Episode 18: Florence Nightingale: Care's Frontline Pioneer

You know the image: the "Lady with the Lamp," a beacon of compassion on the battlefields. But what if we told you Florence Nightingale, the foundational philosopher of modern nursing, was far more than just a quiet caregiver?

Welcome to HerStance, the podcast that dives deep into the lives of history's most impactful women. In this episode, we're pulling back the curtain on Florence Nightingale, revealing the statistician, social reformer, and visionary who transformed medical care as we know it. Did you know she had a rescued owl named Athena who joined her on rounds? It's these fascinating, lesser-known layers that reveal the true breadth of her influence—an influence still profoundly felt in 21st-century healthcare.

Join us as we explore how Nightingale championed not only physical recovery but also the dignity and psychological well-being of patients, laying the groundwork for the modern hospital and the standards of care we expect today.

But our journey doesn't end in the past. We'll also confront the stark realities faced by today's Registered Nurses on the frontlines of volatile environments. From recent deployments abroad to the immense sacrifices and complex challenges in war and conflict zones, these healthcare heroes are vital in saving lives—yet often face woefully inadequate preparation and a lack of decision-making power. We'll delve into the physical and emotional toll, the constant struggle against overwhelming odds, and the profound moral and ethical dilemmas that define their extraordinary service.

For more information about what nurses do, how to become a nurse, challenges they face and so much more, visit https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/

For nurse advocacy groups to pay attention to: https://nursejournal.org/articles/nurse-advocacy-groups-to-pay-attention-to/

Resources: https://www.britannica.com/biography/Florence-Nightingale

https://pmc.ncbi.nlm.nih.gov/articles/PMC10092232/

https://pmc.ncbi.nlm.nih.gov/articles/PMC9690662/

https://pmc.ncbi.nlm.nih.gov/articles/PMC11969315/

https://blog.aarp.org/thinking-policy/ten-things-you-can-do-to-support-nurses

https://ojin.nursingworld.org/table-of-contents/volume-24-2019/number-3-september-2019/ethical-issues-faced-by-military-nurses/

To get a copy of Florence Nightingale's book "Notes on Nursing" -- https://www.goodreads.com/book/show/766216.Notes_on_Nursing

Transcript

Welcome to HerStance, the podcast where we dive deep into the lives of incredible women who've shaped our world. And today, we're shining our spotlight on a woman you might think you know well.

When you hear the name Florence Nightingale, a very specific image probably comes to mind, doesn't it? The "Lady with the Lamp," moving quietly through the night, tending to wounded soldiers in the mid-19th century. And yes, she absolutely was that compassionate figure – a British nurse, statistician, and social reformer who truly became the foundational philosopher of modern nursing. Her impact on healthcare is immeasurable.

But here’s a little detail you might not know: Florence Nightingale had a rescued owl named Athena – after the Greek Goddess of Wisdom, of course – who would accompany her on her rounds, sometimes perched on her shoulder, sometimes tucked into her pocket!

It's those fascinating, lesser-known layers that we're going to explore today on HerStance. There's so much more to Florence Nightingale's story than meets the eye, and her work is surprisingly relevant even now, in the 21st century.

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Okay. Back to the program.

Every year, on May 12th, we celebrate International Nurses Day. It's a date chosen specifically to commemorate the birth of a true pioneer, someone whose vision transformed medical care as we know it: Florence Nightingale.

Now, if you've ever found yourself in a doctor's office, welcomed a new baby into the world, or perhaps navigated pre- or post-operative care in a hospital, then you instinctively understand this: it's the nursing staff who are doing the heavy lifting. They're the ones on the front lines, providing the constant, hands-on care that makes all the difference in a patient's journey.

And it's to Florence Nightingale that we owe so much of what we now consider fundamental. She wasn't just about bandaging wounds; she was instrumental in establishing the very standards of care we expect today. Think about the basics of hospital organization – the cleanliness, the efficiency, the structure – much of that stems from her groundbreaking work. But perhaps most remarkably, Nightingale also championed the psychological well-being of patients, emphasizing the profound importance of dignity and respect. She understood that healing wasn't just about the body, but also about the spirit.

So how did this remarkable woman, who revolutionized healthcare, even begin her journey? Let's rewind and explore her early years, because they truly were formative.

Florence Nightingale was born into a world of privilege. Imagine this: her wealthy British parents, William Edward and Frances Nightingale, were on an extended honeymoon in – you guessed it – Florence, Italy. And just like that, her name was sealed. Interestingly, her father had only recently changed his last name to Nightingale himself, having inherited his great uncle's estate a few years prior. It was a time of burgeoning family fortunes.

When the Nightingales returned home, now a family of four, their lifestyle was, by all accounts, exceptionally comfortable. Think grand summer excursions to the countryside and elegant residences in London during the "social season." If you've ever imagined the world of Bridgerton, you're pretty close to envisioning Florence Nightingale's early environment.

But while many young women of her standing might have focused on balls and social engagements, Florence was... different. To call her precocious feels like a massive understatement. She didn't just enjoy learning; she devoured it. She excelled in mathematics, devoured languages, and found deep satisfaction in philosophy. She possessed a mind that was constantly questioning, constantly seeking.

And then there was her spiritual upbringing. Raised in the liberal Unitarian church, Florence felt a profound, almost undeniable 'calling' – a deep-seated urge to reduce human suffering. For her, nursing wasn't just a job; it seemed to be the path uniquely designed to fulfill this mission.

However, here's where the plot thickens. For a woman of her social standing, nursing was simply deemed inappropriate. It wasn't a profession for a gentlewoman; it was gritty, often seen as a lowly pursuit.

But Florence Nightingale was not one to be deterred. Undaunted by societal expectations, she found her way, twice, to the Institution of Protestant Deaconesses at Kaiserswerth in Germany. First for a two-week intensive in July 1850, and then for a more substantial three-month training in July 1851. This is where she learned the absolute fundamentals, the practical skills that would become the bedrock of her future reforms.

And, ironically, her 'stature' did eventually pay off. Leveraging her family's good connections, she secured a position as the superintendent of the Institution for Sick Gentlewomen (or Governesses) in Distressed Circumstances in London. This was her first real opportunity to shine as an administrator. She swiftly set about improving nursing care, enhancing working conditions for her staff, and streamlining the efficiency of the entire hospital.

After just one year, she realized her next step needed to be even bigger: she had to train others on a larger scale. She began considering another position in London. But fate, and the turbulent regional politics of the time, were about to profoundly reshape her path.

As Florence Nightingale pondered her next steps in London, a conflict brewed in another part of the world. Russian Orthodox Christians were clashing with the Turkish Ottoman sultan over the protection of Russian Orthodox subjects and control of holy sites in Jerusalem. This tension escalated, culminating in the vast Turkish Ottoman Empire declaring war on Russia in October 1853.

Britain Enters the Fray

Known as the Crimean War, the conflict drew in Britain as an ally of Turkey. A year later, in September 1854, Britain and France also declared war on Russia. Allied troops landed in Russian Crimea, on the north shore of the Black Sea, and began a year-long siege of the Russian fortress of Sevastopol.

A Crisis in Care

Reports reaching the London Times exposed the horrific state of care for wounded soldiers. The medical establishment was described as incompetent and ineffective, lacking even the most basic supplies. Public outrage surged, demanding immediate improvements for the soldiers.

Nightingale's Call to Action

In response, the Secretary of State asked Florence Nightingale to lead a group of nurses to the barrack hospital. This invitation was a testament to her growing reputation and advancements in patient care. She arrived with 38 nurses to a truly dreadful scene: a filthy, unwelcoming environment with no supplies, severe overcrowding, and resistant medical officers. Nightingale herself famously described it as the "kingdom of hell."

Transforming the "Kingdom of Hell"

Yet, Nightingale remained undeterred. She used funds from the New York Times to purchase equipment and ingeniously enlisted soldiers' wives to help with laundry. Wards were meticulously cleaned, and basic care—bathing, clean clothing, and fresh dressings—was provided. She even helped soldiers write letters home. Recognizing the importance of holistic care, she also ensured soldiers had access to recreational and educational activities to support their psychological well-being during recovery.

The Lady with the Lamp

Nightingale's dedication was legendary. She would wander the wards at night, lamp in hand, checking on her patients—a practice that earned her the enduring nickname "the lady with the lamp."

Her tireless efforts earned her the respect of both the soldiers and the medical establishment. More importantly, the death rate among the wounded dropped significantly by about two percent. While this might seem modest, it was a profound achievement, especially considering the British government had previously concealed the true mortality figures. Florence Nightingale returned home a national hero.

But not unscathed. A persistent bacterial infection and profound exhaustion plagued her for life. Yet, her impact was monumental. She secured an audience with the King and Queen, presenting meticulous records that led to sweeping reforms in military and supplies procurement.

But her legacy didn't stop there. With private funds raised in gratitude, what do you suppose she did? She opened the very first school of nursing at St. Thomas's Hospital in London – a dream realized. Many of her statistical models and foundational concepts remain cornerstones of nursing today.

Nightingale also championed public health with her seminal work, "Notes on Nursing: What it is and What It Isn't," a publication that has been continuously in print since 1859. Her influence extended to the establishment of a midwifery school and further environmental reforms in India, all based on her data-driven approach. Florence Nightingale was truly a pioneer, honored with the title of Lady of Grace of the Order of St. John of Jerusalem and becoming the first woman to receive the Order of Merit.

Host: While Nightingale believed the home was the most crucial place for care, the harsh reality for millions today, caught in the grip of regional conflicts and ongoing wars, is that they have no homes. And disproportionately, those most affected are women and children.

Let that sink in for a moment.

UNWomen.org reports that in 2023, over 170 armed conflicts raged worldwide. A staggering 612 million women and girls lived within 50 kilometers of these conflicts – a 50% increase in just a decade. Why are women and girls hit hardest? Simply because of their gender. They endure sexual violence, physical and verbal abuse, and immense barriers to essential resources and human rights, all while facing the direct horrors of frontline conflict.

Last year alone, there were over 1,500 reported attacks on healthcare infrastructure in 19 countries experiencing complex humanitarian emergencies, leading to over 2,000 injuries or deaths. These attacks, in places like Haiti, Mali, Myanmar, Sudan, Ukraine, and Palestine, deprived millions of women of life-saving services, including critical sexual and reproductive healthcare.

This brings us to the present day and the critical role of Registered Nurses in these volatile environments. Recent news of the US continuing to deploy nurses abroad and, frankly, our President's actions in Iran, got me thinking about the immense sacrifices and complex realities these healthcare heroes face. 

They are vital in pre-hospital care, significantly impacting the survival and mortality of both military personnel and civilians. Often, these nurses are civilians, readily available to deploy. But here's a crucial point: nurses are rarely at the decision-making level, leaving many civilian nurses woefully unprepared for the unique challenges of war and conflict zones.

Why this disconnect? In part, it stems from unresolved ethical and political concerns among nursing leaders regarding the profession's reputation, its humanist ideals, and its relationship with government.

Despite their vital contributions, there's a surprising lack of comprehensive studies on the full impact on nurses in conflict zones. However, one notable undertaking did attempt to gather data, revealing a host of challenges: physical problems related to training and equipment, the constant struggle of being outnumbered by armed forces, and the profound emotional toll of compassion fatigue. Nurses in these environments must be incredibly resourceful, operating in a reality where nothing is "normal." Patient-to-nurse ratios constantly fluctuate, "downtime" is non-existent, and spare parts or a "fix-it" person are rarely at hand when things break down.

But beyond the logistical nightmares, what about the moral and ethical dilemmas? In nursing, "moral distress" arises when a nurse's professional judgment clashes with decisions made by those in superior positions, like a physician. "Ethical distress" is even broader, stemming from personal convictions, doubts about skills, or the allocation of limited resources to injured enemies, prisoners, local civilian casualties, or even locals seeking care because their own systems are failing.

Military nurses face a unique struggle. They are trained to be "officers first, nurses second." From their initial training, the mission and needs of the military take precedence. While acutely aware of their dual responsibilities, these nurses grapple with the profound challenge of reconciling military objectives with the raw human suffering they witness daily.

Consider the Geneva Conventions and the rules of war – the mandate to provide care, even when it's not reciprocated. As one nurse expressed, "When you're hands-on, when you're actually taking care of the soldier and taking care of the assailant, then it's a little more... it makes it a little more difficult 'cause emotions are involved."

And when they return home, the struggle often continues. If they dare to speak about their experiences, they frequently face a need to defend themselves, leading to re-traumatization. Yet, remarkably, many nurses choose to go back for more deployments, sometimes finding it easier than navigating the angst of civilian life.

The moral and ethical challenges faced by these nurses in war zones are immense, complex, and demand our attention.

 So, what's the takeaway from all of this? How do we address these critical issues facing nurses, especially those in war zones, and ensure their invaluable contributions are recognized and supported?

First, and perhaps most importantly, we need more women at the table – at all tables. Studies consistently show that peace agreements with women signatories are more likely to be implemented and last longer. Yet, in 2023, women made up a paltry 5% of negotiators, 9% of mediators, and 19% of signatories to peace and ceasefire agreements. This imbalance extends to national leadership: in 2024, only 27% of national parliamentarians worldwide were women, dropping to a mere 21% in conflict-affected countries. The numbers are similarly low for cabinet positions. While the share of military women in UN peacekeeping operations has steadily increased, from 4.2% in 2018 to 8.5% in 2024, there's still a long way to go.

This is precisely why movements like feminist foreign policy are gaining traction. As of 2024, fourteen countries have committed to applying a feminist lens to their foreign policy, meaning they prioritize promoting gender equality and women's rights in their international relations. This approach is crucial for recognizing and addressing the unique impacts of conflict on women and girls, and by extension, on the healthcare providers who serve them.

Consider this: over 85% of nurses in the U.S. are women. This isn't just a statistic; it highlights nursing as a still "gendered" profession, even as more men enter the field. Nurses constitute the majority of the healthcare workforce, and in war zones, their role is literally life-saving. Yet, as a Nurse Journal article points out, laws impacting healthcare are often passed without input from these frontline professionals. Decisions are made by those who don't truly understand the realities of "boots on the ground" patient care. Add to this the chronic nursing shortage, long hours, and their intense focus on direct patient care, and it's clear why policy advocacy often falls by the wayside for them.

This is where we have a HerStance opportunity to be allies. Let's put a new lens on the headlines. When bombs drop, when we see images of refugees fleeing, accounts of hostages, or even a natural disaster aid station being set up – take a moment to put a face and a frontline profession to that image. Most likely, there's a nurse there, desperately searching for fresh bandages, trying to alleviate pain, or making agonizing decisions about who to treat first.

They are all, in their own time and way, "ladies with the lamp." We owe them an immense debt of gratitude for bearing such incredible burdens.

Break

You’ve made it to the HerStance Challenge

Have I inspired you to become a Nurse?

Well, that would be wonderful.

However, there are other things we can do to make a difference.

Learn more about what nurses do.

https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/

I will add a great resource from the website Nursing World in the show notes for you to read all about the profession, the scope of practice, laws and regulations, how to become a nurse and more.

Show respect and trust that it’s mutual.

The first line of the Nursing Code of Ethics reads “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.”  

Share your concerns with the right person

Remember, nurses at the point of care are not the policy makers or the person determining your treatment plan. If you have concerns, share them through the appropriate channels. Most hospitals have a patient relations or patient experience office. Start there.

Don’t hesitate to say Thank You

Right now, there is a serious shortage of nurses to provide care for the people who need it. Adopt the mindset to be kind to the nurses who showed up.

Do your part to lighten the nurse’s workload

That means take steps to be proactive in identifying health needs instead of waiting until you are sick. And take care of yourself! Eat right, do some moving, get good sleep – and if you want a good read about health from Florence Nightingale, you can still get a copy of Notes on Nursing: What it is and What it is not. 

Be an Ally

Use your voice, words, influence, and advocacy to remove barriers to safe, quality care delivery. I’ll put a link in the show notes that lists nurse advocacy groups to pay attention to. https://nursejournal.org/articles/nurse-advocacy-groups-to-pay-attention-to/

Vote

Ask candidates about their proposals to address the nursing shortage, improve the work environment, recalibrate compensation, and create protections against violent acts against nurses. Tell them your own story of when nurses have made a difference and why investing in them is wise and necessary.

Thank you for tuning in to HerStance.  I hope you have learned a few fun facts about Florence Nightingale and been inspired by nurses who are heroes today, here and abroad.

HerStance is written and produced by me, Sandra Koelle.

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