The influence of Florence Nightingale

Florence Nightingale was born in Florence, Italy, in 1820 of wealthy, middle-class parents. After several attempts to receive formalized training in 1850 and 1851, she spent brief periods in Germany at a Protestant institution that trained deaconesses in childcare and nursing. Soon afterwards, Florence Nightingale became Superintendent of Nurses at the Institution for the Care of Sick Gentlewomen in Distressed Circumstances in London. For this she received no pay but was able to display her skills in nursing and nursing administration, which included greatly improved standards of nurses and nursing care, and also the expectation that care should be based on compassion, observation and knowledge. One of her legacies, was the ‘Nightingale ward’, a ward layout where long rooms have beds spaced out on each side, which can still be found in some areas today. While working in the military hospital during the Crimean War, she established hygienic care and reduced overcrowding; and consequently, reduced the mortality rate of wounded soldiers. In addition, her caring attitude towards the wounded soldiers led to her becoming known as the ‘Lady with the Lamp’.

Because Florence Nightingale wrote about nursing, collating information about how nurses worked and recording the nursing activities that produced positive outcomes, an evidence-based structure and philosophy of nursing was established. By observing and testing its rudimentary practices, nursing could become more evidence-based. Florence Nightingale recorded nursing practices and produced statistical outcomes, now known as ‘model forms’. As a result of this revolutionary way of working and her model forms – that we would identify today as pie-charts – many now regard her as the first research nurse. Although Nightingale found she was a heroine, she never enjoyed her fame and disliked the sentimental reference that her name inspired. The only testimonial she would accept was a fund, heavily subscribed to by the public and named in her honour, which she used to found training schools for nurses.

The success of the Nightingale reforms led to the rapid expansion of nurse training schools, initially in London voluntary hospitals. This led to the growth of larger provincial voluntary hospitals, and finally to new hospitals being built by local government and poor law authorities (McDonald 2011). Despite this, there was still a lack of hospitals, which led to a need for nursing people at home and Nightingale worked closely with William Rathbone to establish training for district nurses. District nursing started as a voluntary service, run by voluntary committees, until the value of the service was recognized and local authorities gradually began to accept more responsibility for sick people in the community. Professional regulation marginalized those who had previously practiced in often maverick and ungoverned ways, e.g. in the delivery of babies or attempting to cure mental distress through quackery, deception and even rudimentary surgery.

As a result of her work, Nightingale was able to define the role of nursing clearly and how nursing was distinct from, and not subservient to, medicine (Box 2.1). This led to the establishment of nursing as a profession with a sound and specific education base.