WWhen Florence Nightingale arrived at the Scutari military hospital in Turkey in 1854, conditions there were almost as bad as on the battlefield. When Britain and its allies fought back against Russian expansionism in the Crimean War – not far from recent fighting in what is now the Russian invasion of Ukraine – the death rate of British soldiers soared, although many more died from preventable diseases than battle injuries.
The young English nurse saw soldiers festering in the dirt, many of them lying among the rats on the bare floor. Dirty bandages covered putrid wounds, and the neglected soldiers struggled with lice, fleas, and the stench of disease in the unventilated station. There was about one bathtub for every 150 soldiers, but that hardly helped: a dead horse had rotted in the water supply.
Nightingale and her team of 38 women immediately got to work on issues that others – including many of the doctors – considered unimportant, such as hygiene and food quality. Instead of waiting for the 2,000-mile supply chain from England to deliver essential goods, Nightingale went to Constantinople – modern-day Istanbul – and bought soap, towels, clean linens and fresh groceries from local markets. She and her team quickly got to work disinfecting the hospital. Essentially, Nightingale became hospital administrator, handling procurement, sanitation, and feeding. Mortality rates fell and Nightingale was hailed as an ‘angel’.
The “lady with the lamp” – as she was soon known for her nocturnal care of patients – became the mother of modern nursing and one of the most admired women of her time. But she was not exempt from disregard and opposition to nurses in the male military and medical professions.
Her tendency to circumvent existing power structures irked more than one manager. “There is not an official who would not burn me like Joan of Arc if he could, but you know that the War Office cannot expel me because the country is with me,” she wrote during the war. She would win over many critics, who soon saw her ability to get things done, whether it was sourcing fresh produce or sourcing basic supplies from Queen Victoria herself.
After observing the administrative errors at Scutari, Nightingale devoted her life to ensuring that what she had witnessed during the war would not happen again, arguing that hygienic patient care was a necessity, not a luxury. She was a committed public reformer who spent much of her life campaigning to make nursing a profession that commands respect from both physicians and the public, and she founded the first professional nursing school.
As we celebrate National Nurses Week, which began on Friday and will end on Thursday, Nightingale’s 202nd birthday (which is dubbed International Nursing Day), many countries – including the United States – face a nursing crisis . Much like Nightingale in the Crimean War, nurses are often forced to bear the brunt of structural failures over which they have little control. They are undervalued and overworked. The “Big Layoff” has hit the nursing sector particularly hard, and by 2030 nearly 200,000 nursing positions are expected to remain unfilled. A recent survey found that more than a third of nurses plan to leave their jobs by the end of the year. and almost half of them cited burnout as a reason.
The Covid-19 pandemic has only exacerbated existing problems, particularly in hospitals, where the brunt of care often falls on nurses, who are asked to work long hours for pay they feel is inadequate. By demanding safety and dignity in their working conditions, nurses today continue the mission started by Nightingale: to ensure they are treated as professionals and not sacrificed as martyrs.
After more than a year and a half in Constantinople – across the Black Sea from the fighting in Crimea – Nightingale returned to Britain, but her work continued. Taught mathematics from an early age, she had a passion for statistics and not only wanted to understand what had led to so many deaths at Scutari, but to present that information to the public in an easy-to-understand way. The highly visual charts she published were revolutionary for their time. Rather than reciting dry scientific statistics, she used a color-coded rose chart to illustrate how deaths from preventable infectious diseases far outweighed the battlefields in Crimea.
Many now celebrate Nightingale as a pioneer of data visualization and she became the first female member of the Royal Statistical Society, but her interest was not just rooted in an intellectual pursuit. She wanted to use data in her quest for health care reform. In a strikingly modern way, Nightingale believed patient care to be a social and political issue, and understood that high mortality and low income are closely linked (a phenomenon that continues today: poor Americans were far more likely to die from Covid-19 19 than their own wealthy peers). As Nightingale once wrote in a letter, “Whenever I’m angry, I retaliate with a new chart.”
In 1860 she founded the Nightingale Training School for Nurses, which is considered by experts to be the first secular nursing school. (Nightingale cobbled together her own training at several hospitals as a young woman.) “Before that, there was no training,” says Lynn McDonald, a Nightingale Fellow and professor emeritus at the University of Guelph in Canada. “People who used to be called nurses were just hospital workers who didn’t usually know much and were really doing more of a cleaning job than anything.”
Thanks to Nightingale, nurses adopted what we understand as patient care, something she first described in her 1859 book Notes on Nursing. In it she wrote: “I use the word nursing for want of a better word. It was reduced to mean little more than administering medication and applying poultices. It should mean proper fresh air, light, warmth, cleanliness, rest, and the right choice and administration of diet.”
Her school’s year-long program provided the first formal training in modern nursing, teaching basic science and medicine. Nursing was often reserved for working-class women, but by elevating this work to a profession, Nightingale helped make it more acceptable for women of diverse backgrounds to become nurses.
Nightingale’s vision of nursing would soon migrate across the Atlantic to the United States, thanks in part to the wide publication of her writings. The Union Army even consulted Nightingale on how to administer field hospitals during the Civil War. By 1873, just over a decade after Nightingale opened her school in London, Bellevue Hospital in New York City had started one of the first US nursing programs, with a curriculum based on Nightingale’s principles.
Over the past century and a half, medical science has grown by leaps and bounds. (The germ theory wasn’t popular when Nightingale started her school.) Nurses today go through several years of continuing education, and many nurses have similar responsibilities to physicians.
While education for nurses has improved significantly, the way they are treated does not always reflect these changes. That is why so many completely different areas will turn to 2022. “Nurses today are still underpaid and still don’t get the respect,” McDonald said. “These problems remain. Since then, they have obviously declined sharply [Nightingale’s] time, but they are still there.”
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