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  1. I remember in Nursing School learning about Florence Nightingale’s role in the Crimean War - what she did to 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.
  2. spotangel

    Florence In My Time

    The Nursing Unit was abuzz with the news! There was a new Chief Nursing Officer (CNO). Her name was Florence Nightingale. “Have you seen her?” “No, but I heard there is a Nursing Meeting with Breakfast tomorrow from 7 am - 9 am so that the incoming and outgoing shifts can meet her tomorrow and next week Tuesday!” The next day the nurses were surprised at the breakfast! Fresh fruits, oatmeal, freshly baked bread and cheese and of course hot coffee, tea and hot chocolate! Florence turned out to be a practical, data-driven but compassionate leader. She talked about her work during the Gulf War and the issues nurses faced from understaffing, lack of supplies, the cluelessness of the rest of the team about the nursing role. The nurses found themselves nodding as she accurately portrayed their issues. She broke the group into smaller groups for brainstorming sessions about the Covid crisis and the nurses' suggestions on handling the issues. A group of nurses came up with a system to monitor the PPE, and equitable distribution based on a WhatsApp group for days and nights nursing teams. The Nurse Managers were also part of that group. Another group decided to monitor patient outcomes related to staffing ratios. Yet another team of outspoken nurses volunteered to be on Zoom meetings when discussing the hospital’s Covid recovery plan. It was a productive meeting. The nurses left the meeting feeling rejuvenated and it was not just the non-greasy breakfast! Finally, they were really part of a team! Utilizing the nurses' feedback from the bedside, Ms. Nightingale used the data and showed not just positive patient outcomes but an increase in patient satisfaction scores, a decrease in rehospitalizations after a safe nursing discharge, Nurses' retention scores, a decrease in mortality due to Covid for patients and staff. There was a designated 24/7 hotline number for staff to call if any kind of crisis, a “calm down room for all staff ” in every wing and Ms. Nightingale involved the Nurse’s union to set up these resources. Nurses were encouraged to bring their ideas for a better workflow to the table and were listened to. At the same time, they were expected to be professional at all times, dress in uniform and be on time. Slackers were taken to task and “a three times you are out” rule was instituted with the approval and support of the union! More and more nurses wanted to come and work in this hospital. The CNO was looked upon as an innovative leader and role model. Her Nurse Managers took the lead in understanding the data and showcasing the skills of their unit Nurses! It was the ripple effect. One of the initiatives that the nurses came up with was a liquid diet for the covid patients that were easily digested and helped them recover faster. The hot coffee and tea truck rolled through at 10 am and 4 pm. This change in diet correlated to speedier recovery for many patients and also became a cost-effective measure that saved the hospital a ton of money. This model was then adopted by other hospitals effectively. All these initiatives had the backing of the CNO and empowered the nurses. I am happy that Florence is now in my time!
  3. Sisters and brothers of nursing, I see you and I am so proud of you. You are weary and I know your head and heart aches for many, many reasons. Please be sure to take time to rest. I did not, during my time at Scutari, and my body made up for it when I returned home, after the war. We need to relieve our pains that effect our mind, body, and soul. Our pains are different, but we must keep in mind, what our studies taught us; reduce the inflammation causing the pain; find what you need to rest, recover, and rebound. Taking a moment for yourself will help you be able to provide comfort, peace, and cheerfulness to those in your charge. Your patients will need your knowledge and expertise, but comfort, peace, and cheerfulness are essential when navigating a health crisis or other difficult and scary challenges. You didn’t ask for the challenges, but the fire is lit, and I want to share with you some suggestions to help control or tamp down the fire. Nurses have a unique position in society, in that we can be agents of change and reform. Administration requires more diversity Those with the privilege of authority, whom are charged with the policies of our institutions and well-being of patients, must reflect the diversity of those in their trust. As a woman, I was not welcomed at the Barrack Hospital in Scutari. I had to show up, be consistent, and deliver results. You do not have to be at the summit to make a difference and matter, but you can help support the goal of diversity. To do this, I recommend you: Keep learning and make it a pleasure For reform to happen, people must be properly trained. Continuing education helps to accomplish the above-mentioned goal of diversity. Learning does not have to be formal education. There are many ways to learn and grow as a practitioner that are enjoyable; podcasts, journals, magazines, blogs, on-line learning resources, libraries, professional forums, talk radio, professional organizations, and social media can be wonderful compliments to a formal education. Study, take care, and do the work Education will help you gain knowledge and the skills to identify problems, gather the evidence, develop plans, and network with connections, that will help produce reform and change. This, in turn, helps nurses to not only provide better care, but bring diversity to administration and make desperately needed changes to policy and standards of care. Have a mentor or teacher Surround yourself with people who make you better and inspire you. In my youth, the vicar was a mentor to me, and afforded me the opportunity to save an injured sheepdog. The clergyman showed me how to comfort the dog, alleviate the pain, and reduce inflammation; healing, the livestock guardian, Cap (Richards, 40). Have determination There will always be naysayers, people against the change you wish to bring about. You will need to be steadfast in your devotions to overcome this adversity. Network and make connections with people in your community By now, you may have begun to see the interconnectedness of these suggestions. You will make and build connections through your education, and with your mentors and peers. Your relationships are an integral part of accomplishing your goals. Get involved in politics Write letters and suggest reform; make it so you cannot be ignored. While you do this, be sure to celebrate your gains, for this will help you sustain your efforts over time. Some of you will be going among lions, take care, be dedicated, and know your goal; progress will be made. Ask the hard questions and listen Survey, use questionnaires, and enquire to determine the state of existing conditions, this has always helped me produce evidence, for when I suggest plans for reform and change. With the technologies of today, this task can be made simpler than the surveys and process I helped to create and implement for the workhouses. Volunteer Volunteer at food pantries, for food deliver programs, or somewhere in community that speaks to your heart. We must keep working in the communities we live. At a Sanitary Conference, in 1894, my two-page pamphlet was presented that included, “It’s cheaper to promote health than to maintain people in sickness.” and “Money would be better spent in maintaining health in infancy and childhood than in building hospitals to cure diseases.” (Monteiro, 186) These are ideas that you discuss in society today. While there has been progress, more can be done. In parting, I will say to you what the fishwives of Boulogne said to me and the other volunteer nurses as we parted for our final segment of our voyage to Scutari: “Adieu! Adieu! vivent les sœurs! the good God go with you!” (Richards, 82) References/Resources Florence Nightingale, The Angel of the Crimea. Laura E. Richards Public Health, Then and Now. Florence Nightingale on Public Health Nursing. AJPH February 1985, Vol. 75, No. 2. Lois A. Monteiro, PhD
  4. Nurses Week Contest: $1000 in Prizes! 5 Winners - Each Will Receive a $200 Amazon Gift Card Florence Nightingale - “The Lady With the Lamp”, the World’s Most Famous Nurse, the Founder of Modern Nursing, a True Visionary, and more… Her work during the Crimean War and beyond in the 1800’s is legendary and was the basis for much of nursing today. Hence her label - the founder of Modern Nursing. Nursing has come a long way since Florence Nightingale’s time… and we still have a long way to go. If Florence was alive today, what do you think she would say regarding the nursing profession, the healthcare system in general, and the challenges we are facing? It would certainly be interesting to hear what she would say about the COVID Pandemic and what some of her takeaways would be. Unfortunately, she is not with us today, however, we can take a look back to see what she did during her lifetime and speculate what she might say today about the various challenges facing our profession and what we should do. For this contest, we want you to think about all the challenges nurses are facing today and consider what Florence Nightingale might say. What solutions would she recommend? Who better than Flo to add insights on ways to address these issues? Let's hear your thoughts... Article Topics If you are having trouble thinking of ideas for your article, here are some suggestions: COVID Pandemic - Lack of PPE, Hand-washing, Unsafe Working Conditions Nursing shortage Inadequate staffing - Nurse/Patient Ratios Overworked and Underpaid Nursing Higher Education Nursing School Education, Online vs Brick and Mortar, Student preparedness Hospital Administration Unsafe workplace Healthcare Salary Incongruencies Gender Inequalities Compromised patient care Burnout $1000 in Cash Prizes! $200 Each for Top 5 Articles Who Can Enter? This contest is open to nurses and nursing students. You don’t have to be an experienced writer. As long as you are a nurse or nursing student with any experience at all, you have something to share. We want to hear from you. Contest Rules of Submission We are so glad you are interested in submitting an article. Here are the rules of submission: Article tone and content must comply with our contest rules and Terms of Service. No solicitation. Articles must have a minimum of 700 words. Articles must be submitted between May 6th and June 3rd. No plagiarism - your article must be written in your own words and cannot be posted on other websites, blogs, etc. prior to posting on allnurses. Articles will be reviewed and approved by staff for consideration before displaying publicly. Articles must be unique and should not be listed on other websites, blogs, article sites etc. prior to posting on allnurses. Once your articles have been published on allnurses.com, you are welcome and encouraged to share them on your other sites and social channels. If you have created your article in a document, you must post all content from that document in the text box as outlined below. DO NOT POST THE DOCUMENT LINK ONLY You may submit multiple articles. You grant permission to allnurses.com rights to publish in magazines, books, etc. You will be notified and credited if published. Keep personal formatting choices such as font choice and size to a minimum - use only for headings. Check grammar, punctuation, and spelling before clicking SUBMIT. How to Submit Your Article To submit your Article, go to the General Nursing Forum and click the green tab on the right: ADD NEW TOPIC When that loads, click, "Article?". Then, click the dropdown menu that reads: "Yes I'm Submitting An Article". Follow the instructions to complete all required fields (TITLE, ARTICLE SUMMARY, and CONTENT), scroll and click SUBMIT TOPIC. Do NOT submit the article as a PDF file. Once you have submitted the Article, it will be reviewed by the Editorial Staff. If the Editors have questions, they will contact you for additional information. Only Articles containing 700 words or more will qualify for the contest. Winners will be selected by the Editorial Staff. If you have questions about Article submissions, please contact the Admin Help Desk. Don't Wait The deadline to submit articles for the contest is June 4th at 11:59 PM ET Get your article submitted now. The sooner you submit your article, the sooner others will be reading and being inspired by your article, and the more views and likes you will receive. Who knows...You could be one of the 5 lucky prize winners. Good luck to everyone! We are looking forward to reading your articles. What have you got to lose? Celebrate nursing and be proud of the part you play to make nursing the most trusted profession. This contest is sponsored by allnurses Ebooks. Quality Nursing Ebooks. Anytime. Anywhere. Our ebooks are created by nurses, educators, students, and healthcare professionals. We have one goal - To help you succeed in your nursing career.
  5. Maxwell Kpeem

    What Would Florence Nightingale Say Today?

    Florence Nightingale, the lady with the lamp, the best in her days, this generation and perhaps in the generation yet unborn. There might have been nurses before her days but none could conceptualise nursing during her time and even for the future as Florence Nightingale did. She laid the ground work for how nursing should be visualised, considered and developed in the future. She equally created a pathway that, eventually, made nursing to be considered as a profession hence, making it one of the largest and fastest growing professions, in terms of creating new fields or venturing into newer territories in the health care sector today. As with every situation in this world, Florence Nightingale will be both happy and sad with developments in the nursing field because, although, the profession has evolved a lot with significant changes, there are still lots of cracks that needs to be sealed. Below are some of the areas of concern identified and what Florence Nightingale’s reaction will be about these issues. Nursing as a Profession Florence Nightingale will be glad that nursing is now recognised as a discipline to be studied and a profession to be respected. She would be pleased that systems and structures are being put in place to train would-be nurses and to initiate them into the profession upon successful completion of their training. This upgrade has made nurses have a sense of independence, that is, not to feel they are under anyone but to have a sense of belonging in a team of staff who work together for the betterment of the clients in their care. To add to that many specialties have been developed in the nursing sector over the years to, primarily, support some sections of the health sector and to give nurses a variety of options to choose from. Florence Nightingale will also be happy with this development because nurses now have a feeling that they don’t only belong to the ward but can do more to help push the goal and agenda of bringing quality care to all and sundry in almost every department. However, are nurses embracing these challenges? Are they constantly improving and updating on the new chapters that are being flipped every now and then? Though increased stress levels may make this task a bit difficult to accomplish, it is a challenge that we must take upon ourselves to ensure we reduce work place errors that may lead to unnecessary deaths and disabilities. For instance, in 2018, a study concerning medication administration errors at tertiary hospitals in Addis Ababa, Ethiopia in which 298 nurses participated; 203 (68.1%) nurses reported to have committed medication administration errors. Some of these errors were attributed to inadequate training and unavailability of guidelines for medication administration. Nurses can do more to improve their knowledge especially in this age of information technology where every form of training seems to be available on the internet if the right source is sought. The Numbers Florence Nightingale would say kudos to the sort of attention that nursing, as a profession, is getting nowadays. She would be happy about the number of compassionate hearts that have joined this noble profession with a noble cause. As a field that is ever growing and ever expanding to infiltrate more areas of the health care sector, there is the need for more and extra hands to care for the sick and comfort the dying and it seems the world is responding to this need by heeding the call to come and sacrifice their time, efforts and hearts to the cause of this profession. At the center of the Crimean war where Florence Nightingale rose to fame, there were just a few of them at that time caring for the wounded soldiers. Some books about her heroics even identified the fact that in the middle of the night she had to pick up her lamp and make rounds in the ward to care for those who needed help. I believe, in those days and even several years after the Crimean war, there were sick and wounded people who needed this kind of help but could not due to the number of nurses or carers that existed at that time. So, of course, she would be happy about the current population of about 20.7 million nurses which accounts for nearly 50% of the health workforce in the world today (according to WHO). However, she would also want more room for improvement with the numbers because there is a severe shortage of nursing staff across the globe at the moment which is likely to get worse is no action is taken. According to the National Center for biotechnology information, there are lots of factors that are fast dictating the falling numbers and shortages plaguing the nursing field. These factors include; projected ageing of the baby boom generation which means the need for more carers, ageing staff which also means majority of the workforce nearing retirement, nurses’ burnout and violence at the work place which are factors forcing lots of nurses out of the nursing field. These are all factors that are affecting the growing nursing shortages in the world today. When you flip the other side of the coin, thus, into the situation in the developing countries such as in Africa, there is currently a mass exodus of nurses, in search of greener pastures, into the Americas and other European countries largely due to poor working conditions and low remuneration of nurses. The COVID-19 pandemic equally added insult to injury by scooping a part of the nursing population. According to the international Community of Nurses, about 1500 nurses succumbed to COVID 19 in 44 countries. Obviously, Florence Nightingale will not be happy about this looming danger that is about to send her cherished creation (the nursing profession) into a state of oblivion or into a similar situation like the type which existed in her day and will want something to be done about it as soon as possible. Fortunately, authorities are doing their best to tackle this looming danger by instituting interventions such as the use of technology, staff empowerment through motivation and measures to tackle high stress levels, are being put in place to help solve these staffing deficit issues. Service Delivery When it comes to service delivery, nurses have and will always make a statement because, though nurses are most of the times seen as a nuisance by some client’s and their relations, they remain resilient in discharging their duties as they should. It is not easy dealing with some humans as some patients will just try their very hardest to make life for their nurses uncomfortable. This, in my own view, could be attributed to the fact that nurses spend more time with the client than any other member of the health care team and secondly, to the fact that the law seems to focus largely on what the client goes through in the hands of the nurse than what the nurse goes through in the hands of the client. Nurses suffer varying degrees of abuses ranging from physical, verbal and sometimes emotional and even if the statistics don’t show, we can testify to the fact that there were lots of times where nurses had tears behind those beautiful smiles they showed while caring for their clients. Those smiles are not forced as some may think. They are smiles that say, "though you hurt me, I will still give you my best". Some may claim this is what we signed up for when we took the oath of this profession but anyone who experiences a quarter of what nurses go through will surely not think twice about going against the very oath they swore, on the day they decided to accept the call of this profession, by bowing out. This is not what Florence Nightingale would have wished for her nurses. The show of gratitude alone pushes one to give his or her best in terms of service delivery. Nurses have blood running through their veins too but unlike ordinary men and women, nurses are moved by the suffering of their clients and are ready give their all to ensure the speedy recovery and safety of their clients and sometimes journey through with the client to his or her life’s end to ensure that he or she has a peaceful death and rest. This gesture will be boosted if they can be treated with respect by their clients and relations. If this COVID-19 pandemic didn’t prove to the world the big role nurses play in the health care sector, then I don’t know what else will. Nurses who have families had to heed to the call of duty and some, in so doing, never returned, not even to bid their loved one’s goodbye. While other workers were safe and out of danger during lockdown, nurses laid down their lives to fight this pandemic and some did actually lay down their lives to rise no more. So as more is being done to help nurses contain themselves, that is, not to issue the same treatment their clients mete out to them, more can be done to give attention to the stress that nurses go through in the midst of these inhumane treatments that tends to threaten the very existence of this profession. Conclusion Nursing is an ever growing profession which will see changes year in and year out. Of course as I said earlier, Florence nightingale will be impressed with the sort of recognition given to nursing by making it a profession and the numbers that are currently in the profession but she would want more to be done in terms of the attention nurses receive while in the line of duty. She would also want nurses not to give up on their call. As the saying goes, "every cloud has a silver lining"; the silver lining of nurses’ efforts in the midst of all the difficulties they face is to see their clients get well. Despite the difficulties nurses go through, either in the hands of clients or the management, nothing can be more satisfying than the joy of seeing that you have accomplished your task, as a nurse, of seeing your clients get well and having another go at life. As we celebrate the year of the nurse and midwife yearly, let’s be reminded of the vision of Florence Nightingale for the nursing fraternity. As she rightly puts it: She constantly put her feelings and her visions into actions and through her works the world can boast of a close companion; one that can connect more than family in sickness and, though, the time of interaction may be for a limited time, will facilitate the healing process and leave a lasting impression which may be unbeatable for years to come. This companion is none other than the Nurse that cares so much for the sick and the dying. Happy year of the Nurse and Midwife celebration to all colleague nurses and midwifes around the globe. References/Resources 1. Wondmieneh et al, 2018, Medication administration errors and contributing factors among nurses: a cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia, BMC Nursing, accessed 4th June, 202, https://bmcnurs.biomedcentral.com 2. ICN, 2020, ICN confirms 1,500 nurses have died from COVID-19 in 44 countries and estimates that healthcare worker COVID-19 fatalities worldwide could be more than 20,000, International Council of Nurses, accessed 4th June, 2021, https://icn.ch 3. WHO, Nursing and Midwifery- WHO Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020, accessed 4th June, 2021, https://who.int. 4. Haddad et al, 2020, Nursing Shortage, accessed 4th June, 2021, https://ncbi.nlm.nih.gov.
  6. To appreciate Florence Nightingale’s thoughts about hospitals, nursing, and patient care in the 21st century, let’s imagine what she would observe in a hospital today. Florence would walk through the hospital to scrutinize each unit and department and observe patients' and nurses' behaviours. Satisfied that the inspection has shown her what healthcare is like in the modern-day hospital, Florence Nightingale would conclude this–hospitals are noisy, and the noise prevents the patient from achieving health and well-being. The science supports Florence’s (hypothetical) conclusion. Hospitals are Polluted with Noise Noise is any unwanted, unpleasurable, or disturbing sound. Sound, measured in decibels (dB), varies widely. Sound levels range from rustling leaves (20 to 30 dB), to conversational speech (60 dB), to a vacuum cleaner (70 dBs), to a jet aircraft (120 dBs).[1,2] Noise above 65 dB is considered noise pollution.[3] In hospitals, noises are emitted from many things like monitoring devices, alarms, HVAC systems, telephones, overhead pagers, ventilators, suction machines, drains, and people talking. The World Health Organization recommends an average noise level of no more than 35 dB in patient treatment or observation rooms and no more than 30 dB in patient unit rooms.[3] No hospital since 1960 has met this guideline.[4] Noise pollution has many negative impacts on patient health and well-being including: high blood pressure, headaches, respiratory agitation, racing pulse, sleep disturbance, aggressive behaviour, irritability, depression, fatigue, anxiety, stress, the need for more pain medication, and diminished ability to focus. [1,5] In addition, excessive noise can increase a patient’s hospital length of stay for up to a day.[6] Build ‘Quiet’ Into Hospitals What would Florence advise that nurses do about noise pollution in hospitals? Perhaps she would first praise us for our innovations because they prevent diseases, cure illnesses, and prolong life. Then she would point out that our innovations create noise which is a “cruel absence of care”. She would press us to redirect our penchant for building machines and technology to creating noise-reduction solutions to support patient healing and recovery. She would want us to build ‘quiet’ into hospitals. Florence would insist that we begin our journey to develop solutions with an observation exercise. She would ask us to lay down on a patient bed, close our eyes, and pay attention to the noises all around. These noises, Florence would say, are absorbed into the body and mind of the patient. These noises, she would continue, interfere with the calm disposition that the patient needs for a restful sleep, a steady breath, and a relaxed mind. The point of Florence’s observation exercise would be for nurses to understand, through observation, how the patient ‘hears’ the hospital. By understanding the patient, we can begin to develop the right solutions. Our solutions might be technology-focused such as installing soundproofing systems, purchasing equipment with ‘silent’ settings, or eliminating overhead paging by providing nurses with personal devices. Or processed-focused solutions such as restocking supplies in the evening rather than at night when patients are trying to sleep, designating routine ‘quiet times’, or posting signs to remind people to talk quietly. We might devise simpler solutions like planting trees outside of the hospital to absorb sound or transform unused rooms into ‘quiet rooms’ with calming wall colours and large windows to let in sunlight. Reduce Hospital Pollution Through Science and Art According to Florence, nursing “is achieved through environmental alteration”. Because hospital noise pollution is a tremendous problem, it is tempting to believe that the solutions are beyond nursing. But nurses are in the perfect position to fix the problem as we are both scientists and artists. It’s easy to fixate on the science to solve problems because science is groundbreaking and praised. But to focus solely on the science is to overshadow the art. And when the art is forgotten, so too is the patient. Some 200 years after her birth, nurses still look to Florence Nightingale, the mother of modern nursing, for guidance. To make hospitals quieter and thus healthier, I believe that she would encourage us to become reacquainted with the art of nursing– being intuitive, showing compassion, and observing the environment through the eyes of the patient. References/Resources Hsu, T., Ryherd, E., Persson, K., & Ackerman, J. (2012). Noise pollution in hospitals: Impact on patients. Journal of Clinical Outcomes Management, 19(7), 301-309. National Geographic. (2019, July 16). Noise pollution. https://www.nationalgeographic.org/encyclopedia/noise-pollution/ Berglund, B., Lindvall, T., Schwela, D. H, World Health Organization, & Occupational and Environmental Health Team. (‎1999)‎. Guidelines for community noise. World Health Organization. https://apps.who.int/iris/handle/10665/66217 Busch-Vishniac, I. J., West, J. E., Barnhill, C., Hunter, T., Orellana, D., & Chivukula, R. (2006). Noise levels in Johns Hopkins Hospital. The Journal of the Acoustical Society of America, 118, 3629-3645. https://doi.org/10.1121/1.2118327 Iberdrola. (n.d.). Noise pollution: How to reduce the impact of an invisible threat? https://www.iberdrola.com/environment/what-is-noise-pollution-causes-effects-solutions Fife, D., & Rappaport, E. (1976). Noise and hospital stay. American Journal of Public Health, 66(7), 680-681. https://doi.org/10.2105/AJPH.66.7.680
  7. It’s been a long time since Florence Nightingale’s day. The changes, innovations, and advancements in medicine occur at an ever-increasing rate. Even during my own 22-year practice as an acute care nurse in a major hospital - a brief blip in the context of the big picture - the change has been substantial. Therapies and practices that were considered “mainstream” or “leading-edge” in my early days as a new nurse have been replaced by new innovations and therapies that make the “old ways” seem old indeed. And the wheels of innovation and evolution roll on: consider how far we have come in the handling and treatment of the Covid-19 pandemic. It’s inspiring to contemplate how the early fear and ignorance surrounding this unknown intruder have been replaced by understanding, new knowledge, enhanced isolation practices, and heroic response to the demands for supplies, equipment, and manpower. To say nothing of the development and distribution of a vaccine! Everyone involved in healthcare during this revolutionary time in medical history, from the geniuses of epidemiology who have been, and continue to be, the authors of these solutions, all the way down the line to the valiant nursing students - attempting to complete their degree and join the battle despite staggering limitations on their education imposed by the pandemic are, in a word, superheroes. First and foremost, what would Nurse Nightingale’s impression be of this particular drama? I believe she would be proud. I think she would approve of the way all of the players and props in this tale have come together to provide answers and solutions. I believe she would be impressed by the teamwork involved in crafting and implementing all of the component parts and pieces to contend with and control not only the disease itself but also the fear and uncertainty associated with it. Beyond the issue of the pandemic, which has occupied the minds of all of us for so many months now, I like to imagine taking her on a tour of my hospital - to witness up-close the daily practices, therapies, and healing modalities that take place there on a daily basis. What would she think as she looked around herself in the gleaming ICU - surrounded by the beeps and buzzes of technology, the likes of which could scarcely be imagined in her day? The wonders of “CCRT” - continuous renal replacement therapy: ongoing, continuous dialysis that provides precision, patient-specific therapy in real-time? (Especially considering that dialysis of any kind didn’t exist in her day). What would be the look on her face as she visited various departments and witnessed heart catheterization procedures, early stroke interventions to minimize or even prevent the devastating impact of a cerebral embolus or stenosis, or learned of advanced chemotherapy treatment designed to lessen the devastations of cancer and extend life? It’s not unlikely that she’d wonder if she’d been transported to another universe, wherein things that existed primarily in the creative imaginations of practitioners had been brought into reality. Additionally, I also suspect that she’d wonder about progress and innovation that had been made in the non-medical realm of patient care. I picture her questioning what new and revolutionary methods were being consistently and universally practiced to address the inevitable fear, worry, and anxiety that plague a patient whenever physical health suffers. Would we have an equally impressive tour to provide - a similarly outstanding report to present? Nightingale’s concern for and emphasis on these patient needs is clearly evident in her inspiring words: And more directly: It is here that Florence might have much to still teach us - areas in which our understanding and practice (consistent practice, at least), might still be lacking. Do we sometimes get so caught up in the excitement and enthusiasm for all of our new medical theories, therapies and practices that we forget the most basic thing of all: that our patient is also a human being, with all of the complex and convoluted basic human needs that come along for the ride? Nurse Nightingale might point out that “the old ways are still the best ways.” Regardless of why the patient is in the bed with the ID band on their arm - to one degree or another their world has been “turned on its ear” for the time being, with new conditions, new discomforts, perhaps loss of a portion of physical/mental/emotional functioning and independence. Most fearful of all can be the unanswered question - the uncertain future. They are surrounded by the unknown - an unknown which might have a potentially long-standing negative impact on their well-being. Can anything feel as threatening? More terrifying, in some cases? Obvious or not, expressed or not, these individuals are scared. And who better to address these fears and uncertainties than the caregiver who has the most frequent and intimate contact with them? No one has more raw power to positively influence the patient’s well-being than their nurse. Do we have a shadow of a clue to the nature of that power - to the amount of good that we can accomplish, far beyond the mere administration of medications or therapies? Florence’s list of needs is clear and concise: “fresh air…light…warmth…quiet…cleanliness,” as well as “punctuality of care in the administration of diet.” Basic creature comforts - all these, which we all crave and cherish as human beings. It’s ironic that as closely as we claim to value these things, most often we only take note of them when they are diminished or missing. Welcome to the inpatient experience. Equally ironic (laughable, really) is how easy it is to address these needs. I work in acute care and once I receive word that I have a patient coming, I immediately go to the room they’ll occupy and do a little rearranging. I turn the bed toward the television, open the window blinds, and turn up the lights. The white-board on the wall is a powerful communication tool, and I make sure that my name, as well as the name of my assistant, is on that board. Most importantly, I ensure that the patient’s name is there, along with the word “Welcome” in front of it. I turn down the sheets on the bed and place the call light control within easy reach on the bedside table nearby. How long does all of this preparation take? Usually less than three minutes. And yet, what impact on the patient’s first impression? Their room is ready and welcoming. Never underestimate the power of ridiculously simple things when providing care. Be open, patient, and empathetic. Want to stun a patient with surprise? Maintain eye-contact, use their name, and patiently listen to them. Really listen. Want to take it to the next level? For the three minutes while you do this, actually SIT DOWN. Combined, all of these ridiculously simple efforts send a powerful message of kindness, interest, understanding, and a desire to serve. As a human being with human needs, the patient is in as much need of these things as they are the very medications and treatments they’re in need of for their physical health. The value of the softly spoken word of empathy, together with a hand gently placed on an arm or shoulder cannot be underestimated. Simply setting up a dinner tray for a patient with limited vision, or speaking loudly for one who is hard of hearing - will fill needs that the patient will frequently not identify. Offering reassurance to a concerned family member - telling them that they need to go home in the evening so they can get the rest that they themselves need, assuring them that their mother or father will be in good hands throughout the night - provides worried loved ones with the security to do just that. Even providing something as simple as a warm blanket or a fresh pitcher of ice water gives you superhero status in the eyes of someone who is cold or thirsty. Finally - addressing the cause of potentially the greatest fear of all - that of the unanswered question - is perhaps the easiest of all. It’s likely that I won’t have all the answers the patient or their family members need. It’s fine to say, “I don’t know” - when followed up with, “I’ll do everything I can to find out.” Even with no specific answers provided at all - frequent contact with patients, especially when they’re waiting - provides them with the assurance that they haven’t been forgotten. I believe that if Florence Nightingale had a curriculum of total patient care, many of these principles and ideas would be found there. It was important to her to care for the whole patient - to address all of his or her needs, insofar as possible. Successfully accomplishing this is easier than it looks, and takes less time and effort than we might imagine. And, at the end of the day, can there be any compliment more pure, direct, and sincere than a patient or their family member asking, “Are you working tomorrow?”
  8. peblevins

    Inpatient Nurses Answered the Call

    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. An Educator 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. References/Resources 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
  9. Okay, you're not going to believe this. I recently had the most remarkable experience of my life! I spent an entire day with...wait for it...Florence Nightingale! Yes I know, pretty far-fetched you might say, but really, it happened! You know, Florence was quite the innovator, downright brilliant, determined, persevering, and well, somehow she was able to master time travel! She said something about wormholes, quantum physics, special relativity---truthfully, she lost me at quantum physics. Why she chose me to visit, I'm not completely sure. Maybe it's because I've been a nurse for so very long, seen so many changes, and, well, I'm disillusioned with nursing as a profession, and healthcare in general, and....my life right now. Pretty much burned out actually, spiritually, physically, emotionally, and ya, so, she showed up at my door! I'm not going to spend tons of time trying to convince you, so just let me tell you about our visit. When she left that day, I felt a little less disillusioned, less burned out, and actually quite energized to move forward again, instead of going around in circles, digging that rut ever deeper. I wish this for you, too, my nurse friend! Let's get started! After the initial shock of it all, and the introductions, we got right down to business! She wanted to know all about what the nursing profession looks like now, in 2021. Wow, where do you start with that? Let me summarize it for you, otherwise, we'll be here forever! As you may have guessed, I started with the recent pandemic. Florence was empathetic, and could definitely relate to how quickly a disease can advance. She was, however, surprised that our government and our healthcare systems were not completely prepared. I recounted how quickly covid consumed our medical resources. I related how healthcare workers on the frontlines worked long, long hours, without adequate breaks or nutrition, and sometimes without adequate PPE to deliver care safely. Often nurses feared contracting the infection themselves and bringing it home to loved ones, leading to anxiety and depression along with physical exhaustion. Florence picked up on my frustration and anger immediately. She reminded me of a quote from her writings which read, "I never gave, or took an excuse." We as a nation, and as healthcare professionals, have no excuse for our ill-preparedness, and we must not let it happen again! Florence then asked me, "So what do you do now; what's the solution?" I hesitated, and she said that right now, our governmental agencies and healthcare leaders should be gathering data from the pandemic in order to do an analysis of what we need to improve, how we can improve our clinical processes, what we can do to ensure adequate staffing and resources, along with many other aspects of pandemic preparedness. She pointed out that we should be surveying our frontline healthcare workers and really listening to their input. I agreed that we've learned some difficult lessons, and hopefully we won't let history repeat itself. I congratulated her on being such an amazing statistician and repeated her quote, "to understand God's thoughts, we must study statistics." I also stated that this pandemic wasn't all negative. It's always beneficial to reflect on mistakes made but I can't forget the awesome, amazing work done throughout the pandemic on the part of governmental public health agencies, healthcare systems, and healthcare personnel. She was pretty blown away by the speed at which we obtained a vaccine and the smooth vaccination process. Continuing with our discussion, I wanted to give Florence a clear picture of what the typical nurse looks like today! I told her that often a nurse has a spouse, or a partner, and many commitments other than his or her nursing career. She was astounded at this! Florence was single all her life, and apparently had been asked to marry more than once, but declined as she wanted to devote her life to nursing. "How do you do it?", she asked. I gave her some examples from my own life, telling her that I really never mastered the "work-life balance" thing. I mentioned that hospitals and other healthcare systems had come up with the idea of 12-hour shifts, but those would often turn into 13 or 14 hours, and extra days off would be spent recuperating from the long shifts! I've noticed that employers are now advertising "work-life balance" for the job they are posting, and some employers offer "mom shifts" for mothers who want to see their kids off to school in the morning. I told Florence that there is a projected nursing shortage, and she said that she thinks employers should do their best to create a work environment that will attract and keep nurses. I gave her a high five on that point, and she laughed at the weird gesture of high five! I also admitted that much of the work-life balance issue had to be the responsibility of the individual nurse. Nurses tend to be people-pleasers and we need to learn to say "no" to extra shifts and responsibilities. Florence chimed in with her quote, "The martyr sacrifices themselves entirely in vain. Or rather not in vain for they make the selfish more selfish, the lazy more lazy, the narrow, narrower." Florence also admitted that she was not very good at "self-care" and this might have contributed to her long illness after the Crimean War. I thanked her for her transparency and told her I thought nurses were becoming more aware of taking care of self, but we have a long way to go. We couldn't end our discussion without talking about inadequate staffing. I related how nurses work long hours, often without getting an adequate meal break, which leads to irritability and exhaustion. There's no time to socialize with coworkers, or even to ask for an opinion. The nurse can feel isolated and alone in a sea of coworkers. It's frustrating to not be able to spend adequate time with a patient, to hold a hand, or give information to decrease anxiety about an upcoming procedure or diagnosis. Not being able to spend adequate time leads to not being able to make good observations and assessments, which directly correlates with patient outcomes. Again, Florence asked, "So what's the solution?" I think I knew she'd ask that. I gave her a few of my thoughts. The solution is most certainly multifaceted. Nurse retention is a major factor in adequate staffing. Employers need to collect data from nurses regarding what would encourage them to stay at a job. I'm thinking nurses want reasonable hours, professional development with training on and off-site, good pay, adequate break time, paid time off, respect, the ability to share ideas and concerns, and tuition reimbursement. An on-call pool of nurses to fill in when someone calls off would be wonderful. Of course, this is expensive, but in the long run, isn't it more expensive to hire and train new nurses? I mentioned shared governance to her and she thought this was a wonderful idea. Unfortunately, shared governance won't work if time isn't allotted by administration to develop it. Again, this is expensive. Also, both leadership and staff need to buy in. Finally, our voices need to be heard in local, state, and national government. Florence said she couldn't get the government to read what she wrote, so she starting using colorful pictures of her data and analysis. I made a mental note of that! I mentioned that it seemed like I was awfully negative, and Florence gave me another quote from her writings. "Were there none who were discontented with what they have, the world would never reach anything better." When it was time for Florence to leave that day, she asked me if I could possibly do her a favor. "Of course, what is it?", I asked. "Well, I think in your time the expression is "set the record straight." Could you set the record straight that I did not die of syphilis? I died of old age!" I grinned, and said, "I'm on it!" By now you've surmised that the above story is a fantasy. Florence Nightingale did not appear to me. However, she does continue to appear to us all in her writings. I feel like I know her after studying her biography, and who knows, maybe someday ... References/Resources 35 Famous Nursing Quotes by Florence Nightingale: https://www.mothernurselove.com/35-famous-nursing-quotes-by-florence-nightingale/ https://www.famousscientists.org Florence Nightingale actual cause of death: https://blog.oup.com/2015/08/florence-nightingale-syphilis-death/ Death of Miss Florence Nightingale: https://www.theguardian.com/century/1910-1919/Story/0,,126410,00.html#:~:text=We greatly regret to announce,of death was heart failure What Florence Nightingale can teach nonprofits about telling better stories (through pictures): http://www.tricycleusa.co/blog-1/2017/6/30/florence-nightingale-nonprofit-data-visualization
  10. nikkulele77

    Texting with Flo

    Texting with Florence Nightingale Yo, Flo! Can u talk right now? (I like saying yo flo) 😊 Talk? Do you mean text? Yeah, I do mean text. Yes. But why do you say talk instead of text? IDK. I know we aren’t literally talking, but ….our fingers do the talking. 👋🏽 Yes, I see. I’m still learning this new technology. What can I help you with? Well….I still can’t believe I’m somehow talking to u. So crazy. 🤪 Anyway, I had a horrible shift the other night and I just wanted to talk it out a bit. If u don’t mind. Oh. OK…. No offense, but I think that may be a little outdated, Flo. It’s 2021. We talk. I think there’s, like, studies and stuff that say debriefing is really important. It helps people process and decompress. And it can lead to action. Changes. Studies, you say? I think so. Ummm, OK. So ... Apologies. You were saying? Yeah. My shift the other night was rough. We were understaffed, like usual, so I had to triple while being charge. Ridiculous! IDK how they expect us to work like that! Patient safety, anyone? Right? It’s just so frustrating when we tell admin over and over and nothing happens. I guess u dealt with that. Getting the men in the military to see that the medical facilities were unhealthy was very difficult. I can only imagine. Anyway, I’m still pretty new at being charge. Any words of wisdom? Ooo, I like that. I’m gonna take it to our unit director. Did you work in the Covid unit? Yep. So so sick of this pandemic. 😷 ??? 😶 I am proud of you for working through such an ordeal. How were your patients? Had a sweet little old lady who always said TY. Seemed lonely, so I gave her an extra long bath last night and talked to her. That was one good thing…. Says the Queen of Hygiene! 👑 Where would we be without u, Flo? I shudder to think…. Haha! True. And some people still suck at hand-washing. This poor lady is getting confused though. Maybe a touch of ICU delirium That interests me. Agreed. My other patient goes berserk whenever we try to wean his sedation. Nearly ripped his tube out. I had just got him settled when the docs came in and just HAD to get their neuro exam. I was like, EM? Let this dude rest! 😡 IDK what sine qua non is, but after they left it took a good half hour for my guy to settle back down. Even the monitor alarms got to him. Remember how I told u about all our monitor and vent alarms? Oh, yes. I must say that bothers me. Sing it, sister. I wish u could come teach us a thing or 2. Most of us could use your wisdom. So you are saying all my CE and classes aren’t a waste of my time? 😉 Flo, did u ever get scared about how nursing would go after u left it and your nursing school? I would be lying if I said I never feared. But I learned that ... I try. I don’t have to tell u how tiring it is. Feels like all I do is work, eat, and try to sleep. I know nursing was like a calling for u, but how did u find any time for urself? Netflix and chill, am I right? 👊🏽 Yes! See, u get it! They can scream self-care at us all day, but until we feel like we are being listened to ... I guess I don’t have to tell u. I don’t mean to complain. Keep that in mind if you want to ignite change. Who was your 3rd patient? Oh, right. I had a 42 yo woman who probably won’t make it. So sad. Married and has 2 kids. She’s been here so long they are starting to talk about what the goals are with her. Like, should we extubate. IDK. Usually I’m pretty on board with it, but this time . . . she’s so young and I don’t think her husband is ready. I know u didn’t deal with this exact thing, but u had some moral dilemmas, right? Oh my ... 👍“The world does nothing but sketch.” I’ve talked to her kids on the phone. So nice. But that just makes it harder knowing she probably won’t make it. Curse Covid! Flo, u dealt with a ton of death. What do u think? It’s never easy. I’m sorry. Remember though ... Hmm. Can I share that with the family if I need to? Of course. 💜 Thx. Hope I don’t have to. I have a few days off and I’m going out for the first time in a long time. TBH, I feel a little guilty. TBH? Guilty? To be honest. Yeah. I guess bc there are all these people and their families who are suffering and here I am going to a movie and eating popcorn. So trivial. Dear, with this pandemic the war you are fighting is different than the one I engaged in. But my response is the same ... Beautiful. TY. Makes me feel better. References Florence Nightingale Quotes from BrainyQuote
  11. What would she think if she saw us now? Florence Nightingale was a daughter of privilege with a well-rounded education in languages and the arts and with connections to high society of her time. She was able to see beyond her class and use her relationships for the greater good. Her approach to nursing was a public health approach. She understood that illness and disease were as much, if not more the result of social and economic inequities such as lack of sanitation and pure water, of underprivilege and poverty as they were infections. She demonstrated this in her work in the Crimea which reduced infections and mortality ( by ⅔) by having able soldiers scrub the floors and walls of the hospitals and bathing soldiers found lying in their own waste. Florence Nightingale’s understanding of what constitutes good health and what the root causes of bad health are informed by her combined approach to achieving health through social reform and data collection. Florence collected data and set the foundation for evidence-based treatment and prevention. In a study she did for the army she determined that 16,000/18,000 men died from preventable diseases during the Crimean War and not on the battlefield This comprehensive approach continues to guide good practice and public health. There is a direct connection between scrubbing the walls and floors in the Crimea in 1852 to the recent plugging of the rodent holes in the walls of a Harlem building (Harlem Children’s Zone Asthma Initiative) to reduce the incidence and prevalence of severe asthma in the children living in the building. What would she see if she saw us now? She would see us true to her words: “What nursing has to do….is to put the patient in the best condition for nature to act upon him”. Prevention is a primary principle of Nursing care-from proning Covid patients, to protocols for prevention of pressure sores to neonatal monitoring and beyond. “ Building trusting relationships with patients” She would see nurses who cared for so many during Covid and who in the end, literally, were the ones with the patients. She would see those same nurses fight for the supplies they needed to care for their patients just as she fought for brushes to scrub the floors of Scutari in 1852. What would she see if she saw us now? A profession of women and men- 4million alone in the US who are the bedrock of health care, whose skills range from hospital bedside, critical care, extended care, ambulatory care, home care, nurse researchers, mental health nurses and beyond. She would see that the nursing process still holds: she arrived in Scutari, assessed the situation, took charge, implemented her plan, and had the data to make permanent changes that benefited thousands. Nursing practice continues on these principles. She would see nurses answering the call to war as she did- through every War since The Crimean. She would see a grateful public beloved to Nursing- from small-town America to large urban areas and best expressed by President Biden based on his personal and family experiences on the eve of his inauguration. There is no nobler profession. She would be proud She would be satisfied with the health care system in her own country- the UK. A national Health System that serves all. However, I feel she would be less satisfied with the United States which has no system and grave inequalities in health care delivery, access and affordability- though somewhat improved with the Affordable Care Act but not in every state. Nothing exposed the inequities in our health system more than the Covid pandemic as was evident in the distribution of vaccines, vaccinations, access to care and and increased mortality in underserved and underprivileged communities. Florence would find the greatest challenge to Nursing’s future in the fact that there is still no standard for education and level of entry and that fact, despite being beloved by the public, continues to undermine Nursings’ credibility with doctors, other professionals and health care administrators. I believe she would fight for standardization in order to achieve the credibility necessary for an equal voice and a seat at the table to advocate for critical issues that impact patient care: the resources to provide excellence in care, safety, optimal pt/staff ratios. May the words from “lady with the lamp” continue to illuminate us: “I never gave nor accepted excuses.”
  12. In times of crisis, sometimes there is a hero, an angel, a person who inspires others to make a difference. In 2020 the world was shaken to the core by a deadly pandemic. There was much loss of life and of hope, but the medical community forged ahead taking care of the gravely ill, holding a hand during someone’s last breath, and developing many versions of the vaccine in record-breaking time that saved many lives. It is these moments in history that can lead to dramatic breakthroughs in medicine and medical treatment. A similar situation arose during the Crimean War. Thousands of soldiers were dying, not due to their injuries, but from infections caused by that plagued them because of the unsanitary conditions they were expected to heal in. It was one woman, who stepped out of the comfort and safety of her own upbringing, who changed nursing and medicine forever. Florence Nightingale came from a wealthy British family and social elitism was an important part of her upbringing. She grew up on one of the family’s two estates in the English countryside of Derbyshire and was educated in the classics in addition to being taught German, Italian and French. Florence's call to nursing came early in life. To her mother’s dismay, Florence attended to the sick and needy in the villages around her home. By the time Florence was 16, she declared her passion for nursing to her parents. They strongly disapproved. Being a nurse was not something a young lady of her status should strive for, but this did not deter Florence. At the age of 24 she enrolled in Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany. Florence not only revolutionized the role of the nurse and nursing, she brought esteem and legitimacy to the profession during a time when women who worked were seen as “less than,” lower class, or servants. On her return to London, Florence was employed as a nurse at a Middlesex hospital and was greatly challenged by a cholera outbreak. She quickly understood that the unsanitary conditions, such as dirty linens and lack of hand washing, contributed to the rapid spread of the disease. By focusing on improved hygiene, Florence lowered the death rate significantly at the hospital. She also applied her hygiene practices when she cared for soldiers in the Crimean war and reduced the death rate by two thirds. Florence was also a statistician, and it could be said that she was the first informatics nurse. She helped start a Royal Commission looking into the health and well-being of the British army. Florence created the polar diagram, now known as the “Nightingale Rose Diagram''. The Nightingale Rose Diagram is a circular grid divided into equal parts. Each section expands from the center depending on the magnitude of the value it depicts. Nightingale’s diagram clearly showed how sanitary conditions and focus on hygiene decreased death rates and improved health outcomes during the Crimean War. Florence turned data into best practices and laid the foundation of nursing today. (History, 2020) Florence Nightingale’s original rose diagram (Natarajan, 2019) What would Florence Nightingale say about modern nursing? The Covid-19 pandemic laid bare the shortcomings of nursing and the medical system. I believe that Florence would be heartbroken and outspoken about the many social disparities that impact health outcomes: People unable to afford health care or medications A nursing culture that is riddled with bullying and abuse Unsafe working environments Unachievable expectations of workloads Nurses are taking care of a more acutely ill population of patients. Our readiness to care for these patients needs to be elevated and supported by the nursing profession. I graduated in 2007 with an associate's degree in nursing. At that point in my life I already had earned a BA, had two children, and experienced first hand the patient side of medicine. I thought my maturity and life experience had prepared me for the profession. I was the student keynote speaker at our nursing graduation. I spoke of hope, responsibility, ethics, and self care. Through teamwork my classmates and I survived nursing school. In our bubble of academia, we shared and listened to ideas, studied together, and built our courage and commitment to nursing. But many things changed after that graduation day as we went our separate ways into a profession that expected so much and gave very little in return. I never realized as I stepped onto the hospital floor what challenges awaited me from unsupportive and even bullying colleagues, condescending doctors, unrealistic time management expectations, demanding and even violent patients. I recoiled and moved inward to protect myself as I tried to care for and advocate for my patients as best I could. The nurse who spoke so assuredly on graduation day was gone. We can not tolerate or accept the continued shortcomings and old culture of the nursing profession that has been riddled with exploitation and abuse. Florence Nightingale would have shined her light on these issues and challenged us to do better and to be better. Thankfully things are changing. Nurses are more empowered to stand up and together against social and workplace disparities. There are nursing organizations that advocate for both nurses and patients. The ANA, the American Nursing Association, is a national organization that promotes, “Through our united voice on policy issues, we support nurses to practice to their full potential – and improve health care for all.” (Nursingworld, n.d.) The ANA recently keynoted The National Commission to Address Racism in Nursing. They both commit to addressing racism, and focusing on equality and diversity in nursing. 2020 was also “The Year of The Nurse” and a call to action in response to Covid-19. The ANA article, The National Commission to Address Racism in Nursing Reflects on Nurses’ Vast Contributions During Nurses Month, states, “Nurses developed innovative solutions to deploy lifesaving treatments to COVID-19 patients, participated in clinical trials to contribute to COVID-19 vaccine development, advocated for their patients and social justice issues, and confronted long standing health inequities exacerbated by the pandemic.” (McClendon, 2021) I believe Florence Nightingale would be singing the praises of nursing as a powerful force that can influence and change policies and harmful cultures. She would be impressed by the continued determination to be a fierce patient advocate that she had promoted so many years ago. As nurses, we celebrate our achievements, but we still must work to continue to ensure the health and safety of our patients and ourselves. Florence Nightingale was called the “the Lady with the Lamp' because she brought light to the darkest shadows. She not only dedicated her life to the well-being of others, she revolutionized what nursing could be in a time of crisis. Nurses today have similarly illuminated the gaps revealed in the healthcare system during the Covid pandemic and used this opportunity to bring change to the nursing profession and care of patients. Modern nursing is based on the foundation of a woman who stepped out of a life of comfort to help and heal others. Like the nightingale, “Nightingale became a figure of public admiration. Poems, songs and plays were written and dedicated in the heroine’s honor.” (History, 2020) References/Resources Animalia. (2020). Nightingale. History. (2020, April 21). Florence Nightingale. https://www.history.com/topics/womens-history/florence-nightingale-1 McClendon, S. (2021, May 26). The National Commission to Address Racism in Nursing Reflects on Nurses’ Vast Contributions During Nurses Month. Nursingworld. https://www.nursingworld.org/news/news-releases/2021/the-national-commission-to-address-racism-in-nursing-reflects-on--nurses-vast-contributions-during-nurses-month/ Natarajan, S. (2019, July 15). From the Battlefield to Basketball: A Data Visualization Journey with Florence Nightingale. Medium.com. https://medium.com/nightingale/from-the-battlefield-to-basketball-a-data-visualization-journey-with-florence-nightingale-c39571686dfc Nursingworld. (n.d.) Practice-Policy. Retrieved May 30, 2021, from https://www.nursingworld.org/practice-policy/
  13. cherylrenee

    The Nightingale Solution

    Florence Nightingale. The name is synonymous with nursing. She is the founder of modern nursing, a scientist, humanitarian, and above all, a patient advocate. She was certainly a woman who was way ahead of her time, a visionary and a leader. And, what would be her reaction if she could see healthcare today? What stunning revelations would she impart to ensure quality-driven, equitable, accessible, and holistic healthcare for everyone? For starters, I’m sure she would view the technological advances as amazing and valuable, as they were not even conceivable in her time. Our wealth of scientific knowledge, abundance of medical equipment, and extensive network of healthcare facilities and personnel would most certainly seem overwhelming and even pretentious compared to 1800’s England. But how would she reconcile our excess in comparison to our access? Nightingale was certainly an advocate for universal healthcare in the sense of available nursing care to all. She believed everyone deserved healthcare regardless of economic status, and she worked tirelessly to elevate patient care to the noble and respected profession that it is today, believing that disease and illness could be healed with patience and commitment and, above all else, compassion. I believe she would certainly question our lack of compassion and commitment to those who are unable to care for themselves. Furthermore, what would she say upon discovering that financial considerations are always discussed prior to meeting patient needs. Payment is expected prior to services or even worse, there are no services within miles. That is primarily because it is not financially profitable to offer medical services in those areas for the reason that people who do not have access usually do not have the economic means to pay for services even if they were available. What would she say to the undeniable realization that healthcare is only for the wealthy or those who work for wealthy corporations that offer insurance policies? I think Nightingale would be extremely dismayed by the highly advanced, state of the art, scientific, profit driven, corporate run healthcare system of today. Needless to say, she would have sharp words of reprimand for the legislative and corporate entities that have helped to shape the healthcare we have come to accept and tolerate over the years. Even in her day, Nightingale felt nursing was separate from the medical profession and hospital administration. How would she consider the fact that insurance and healthcare corporations exercise an overpowering control of healthcare, especially nursing. Through Nightingale, nursing was an autonomous profession owing to the fact that it was a new creation developed by nurses. There were no outside entities with demands or requirements. The role of a nurse was to advocate for her patients, as it still is today, but now we are governed by federal and state requirements, legal policies, and clinical protocols. There is an endless checklist of assignments that must be completed and observed before direct patient care even starts. And holistic care? Is that even possible in today’s clinical environment? If administering medications on time is a constant struggle and many times charting does not get done even at the end of the day, then how can we spend time sitting and talking with patients or family members to understand the emotional and mental and spiritual needs of our patients? We struggle to meet their physical and medical needs. Even as she would be optimistic about the scientific knowledge and technological resources at our availability, she would look to the nurses for some clarification. Now that we have so many inequities within our system that not only impact patients, but nurses as well, what are we doing to advocate for our patients. What are we doing to advocate for ourselves? It is true, that the problems within our healthcare system cannot be corrected by nurses alone, but in order to stay true to our profession we must advocate for necessary changes. It is critical for our patients, our healthcare system, and the health of our nation. In addition, it is important that we maintain our commitment to our profession. Nurses are an essential component of the healthcare system, and we must recognize the authority of our expertise and influence. We are the most trusted professional in America. It is time that we live up to the standards exemplified by Florence Nightingale and stand united for change.
  14. Understanding Florence Coming from privilege, determined and passionate about helping those in need, she used her influence and intellectual voice to bring about change. At times that voice was pointed and harsh, her will strong. A study of Florence shows so many examples of this (McDonald, 2020b, para. 2-4). One such example can be seen when she circumvented commanding officers to order and obtain much needed medical supplies, The Chief British Officer, John Hall wrote in anger, “Miss Nightingale shows an ambitious struggling after power inimical to the true interests of the medical department” (Hammer, 2020, para. 8). Although Florence Nightingale was a practicing nurse during the Crimean War, who started one of the world’s first nursing schools, the vast majority of her career was devoted to research and hospital reform. She did this through years of collaborative efforts with government and private organizations, associations, and individuals at the top of their field. Working alone and with others, she compiled data and statistics to convince bureaucrats and the medical community of desperately needed change (McDonald, 2020a, para. 2-4). She used her station in life and her connections to help influence decision-makers and fund those changes (McDonald, 2020a, para. 21). Her ideas and observations were not always received well by bureaucrats and superiors. Some were inaccurate, however when shown the evidence she did change her recommendations (McDonald, 2020a, para. 19). Through hard work and relentless drive, she was able to contribute so much to her profession and humanity. Her hope was to improve healthcare for all, not just the elitist class she was born into. Even though her own health was poor she was a tireless staunch advocator, opening the eyes of many who were resistant (Hammer, 2020, para. 16 & 20). The scope of her work regarding Hospital Reform covered multiple topics and subtopics. She was so much more than “The Lady with the Lamp.” She was a forward futuristic thinker, and although not all of her advice proved relevant, much of her work remains the basis of nursing, hospital and healthcare reform today (McDonald, 2020b, para. 23-24). What Would Florence Advocate for Today? Historical writings through publications, correspondence and notes by Florence show us what she fought for. These findings would lead us to believe in modern-day, she would continue to advocate for best practice in: infection prevention disease prevention hospital architectural design to enhance healing and nursing efficiency supportive research and data collection to justify changes remediating patient safety issues to avoid errors questioning hospital expenditures allocating healthcare funds access to healthcare for all stress reduction (both physical and psychological) But besides these broad areas listed she also fought for equality and the protection of not only patients, but nurses as well, inside and outside of hospital walls. Much of today’s terminology, with regards to the treatment of nurses on the job was not commonly used in her time. It was even thought that she alluded to protecting nurses and nursing students from “sexual harassment” and “sexual abuse” when she advised against “holes and corners” with regards to hospital design (McDonald, 2020b, para. 5). Florence also expressed that nurses and student nurses should have a safe environment to work in, and they should have a comfortable work environment (McDonald, 2020b, para. 5-6). What Constitutes a Safe Work Environment? Certainly, a safe work environment includes Physical and Psychological Safety. Physical and Psychological Safety have always been of great concern for Nurses and Healthcare Worker’s and has been unbelievably magnified since the COVID-19 pandemic (Mann, 2020). While Physical Safety must be considered first, Psychological Safety can no longer be ignored. Yes, the lack of Physical Safety can lead to injury, contracting disease of all kinds, short and long-term disability, and even death. The absence of Psychological Safety can and does have the same implications, but many times gets ignored within our healthcare institutions and healthcare culture. Hospital Reform Through Internal Culture Change Now more than ever healthcare organizations need to understand the importance of assuring, to the best of their ability, healthcare workers are psychologically safe on the job. There is no more denying the problem exists. When organizations private and public publish articles and a call to action on Harassment, Bullying, Bystander Effect, and Microaggressions (which stretch beyond gender and racism) we know how pervasive the problem is. Awareness is all around us through peer reviewed articles and books, and leading speakers touring and training on these subjects. Let’s take a look at some of these organizations and what they are publishing: American Nurses Association, (2015, July 22) American Medical Association (AMA), (Murphy, 2020) The Robert Wood Johnson (RWJF), (Fountain, 2014) National Institutes of Health (NIH), (Edmonson & Zelonka, 2019) Occupational Safety and Health Administration (OSHA), (OSHA, 2015) The Joint Commission (The Joint Commission, 2016) With all we know of Florence, today she would be an advocate for Hospital Reform through “Internal Cultural Change” to promote Psychological Safety for nurses and healthcare workers. She would ask, “Given all the attention issues surrounding the lack of Psychological Safety in recent times have had, why is it still so prevalent within healthcare settings”, “Why are we all talk, and despite attempts to mitigate the problems, having little success?” She would undoubtedly let the statistics speak for themselves. Our Modern Day Nightingales: Solutions Offered Researching who Florence Nightingale was and what she stood for reveals an individual that was: always looking; always leading; always problem-solving; never accepting that this is all we have; that this is all we can do; never giving up on finding solutions. She is a voice from the past that resonates with us today on current issues. If she were alive today, we know this driving force would continue doing the same, utilizing modern-day research and listening to frontline staff that brings to light problems that need to be addressed. So, what are our modern-day Nightingales doing? Collaboratively, nurses and non-nurses are doing the same, working towards Hospital Reform through creative solutions such as: Training on Harassment and Bullying Training on Microaggression Training on Bystander Effect Training on Psychological Safety Working Around Obstacles to Protect Staff Physically and Psychologically Books and Journal Articles Calling Out Issues Foundations and Professional Organizations Giving Voice and Solution to Issues Promoting Psychological Safety Software and Apps Created to Track Internal Issues Giving Staff Anonymity When Reporting Listing resources for the above list would be exhaustive. A simple Google search opens our eyes to the ubiquity of these problems, and the attempt to bring awareness and solutions to them. However, three individuals worth mentioning here are Amy Edmondson, Toni Howard Lowe, and Pamela M. Tripp. Amy Edmondson is a Harvard Business School professor who coined the term Psychological Safety and defines it as: “a sense of confidence that the team will not embarrass, reject, or punish someone for speaking up with ideas, questions, concerns, or mistakes. It is a shared belief that the team is safe for interpersonal risk-taking.” (Andreatta, 2020). Toni Howard Lowe is, “a global diversity and inclusion strategist and consultant” and founder and CEO of TCT Consultant Group. She consults corporations, engages in speaking tours across the country, and gives trainings on “Microaggression” in the workplace (Lowe, 2021). Those interested in her trainings can view her on LinkedIn free. Pamela M. Tripp is President and Founder of “Corporate Transcendence” and author of “The Culture Cure: Transforming the Modern Healthcare System” (Tripp, n.d.). These three women, non-nurses, are working inside and outside of healthcare. Their aim is to change our toxic cultural workplace practices, from employees on up to CEO’s. Wouldn’t Florence be so proud of these women, wouldn’t she collaborate with them? Conclusion While honoring and acknowledging frontline healthcare workers through media, billboards and such is welcomed and appreciated, it should never take the place of protecting, supporting and compensating those workers both Physically and Psychologically in an effort to “cause no harm.” It takes a village of like minds, working for a common cause to bring about change. It is so important to “Critically Think.” There may not be a best practice in the moment. The best practice at the time may be standing up, speaking out and doing the right thing. Isn’t that what Florence would do? References American Nurses Association (ANA). (2015, July 22). Incivility, bullying, and workplace violence. ANA Position Statement. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/ Andreatta, B. (2020, October 26). Work shouldn’t hurt: Resources for workplace bullying and psychological safety. Retrieved from https://www.brittandreatta.com/about-britt-andreatta/ Edmonson, C., Zelonka, C. (2019, June 4). Our own worst enemies: The nurse bullying epidemic. Nursing Administration Quarterly. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716575/ Fountain, D. M. (2014, April 27). How to address disparities? End bullying of nurses in the workplace. Culture of Health Blog: Robert Wood Johnson Foundation. Retrieved from https://www.rwjf.org/en/blog/2014/04/how_to_address_dispa2.html Hammer, J. (2020, March). The defiance of florence nightingale. Smithsonian Magazine. Retrieved from https://www.smithsonianmag.com/history/the-worlds-most-famous-nurse-florence-nightingale-180974155/ Lowe, T. (2021). Dealing with microaggression as an employee. LinkedIn Learning. Retrieved from https://www.lynda.com/Toni-Lowe/20544000-1.html Mann, B. (2020, May 2). Nurses left vulnerable to COVID-19: 'We're not martyrs sacrificing our lives'. Retrieved from https://www.npr.org/2020/05/02/848997142/nurses-left-vulnerable-to-covid-19-we-re-not-martyrs-sacrificing-our-live McDonald, L. (2020a, May 4). Florence nightingale: The making of a hospital reformer. HERD: Health Environments Research & Design Journal. doi/full/10.1177/1937586720918239 McDonald, L. (2020b, June 8). Florence nightingale’s influence on hospital design, hospitalism, hospital diseases, and hospital architects. HERD: Health Environments Research & Design Journal. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1937586720931058 Murphy, B. (2020, November 17). Workplace bullying must have absolutely no place in medicine. American Medical Association. Retrieved from https://www.ama-assn.org/practice-management/physician-health/workplace-bullying-must-have-absolutely-no-place-medicine Occupational Safety and Health Administration (OSHA). (2015, December). Caring for our caregivers: Preventing workplace violence: A road map for healthcare facilities. Retrieved from https://www.osha.gov/sites/default/files/OSHA3827.pdf The Joint Commission. (2016, June). Bullying has no place in health care. Quick Safety Issue 24: The Joint Commission. Retrieved from https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/joint-commission-online/quick_safety_issue_24_june_2016pdf.pdf?db=web&hash=84E4112AB428AD3CA1D5B9F868A1AD10 Tripp, P. (n.d.). Transformational change in healthcare Speaker profile. Retrieved from http://www.sahalliance.org/files/Pamela Tripp - Speaker Profile.pdf Additional Resources & Reading Duma, Maingi, Tap, Weekes, Thomas Jr. (2019, May). Establishing a mutually respectful environment in the workplace: A toolbox for performance excellence. American Society of Clinical Oncology. Retrieved from https://ascopubs.org/doi/10.1200/EDBK_249529 Edmondson, A. (n.d.). Why is psychological safety so important in health care? Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Amy-Edmondson-Why-Is-Psychological-Safety-So-Important-in-Health-Care.aspx Hughes-Reese, M. (2017, April). Magnet tip: Cultivating psychological safety at the unit level. American Nurses Association. Retrieved from https://www.nursingworld.org/organizational-programs/ana-consultation-services/tips-articles-and-videos/cultivating-psychological-safety-at-the-unit-level/ Institute for Healthcare Improvement. (2021). Why is psychological safety so important in health care? Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Amy-Edmondson-Why-Is-Psychological-Safety-So-Important-in-Health-Care.aspx Redford, G. (2019, November 12). Amy Edmondson: Psychological safety is critically important in medicine. Association of American Medical Colleges. Retrieved from https://www.aamc.org/news-insights/amy-edmondson-psychological-safety-critically-important-medicine Tripp, P. (n.d.). The fix the healthcare industry yearns for. [Web log post]. Retrieved from https://pamelatripp.com/culture-fix-healthcare/
  15. Florence Nightingale's Mission: Holistic Health If Florence Nightingale were alive today, there is no doubt that she would be the President of a nursing program at a university or the Chief Nursing Officer (CNO) at a large health system. She would also be involved in politics in an enormous capacity to ensure that nurses have healthy work environments, including safe nurse-to-patient ratios. Famous for her Environmental Theory, Nightingale had a passion for service. Her mission can be summed up in two words, holistic health. The Environmental Theory addresses healing from two perspectives, healing of illness and correcting environmental issues that cause disease. Nightingale believed that one’s environment primarily impacts their ability to heal. The health disparities plaguing the United States would no doubt trouble the heart of Nightingale. As CNO, Nightingale would spearhead initiatives that would impact the community for which she serves. Nightingale would empower nurses under her umbrella to participate in community activities and offer incentives like promotions and paid time off to encourage such participation. Not only would Nightingale challenge her staff, but she would also be on the frontlines working alongside the nurses, leading by example. Florence Nightingale: Nurse Advocate Florence Nightingale was an advocate for the education of nurses in her time, with her works serving as the basis for nursing education in the 19th and 20th centuries. There is no doubt that Florence Nightingale would have a terminal degree in nursing, be it a PhD or a DNP. Therefore, for the remainder of this article, Florence Nightingale will be appropriately titled, Dr. Florence Nightingale. Dr. Nightingale was well respected in her time and did not back down to authorities simply because she was a nurse. She challenged local and federal authorities to practice humane treatment for soldiers during wartime for the British soldiers. A fighting spirit was part of her DNA. As a CNO, Dr. Nightingale would advocate for the often-silenced voice of nurses working under her. Physicians and non-medical administrators run hospitals and health care systems, yet most of the hospital is staffed with nurses. Dr. Nightingale would not be silenced simply because she holds the title of RN. No way! She would challenge administrators, politicians, and hospital governing boards to see the art behind nursing practice. Hospital administrators who are not nurses only see nursing from the standpoint of bedpans and pill pushers. Dr. Nightingale would bring to light the holistic approach to nursing and the theoretical basis that defines the science for which nurses practice. Dr. Florence Nightingale: Transformational Leader Transformational leaders are motivators. They possess the power to walk into a failing hospital system and completely flip it upside down. Dr. Nightingale would undoubtedly be a transformational leader with the ability to positively influence the profession of nursing and make it a more desirable and well-respected career. Creating a more desirable profession would help to close the gap on the never-ending nursing shortage in America. People like to see leaders who are willing to roll up their sleeves and get in the trenches from time to time. Such leaders are not afraid to interact with subordinates. Transformational leaders understand the power of people connection. Dr. Nightingale would no doubt possess the power of people connection. Having the ability to connect with people is a hallmark characteristic of nursing. Dr. Florence Nightingale: Resolving the Nursing Shortage Dr. Nightingale would be troubled by the nursing shortage that continues to plague this wonderful profession. Her approach to resolving the nursing shortage would be to examine the root cause of why it exists. There have been several studies published addressing the rate of burnout among health care professionals. Nurses, in particular, are susceptible to burnout. Dr. Nightingale would use her platform as an engine to change the direction of this great profession by being actively involved with self-care initiatives at her health system. The crux of the Environmental Theory is to address all factors associated with illness, both physically and mentally. Dr. Nightingale believed that a healthy environment was essential for healing. Part of the self-care initiatives would include mindfulness and meditation routines using dedicated breakrooms throughout the hospital and outpatient clinic areas catering to mindfulness exercises. Dr. Florence Nightingale: Provoking Change In closing, Dr. Nightingale would have worn many hats if she were with us today. But the belly from which she spoke was to serve all humanity and create an environment of healing at work and in the home. Dr. Nightingale would have used her voice to provoke change where needed, in the political realm and the hospital boardroom. Her mission would be to change health care policy so that there is adequate health care for all Americans, safe nurse-to-patient ratios within hospitals, and a reduction of the nursing shortage in hospitals coast to coast.
  16. GingerFowler

    What Would Nightingale Think of Us Now?

    Florence Nightingale is known to everyone who enters the nursing profession. She is the pinnacle of nursing, the “Lady with the Lamp”, the Mother of Modern Nursing. Nightingale said that the nursing profession would not come into its own for 100 years from her time. But what would she think of us now? There isn’t a nursing student on this planet that would say “who is Florence Nightingale?”. Her work with the Crimean War changed the world. She was a woman ahead of her time - breaking societal norms - to do the right thing. She set the course for nursing to the profession it is today. Things Nightingale May Like I believe she would be impressed by the technology we have at our advantage. Medicine back in her time was more an observable ‘guessing game’. The stagnant air was seen as unhealthy, so she directed her students to be sure clean, fresh air was available when caring for a patient. Drawing labs was unheard of, medication administration was not in the scope of practice for the nurse, and basic housekeeping was revolutionary around a sick patient. No insurance companies made financial demands on procedures and no one filled out a survey to complain about the food from the kitchen. I believe she would be very proud of how the nurse has evolved. We are now considered part of a medical team instead of the doctor’s subordinate. We no longer have to stand up and let the physician have our seat. Nurses are considered to be trustworthy in the eyes of the public. When the pandemic was in full swing, it was the nurse who stepped up and helped get America through it. We all went home with marks on our faces from our PPE and our hearts heavy with the burden of care for our patients who were infected. Some of us went home with the virus in us and got sick, but we persevered. I believe Nightingale would smile and tell us “Well done”. I also think she would get a kick out of TikTok videos! Things Nightingale Would Not Have Liked Have you ever gone to a hospital for clinical or started your new job fresh out of college and once you got on the floor the seasoned nurses treated you like dirt? Have you ever seen a seasoned nurse talk down to a new nurse like she was stupid because she asked a question? We have all been that new nurse or that student and felt overwhelmed only to have our colleagues make everything worse by bullying you all shift! “Nurses eat their own.” This is my biggest pet peeve with the profession! No one is perfect. We are a team, and if this ship is sinking, we are all going down with it! I believe Nightingale would tell us that we need to set our differences aside and care for the patient. If someone is falling behind on their medication pass or has a total care patient that has C-Diff, we should come to our fellow nurse’s aid. Nightingale knew that nursing was not a one-person job. This is why she wrote her book and established her training program. Nursing is a team sport. Another thing that Nightingale would not have liked is how the money involved in healthcare is allotted. What I mean by that is the health disparities we see in the American healthcare system would confound Nightingale. I can picture her saying: “What do you mean this child can’t get this procedure because their parents don’t have the money?” The money that is involved in healthcare in America is astonishing! We spend the most money of any country on our healthcare, but we have poor outcomes overall in our public health. I believe this would be Nightingale’s strongest dislike of our modern healthcare. When she worked in the Crimean War, she was caring for those in great need, not worried if that bandage, she was using was scanned to the patient’s account. She went to where the need was and was able to improve the patient outcomes without having to deal with expenses. True, she came from wealth, so money was not a priority per se, but she was able to focus on the great work. I feel that nursing can get distracted because of Press Ganey scores and insurance claims to a degree. The amount of charting nursing does to legally cover everything can feel overwhelming and that is a direct result of monetary justification as well as legal documentation of the patient care. Overall, I believe Nightingale would be very proud of how nursing has progressed to the amazing profession it is today. I believe her vision was that nursing would be one of the most trusted and dependable positions in healthcare. I am proud to be a part of her continuing legacy. We should all be proud to be the nurses Nightingale always knew we could be!
  17. Florence would be amazed at the bright, shiny hospitals of today – little does she know that the lessons she taught about cleanliness and sanitation still are not being used. A hospital holds an amazing appearance of cleanliness however that is just a facade. Once Florence can see the running hot/cold water, availability of soap, alcohol gel and gloves; she would think that healthcare providers would use these easily obtained items routinely to keep their hands clean between patients and care tasks. The sad truth is today’s healthcare providers rarely perform hand hygiene routinely. According to the Centers for Disease Control (CDC), healthcare providers clean their hands half of the times they should. During the Crimean War, Florence knew that cleanliness was vital to her patient’s health. Yet today, 1 out of 20 hospitalized patients acquire an infection from healthcare providers (1). Florence would ask, “How can that be?”. As an RN, how do I answer that question? Looking back, my usage, failed to follow Florence’s basic principles. Oh, I used all the same excuses that I hear from my teammates now, when I observe them not performing hand hygiene. Most are the same, such as too little time, too rushed and I know I should. I am ashamed to admit this and look to all healthcare providers for the answer to this public health crisis. What is preventing us from following Florence’s example? Florence’s solution to this disgraceful lack of basic patient care would be ... Just do it! When she saw the unsanitary conditions, she began scrubbing and cleaning. Thinking about it, I would have to agree, just perform hand hygiene as we were taught. That brings up the question, is there enough emphasis on hand hygiene in healthcare education? We all received hand hygiene education, however, did our educators, preceptors and mentors encourage us and expect us to properly perform hand hygiene, or were they just as lax as everyone else. Do we need re-education? Can re-education change hand hygiene practices? Studies show that initially after re-education, there is an improvement in hand hygiene performance. Can this initial improvement be sustained? If so, how? Another factor to consider is healthcare providers' willingness to change. Most people are ambivalent to change. Yes, we want to or need to change however something prevents us from changing. A good example, new year’s resolutions. How do we get past this natural ambivalence and make a lasting change to improve our performance? Providers can be “forced” to perform hand hygiene by implementing punitive consequences. This is management giving consequences to staff unwilling to follow hand hygiene policies. In a world with a provider shortage, penalizing providers is not going to increase retention or on-boarding of new staff. Can you force change? Wake-up call At times, hand hygiene supplies have been lacking due to the covid pandemic. This should be a wake-up call to all facilities and providers for the need to maintain a “what if” supply, ensuring that providers have what they need when they need it. This lack of adequate supplies only increases providers’ reluctance to use the available supplies and creates poor habits for the future. Patients also need to be involved in hand hygiene Just as Florence recruited patients to help clean the hospital and improve sanitation. Patients today need to be involved in assuring that they and providers are performing hand hygiene. Patients need to feel free to ask a provider to perform hand hygiene prior to giving them care. This will give patients a sense of self-determination and remind providers of the importance of hand hygiene. Last, but probably the most important consideration is ... ... time. Providers feel pressured to get more done with less. This constant need to rush, forces providers to take short cuts, ignore policies and go against training just to get through the workday. Florence would be amazed and saddened at all the demands placed on a nurse in one work shift. How far we have come from just doing basic patient care such as hand hygiene? What do we need; more staff, nurses being nurses, job requirements? Florence led nursing toward better patient care Due to healthcare’s "do more with less attitude", many of her principles have been pushed to the side, just so the minimum can get done, so a patient might get well. Hand hygiene is one of those principles that is ignored/pushed aside by providers. The result is increased patient infections and deaths from something so simple as washing your hands. There are still many challenges to improve hand hygiene performance and no easy solutions. Florence can be our guide and mentor in making the changes required to ensure that all providers perform hand hygiene and improve patient outcomes.
  18. SCB_RN

    Dear Florence...

    Dear Florence, Greetings from 2020! Does it surprise you to know that we continue to remember and celebrate you 2 centuries after your birth? There is certainly no greater world-famous celebrity in the sphere of nursing! We nurses, in general, have become quite popular lately, and you will soon see why. I’d like to invite you to celebrate your 200th birthday watching the modern nurse in action: observing the way we have changed in the past 200 years, but also seeing the fundamental ways in which nurses remain the same throughout the centuries. Just don’t expect a birthday cake or a large celebration in the staff break room. These things are forbidden right now…we are in the midst of a pandemic! So don a mask, rub some sanitizer on your hands, and follow me into the hospital! The nurses and aides on this unit were apprehensive about caring for Covid- 19 patients several weeks ago when local people began to fall ill. No one seems to know much about this virus or how we should be treating it. But you will be pleased to see how our staff refused to let their fear keep them from providing the best possible care for their patients. We’re all dressed alike in the same hospital-provided scrubs; even though they can be scratchy and not fit well, many are concerned about bringing the virus home on their clothing and inadvertently passing it to a vulnerable family member. Concern for family members at risk has been a great stressor and even brought some nurses to tears, but they still persevere, showing up to do the work that is so needed right now. We see what must be done, and we make no excuses: our patients are counting on us. Since we take this virus so seriously, we are following strict isolation protocols. You’ll see how everyone is working as a team, bringing supplies or medications to their co-workers in isolation rooms. Our presence in our patients’ rooms is more important now than ever before. Many of them may not have seen family or friends in days, or weeks even. Other members of the healthcare team have been staying out of patient rooms as much as possible, in an effort to preserve PPE supplies. We, nurses and aides, are their primary human connection, the only in-person voices and eyes making contact with them throughout the day and night. Some patients are so desperate for human connection that even the conversations muffled through N95 masks, the touch of a gloved hand, bring comfort and reassurance. In the midst of this pandemic, we face many uncertainties from one day to the next, as recommendations and policies constantly change; as some medications are determined to be useless for treating Covid- 19 and other, lesser-known medications are brought into the spotlight. Ventilators, we have found, are not as useful as we thought they would be. There is much learning, through trial and error. We nurses are, as always, being observant: seeing who recovers and who struggles, noticing which activities cause our patients to battle with breathlessness, learning new ways in which we can improve their oxygenation. Every day we are learning more, gaining helpful skills, and promoting better outcomes for our patients. You can be proud of how today’s nurses are not standing idly by! No, we are constantly on the move. Right in the heart of this crisis, we are adapting, watchful, ready and excited to see the next big breakthrough. Florence, nursing has grown and expanded in so many ways since your work brought much-needed attention and respect to the career of nursing. I’m sure you’re not surprised that nurses now have so many opportunities for education. Many are involved in research, and we’re all concerned about ongoing quality improvement to ensure that we’re providing the best evidence-based care for our patients. Even in the middle of a pandemic, we work hard to ensure a safe hospital stay for our patients: to protect them from falls, pressure injuries, medication errors, and hospital-acquired infections. But while I’m sure you’ll be fascinated by our EMR documentation, and intrigued by the idea of patient satisfaction scores, I think what you’ll find most impressive is to see us in action, demonstrating the core values of nursing that have been preserved through generations of nurses: our dedication to the profession, our loyalty and commitment to each other and to our patients, our never-ending thirst for knowledge, and our tireless service even in the middle of fear and uncertainty. These things I know you recognize very well, and I’ve no doubt you are very pleased with the nurses of today’s world. Sincerely, A Nurse of 2020
  19. I have been a school nurse for almost 30 years. During this time I have worked in several different school buildings, some very nice and some not so nice. In one of the schools where I was once assigned, in the small nurses' office, there was a lone broken window with a slab of metal and wood covering it to keep out the drafts. At the top of the slab of metal and wood was a small vent window with a handle that could be accessed using a large pole with a hook at the end of it. It was the only slice of daylight that entered the office and with the pole I could pull the small, hinged window open and access some fresh air. Outside of my nurses’ office was an outer area with two cots and two small bathrooms. There were no windows in either the outer area or the bathrooms, and at times it would get very stinky in that area where students would be trying to rest when they were feeling ill or waiting for a parent to come pick them up. Being a nurse and a mother, I was very particular about opening windows from time to time to “change out the air” and “get rid of all the cooties,” even on the coldest of days. The small vent in my office was utilized at least once a day to do just that, and more if a sick child had just left or the air freshener didn’t quite cut it at eliminating any foul odors in the area. I worked in this “cave” for well over a year until the school invested some money in new windows for the school building. I was so excited when I opened my office door one morning to find a brand new, large vertical window that let in plenty of sunlight and exposed a view of a lovely flowering tree outside. I was beyond delighted until I noticed that this was a fixed window that did not have a vent to open to allow fresh air in. I immediately went to my principal to politely ask why I was not given a window that could open. I stressed the importance of having at least a modicum of fresh air in the office to help get rid of germs and allow for comfort of the students in my care. She was remarkably quite amenable to my suggestions and asked that I draft a letter to the district operations department stating my case for installing a replacement window with a vent. My letter discussed Florence Nightingale’s Environmental Theories regarding the need for fresh, circulating air. I offered vignettes of Ms. Nightingale’s accomplishments during the Crimean War as she boldly advocated for supplies for her nursing team to care for ailing soldiers and the results of her concern for sanitation, hygiene, clean water and fresh air. Well, I can never be sure if it was my words or just the fact that the “powers that be” didn’t know what to do with all this information, but the following Monday I arrived at work to find that a new window had been installed in my office complete with a vent at the top to allow the fresh air in! I felt victorious, knowing that my persistence paid off, just as it did for Florence and her nursing team. The Impact of Florence Nightingale’s Environmental Theories on the Current Pandemic Florence Nightingale is considered the first nursing theorist. She believed that environment had a strong influence on patient outcomes and that people are essentially “in connection” with their environments. Proper nursing care according to Nightingale was to put the patients in the “best conditions for nature to act upon them.” Paramount to these conditions were fresh air, sunlight, warmth and cleanliness. In 1859, Florence Nightingale was the first to conceptualize nursing’s work into a theoretical framework. Although Nightingale’s Environmental Theory was presented over 160 years ago, many elements of her assumptions are still practiced today. Nightingale challenged nurses to create environments where the health of populations was a realistic expectation. She was also the first to propose that nursing required specific education and training. Evidence-Based Design Nurses play a crucial role in applying their research and data through evidence-based practice to influence the design process in hospitals and healthcare settings that promote positive patient outcomes. As nurses, we apply evidence-based design practices through case studies on reducing infection rates, particularly during the current Covid-19 Pandemic. In the Spring of 2009, the Swine Flu swept through the country causing some excitement as school nurses scrambled to find N95 masks and other PPE and closely monitored emerging cases within school buildings. I had just completed my Master’s thesis on “Pandemic Preparedness in Schools” just one year prior and I was aware of what could happen should the virus spread and mutate into something more deadly. There were many students as well as staff who were sickened with the virus and there were temporary closings of some schools for a few days or up to a week to allow for social distancing and stopping the spread of infection. Luckily, Summer break was on the horizon allowing for the social distancing needed. Later there was Ebola and then Zika Virus, both of which gave pause to again plan for isolation and mitigation strategies should these diseases become serious global threats. What I had learned from writing my paper on pandemics was that it was only a matter of when and not if something close to the unusually deadly 1918 influenza pandemic, (where it was estimated that about one-third of the world’s population became infected), could happen again. Fast forward to February 2020. Covid-19 crept into the country, seemingly slowly, yet all at once. Cruise ships. Nursing Homes. West Coast. East Coast. Europe. The entire world. Shutdowns. Lockdowns. Toilet paper shortages. Supply hoarding. Essential workers. And so it went on. We needed to find ways to Flatten the Curve, Stop the Spread. And how do we do this? Florence Nightingale knew. Care for the sick while establishing mitigation strategies such as thorough handwashing, personal protective gear, quarantines and isolation of infected persons. School nurses have worked tirelessly over the past year preparing and allowing for the safe return of students to school. We have collaborated with facilities management to provide adequate ventilation systems including HEPA filters in every classroom and office area. Medical waiting rooms have been established with an emphasis on social distancing and proper isolation procedures for sick students. PPE for nurses, such as gloves, gowns, face shields, surgical and N95 masks have been procured and hand washing stations have been installed at key places throughout buildings. School nurses have assumed roles as teachers and counselors, reassuring staff and students and providing up-to-date knowledge and information about current national and local protocols and procedures, mitigation strategies, contact tracing, travel guidance and Covid testing sites. Nurses have acted as Covid-19 test site coordinators in schools by implementing weekly in-house PCR testing for staff and running weekly Pool Testing for students to provide district-wide surveillance of Covid-19 infection rates among student populations. We have advocated for and provided information regarding Covid-19 vaccines for our staff and helped them to weigh the safety and efficacy of the vaccines vs side effects by keeping our knowledge current through many professional development offerings and other training. Overall, school nurses have served as key players as part of a multidisciplinary team approach to design safe and healthy school environments for our staff and students during this pandemic. In 1860, Florence Nightingale published “Notes on Nursing: What it Is and What it Is Not.” She discussed her environmental theory, citing a multi-faceted approach to healing stressing the importance of fresh air, natural light, clean water and sanitation, a healthy, varied diet along with environmental stimuli such as colorful flowers and plants to keep the mind stimulated. Her theories aim to provide the best possible chance of recovery for patients. Nightingale believed in treating the whole person, taking into consideration not just the body, but the mind and spirit as well. It is my belief that Ms. Nightingale, our first mentor and founder of nursing practice would be impressed with how the nurses of our generation have stepped up and shown their worth by being fearless warriors in the fight against Covid-19. She would marvel at stories of nurses acting not only as the trained medical professionals that they are, but also as teachers, counselors, listening ears, hand-holders, family caretakers, and overall guardian angels in this time of a global health crisis. References Gonzalo, Angelo. "Florence Nightingale: Environmental Theory." www.nurselabs.com Nightingale, Florence. "Notes on Nursing: What It Is and What It Is Not."
  20. What would she say? “I am so proud of you!” During this Covid pandemic, nurses have been teaching patients and the public about proper handwashing. When I worked as a Covid nurse, we were tested to see just how well we washed our hands – many failed -- the blue light got them! The light showed how many “germs” were left on the hands after they had washed them. It was a great learning experience not to mention an eye-opener! If she had not been so adamant about proper handwashing, this pandemic would be far worse. Teaching the public about proper handwashing has been paramount to getting control over this virus. What WOULD she say if she could see us now? "You are doing great! Keep up the good work!” Her guidelines, nursing skills and knowledge at the beginning of her career saved a lot of lives during the war. Thanks to her teachings and education nurses have used that training and knowledge and put it to good use for our own “Crimean War”. After all, this pandemic has been a war to kill a deadly virus and save lives -- and it is not over! What would she say if she could see us now? "Overworked and underpaid!" Talk about being overworked and underpaid! Florence Nightingale certainly was! She would completely understand this complaint. She got no pay! Can you imagine what it must have like working for no pay in a war? Plus the fact she had no specialized training as a nurse, yet she knew what was needed and put her knowledge and skills to life-saving work. In fact, she had military leaders who would not listen to her instructions regarding proper handwashing and waste disposal, as well as other ways to save lives because she was intimidating, and she was a woman and no military training. They simply could not have a “nurse” telling them how to deal with death and disease, not to mention a war! As mentioned, Florence was not a nurse. She did not have formal training as a nurse, but she was well trained and very highly educated and had a gift for taking care of patients. She said it was her “calling”. It took time, but the military leaders finally listened. Talk about patience! What would she say if she could see us now? "Have patience, do your best and keep up the good work." I believe she would be astounded at what “war” we are facing. Her war was a real, blood-and-guts war with people dying from diseases and fatal wounds. As a nurse, I cannot imagine what she experienced back then. Since last year, our war on the Covid-19 virus has also taken thousands of lives. We have faced a virus that is relentless and many times deadly. I am glad we had her guidance and education to help us deal with our war on Covid-19. And I know she would be immensely proud of all nurses, whether you worked with Covid patients or knew someone with Covid, or had it yourself, it does not matter – we have all been in this together. What else would Florence Nightingale say if she could see us now? “Here wear this mask, it is safer.” Masks: What kind of mask do you think she would wear? Would she design her own mask and say “here wear this mask, it is safer.” I think so; after all, she figured out good hand hygiene and sewer and drainage issues making for a safer environment and saving lives, why not a mask? I also believe she would have made masks for the military to protect them, including the ole mean and determined-not-to-listen generals and other leaders. She would want their lives protected as much as patients and nurses. She was that kind of person. She probably would laugh at some of the masks made today -- and worry about ones made just for looks and not protection. “Okay, guys, I’ve got this!” I think she would probably feel a little frustrated with CDC and a few higher-up doctors. Their guidelines keep changing on social distancing and what kind of mask to wear and how many, and I think she would finally step in and say, “Okay, guys, I’ve got this!” Florence Nightingale was a leader, a highly intelligent leader. She knew her stuff and she knew nursing like no one else. She is the epitome of nursing. It has been a marathon, but we are winning! I think when all said and done, we would hear her said loud and clear: “Well done! You did it! You were listening after all!”
  21. Florence Nightingale is famous for her pioneering nursing education, her development of statistical analysis and her improvements on methods of care delivery. She is also famous because she was "the woman with the lamp," a caring nurse who walked around late at night in the barracks, amongst the wounded soldiers, dispensing comfort and a big dose of healing therapy. What in the world does Flo have to say to us today? In this world of EMRs, diagnostic testing, and multi-disciplined care, what do we has nurses uniquely offer to our patients? How can we continue to be outstanding patient advocates as well as thinking professionals who constantly look for ways to do things better? In this day of increasingly depersonalized care, how do we keep making a difference? Nightingale was born to English aristocracy. She was wealthy and travelled widely but she rebelled at following the usual roles laid out for women of her time. Instead, following what she regarded as a divine call, she dedicated her life and considerable intellect to improving the care that soldiers received as they recuperated from war, especially during the Crimean War. She observed entirely new practices of hygiene and cleanliness-despite strong opposition. In addition to saving hundreds of lives, she is credited with using scientific process to change practice. She kept careful records and published statistical analyses of her work. A mathematical prodigy from an early age, she harnessed her mind and applied it well to practical, every day problems. As professional nurses who seek to emulate Nightingale and others like her, we have a strong responsibility to continue to think clearly, to use our intelligence and training to continue to make strides in our work. What are some guiding principles we can apply? Keep our eye on the ball In athletics, players are admonished to focus on what they are doing and to selectively tune out anything besides the main event. As nurses, we too have to keep our attention focused on our patients, giving them the priority. With the fragmentation of patient care, we are often the only persons on the care team that have the big picture in mind. As team players, we need to do an excellent job of communicating the patient's story, of hearing what is said around the bedside, of connecting the dots related to the patient's care. I remember the elderly woman who came in with pneumonia. She was a very attractive older lady and in talking with her casually, I could not detect what the family later told me: although she could carry on a good casual conversation, her memory was simply "gone." This bit of information helped to guide the care team in sending her home with home health instead of to rehab because that was simply a better fit for her. Don't let the EMR rule the day With all the computer work that is required, there is often little time for face-to-face interaction and for that extra measure of comfort. Despite the limits of time, touch, attention and eye contact- all of that old fashioned "lady and the lamp" care- never cease to be critical. As professional nurses, we continue to hone our listening skills, to increase our ability to be empathetic and to use our scientific knowledge to help our patients. I remember when I had a family member in the hospital and the nurse came in to give her medication. She did what she needed to do and then-she sat down. I mean, she took a seat and sat down! She only sat for about a minute, but it was long enough to make an impression. Her act said to us: "I am with you. I can't fix it, but I want to help by being here." We have never forgotten that. Pioneer something Back in the 1850's when Flo was laying the groundwork for modern nursing, there was plenty that needed fixing. Nowadays, we all hope that we have made a little progress in terms of germ theory and modern application of those scientific discoveries. But the truth is, there is always room for improvement. We all make mistakes. We begin to see the patient as a collection of lab results and diagnostic tests, and we forget to listen to some of what they are telling us. From improvements in hand washing to basic skin care to catheter care to wound healing, there is a constant stream of new areas to be explored, documented, changed. In recent years we have seen dramatic improvements in lives saved because of cardiac and stroke protocols, Foley catheter care and discontinuance, CHF follow up, etc. As medical care has progressed, we have gone from innovative and truly astounding developments in transplantation and stenting to a point where we are now looking in the rear view mirror and wondering if we need a more comprehensive approach to death and dying-truly a new frontier awaits! Marianne Williamson wrote, "And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others." As professionals who seek to spread the light of good care and of thorough and useful knowledge, we identify with Williamson's thoughts. Florence Nightingale got us started off right, now it's up to us to not let that light go out but to instead, keep carrying it and sharing it. Joy Eastridge
  22. Florence Nightingale Attributes Florence Nightingale demonstrated so many admirable attributes. These include a commitment to lifelong learning and teaching others, standing up for what she believed in, a deep respect for science and the data, and, last but not least, courage. This was evidenced by her tireless work to protect women’s rights and her testimony before the Royal Commission on the Health where she convincingly urged the British government to improve living conditions and sanitation in Army hospitals and rehabilitation homes. She was heard. Advocacy for Nurses So, it is fitting that we recognize the importance of this day as we consider the importance of advocacy on behalf of nurses. During this critical time, we must protect the institution and support all front-line caregivers. This is why Rosica Communications has volunteered to assist allnurses.com in acknowledging nurses everywhere through the #GiveANurseAHug campaign, which is designed to show gratitude to nurses for the impact they make on people’s lives daily. The effort centers on “raising” virtual, or air, hugs to express gratitude for the courageous work performed by nurses who are severely compromised during this crucial time. This is being done through facebook, Twitter, and Instagram to show our undying appreciation for them. We also recognize other organizations that are stepping up to help nurses at this perilous time. Healing Hands is a uniform and scrubs company that truly “walks the walk” and is committed to helping nurses. The company’s founder Bansi Lakhani suffered a massive heart attack in his early 40s. Recovering from open-heart surgery, he realized the critical and curative role of his nurses, whom he called “healing angels.” He felt they cared for him like family. Lakhani had worked in the clothing and apparel industry for decades. After his hospital experience, he shifted his business to help nurses feel and look better by launching Healing Hands, which makes more comfortable and attractive scrubs and uniforms. His experience with nursing professionals was so impactful and uplifting that when he designed scrubs for them, he included inspirational messages printed inside their uniforms to show appreciation for the great work they do. During the pandemic, Healing Hands has donated 10,000 sets of scrubs and is donating 1,000 pairs to allnurses.com members’ hospitals/facilities. They are also making N95 masks and donating these as well. If your hospital or healthcare facility is in need of scrubs to help protect nurses working through the COVID-19 pandemic, please complete the Nomination Form here and be eligible to receive 100 pairs of scrubs at no cost. Exergen is another company that is demonstrating high-level support for nurses. A former nurse, Dr. Marybeth Pompei is Chief Clinical Scientist of Exergen Corporation. She and her husband, Dr. Francesco "Frank" Pompei, Exergen’s founder and CEO who received degrees from MIT and Harvard, are extremely committed to the nursing community. It is essential to their company’s mission. The duo has dedicated their lives to advancing science through noninvasive thermometry. They support scientific research and offer professional development to nurses across the US. Exergen manufactures two primary TemporalScanner thermometers - a professional version for hospitals and physicians’ offices, and a consumer version sold through major retailers nationwide. More than two billion temperatures are taken each year with TemporalScanners. It is no surprise that Exergen’s accuracy is supported by more than 80 peer-reviewed published studies covering all ages from preterm infants to geriatrics and all areas of care, from hospitals to homes. Temperature being an essential determinant of COVID-19, Exergen has provided thousands of thermometers to nurses and other front-line healthcare professionals. These are needed not only to protect patients but protect these caregivers. The Exergen team is working overtime to meet demand for their thermometers and serve nurses across the nation and globally. Companies like Healing Hands and Exergen are not just reactive. For decades, they have been proactive - in terms of innovation, caring, and giving back. They, like us, believe that recognizing nurses should be ongoing. We must continue to stress the importance of this area of the profession, which Nightingale so suitably represented. Of course, there are dozens of PPE companies, including Halo Life, that are also donating masks and other essential products. Without these donations, nurses will be compromised. With these donations, there is hope. We hope that many others will be inspired by the courage and dedication that nurses are demonstrating. We support you and are grateful for your service.
  23. I liked to take care of my younger brother and he cooperated with my schemes in make-believe which meant he sometimes had to drink whatever “medicine” I came up with and submit to a variety of bandages made from scarves or my mother’s sewing scraps. Over time, I became an avid reader and enjoyed adolescent fiction about nurses as well as biographies of Florence Nightingale and Clara Barton. In high school I started reading nursing journals that a nurse friend shared with me and took all the science classes my tiny high school could offer, begging our teacher for independent study so I could learn more about biology. The idealized version of nursing that made up my early dreams gave way to reality as I launched into the true study of nursing and put in all the long hours to make my goal a reality. It was harder than I had anticipated, and I had to study hard to make it happen and to pass the terror of the boards. While in school, I started working as a nursing assistant in a children’s hospital and as a personal assistant to a handicapped student. All of this gave me a little taste of what would become a lifelong vocation—helping others and working to provide healing or comfort any way that I could. My formation as an RN, a Real Nurse, started small, with the little ones in pediatrics and went on from there. I remember how hard those first few months of night shifts were. As a charge nurse on a pediatric ward, I struggled to learn and to be a professional, quickly realizing that this job might not have been the best choice for someone just learning the ropes of the profession. I didn’t know how much I didn’t know. I don’t remember doing a lot of great things during that year—in fact, it was really a divine grace that I didn’t make some egregious mistake! The memories of that time flash by in black and white like a dim slide show: the child with asthma who nearly arrested before I could get the resident to come, the toddler who was a “failure to thrive” for whom I bought a small toy, the angry mother that didn’t like my attitude, the commute to the downtown hospital late at night, the wards with 8 kids each… From peds I found a different calling with adults on a general medical/surgical floor. There I learned to balance time demands and prioritize my work, honing the skills needed to be efficient, and cramming my brain with some of the more practical knowledge that doesn’t always get included in the general nursing curriculum. The slide show continues, picking up more hues as it moves forward through time: the man bleeding out that I transferred to the ICU in a big hurry (and I ran over someone’s toe with the bed on the way—and no, they didn’t get seriously injured but I was horrified!); my first time doing CPR and feeling the elderly lady’s ribs cracking under the pressure of my wrists and then the tears later in the locker room; being asked to teach a group of peers about acid/base levels in a staff meeting—all of these blend to make a picture of years that added up to a satisfying experience and made me much more competent as the RN I longed to be. The step into home health in a backwoods town in Tennessee brought me out of the hospital and into living rooms. Pulling from past experiences, I was able to build higher on that wall of competence, again starting at foundational principles and learning from others as well as from my own interest. The interactions with people in their own settings brought with it the realization that the patients are ultimately in control of their own bodies and their own decisions and it was my job to help them have the tools they needed to maximize their own goals for health. This ability to see the limits of my own interventional care brought a new dimension to nursing and gave me a greater respect for my own limits and the boundaries between medical care and the individual’s choice. In the hospital setting, it was so much murkier as patients submitted (mostly) to what the doctor prescribed and adopted a more passive role of recipient, blending back into the whiteness of their crisp pillowcases with resignation. At home, even the very ill patients were more likely to express themselves, to be comfortable in their own choices and to challenge the edicts handed down by medical staff. Over the years of traveling through t the hills and hollows of mountain villages, the slide show becomes brighter, clearer but also holds the shadows of difficult days replete with defeat: the elderly man in the overalls, living in a hermit's cabin, legs swollen with cellulitis, stasis ulcers draining, who proudly proclaimed, “I ain’t movin’” and pointed to a shotgun to emphasize his statement; the bed-bound woman whose bed sat smack dab in the middle of the living room as family members rotated sleep so they could keep her turned in a timely fashion; the mouse that ran under my legs while I sat perched on the edge of a dirty couch causing me to leap up in a most unprofessional way; the edentulous woman, mouth stuffed with snuff who unexpectedly sneezed—I had to change uniforms! The attraction to hospice nursing should have been clear from the beginning but didn’t come into stark relief until a beloved sister-in-law lay dying at a hospice house from the ravages of ovarian cancer. I admired the care, consumed the comfort greedily and promised myself that as soon as I could, I would pursue this new passion. Hospice nursing also took me out and about and again placed me squarely in the center of the patient’s own domain. Clearly, in rounding the bend and heading toward home, the patient and their family were firmly planted in the driver’s seat and I sat behind, offering simple suggestions to help make the way less confusing and to shine a small light on the path ahead. I learned a lot about the blessing of using my skills quietly and respectfully, always trying to be aware of who was really in charge and fitting in without imposing my will. My knowledge and skill set continued to expand as the dying required creative and caring solutions to all the myriad ways the body can break down at the end of life. Defeat was not an option, and working with the team at hospice, we worked hard to circumvent the impossible and to find a way toward our ultimate goal which often included making the passing as easy and as peaceful as possible. In this new setting I learned the truth of the maxim: “People don’t care how much you know until they know how much you care.” (attributed to T. Roosevelt). My technical knowledge and nursing skills were all tested and tried and sharpened but the “soft” nursing skills grew even more as I learned to communicate better, to “read” the situation in the room, to help patients and family move to a new place in their view of their situation. In this expanded nursing theater where life and death live intertwined and the distance between them grows smaller, I learned to respect the limits of my skills and to understand that sometimes the gift of presence was all I could offer. Coming to the end of myself as a nurse gave birth to a more profound respect for my work and my colleagues. The team approach of hospice helped me to broaden my horizons and see up close and personal how the social workers, aides, chaplains and physicians all worked in a fine concert to play the music the patient wanted to be played, as they directed the symphony from their place on the bed or the couch or the front porch. As nursing butted up against the hard wall of death, I found myself with renewed courage to face the unknown and to help others prepare for that same encounter someday. The slide show from the years in hospice is bright with the edges tinged dark from the sadness of loss as patients transitioned on from us to their next stop: the elderly couple who held hands and looked with longing into each others’ eyes; the young man surrounded by his boisterous friends who slipped away peacefully right in the middle of their conversation, surprising us all; the humor of knocking on the door of the wrong “yellow house on the left” and announcing that I was the hospice nurse; the occasional families whose motivations and possible drug diversion made our jobs difficult; watching Youtube videos in the car to refresh my skills in changing specialized dressings; the long drives following GPS instructions into rutted roads that gave way to dilapidated, thrown-thrown-together houses with a dozen dogs; the sometimes angry family who saw us not as angels of mercy but harbingers of death; the exhaustion of caregivers etched with stark clarity on pale faces that mixed resignation with relief and grief. Faith Community Nursing was simply a logical next step, blending those carefully practiced assessment, teaching and leadership skills into a position of trust within the staff of my local church. Over the years, things have changed as the moniker Parish Nursing has given way to the more inclusive “Faith Community Nursing” but the work itself has remained unaltered. Being an FCN is a natural morphing for a nurse who sees the intersection of life and death as not an end point but as a transition and as such, a call for us all to do what we can to make the most of every day on this side, living well in the body we have for now. As an FCN, I work to help people maximize health through interpersonal relationships, increased activity, medication management and mobility protection. Assessing, teaching, visiting, planning, coordinating all come together as a lifetime of nursing experience coalesces into work that uses all the collected ingredients to make a work of nursing art, not perfect to be sure, but blended nicely and resulting in a worthwhile final product. Here, the slideshow glows with the brightness of an updated powerpoint: opening the door of an independent living to see an elderly man with a rapid respiratory rate and probable pneumonia and getting him to the hospital; teaching CPR through fatigue; organizing a group walk/hike; participating in advance care planning by teaching about “5 Wishes;” helping coordinate volunteers to visit the homebound and let me know of any needs; working to organize food delivery to those experiencing times of illness or grief. The beauty of a career in nursing is the variety that is possible. Every experience, every position, every shift brings new insights and learning. As nurses, we walk through the department store of experiences and fill our buggies with patient encounters that help shape us, with responsibilities that stretch and grow us and eventually with the wisdom to practice our profession well, becoming a credit to our peers. As we all take stock of our practice and celebrate the nursing profession, let us encourage each other along the way: it won’t all be good, but through perseverance, our slideshow of memories can be bright.
  24. As part of our pinning ceremonies in nursing school, we all probably remember reciting the Nightingale Pledge, a modified "Hippocratic Oath" composed in 1893 by Mrs. Lystra E. Gretter and a Committee for the Farrand Training School for Nurses, Detroit, Michigan. The pledge is as follows: Since today is the birthday of Florence Nightingale, I thought it would be a good time to look back at the life of the woman considered to be the founder of modern nursing. Early Life Florence Nightingale was born on May 12, 1820 in Italy into an affluent, upper-class, well-connected British family. Although her mother, Francis, who came from a family of merchants was interested in social-climbing, Florence, the younger of two daughters, was reportedly awkward in social situations. Florence's father, William Edward Nightingale, was a wealthy landowner and provided Florence with a classical education, including studies in mathematics, German, Italian, and French. Florence, who was strong-willed, often butted heads with her overly controlling mother. Instead of socializing with the upper-class females in her mother's circle, Florence was always interested in ministering to the ill and poor people in the village which bordered her family's estate. It was clear to Florence when she was 16 that nursing was her calling. At that time, nursing was seen as menial and lowly labor - certainly not an honorable profession. Her upper-class parents wanted her to marry someone respectable. Education At age 24, Florence defied her parents' wishes and left England to enroll as a nursing student at the Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Düsseldorf Germany. Upon her return to England in the early 1850's, she took a job at a London Hospital. After her impressive work there, she was promoted to superintendent after only a year. Florence Nightingale became known as a reformer and advocator for public health due to her work at greatly improving sanitary conditions after an outbreak of cholera. Crimean War - "Lady with the Lamp" Florence became a living legend as the "Lady with the Lamp". Her work during the Crimean War from 1854 until 1856 was well-known as she led nurses who cared for thousands of soldiers. She and her team of nurses improved the unsanitary conditions at a British base hospital, reducing the death count by two-thirds, which helped save the British army from medical disaster. She was also a visionary health reformer, a brilliant campaigner, the most influential woman in Victorian Britain and its Empire, second only to Queen Victoria herself. Upon Florence Nightingale's return from the Crimean War, the Queen rewarded her work by presenting her with an engraved brooch that came to be known as the "Nightingale Jewel" and by granting her a prize of $250,000 from the British government. Achievements Florence Nightingale's greatest achievement was to make nursing a respectable profession for women. Her writings on hospital planning and organization had a profound effect in England and across the world. She published over 200 books, reports and pamphlets. Florence died at the age of 90, on 13th August 1910. She became one of the most famous and influential women of the 19th century. Her writings continue to be a resource for nurses, health managers and planners to this day. Nursing has certainly come a long way since the time of Florence Nightingale. We should not forget the courage and perseverance of the Lady with the Lamp who remains the most famous nurse in history. This inspirational figure helped to transform nursing into the highly respected profession it is today. Happy Birthday, Flo! More Fun Facts! Watch Florence Nightingale - Mini Biography... Trivia questions for you.... How did Florence Nightingale get her nickname, "The Lady With the Lamp"? What was her sister's name? What animal did Florence Nightingale carry with her, even when doing hospital rounds? Was Florence Nightingale ever married? What is the name of the nursing school Florence Nightingale opened in 1860? How did Florence Nightingale get her name? What was the cause of death for Florence Nightingale? Where is Florence Nightingale buried? Related Topics... Whatcha Know about Flo (Florence Nightingale)? The Nightingale Pledge - Still relevant today?
  25. Personally, I feel like it could use an update. I feel like its outdated and perhaps out of touch, and it diminishes the critical thinking and professionalism that one needs to be an excellent nurse, instead focusing on nurses promising to be good people and to play handmaiden to the doctors. I wouldn't mind an oath for nurses...but I'm not a fan of the one we currently have. If I were on a committee to write a new pledge, I would want to add to it some wording about being critical thinkers and knowledgeable about our fields. Something that encompasses our roles as professional clinicians AND as comforters and caretakers. I would definitely keep the part about elevating the standard of our profession. I would probably want to update the wording on the "aid the physician in his work"...because heath care is our work too, and it takes a team. For anyone who doesn't recall the pledge, here it is: "I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care." Anyway, I'm just wondering if I am the only one who feels this way. Please don't hate - I still love my job as a nurse and I try to be a good one!