Is Florence Nightingale still relevant today?

She was educated by her father who exerted a profound influence on her intellectual and moral development. Her polymathic gifts meant she could access data and works of reformers from a range of European sources. She was also blessed by her family’s support of women’s education, which enabled her to network with the intellectual and political elite, using them as an audience for her reforms. Leading thinkers passed through the Nightingale household and it was here that the young Florence was introduced to some of the best minds of the Victorian era. It was partly through such networks, that Nightingale was able to visit the hospital in Kaiserwerth, Germany, which spurred her decision to enter nursing, an unusual decision for a woman of her birth and standing.

The interdependence of her theological and scientific thinking led her to regard statistics as key to understanding the ‘laws of nature’. This was all important in the context of the social upheaval, urbanisation and industrialisation of Victorian Britain where randomness seemed to rule the human condition. Statistics became a vehicle for targeting intervention, reducing risk and combating poverty and deprivation. Her quest to do something practical was not only driven by her empathy for the human condition and a moral compulsion to act, but also by frustration with the role of women. Nightingale railed against gender as a barrier to participating in public life. Her mode of nursing relied upon working to the authority of one female leader in an institution as well as affording the opportunity to women of earning their living and forging independent careers.

200 years later, does Florence Nightingale speak to us today?

Nightingale’s nursing intersected with a broader set of interests in public health, advancement of medicine, hygiene, epidemiology, statistics and military health. In that sense, her vision was thoroughly modern: intersectoral, interdisciplinary and global. Her understanding of the physical and psychological environment of the hospital and home reveal not only a deep scientific understanding of hygiene, but health and healing, details of care that added to comfort as well as nourishment of the human spirit.

Nightingale’s statistical and analytical skills formed the bedrock of her international and comparative statistics, anticipating the development of International Classification of Disease (ICD) codes today. Her research on hospital outcomes finds echoes in the work on staffing by Aiken et al. She was, above all, a brilliant communicator both visually, through data, and verbally, through the power and epigrammatic prose style. She was adept at presenting data in a graphic form to dramatize her message and move her audience to action. She understood the power of statistics to change minds and encourage politicians to implement reform.

Nightingale’s statistical and analytical skills formed the bedrock of her international and comparative statistics, anticipating the development of International Classification of Disease (ICD) codes today. Her research on hospital outcomes finds echoes in the work on staffing by Aiken et al¹. She was, above all, a brilliant communicator both visually, through data, and verbally, through the power and epigrammatic prose style. She was adept at presenting data in a graphic form to dramatize her message and move her audience to action. She understood the power of statistics to change minds and encourage politicians to implement reform.

Example of a polar area diagram, showing ‘The Causes of Mortality in the Army in the East’.

Her clear, persuasive style and proactive approach to policymaking made her a skilled policy entrepreneur - putting the evidence in the hands of policy makers via her networks; communicating it in an easily digestible format, then lobbying her case with every tool she had at her disposal. The rise of random controlled studies and evidence-based practice is now common currency in nursing and healthcare practice. Indeed, Nightingale’s very definition of nursing, both sick and health nursing, resonate with our approaches today²: 

Her teaching on hygiene remains exemplary as we battle with sepsis, excess mortality attributable to hospital acquired infections: MRSA and C. difficile. Added to that, antimicrobial resistance (AMR) is poised to be one of the leading causes of mortality by 2050, in which hand washing and hygiene may be some of the most potent defences against transmission. AMR forces us to fall back on practices of the pre-antibiotic period³.

Hospital scandals are not a thing of the past and recent experience in the US, UK and elsewhere demonstrate many of the underlying causes are staffing shortages and the want of good quality nursing⁴.

Her support for nursing as a secular occupation; a means to enable women to be trained, educated and pursue an independent living has amplified the impact of education on the health of the population, both indirectly and indirectly. Evidence demonstrates that investing in the education of nurses delivers a health dividend for the community in terms of its health literacy⁵.

She would put her righteous indignation to work, call time on the nursing shortage and escalate it up the international political agenda by declaring it an international emergency. She would rally support for a global nursing summit at the 2020 World Health Assembly; marshal all her networks and political resources to lobby governments and non-governmental organisations to commit to a treaty compelling governments to take action by putting a legal framework in place to ensure sufficient supply of nurses to speed up progress on the SDGs and UHC for underserved populations. She would convene a follow-up summit with finance ministers at the World Economic Forum meeting in Davos to create a new global Nightingale Fund to deliver the biggest ever investment in nursing and midwifery in history.

She would call on all nurses to take leadership of hygiene and antibiotic stewardship. Notes on Nursing would be relaunched as an online platform to empower patients and their families in the 21^st Century in how to keep healthy and look after themselves, targeting those with chronic disease and mental health problems in the first instance. She would train a new breed of digital nurse designers to produce solutions for care delivery and patient safety systems as well as engage with innovations such as block chain. She would remind us that globalisation is an opportunity to connect with our values, each other and set out a bold manifesto for change. This would require a power shift from ’old’ to ‘new power’⁶ and new ways of collaborative working. Nursing associations would need to adapt and work together to form a super collaborative to use their collective organising power to mobilise on a scale as never before, working closely with the public, patients and families.

Finally, she would urge an intergenerational approach, with young and older leaders trained together in organising methods and political influencing skills. Together, they would act as the new generation Nightingales who would lead the charge and create nursing as a global social movement for social good.

Footnotes

1. Aiken, L.H., et al., Nurse staffing and education and hospital mortality in nine European countries:a retrospective observational study. Lancet, 2014.383(9931): p. 1824-30.

2. Nightingale, F., Sick-Nursing and Healthy-Nursing in Burdett-Coutts, A.G., 1893. Woman’smission; a series of congress papers on thephilanthropic work of women, by eminent writers.1893, London: Marston & Company, Limited.
3. Rafferty, A.M., et al., Germs and Governance:The Past, Present and Future of Hospital Infection, Prevention and Control. In Press: Manchester University Press.
4. Rafferty, A. and R. Wall, An Icon and Iconoclast for Today’ in Nelson, S., Rafferty, A.M., 2010. Notes on Nightingale: The Influence and Legacy of a Nursing Icon. 2010, New York: Cornell University Press
5. All-Party Parliamentary Group on Global Health,Triple Impact: how developing nursing will improve health, promote gender equality and support economic growth. 2016, APPG: London.
6. Heimans, J. and H. Timms, New Power: Why outsiders are winning, institutions are failing, and how the rest of us can keep up in the age of mass participation. 2018: Pan Macmillan