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Steve Fouch

The Nightingale Legacy

Steve Fouch is CMF Head of Communications. He has worked in community nursing, HIV & AIDS and palliative care. He serves on the International Board of Nurses Christian Fellowship International.
The views expressed do not necessarily reflect those of CMF.

With the news just over a week ago that the London Nightingale Hospital was to be ‘mothballed’ as no new COVID-19 cases were expected to need the facility in the foreseeable future, it is ironic that today we celebrate the institution’s namesake’s 200th birthday.

One wonders what Florence Nightingale would have thought of the temporary hospital that bears her name, and the six others across England? (Scotland has named their COVID-19 temporary hospital after the WW1 Scottish nurse Louisa Jordan who died nursing patients during a typhus outbreak, and Wales is naming theirs Dragon’s Heart after their national symbol).

Getting things done

During the Crimean War, Nightingale had managed to persuade the War Office through her incisive use of statistics that Scutari hospital was not suitable for the care of soldiers wounded in the conflict. Bending to her letter-writing campaigns and the influence of her old friend, Sidney Herbert (who also happened to be Minister of War) the British Government commissioned no less a personage than Isambard Kingdom Brunel to build a brand-new field hospital to her exacting specifications. This field hospital had a tenth of the mortality rate of Scutari.

Yes, Nightingale got things done. And she was successful for several reasons. First, and possibly foremost, she was incredibly well connected. Her family had a long history of parliamentary service and political campaigning, her grandfather having been an associate of William Wilberforce during the anti-slave trade campaigns earlier in the century. Counting the Minister of War as a close personal friend probably didn’t hinder her influence either.

She was also very tenacious. Even in some years later, as she was bed-bound by complications of brucellosis probably contracted during her two years in Asia Minor, and on into her eighties, she was still writing influential letters to government ministers on matters of public health and nurse education. She oversaw the design and building of several hospitals (creating the Nightingale Ward layout that many of my generation of nurses and medics will still recall). In 1860 she founded a school of nursing at St Thomas’s Hospital in London that still bears her name.

She fought endlessly with the War Office during her time in Crimea, not only for proper resources for her hospitals and her nurses but even for the right for her and her nurses to stay at the hospital at all. Many believed that an English gentlewoman’s place was not in the midst of such dire human circumstances and squalor.

Nightingale was also a rigorous statistician and data collector, using that information fearlessly to make her case – even when her figures showed the rise in the mortality rate at Scutari was directly correlated to the arrival of her nurses. While many would have hidden that data for fear it would shut down their work, Nightingale took it to the War Office to make the point that she needed the facilities and equipment to maintain hygiene between beds. She and her nurses were vectors for frequently lethal hospital-acquired infections because they did not have handwashing facilities and clean aprons to use between caring for patients. In fact, she had had to buy aprons and handwashing facilities out of her own pocket and through fundraising until her stark presentation of morality data in her now-famous coxcomb diagrams persuaded the Government to intervene. She lacked neither courage nor conviction.

After the war, the data she collected from Scutari was the basis for a Royal Commission that reformed the provision of medical services for the armed services. Indeed, even well into her eighties, she remained an active social reformer.

Today’s COVID-19 health crisis and that of the war wounded in nineteenth-century Crimea have some obvious parallels. This has led some to speculate that, were she alive today, Nightingale would have been on the clinical frontline while tirelessly lobbying the Government on evidence-based epidemic control measures, access to personal protective equipment (PPE) and COVID-19 testing for all those in clinical and caring roles.

A sense of calling

What made a middle-class Englishwoman up sticks and travel a quarter of the way around the world to care for the wounded in a war that the British Empire was losing? What was the source of that tenacity, courage and uncompromising commitment to evidence-based practice?

At the age of 17, Nightingale wrote in her diary ‘God called me in the morning and asked me would I do good for him alone without reputation‘. It would not be until she turned thirty that she would discover what that good was to be. On a journey through Europe, she happened upon the work of the Deaconesses at Kaiserswerth-am-Rhein in Germany. There Nightingale observed the Lutheran pastor Theodor Fliedner and his Deaconesses working for the sick and the socially deprived. She saw in the Deaconesses’ tireless devotion to caring for the vulnerable the good that God had been calling her to do. She returned shortly thereafter to gain formal nurse training from the Deaconesses. Within a couple of years, her childhood friend Sidney Herbert called upon her to go to Crimea to reform the care of wounded soldiers. She had found the outworking of her calling, and nothing would now stand in the way of doing what God had asked her to do for him.

While her Christian faith was far from orthodox, she held that her calling and her work was essentially a Christian ministry. Furthermore, she recognised that while her nursing had to be based on the best science available to her, it was also an art that was as much spiritual as it was evidence-based. Writing in Notes on Nursing, she famously stated:

Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts.’ 

That is what makes her contribution to nursing so significant – rigorous science, political engagement and advocacy, married with a human core of compassion. And underlying it all, a courage born of a deep sense of calling.

The roots of nursing before Nightingale were undoubtedly to be found in the Christian monastic traditions; Nightingale simply got the profession out of the cloisters and the churches and into the wider world. But she never forgot that calling from God as a 17-year-old.

Legacy

Two centuries on from her birth in the Italian city for which she was named, Florence Nightingale’s legacy is as relevant as ever. Nursing remains an activist profession, as concerned with research and advocacy as it is with compassionate care. It is the backbone of every healthcare system in the world. Which is why 2020 has been designated as the Year of the Nurse and the Midwife by the World Health Organisation.

It is not at all ironic that, as 2020 is also the year of COVID-19, it is after Nightingale that the NHS chose to name seven of its temporary epidemic hospitals. The images of nurses, doctors and other health workers clad in PPE have become synonymous with courage, evidence-based care, and compassion. Nightingale would have been proud.

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