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EDITORIAL

Happy Birthday, Florence Nightingale

Pickler, Rita H.

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doi: 10.1097/NNR.0000000000000431
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May 12, 2020, will be the 200th anniversary of the birth of Florence Nightingale. When I wrote the first version of this editorial in February, I assumed May 12 would be a day of celebration around the world. I was looking forward to joyful parties with my nurse colleagues, all of whom should be first in line to celebrate this significant occasion. I was pleased to know that a Commemoration Service for Ms. Nightingale was scheduled for Westminster Abbey in London. I was delighted to be taking part in numerous in-person as well as social media discussions and callouts about Florence Nightingale and her legacy.

Then, there was a pandemic.

The celebrations are, appropriately, indefinitely postponed or canceled. The Florence Nightingale Museum in London, like almost all museums everywhere, is closed. Nurses, most of whom were excitedly looking forward to observances, are busy with other, more important matters. The attention of the World Health Organization has shifted, fittingly, from its Year of the Nurse and Midwife campaign, designed to correspond to the Nightingale 200th, to the COVID-19 crisis. At Nursing Research, we are well aware of the challenging conditions nurses are facing along with our colleagues in the broader healthcare provider community, as well as the hardships facing the world’s population.

Yet, despite these challenges and difficult times, I hope we will celebrate, perhaps in a small way, the anniversary of Ms. Nightingale’s birth. I particularly hope for at least a small public recognition of the day. Although we have much work yet to do to ensure that everyone worldwide has the healthcare they need, delivered in the safest and most efficient manner, without the work of Nightingale at the end of the 19th century, we would be much worse off than we are today. Very specifically, I hope for some public recognition for the work Nightingale did to “establish” professional nursing. Without her efforts, healthcare delivery and health outcomes, especially during these frantically frightful times, might be much different and likely not as good as they are. Nightingale is the reason those nurses, who are valiantly and capably providing care during this time of crisis, are even there.

You see, we must credit Nightingale with launching what has become the most respected of professions. She helped move nursing from an unregulated, “uneducated,” and often unhealthy trade to a rigorous, learned, and valuable vocation. Of course, it is important to note that Ms. Nightingale probably would not recognize the profession she “established.” She might even say that establishing a nursing profession was not what she meant to do, nor would she consider it her most outstanding accomplishment. Yet, despite nursing being a profession largely composed of women, many of whom are from less privileged backgrounds, nursing is now a respected profession with educational programs generally based in university settings and using well-established educational practices.

I will acknowledge that Nightingale was not perfect. The final decades of her life were lived in her sick room, suffering from an illness that remains a mystery. In addition, Nightingale made a number of proclamations that have since, if not at the time, been shown to be erroneous and perhaps cruel. Yet, none of us are perfect, and like Nightingale, we are all a product of our time and place. Indeed, Nightingale, who came from a privileged background with a fixed view of a hierarchical world, was very much a woman of her era. As a woman of “higher class,” she believed that women like herself were responsible for leading (i.e., teaching, directing, managing) those from classes considered not quite as lofty. At the same time, those who were called nurses in her time were often besmirched and, in many cases, thought to be no better than prostitutes. Yet, Nightingale fought her family and society to “train” as a nurse (in Germany) when family and society alike adamantly opposed a young woman of her standing doing so. Women of her time did not nurse “professionally” or lead movements. Nightingale did. She publically practiced a level of nursing not previously seen, and she led a movement that provided a way for women to contribute to meeting the needs of society in a time when women were largely unseen in the provision of formal healthcare. For these accomplishments alone, I thank her.

Of particular interest to readers of Nursing Research is Nightingale’s use of research-based evidence to guide practice. This may surprise those who have “heard” that Nightingale did not “believe” in germs or germ theory and that she relied more on good housekeeping skills rather than “scientific” knowledge. However, a closer examination of Nightingale’s work would lead us to different conclusions. For example, Nightingale applied concepts of her “evidence-based” observations to reform hospital care delivery, including the use of statistics to show how infections could spread in hospital wards (Kudzma, 2006). These same principles of disease spread and hygiene are being applied today in the fight against COVID-19.

Unquestionably, the “research” Nightingale did as part of her practice looks little like most of the research we do today. Specifically, Nightingale’s research first focused on her own observations of sick care provided in homes and institutions in England. She wrote about those observations and gave her advice about “best practices” in her seminal book, Nursing: What It Is and What It Is Not (Nightingale, 2020). Later, in probably one of the earliest documented examples of implementation science, Nightingale applied those lessons learned to the care of wounded and sick soldiers in the Crimea. Today, nursing research or, as I prefer, nursing science is far more advanced than even the important observations and applications made by Nightingale 160 or more years ago. In fact, nursing science is much more advanced today than it was over 40 years ago when I first became a nurse, and for that, I also celebrate.

For my nursing colleagues who have been on the frontline over the last few months providing needed care and comfort, I thank you. On May 12, I will celebrate you for your dedication and care. I hope that you will find a way to write about your experiences as nurses and observers of those very sick individuals to whom you provided care. I hope you will systematically examine your experiences and your observations, just at Nightingale did, so that we might all learn.

Earlier this year, I made a week of resolutions for 2020 based on Nightingale’s writing. In celebration of her great legacy, I offer them to you here: (a) Live life while you have it; (b) Do the right thing; (c) Study statistics; (d) Get straight to work; (e) Never lose an opportunity to encourage others; (f) Bring the best you have to whatever you do; and (g) Never give or take any excuses. To these, I will add: Do not be fearful. This is very hard to both say and do. Yet, I believe we must say it and live it because only together we will survive these difficult times.

To celebrate Florence Nightingale, I will work on these eight resolutions for the rest of the year and perhaps, as would be fitting, for the rest of my life. I am grateful for Nightingale’s work that led to the profession and scientific discipline that is her great legacy. I am extremely grateful to nurses everywhere for all they have done in the past and especially during this awful time. To all our readers, I ask that you please take time to thank a nurse. In particular, thank those nurses who continue to contribute to nursing’s scientific base and especially those who will take their current experiences and translate them into scientific knowledge for the future, pushing us ever forward to do the best we can do for those who need our help the most.

REFERENCES

Kudzma E. C. (2006). Florence Nightingale and healthcare reform. Nursing Science Quarterly, 19, 61–64. PMID: 16407602.
Nightingale F. (2020). Notes on Nursing: What it is and what it is not (160th anniversary ed.). WoltersKluwer.
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