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Florence Nightingale: A Personal Epiphany!

Gloria Ferraro Donnelly, PhD, RN, FAAN
Dean and Professor, Drexel University, Philadelphia, Pennsylvania

I never paid much attention to lectures about Florence Nightingale's contributions to modern healthcare when I was a nursing student many years ago. I learned the basics, enough to get by on a test, facts like Nightingale was a wealthy Victorian woman who could have married well, managed the manor, and lived happily ever after. Instead, she wanted to work, to do something meaningful with her life: she wanted to be a nurse for the purpose of designing and improving care. A visit to the Institute of Deaconesses in Kaiserswerth, Germany, to study with Pastor Theodor Fliedner for 2 weeks in 1850 sealed her fate and the fate of modern nursing. Nightingale finally managed to convince the British War Office to send her and a band of female nurses to Scutari, Turkey, to take care of wounded soldiers fighting in the Crimean War. She was called the "lady with the lamp" as she strode through the tents making rounds on the wounded at night. Her successes in the Crimea led to the development of a formal school of nursing at St Thomas' Hospital in London, the model of which was widely adopted in the United States. Nightingale was the mother of modern nursing, an icon whose pledge we recited at capping and later pinning ceremonies.

It was not until I was 20 years into my career and a doctoral student at Bryn Mawr College that I had my epiphany about Florence Nightingale: she was so much more than the "lady with the lamp." Bryn Mawr is a small, prominent women's college in the suburbs of Philadelphia, Pennsylvania. Its mission is to prepare women to take their rightful places in any endeavor of their choosing. It does not have a nursing program. The library has a magnificent collection on women's studies, and it was there, in the stacks at Bryn Mawr, that I finally learned the significance of Nightingale's contributions. The list below represents just a sampling of my personal epiphany concerning Nightingale's contribution to women, nursing, science, and health care delivery.

• Nightingale legitimized nursing as respectable work for women in an era when "respectable" women never worked outside the home. This was a radical departure from the cultural mores of the time.
• Nightingale was a believer in hygiene, cleanliness, and order. She applied her principles to reorganizing and "cleaning up" the wards where wounded soldiers were dying in droves, not necessarily from their wounds, but from the infections caused by lack of proper care. She would have been a champion of the patient safety movement today, since she invented it in the late 1800s.
• Nightingale was a scientist who believed in the power of evidence. She was an early adopter of the use of statistics, the new science of data analysis. She used statistics to demonstrate the relationship between good nursing care and the lower mortality rate among soldiers in the Crimean war hospitals. Her statistical pie charts, which she called coxcombs, dramatically illustrated the powerful effects of nursing care.
• Nightingale was passionate about accountability. She decried the lack of attention given to even the most basic hygienic environment for wounded British soldiers. She got word out to the media of the times and called attention to what needed to be done to improve care. She tangled with physicians who viewed her as a meddling woman, but in the end, she got her way and got results.
• Nightingale had clout in high governmental and social circles, and she used her money and influence to promote her ideas about how care should be delivered and how essential nurses were to health care reform. She was a cultured woman who could mingle with those who were in control and could drive change.
• Nightingale established the St Thomas School of Nursing, handpicked those admitted, and sent her disciples forth to spread the word about the power of good nursing care.
• Nightingale was a foremost consultant on the design of hospitals, and in her room in London, she consulted with a visiting team that was designing the new Johns Hopkins Hospital in Baltimore, Maryland. I had the privilege of reading her consultation report when I was a summer fellow in a National Endowment for the Humanities program in the 1970s.
• Because of her intellect, scientific orientation, persistence, and dogged attention to detail and follow-through, she became one of the most powerful women of her times as a reformer of health care worldwide and the legitimization of the nursing as a respectable, secular profession. She had a rapier wit and could be cynical at times, but she applied even her negative energy to achieving her goals.
• Nightingale was a prolific writer of books and reports; Notes on Nursing and Notes on Hospitals are among her most famous, and of course, there is her feminist monograph Cassandra, in which she rails against the idle life of the Victorian woman. I just uploaded her speeches to nursing graduates of the St Thomas School of Nursing onto my e-book reader (Florence Nightingale to Her Nurses). Nightingale surely would have been an early adopter of this technology.

There are many biographies about the life of Florence Nightingale: Lytton Strachey's, Sir Edward Cook's, and most recently Mark Bostridge's Florence Nightingale: The Making of An Icon (2008). Start with Bostridge, and work your way back. Begin your own collection of books and articles by and about Nightingale. It is the International Year of the Nurse. Celebrate it by examining nursing's roots through the life of Florence Nightingale.