The year 2020 has been designated as the “Year of the Nurse and midwife”, in honour of the 200th birth anniversary of Florence Nightingale.
The year 2020 is significant for WHO in the context of nursing and midwifery strengthening for Universal Health Coverage. WHO is leading the development of the first-ever State of the World’s Nursing report which will be launched in 2020, prior to the 73rd World Health Assembly. The report will describe the nursing workforce in WHO Member States, providing an assessment of “fitness for purpose” relative to GPW13 targets. WHO is also a partner on The State of the World’s Midwifery 2020 report, which will also be launched around the same time. The NursingNow! Campaign, a three-year effort (2018-2020) to improve health globally by raising the status of nursing will culminate in 2020 by supporting country-level dissemination and policy dialogue around the State of the World’s Nursing report.
Nurses and midwives are essential to the achievement for universal heath coverage. The campaign and the two technical reports are particularly important given that nurses and midwives constitute more than 50% of the health workforce in many countries, and also more than 50% of the shortfall in the global health workforce to 2030. Strengthening nursing will have the additional benefits of promoting gender equity (SDG5), contributing to economic development (SDG8) and supporting other Sustainable Development Goals.
As this year goes forward, this website will seek to highlight issues and challenges facing today's nursing and midwifery workforce.
However, perhaps it is salient to take a look at the woman who revolutionised nursing..
May 1820 – 13 August 1910) was an English social reformer and statistician, and the founder of modern nursing.
Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organised care for wounded soldiers. She gave nursing a favourable reputation and became an icon of Victorian culture, especially in the persona of "The Lady with the Lamp" making rounds of wounded soldiers at night.
Nightingale was a prodigious and versatile writer. In her lifetime, much of her published work was concerned with spreading medical knowledge. Some of her tracts were written in simple English so that they could easily be understood by those with poor literary skills. She was also a pioneer in the use of infographics, effectively using graphical presentations of statistical data.
Florence Nightingale's most famous contribution came during the Crimean War, which became her central focus when reports got back to Britain about the horrific conditions for the wounded. On 21 October 1854, she and the staff of 38 women volunteer nurses that she trained, including her aunt Mai Smith, and 15 Catholic nuns, (mobilised by Henry Edward Manning) were sent (under the authorisation of Sidney Herbert) to the Ottoman Empire. Nightingale was assisted in Paris by her friendMary Clarke. They were deployed about 295 nautical miles (546 km; 339 mi) across the Black Sea from Balaklava in the Crimea, where the main British camp was based.
Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Üsküdar in Istanbul). Her team found that poor care for wounded soldiers was being delivered by overworked medical staff in the face of official indifference. Medicines were in short supply, hygiene was being neglected, and mass infections were common, many of them fatal. There was no equipment to process food for the patients.
“ This frail young woman [...] embraced in her solicitude ” the sick of three armies.
— Lucien Baudens, La guerre de Crimée, les campements, les abris, les ambulances, les hôpitaux ,
After Nightingale sent a plea to The Times for a government solution to the poor condition of the facilities, the British Government commissioned Isambard Kingdom Brunel to design a prefabricated hospital that could be built in England and shipped to the Dardanelles. The result was Renkioi Hospital, a civilian facility that, under the management of Dr Edmund Alexander Parkes, had a death rate less than 1/10th that of Scutari.
Stephen Paget in the Dictionary of National Biography asserted that Nightingale reduced the death rate from 42% to 2%, either by making improvements in hygiene herself, or by calling for the Sanitary Commission. For example, Nightingale implemented handwashing and other hygiene practices in the war hospital in which she worked.
During her first winter at Scutari, 4,077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds. With overcrowding, defective sewers and lack of ventilation, the Sanitary Commission had to be sent out by the British government to Scutari in March 1855, almost six months after Nightingale had arrived. The commission flushed out the sewers and improved ventilation. Death rates were sharply reduced, but she never claimed credit for helping to reduce the death rate.
The Lady with the Lamp
During the Crimean war, Nightingale gained the nickname "The Lady with the Lamp" from a phrase in a report in The Times:
She is a "ministering angel" without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.
Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas' Hospital on 9 July 1860. The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary. Now called the Florence Nightingale School of Nursing and Midwifery, the school is part of King's College London. She also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury near her sister's home, Claydon House.
Nightingale wrote Notes on Nursing (1859). The book served as the cornerstone of the curriculum at the Nightingale School and other nursing schools, though it was written specifically for the education of those nursing at home. Nightingale wrote, "Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognised as the knowledge which every one ought to have – distinct from medical knowledge, which only a profession can have".
Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale spent the rest of her life promoting and organising the nursing profession. In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote: "The book was the first of its kind ever to be written. It appeared at a time when the simple rules of health were only beginning to be known, when its topics were of vital importance not only for the well-being and recovery of patients, when hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing".
As Mark Bostridge has demonstrated, one of Nightingale's signal achievements was the introduction of trained nurses into the workhouse system in Britain from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff. In the first half of the 19th century, nurses were usually former servants or widows who found no other job and therefore were forced to earn their living by this work.
Charles Dickens caricatured the standard of care in his 1842–1843 published novel Martin Chuzzlewit in the figure of Sarah Gamp as being incompetent, negligent, alcoholic and corrupt. According to Caroline Worthington, director of the Florence Nightingale Museum, "When she [Nightingale] started out there was no such thing as nursing. The Dickens character Sarah Gamp, who was more interested in drinking gin than looking after her patients, was only a mild exaggeration. Hospitals were places of last resort where the floors were laid with straw to soak up the blood. Florence transformed nursing when she got back [from Crimea]. She had access to people in high places and she used it to get things done. Florence was stubborn, opinionated and forthright but she had to be those things in order to achieve all that she did."
In the 1870s, Nightingale mentored Linda Richards, "America's first trained nurse", and enabled her to return to the United States with adequate training and knowledge to establish high-quality nursing schools. Richards went on to become a nursing pioneer in the US and Japan.
By 1882, several Nightingale nurses had become matrons at several leading hospitals, including, in London (St Mary's Hospital, Westminster Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables at Putney) and throughout Britain (Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary and Liverpool Royal Infirmary), as well as at Sydney Hospital in New South Wales, Australia.
In 1883, Nightingale became the first recipient of the Royal Red Cross. In 1904, she was appointed a Lady of Grace of the Order of St John (LGStJ). In 1907, she became the first
woman to be awarded the Order of Merit. In the following year she was given the Honorary Freedom of the City of London. Her birthday is now celebrated as International CFS Awareness Day.
From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography cites brucellosis and associated spondylitis as the cause. Most authorities today accept that Nightingale suffered from a particularly extreme form of brucellosis, the effects of which only began to lift in the early 1880s. Despite her symptoms, she remained phenomenally productive in social reform. During her bedridden years, she also did pioneering work in the field of hospital planning, and her work propagated quickly across Britain and the world. Nightingale's output slowed down considerably in her last decade. She wrote very little during that period due to blindness and declining mental abilities, though she still retained an interest in current affairs.