A Century After Her Death, Florence Nightingale Still Offers Lessons for Today

    • September 22, 2010

To commemorate the centennial anniversary of the death of Florence Nightingale, nurse leaders are looking to the past to figure out ways to solve the health problems of the present and the future.

That is one aim of a highly anticipated Institute of Medicine report about the future of nursing, to be released October 5, 2010. The new report will offer a series of recommendations about how to improve patient care by developing a concrete plan of action to ensure that, as our nation’s health care system is transformed, so too is our approach to addressing the problems that helped create and sustain America’s underperforming system.

The IOM’s recommendations will include a range of system and policy changes including tested, proven, solution-oriented ways to most effectively and efficiently utilize nurses, including advanced practice registered nurses, in a transformed health care system, with a focus on how health care services are delivered so that better patient outcomes can be achieved at lower cost.

The recommendations will also focus on the role of nurses in health care promotion, disease prevention and care at the end of life, including avoiding expensive conditions that are more affordable to treat at earlier stages and improving the quality of nursing, the health of patients and the delivery of quality care.

The report is precisely the kind of in-depth study of nursing that would be championed by Florence Nightingale, a visionary whose teachings still resonate today, nurse leaders say.

“Nursing needs to remember its roots,” said Cynda Rushton, Ph.D., R.N., F.A.A.N., an associate professor of nursing at Johns Hopkins University, an alumnus of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2006-2009), and co-director of the Nightingale Initiative for Global Health. “Nurses need to embody Nightingale’s legacy of precise and courageous advocacy, policy development and leadership. We must ask the hard questions, participate in developing solutions that are scientifically sound and ethically grounded, and reflect excellence in holistic caring.”

Barbara Dossey, R.N., Ph.D., A.H.N.-B.C., co-director of the Nightingale Initiative for Global Health, agreed: “By understanding our legacy we then become a stronger voice for exploring optimal healing environments and how we can work in collaborative relationships,” she said, adding: “In everything we are doing right now, Nightingale has a message for us.”

Although she is known as the “Lady with the Lamp” who tended to wounded soldiers during the Crimean War, Nightingale’s reach was far broader than that simple nickname suggests. She transformed nursing­—which during her day was considered a job for poor women with bad manners and weak morals­—into a respectable profession that was grounded in science.

Nightingale’s many accomplishments include establishing schools for nurses and funding a nurse midwifery program; publishing hundreds of books, reports and pamphlets on health; and advocating to improve health by redesigning hospital wards, implementing infection control measures, and promoting healthful diets. A renowned statistician, she also invented the pie chart. Her work in England and abroad laid the foundation for modern nursing, inspired the founder of the International Red Cross, and helped improve and save the lives of untold millions.

She was a social activist, an environmentalist, a policy-maker and an author. But above all, she was a nurse­. Nightingale gave up the conventional 19th century female life of marriage and motherhood so she could heed her calling and help transform health and health care.

Nightingale would likely give today’s system a mixed review, Rushton said. She would have applauded the many advances in health and medicine since her death in 1910 and praised the profession for grounding its work in science and expanding practitioners’ roles.

At the same time, she probably would be concerned about the erosion of holistic care, the heavy workload on individual nurses and the looming nursing shortage, Rushton said.

She would be “appalled” at infection rates and safety ratings of hospitals and the emphasis on medicine and surgical operation over prevention and wellness, Dossey noted. “We have a disease management industry,” she said. “It is not a health care system. She would be very distressed about that.”

To rectify those problems, Nightingale would encourage today’s nurses to take risks, assume leadership positions, and advocate for a system that better serves all people, Rushton said. In addition, Nightingale would encourage health officials to give nurses more time to care for themselves so they can better care for others, Dossey added.

Those are the kinds of issues the upcoming IOM future of nursing report will address. “These recommendations will be a blueprint for creating a 21st century workforce that transforms the nursing field and improves the capacity of the transformed workforce,” said Susan B. Hassmiller, R.N., Ph.D., F.A.A.N., RWJF’s senior adviser for nursing. “Our ultimate goal, our top priority, is to meet the health care needs of all Americans within this reformed delivery system.”

"We expect this report to help point the way to a stronger, more skilled and empowered nursing workforce that can help make Florence Nightingale’s vision a reality 100 years later,” Hassmiller added.

“The future of nursing demands that we embrace our history and our present reality and mindfully create the architecture for the future that will produce the results that we desire,” Rushton said. “The health of the world depends upon it.”

Nightingale is being celebrated this year in many ways, including the reopening of the Florence Nightingale Museum in London; celebrations of her life at the Washington National Cathedral in Washington, D.C. and Westminster Abbey in London; advocacy by the Nightingale Initiative for Global Health to improve health around the world; and a weblog about an immersion tour of Nightingale’s life written by Hassmiller. It is called “In Florence’s Footsteps: Notes from a Journey” and is hosted by the American Journal of Nursing’s Off the Charts blog.