Florence Nightingale's Revolution from Home

SusannahM, BSN, RN

I remember in Nursing School learning about Florence Nightingale’s role in the Crimean War - what she did to help establish safe sanitation practices, and that she was a tremendous advocate who worked tirelessly for her patients. However, it was not until this year that I learned that the bulk of Florence’s life and career took place at her home, starting at the age of 38. She had become homebound and bedridden due to contracting Crimean fever and suffering from its after-effects until the time of her death at 90 years of age. According to the “History” documentary on Florence’s life [see Florence Nightingale], she continued to work tirelessly from her bed - writing articles and books, interviewing politicians, and consulting as an international expert on sanitation best practices. This added up to almost 50 years of continued work that she conducted from home – our first “Remote/Work from Home” Nurse, if you will.

A few other interesting things I learned about her this year was that she was a renowned statistician who developed new ways of visualizing data that was convincing to even the layperson (also a good work from home position), that she enlisted fewer sick hospital patients to help clean the hospitals from top to bottom during the Crimean War (making nursing a communal effort), and that she created a holistic model for patient recovery by establishing the first hospital kitchen (“the Invalid’s Kitchen”) that could accommodate patient’s dietary needs and make more appealing food (as well as a laundry system so patients could have clean linens, and a classroom and library for intellectual stimulation and entertainment) (https://www.history.com/topics/womens-history/florence-nightingale-1).

So when I think about our modern problem of compromised patient care and inadequate staffing, where nurses are overworked and underpaid -- and apply Florence’s advocacy skills, her political connectedness, her passion for public health, and her endless desire to think outside of the box (ie enlisting fellow patients to help clean a hospital during war-time) -- there are several things she might do today. She might work with our national political leaders to convince them to formally identify our current healthcare status as an “emergent healthcare crisis”, requiring all available medical resources to be accessed immediately. She might convince the US government to deploy military medical personnel to all hospitals in need until the healthcare crisis stabilizes. She would help develop a joint military-civilian healthcare team, with the full force of the federal government behind it, including its funding and medical resources. This would solve both our Staffing and pay crises (the military budget is currently 54% of our national budget, so the money is already there), which would then also have the trickle-down effect of improving patient care. [See “National Priorities Project” for the US governmental budget breakdown statistics]

Since Florence was a statistician, I think she would also be very excited about all of our current technology (both medical and non-medical), and push for it to be used to its fullest capacity. If we have Nurses who are unable to work in a hospital setting for any number of reasons, she would *find* a way to make sure they could work from home if they so choose. She would not view work-from-home options as a hurdle to healthcare – she would view it only as an incredibly valuable asset. She would deploy public health nurses, research nurses, and statisticians to be working from home around the clock – whenever they are able to work without hurting their health (I think Florence would have learned at this point that overwork is unhealthy, as she was forced to work from home for decades due to poor health that she contracted while working).

I also think that Florence would be taking our emerging mental health crisis very seriously, especially since she seemed to recognize that all healing required holistic care (as evidenced by her advocacy for high-quality on-site food, laundry, and educational/entertainment resources). I think she would argue that we wouldn’t be able to solve our healthcare problems without incorporating high-quality mental health supports throughout the entire healthcare system’s structure. She may advocate for all patients to be assigned a bedside advocate from the moment that they arrive at the hospital. A bedside advocate would be there to help make sure the patient’s voice is always heard (regardless of race, sexual orientation, ethnicity, etc.), and that mental health support is always present. She may also advocate for a huge overhaul of our current hospital food system, to make sure the food options are clean, high-quality, whole foods promoting physical and mental wellness. As a public health nurse with a passion for statistics, she would find creative ways of convincing the US government that all health (and healthcare costs) would dramatically improve if serious preventative measures were put in place. Since she enlisted less sick patients to help clean the hospitals during the Crimean war, she may also advocate for more community support and engagement throughout all of these above-mentioned overhauls – enlisting restaurants and food services to support hospitals and patients at home. She might also ensure that patient’s hearts and minds continue to be stimulated as an aid to recovery by creating a coalition of artists and healthcare providers so that there would always be live music or any form of art accessible to any of the patients.

I also think Florence would think deeply about what it means to be home with an illness, as she was home for over 40 years with her own illness. She may advocate for people from every walk of life to visit homebound patients who could tolerate it. She may even recognize that a lot of good healthcare services can be provided at home, and work with politicians to develop a national strategy to help patients be treated at home when the hospitals are overwhelmed, or when it was in the best interest of the patient to stay home.

Overall, I think Florence today would really push politicians to finally buy in to the age-old concept that an ounce of prevention is worth a pound of cure. I think she would know it to be an uphill battle to convince them of this wisdom, but that she wouldn’t give up, and certainly would not take “No” for an answer.

Florence Nightingale's Revolution from Home

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