The Inspirations of Florence Nightingale: Nurses Advocate For Change in a Time of Crisis

What would Florence Nightingale say about the nursing profession today, especially in light of the Covid-19 pandemic? I think she would be fearlessly outspoken about the shortcomings in nursing and extremely proud of the continued advocacy for both nurse and patient. Who was this "Lady of the Lamp" and how has she influenced nursing today?

The Inspirations of Florence Nightingale: Nurses Advocate For Change in a Time of Crisis

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. 

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“The Nightingale is a small insectivorous bird best known for its powerful and beautiful song...The song of this secretive bird has been described as one of the most beautiful sounds in nature, inspiring songs, fairy tales, opera, books, and a great deal of poetry.” (Animalia, 2020)

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)

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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/

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Esther Greenburg

About Esther Greenburg

I have been a nurse since 2007 in areas such as Medical/Surgical, Forensics and SANE, and Hospice/Palliative Care for the past four years. I have a BA in Art and Women's Studies and an Associates Degree in nursing. I'm currently working on my BSN. I recently moved to Massachusetts from California to be closer to family. I have three children, spanning a wide age range, with the oldest serving in the Air Force. In addition to human children, I have two dogs, a cat and six chickens. I love writing, sewing, ocean swimming and drinking coffee.

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Specializes in oncology.

I presented at the University of Oxford on Florence Nightingale. I believe that she put down in writing what nursing genuinely is and even Queen Victoria read her book, "Notes on Nursing: What it is What it is Not". She taught by example, knowledge acquisition and was politically astute. I am dismayed by the educational "on line" programs that exist,  allowing those who never worked as a Registered Nurse  ( never experiencing the full responsibilities of nursing ) into a  Nurse Practitioner program,  where you can  do partial employment,  work full-time (in an entry 3 month orientation RN position) and then  pay someone who 'mentors' you as a student NP and sees you as a paycheck.  You can also enter a Nurse Midwife program without working in L & D (many with no GPA measurement for determining if the applicant can deliver to an academically rigorous program.) 

You bet I am mad!  I am mad at the institutions that developed these poor excuses for education  ( but financially  advantageous);  ....the accrediting bodies that approve them;  the faculty that work them and the students looking for an easy way to a degree. Let's not forget about the ANA adding their "certification programs and tests" to add that shiny luster  ($$$$) to  an RNs knowledge that should have already been guaranteed if the higher learning institutions actually took their education job seriously/responsibly.  I have worked in professional nursing education for over 40 years and our students came out EDUCATED for their RN role. 

How did we get to this point? Giving 'participation ribbons to anyone who read the Golden book on nursing' or who put a band aid on a scraped knee?

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