“Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation as any painter's or sculptor's work.”
Florence Nightingale (1868)1
FOR ANY PROFESSION to advance, it's important to remember the contributions made by those who built its foundation. Many healthcare professionals are so focused on present and future challenges that they never take the time to remember the past. This article is the first in a series examining some of nursing's past leaders—some well-known, others largely unknown—in order to foster in today's nursing workforce an appreciation for their predecessors' accomplishments and contributions to the profession.
Becoming the “lady with a lamp”
Florence Nightingale is generally considered the founder of modern nursing, as she was the first person to clearly describe a distinct nursing role. She was born on May 12, 1820, in Florence, Italy, to affluent British parents. She grew up in England where she became well educated in mathematics and fluent in several languages.2 From an early age, she expressed a desire to be a nurse—much to the disappointment of her family; at this time, nursing was considered a disreputable occupation.3
In 1851, against her family's wishes, she went to the Institution for Protestant Deaconesses at Kaiserwerth in Germany to study nursing for 2 months.4,5 Later, she continued her education in Paris for 6 months before returning to London, where she was named the head of the Institute for the Care of Sick Gentlewomen in London.3
At the start of the Crimean War in 1853, English newspapers published many reports of army inefficiency, inadequate care, and a high death rate—not only from wounds, but also from infection and disease. In 1854, in response to these conditions, Sir Sidney Herbert, the British Secretary of War, asked Nightingale to lead a contingent of 38 nurses to improve the conditions at Barrack Hospital in Scutari. This military hospital had accommodations to treat 1,700 wounded soldiers, but upon arrival, Nightingale and her nurses found 4,000 soldiers, many of whom were dying in squalor due to rampant infection. Nightingale became convinced that the environment was connected to patients' health.6 Her approach to the problem was to systematically collect and statistically analyze data to justify policy and protocol changes leading to improved sanitary conditions. She brought order and cleanliness to the practice of nursing, as well as the organization of kitchens, a laundry service, and supply departments.4 She and her nurses ultimately reduced mortality from 43% to 2% within 6 months.3
After the other nurses retired at night, Nightingale made solitary rounds with a lamp to check on the patients. Henry Wadsworth Longfellow immortalized Nightingale as the “lady with a lamp” in the 1857 poem “Santa Filomena.” During this time, Nightingale contracted and nearly died from a disease then known as Crimean fever, but today recognized as chronic brucellosis.6
After the war and a period of convalescence, Nightingale clarified standards for conduct on how nurses provided care to the sick. In 1858, she wrote Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army in which she charted the number of men who died from the conditions in the hospitals compared with those who died from battle wounds.7 After this work, she became the first female member of the Statistical Society of London and became an honorary member of the American Statistical Association. In 1859, she wrote the bestselling book Notes on Nursing, which strongly influenced the vision of professional nursing.5,7
This same year, she opened a nurse training school at St. Thomas Hospital in London, which provided 1 year of training with an expectation of completing 2 years of postgraduate training. On August 13, 1910, after a long life of service, Nightingale died at age 90 in London. She's buried in the graveyard at St. Margaret's Church in East Wellow, Hampshire, England.7
Florence Nightingale's work created the foundation for professional nursing by establishing guidelines and standards for nursing education and practice. She believed in holistic patient care; the basis of her nursing philosophy was that nurses could let nature help patients recover their health by providing a sanitary and healthy environment.8 She was the first nurse researcher and instituted the first evidence-based practices in nursing. Using this information, Florence Nightingale brought an organized approach to the operation of both military and civilian hospitals, created many of the foundations of public health, and is considered by many to be the first true healthcare administrator.4 Through this work, she moved nursing from a profession of disrepute to a model based on honor and scientific advances.
“Unless we are making progress in our nursing every year, every month, every week, take my word for it, we are going back.”
—Florence Nightingale (1872)9
2. Judd D, Sitzman K, Davis GM. History of American Nursing: Trends and Eras
. Sudbury, MA: Jones & Bartlett; 2010.
3. Donahue MP. Nursing: The Finest Art—An Illustrated History
. 3rd ed. Maryland Heights, MO: CV Mosby Company; 2011.
4. Griffin DJ. Hospitals: What They Are and How They Work
. 4th ed. Burlington, MA: Jones & Bartlett Learning; 2011.
5. Selanders LC. All in the Details. Florence Nightingale. Nurse.com. 2011.
6. Stringer H. Principles for a new philosophy. Florence Nightingale. Nurse.com. 2011.
7. Porter-O'Grady T. The Legacy Lives On. History of Nursing. University of Phoenix & Nurse.com. 2010.
8. Habel M. Nursing Theory: At the Heart of Practice. Florence Nightingale. Nurse.com. 2011.
9. Nightingale F. A Selection from Miss Nightingale's Addresses to Probationers and Nurses for the Nightingale School of St. Thomas Hospital. http://www.archive.org