When I was nine years old, my Icelandic grandmother (Amma), gave me a book for Christmas called Nurses Who Led the Way. That treasured and tattered book has travelled with me across continents.
There are no accounts of women in starched uniforms or obedient handmaidens. These are stories of spirited nurses who cared for the dying, healed shattered soldiers, improved sanitation, and reformed health care. Nurses such as Lillian Wald (1893-1940) who founded New York’s Visiting Nurse Service and the Henry Street Settlement; Clara Barton (1821-1912) who established the American Red Cross; and Florence Nightingale (1820-1910) – the “Angel of Crimea”, my heroine and pioneer of modern nursing. In these writings, I uncovered a path to life with shape and purpose.
During the Victorian Era, nursing was a lowly and menial vocation, one relegated to poor women with no other prospects - a view held by Nightingale’s affluent parents. Despite their objections, Florence enrolled as a nursing student in a hospital in Germany. After graduation, she returned to London to take up a post at Middlesex hospital and became a nursing superintendent within a year.
Nightingale was immediately faced with a cholera outbreak; complicated by the fears, competing theories and superstitions that accompany a pandemic. We now know that cholera is a human disease, transmitted through faecal-polluted river waters and contaminated foods. Nightingale insisted upon rigorous hygiene practices and the standards she demanded became visible, resulting in a marked decline in hospital death rates.
Nightingale exacted a boundless sense of duty from her nurses and demanded the same from herself:
I attribute my success to this: I never gave or took any excuse.
Challenges in Constantinople
In 1853 Britain was at war with the Russian Empire for control of the Ottoman Empire. Within a year, no fewer than 19,000 soldiers had been admitted to military hospitals; stories of the neglect of ill and injured soldiers soon reached England, prompting an uproar.
Nightingale received a letter from Secretary of War, Sidney Herbert, asking her to organise a corps of nurses to tend to the sick and fallen soldiers. Nightingale assembled a team of 34 nurses and sailed for Constantinople.
Nothing could have prepared the nurses for the despair they encountered when they arrived at Scutari, the British-based hospital. The hospital had been built on top of a large open culvert. Patients lay in their own excrement on stretchers strewn throughout the passages. Rodents and cockroaches scurried past them. Basic supplies, such as bandages and soap, were scarce and the tainted water needed to be rationed. More soldiers were dying from typhoid and cholera than from wounds earned in battle.
Nightingale set to work. She procured hundreds of scrub brushes and asked the least infirmed patients to help the nurses scrub the inside of the hospital from floor to ceiling. In addition to advancing the sanitary conditions of the hospital, she created a kitchen devoted to the dietary needs of the patients. She established a laundry to ensure that the infirmed soldiers would have clean linens. She created a classroom and a library for patients to provide inspiration and diversion from solitude.
In the evenings, Nightingale moved through the shadowy corridors, carrying a lamp while ministering to patient after patient. Soldiers, calmed by her gentle benevolence, took to calling her, “the Lady with the Lamp”.
Under her leadership, the hospital’s death rate was reduced by two-thirds.
Communication of data
At the conclusion of the war, Nightingale returned home and wrote an 830-page report outlining reforms for military hospitals. With the backing of Queen Victoria, she created the Royal Commission for the Health of the Army, which found that 16,000 of the 18,000 Crimean army deaths resulted from preventable diseases - not battle. But it was Nightingale’s ability to translate this data visually, now known as a “Nightingale Rose Diagram,” that demonstrated how sanitation decreased mortality.
Florence Nightingale was the first female member of the Royal Statistical Society and was named an honorary member of the American Statistical Association - her work recognised as a critical stimulus to the development of germ theory.
Education and an honourable vocation
In 1860, she funded the establishment of St. Thomas’ Hospital, and within it, the Nightingale Training School for Nurses. She became an admired public figure. Eager to follow her example, even women from the wealthy upper classes started enrolling at the training school. Thanks to Nightingale, nursing was an honourable vocation.
While at Scutari, Nightingale had contracted “Crimean fever” and would never fully recover. By the time she was 38 years old, she was bedridden and remained so for the rest of her life, taking comfort from the piping songs of red-chested robins in her garden. In spite of ailing health, she continued her work.
Live life when you have it. Life is a splendid gift
—there is nothing small about it.
In 1858 she published Notes on Hospitals, which focused on how to properly run civilian hospitals. Throughout the American civil war, she was consulted on how best to manage field hospitals.
In 1908, when she was 88, King Edward conferred upon her the merit of honour. Two years later, she fell ill and died at her home in London. Nightingale had requested no fanfare or public funeral.
I reflect on my own nursing career over the past four decades - the first time I nursed fragile polio survivors sealed in iron lungs and truly understood the importance of caring connection; the tolerant greeting I received from regular patrons when I walked into a bar or brothel in my community health nursing uniform, my black bag in hand in an effort to track down untreated tuberculosis cases; the mysterious AIDS epidemic that emerged in the 1980s and challenged us to manage symptoms and provide compassionate palliative care to frightened young men. And later, my clinical research to measure symptom distress, improve pain management for patients with cancer, and include the family as the unit of care - with education about the illness, caregiving support, and grief counselling—confirmed the importance of scientific evidence to guide nursing practice.
Advocacy for patients
Over the last two years, I saw us return to time-honoured public health practices of infection control, as we buckled under the biological proficiency of COVID 19. Nurses stepped up to care in the midst of uncertainty, fear and strained resources. Our cancer nursing community shared learnings about how to best support our patients during the pandemic, offering tailored clinical expertise, sound empirical advice, and most importantly - hope.
If I were to magically time travel and speak to Florence Nightingale about these things, I think she would have little patience for introspection, and instead implore us to advocate for our patients and the standards that underpin our profession.
I think one’s feelings waste themselves in words,
they ought all to be distilled into actions and
into actions which bring results.
Each 12th of May, nurses worldwide gather to commemorate International Nurses’ Day, Florence Nightingale’s birthday. This year I will remember the work of nurses – still battling communicable diseases, supporting people with chronic illnesses, managing complex cancer therapies and offering mental health support. I will pay tribute to their courage, their wisdom and their sacrifices; grateful to my Amma for leading me to the Lady with the Lamp.
Emeritus Professor Linda Kristjanson
Chair, VCCC Alliance