing research to ascertain needs and devise strategies to meet them.
She favoured health promotion over medical treatment, advocating better nutrition and housing and clean air and water. In caring for the sick, the task of nurses, she believed, was to create the conditions that best promoted healing. Hospitals were a last resort.
Nightingale’s core contributions and her approach to research and policy development should be on the curriculum for students of nursing at every level, to better equip them to address today’s pressing issues, such as equity in access to health care and hospital safety, for the benefit of all.