As I watched the spread of COVID-19 across Asia and Europe in late 2019, I recall a sense of shock and disbelief but held on to a sense of hope that the effects on the U.S would somehow be less severe. I recalled the twenty-three years that I worked in a hospital and the effects of an airborne isolation patient on the nursing units. I currently work at a community mental health center. Although I am an essential worker, anything I had to contend with during this pandemic has been minor compared to the inpatient world. When I worked in the hospital, we were periodically fitted for N-95 masks to ensure proper seal, equipment was never re-used or shared, hand washing was paramount, and the patient had to be placed in a negative ventilation room. The presence of this type of patient changed the workflow of the entire unit. The workload for this patient was much greater due to maintaining precautions therefore a nurse was usually assigned fewer patients but that made more patient assignments for others. The thought of having multiple critically ill patients on ventilators in airborne isolation was more than I could fathom. I feel deeply for the nurses working on those units during the height of the pandemic and agree wholeheartedly that they are our heroes.
It is likely that Florence Nightingale experienced shock, disbelief and despair during her treatment of wounded soldiers during the Crimean War. However, as she has been quoted as saying, "how very little can be done under the spirit of fear," she got to work. Florence Nightingale was a pioneer in nursing who confronted infectious diseases. As her accomplishments were visionary and have been advanced and interwoven into nursing standards, I think she would be disappointed in the public health response to COVID-19. It is clear to see the use of her visionary ideas but they were without the vigor and determination in which she would have practiced them. One of her visionary ideas relevant to the COVID-19 response included the recording data on which future nursing actions would be developed. She used her affluence to obtain buy in from stakeholders and encouraged nurses to take part in legislation. She understood that leadership buy in was essential in meeting needs. She understood the importance of education and that public health required inclusion of the poor.
The First Statistician
If Florence Nightingale was here at the time COVID-19 began, I suspect there would have been greater preparation. As she was known as the first statistician, she would have demanded infection, morbidity and mortality rates and any and all real time data that had been compiled or compile them on her own. In 1860, she called for a uniform method to collect and present hospital statistics to improve hospital treatment. Due to being informed, and deducing that the virus was airborne and spread from human to human, much of her effort would have been towards obtaining necessary equipment to treat patients and supplies to protect nurses and patients.
Used Affluence as a Tool and Identified Stakeholders
As Florence Nightingale was known for using her affluence, she would have used this to gain the finances and political buy-in required to meet the needs of the pandemic. She realized that there are often problems due to layout of facilities and administration. She was aware that if leadership isn't engaged and doesn't see the advantages, outcomes are diminished. She was not afraid to be a part of the legislative process. She would have reached out to the WHO, the CDC, the NIH, the president, congress, state governors to educate, collaborate and organize an action plan.
Florence Nightingale was an educator. She took the time to write information at a lower level of reading to ensure all could read her writings. Due to the magnitude of the pandemic, it is likely that one of her actions in response would be to educate the public with all she was learning about the virus. She was aware the education was a strong determinant of healthy practices.
Advocate for Minorities and the Poor
Due to her view that nursing should exist within a broad social context where poor people matter, she would have anticipated the fact that racial and ethnic minority groups would be disproportionately represented among COVI-19 cases. She professed that healthy environments save lives and when they are weak, people are at risk. She would have addressed these populations in their communities at the beginning of the pandemic.
“If only (this was done) … this many lives would have been saved." There are so many suggestions for examples to complete this phrase. One certainty is that we were better prepared through the contributions of Florence Nightingale. She would have been proud that, as a profession, we excelled when called upon. Hospital nurses were steadfast against enormous obstacles to care for and comfort the sick which is exactly what she would have wanted.
Stanhope, Marcia; Lancaster, Jeanette. Seventh Edition. Public Health Nursing Population-Centered Health Care in the Community. 2008 by Mosby Inc.
Nightingale, Florence. "Notes on Nursing: What It Is and What It Is Not."
https://www.biography.com/scientist/florence-nightingale Accessed June 1, 2021