Nightingale's legacy

With Florence Nightingale’s 200th birthday falling during the COVID-19 pandemic, the reforms she fought for feel more relevant than ever

Every year, on 12 May, we mark International Nurses Day. It’s not just a celebration of nursing, it’s also the birthday of one of the world’s most famous nurses, Florence Nightingale. We knew 2020, two centuries since her birth, would be a big occasion. But with the COVID-19 pandemic highlighting similarities between Nightingale’s experiences and those of nursing staff today, it’s taken on new significance.

Nightingale was named after her birthplace – Florence, Italy. Her parents were influential, upper-class, and gave her a thorough education. A talented mathematician, she was also drawn to caring for the sick in her family and community.

An engraving of Florence Nightingale from 1873

Many still know her as “the lady with the lamp”, keeping watch over injured soldiers in the Crimean War. Nightingale was recruited by her friend and secretary of war Sidney Herbert to lead a mission of nurses to Crimea in 1854. The war had been raging for a year, and newspaper reports of the terrible conditions for injured soldiers shocked the British public. Nightingale’s party of nurses was sent to ease suffering in Crimea and reassure citizens at home.

RCN President Professor Anne Marie Rafferty co-edited Notes on Nightingale, a collection of essays about her life and legacy. “She was essentially a celebrity in her own lifetime and achieved that iconic status early on,” says Anne Marie. “Her image was of great appeal to the public and must have been a source of tremendous reassurance. Many of those feminised virtues – compassion, heroism and sacrifice – are very powerful during times of crisis and seem to coalesce around female figures.”

Supplies and hygiene

Nightingale went from a comfortable lifestyle into a warzone, experiencing terrible seasickness on the way out. She arrived to big challenges. She had to create a functioning hospital, introduce hygienic practices, and find supplies to make it all possible.

Many of those issues sound familiar during the COVID-19 pandemic. “We’re getting the most timely reminder of the importance of Nightingale’s work,” says David Green, Director of the Florence Nightingale Museum. “Nightingale, as a leader of nurses, knew when to stand up for her nurses and patients. We have seen, through the RCN and the chief nursing officer, that is still very much part of the role. Nurses will fight to get the best resources they can for their team and the people they are looking after.”

Nightingale also had “considerable skills in organising, leading and administration,” says Anne Marie, which allowed her to oversee Scutari Hospital and improve conditions. One of the first challenges on arrival in Crimea was finding supplies such as bed linen, nightshirts, bandages and food: “The supply chain was deficient, a bit like us trying to wrangle PPE from the government.”

Project Nightingale is part of the UK government’s response to the pandemic. Seven hospitals for COVID-19 patients have been announced, all named after Nightingale. “Like the new hospitals, Scutari was a pop-up field hospital,” says David. “It's a reminder about the need to improvise but provide the best possible care you can under those improvised circumstances.”

Had it not been for Nightingale being nursed herself, there would be no Nightingale story

Naming the hospitals after Nightingale brings back the vision of the lady with the lamp. “It’s a symbol of safety, security, reassurance,” says Anne Marie. “It evokes a collective memory of what Nightingale represents for a frightened British public, the courage that nurses are demonstrating, and the fact that someone will be there for you.”

Nightingale herself suffered in the line of duty. During the war, she came down with Crimean Fever, or brucellosis. “Had it not been for Nightingale being nursed herself, there would be no Nightingale story,” says Anne Marie. “She owed her life to one nurse in particular.”

Statistical pioneer

Nightingale’s legacy goes beyond her nursing. Her contribution to statistics was recognised when she became the first female member of the Royal Statistical Society in 1858. She carefully collected data in Crimea and turned it into coxcomb charts (similar to pie charts) and bar graphs, which helped her campaign for improvements in the British Army. One chart (pictured below) showed more soldiers were dying from disease than from battle wounds.

“The fact that she had data quantification skills to create a record of what had happened was another gift. That’s why she’s still relevant,” says Anne Marie. “And that’s what we need to do today – we need to understand why this has happened, capture the experiences of patients, and also capture the experiences of nurses.”

Data also backed up her belief in sanitation. She saw ventilation, light, nourishing food and exercise as necessary for good health. In hospitals, she believed beds should be a certain distance apart and nurses should wash their hands regularly – all too familiar as we’re social distancing and ritually washing our own hands.

Defining nursing

Nightingale’s evidence-based approach was one of the first steps towards professionalising nursing. In her time, nursing was thought of as a domestic task done by women or religious figures. Her 1859 book Notes on Nursing was meant mostly for a domestic audience but, for the first time, defined what nursing was.

The following year, she oversaw as the first nursing school was set up at St Thomas’ Hospital, London. “She kept in touch by writing letters and helped to mentor some of the great leaders who trained there, providing support and direction for their careers,” says Anne Marie.

Nightingale’s compassion built upon the science and took care to a new level

Nurses were sometimes stereotyped as disreputable, like Charles Dickens’ character Mrs Gamp, and Nightingale wanted to change that and encourage respect for nursing. “Today, the public are hugely sympathetic to the plight of nurses,” says David. “When everyone joins in the clap for carers, I’m sure Nightingale would be having a wry smile at how far things have come.”

Her dedication to evidence-gathering and respectability came with a desire to tackle suffering and inequality. “For Nightingale, compassion built upon the science and took care to a new level,” says David. “We’ve seen some fantastic examples of that, particularly in end of life care, with nurses going the extra mile to make sure patients have not died alone. That is pure Nightingale in action – really wanting to do the best for people.”

Many 200th birthday events have been cancelled, but there are still ways to celebrate Nightingale’s big day. The Florence Nightingale Museum has an online bicentenary exhibition to explore. Meanwhile, the day offers a moment to think of the hope nursing can bring. Anne Marie says: “We could reflect on what it means to be a nurse, feel the power of our nursing community, and reach out to nurses across the world who are doing amazing things every day. This virus is teaching us the value of nursing, but we need to see that recognised and built into our health system and policy moving forward.”

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