Florence Nightingale Showed Us the Value of Nurse Leaders Long Ago
Angela Barron McBride, PhD, RN, is a distinguished professor and dean emerita at the Indiana University School of Nursing, a member of the Indiana University Health Board, and chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program.
As we celebrate National Nurses Week, which ends on Florence Nightingale’s birthday (tomorrow, May 12th), I have been thinking anew about why she is such a good role model for 21st-century nurse leadership. No insipid “Lady with a Lamp,” she pioneered the use of applied statistics to develop policy and other novel ways of displaying data to change minds. For example, she developed the coxcomb, a variation on today’s pie chart in which each wedge represents a month’s worth of mortality figures, and then made use of these graphic displays in arguing for how improved hygiene can dramatically result in decreased mortality.
The Robert Wood Johnson Foundation (RWJF) has been particularly encouraging of getting more nurses on boards, and Nightingale personified the skill set and abilities that we need on today’s hospital boards. While I wouldn’t presume to put myself in the same company as Ms. Nightingale, I do serve on the board of Indiana University Health, an 18-hospital network, and I have chaired the board’s committee on quality and patient safety for over nine years. That perspective has confirmed for me that the lens through which nurses look at health care, particularly as exemplified by Nightingale, is very much needed at the board level.
The American Hospital Association lists a number of capabilities needed for board governance—an understanding of health care, business acumen, achievement orientation, community-mindedness, organizational awareness, a sense of strategy, innovative thinking, and team leadership. These are the competencies Nightingale had and so do her 21st-century sisters and brothers.
So community-minded was she that she developed district nursing in Liverpool, which quickly spread throughout the country. So strategic was she that she helped establish the Royal Commission on the Health of the Army after she returned from the Crimea. So team-minded was she that she worked with William Farr, Britain’s leading statistician, to improve the routine collection of national data for planning purposes, and she collaborated with Elizabeth Blackwell in planning a Women’s Medical College, which opened in 1868. So business savvy was she that she used the Nightingale Fund, set up to honor her work in Crimea, to establish the first truly professional school of nursing at St. Thomas’ Hospital in London. So achievement-minded was she that she took pleasure in being named the first female fellow of the Royal Statistical Society (1858), always using any honors that came her way to buttress her authority and boost her voice as she argued on behalf of patients and their concerns.
The historic Nightingale wrote the definitive statement on organization of military hospitals, shaped the field of sanitation, and was, if anything, much more politically astute than her touchy-feely image. I find it interesting that Prince Albert met her and commented on her modesty, but Queen Victoria remarked on her mind, wishing that she was part of the country’s War Office.
When I think of today’s Nightingales—Marilyn Tavenner, MHA, BSN, RN, head of the Centers for Medicare & Medicaid Services; Maureen Bisognano, MSN, BSN, president and CEO, Institute for Healthcare Improvement; Mary Wakefield, PhD, RN, head of the Health Resources Service Administration; Patricia Horoho, CNS, RN, surgeon general and commanding general, US Army Medical Command—I see her successors operating on the same global stage she did.
What is discouraging, though, is that such nurse leaders still regularly are seen as exceptions to the rule. Label an individual nurse exceptional, and you don’t have to change your stereotyped thinking about nursing. It can, of course, be personally gratifying to be viewed as exceptional, but whatever pleasure there is evaporates quickly when you realize that old-fashioned views of nurses as helpers, not doers or leaders, prevail.
To the extent that stereotyped thinking persists, the nurses in all of our communities are invisible as possibilities for board assignments, yet they have the systems thinking, cultural competence, team orientation, and care-coordination perspective so necessary to the realization of the Institute of Medicine’s goal of Best Care at Lower Cost (the title of one of its 2014 publications). The prevailing stereotype of nurses as something less than leaders was disproved long ago by Florence Nightingale herself. Let’s learn from the past and put more nurses in positions of leadership today.