Nightingale Home and Training School for Nurses, St. Thomas Hospital

Florence Nightingale Organizes Modern Nursing

Photograph

By: Anonymous

Date: ca. 1890

Source: The Nightingale Home and Training School for Nurses, St. Thomas's Hospital. Photograph in A History of Nursing: The Evolution of Nursing Systems from the Earliest Times to the Foundation of the First English and American Training Schools for Nurses, by Adelaide Nutting. Vol.2. New York: G. P. Putnam's Sons, 1907–1912.

About the Author: Mary Adelaide Nutting (1858–1948) is chiefly remembered for her contributions to nursing education, including the establishment of the department of nursing at Teachers College, Columbia University, and her authorship of the four-volume A History of Nursing: The Evolution of Nursing Systems from the Earliest Times to the Foundation of the First English and American Training Schools for Nurses.

INTRODUCTION

Nursing originated as one of the maternal crafts, a service traditionally performed by women with little or no training who served from a sense of duty or kindness, and expected no compensation. Later, nursing became a charitable occupation chiefly for nuns. When the Reformation during the sixteenth century closed Roman Catholic religious orders in England, few nuns were left to care for the sick. In order to fill the nursing ranks, women were recruited from numerous sources, including the jails. By the nineteenth century, nursing still lacked organization, professionalism, and standards of practice.

Florence Nightingale remedied this problem and structured nursing into a profession. Born on May 12, 1820, in Florence, Italy, to British parents on a European tour, Nightingale received the best education available for a young girl in the early nineteenth century. In the Victorian era, women of Nightingale's elite social class did not seek careers. Nightingale believed, however, that she had a calling from God to become a nurse. She studied nursing in a three-month course at the Institution of Protestant Deaconesses at Kaiserswerth, Germany, and then traveled to Paris to study with the Sisters of Charity.

When the Crimean War began in 1853, there were no organized nurses to care for wounded British soldiers. Nightingale traveled to the front with the permission of the secretary of war. Assigned to a filthy, cholera-ridden, overcrowded hospital, Nightingale and the nurses under her command quickly established order. They scrubbed the hospital, set up kitchens to provide balanced meals, put up screens to give the patients privacy, and set up recreational activities for recuperating soldiers. When Nightingale arrived in the Crimea, the death rate at her hospital was fifty to sixty percent. Within six months, the mortality rate among the wounded had dropped to two percent. As most deaths occurred at night, Nightingale made nighttime rounds carrying an oil lamp to illuminate her way. Afterwards, Nightingale was often referred to as "The Lady with the Lamp."

Returning to Britain, Nightingale opened the Nightingale Home and Training School for Nurses at St. Thomas Hospital in London on June 24, 1860. She believed that the focus of a training school should be nursing education rather than nursing service. While other training schools offered courses lasting only a few weeks or a few months, Nightingale enrolled students in a year-long program that included coursework on anatomy, surgical nursing, physiology, chemistry, food sanitation, ethics, and professionalism. Stressing compassion and empathy, she insisted that the patient be treated as a whole person and not simply as a disease. The Nightingale school is considered the first modern school of nursing and its foundation marked the beginning of nursing as an organized profession.

Nightingale spent the remainder of her life working to better nursing education. She focused on improving hospital care for the poor and attempted, without success, to persuade the military to hire female nurses as the backbone of hospitals.

PRIMARY SOURCE

NIGHTINGALE HOME AND TRAINING SCHOOL FOR NURSES, ST. THOMAS HOSPITAL

See primary source image.

SIGNIFICANCE

In the nineteenth century, medical science was developing rapidly, particularly after the tentative acceptance of the germ theory for causing wound infections and disease in general. The potential for saving many lives existed, but could not yet be realized because the structure to support the new measures for antisepsis (such as cleanliness of instruments and in care giving methods) was not in place. Physicians were frustrated in their efforts to provide good health care because hospital facilities and the personnel that staffed them were inadequate. Although the problems were well-known, no remedies were proposed until Florence Nightingale offered them.

Nightingale launched the modern nursing movement by setting standards for nursing education. As Nightingale realized, nurses played a vital role as the foundation of hospital care. Physicians did not see patients as often as the nurses, and physicians did not typically concern themselves with matters such as cleanliness and diet that were crucial to a patient's recovery. It was left to the on-duty nurse to spot problems and to remedy them before a patient suffered. However, despite the growing importance of nursing, most nurses before Nightingale's era were taught only a few simple procedures by doctors or their assistants. After nursing education was standardized, they were fully prepared to participate in the medical revolution.

The nineteenth century changes in medical care that enabled people to live longer, healthier lives were the result of scientific and educational advances. However, patients avoided hospitals in the first half of the century, as they were often considered filthy, disease-ridden places where skilled care was lacking and death was common. Nightingale's nurses helped transform the public's perception of hospitals; they became institutions where care was delivered by capable, clean hands.

Today, professional nurses receive standardized education and clinical training, pass examinations administered by a state board of examiners, are maintained on a registry, seek continuing education, and abide by set standards of practice.