Learning from History: Florence Nightingale

In this next installment of the Learning Leadership from History series, I cover Florence Nightingale.

I became interested in seeing how certain leadership practices came to light throughout history.  As the very proud son of a nurse, I wanted to look at how Florence Nightingale created such change in the nursing profession. I found, as with most great leaders, that The Five Practices of an Exemplary Leadership® were all present with Florence. For this very brief review though, I’m going to focus on a single practice, Challenge the Process.

Florence Nightingale – Challenging the Process

Growing Up

Florence Nightingale was born into a rich, upper-class, well connected British family in 1820. She was named after the city in Italy where she was born. Her family moved back to England in 1821 where she was educated by her father.

The family was visiting Europe when Florence was a teen and was introduced to Mary Clarke, an independent woman with whom Florence developed a long friendship. Clarke showed Florence that women could be the equals of men. As a woman of the upper class, Florence was expected to marry well and become a mother. Her feelings and desires followed a different path. She felt called to be of service to others.

While nursing is an honored and exalted profession now, this was not the case in the first half of the 19th century. Nurses were often former servants or widows who could find no other work and were forced to earn their living this way. Nursing was not viewed as a profession and nurses were frequently not properly trained.

When Florence entered the field of nursing at the age of 24, it was over the express wishes of her family. She was dedicated to educating herself in the science of nursing.

Seeking out challenging opportunities−testing her skills and abilities.

Florence Nightingale contributed to the advancement of nursing and medicine during her work in the Crimean War. In 1854, she and a staff of 38 women, volunteer nurses that she had trained, were sent to the Ottoman Empire. They were deployed to Crimea, where the main British forces were based.

Upon arriving, Florence and her team found overworked medical staff, medical equipment, and medicine in short supply, poor hygiene practices, and no equipment to process food for patients. Major infections were a common and often fatal issue at the hospital.

Nightingale wrote a letter to The Times calling for a government solution to the poor conditions and care the soldiers were receiving. During her first winter in Crimea, more than 4,000 soldiers died at that hospital. Ten times more soldiers died from illnesses, such as typhoid, dysentery, and cholera than from wounds sustained in battle.

Illness wasn’t the only issue. The hospital was severely overcrowded, there was a lack of ventilation and a defective sewer system. The Sanitary Commission was dispatched by the British government within six months of her arrival to remedy what could be improved: flushing the sewers and making improvements in the ventilation system. Death rates were sharply reduced, though Nightingale did not claim credit for helping to reduce the death rate.

Challenges people to try out new and innovative ways to do their work.

Florence Nightingale implemented handwashing and other hygiene processes in the military hospitals where she worked to improve outcomes. She also recognized that poor nutrition was a contributing factor to the death rates of patients.

Upon her return to Britain, she collected data for the Royal Commission to provide evidence about the impacts of diet and hygiene on the health of the soldiers. She believed that more soldiers were being killed by the poor living conditions at the hospital. As her view came to be more accepted and applied, she was able to reduce the death rate further and began to focus on how hospital design could assist in increasing sanitary conditions.

The Lady with the Lamp

During the Crimean War, Florence Nightingale came to be called “The Lady with the Lamp” for her service ministering to the troops. This nickname came from a story in The Times of London:

“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.”

Her dedication and compassion for the people she served inspired the actions of those around her and continued to energize her calling to improve healthcare well after the war.

The continued push for progress

In 1859, Nightingale wrote and published Notes on Nursing. The book was written as an introduction to nursing. It introduced simple rules of health not only for the sick but also the healthy. This book came to be a cornerstone of the curriculum in the Nightingale nursing schools as well as other nursing schools.

In 1860, she began the Nightingale Training School at St. Thomas’ Hospital. The first trained Nightingale nurses began serving in 1865 in a workhouse infirmary in Liverpool. This school is still in operation as part of King’s College London. Nightingale also raised funds for additional hospitals.

Actively searching for innovative ways to improve

Nightingale had access to people in high places in government and was able to use those connections to get things accomplished. Nightingale expanded the use of trained nursing staff to the workhouses in Britain during the 1860s. She also served to inspire the Union government during the American Civil War to ask her advice on organizing field medicine for their troops. The United States also created the US Sanitary Commission, inspired by her work showing the impact of sanitation and hygiene on health.

Nightingale mentored “America’s first trained nurse”, Linda Richards, who came back to the United States with the knowledge and skill to set up high-quality nursing schools in America. Bellevue School of Nursing in New York City was the first school in the US-based on Florence Nightingale’s principles. This is the school that I am proud to say my mother graduated from many years later.

Nightingale also used her unique skills in sharing visually impactful data and statistics throughout her life. Some of the illustrative techniques that she used to share the impacts on the soldiers in Crimea were novel, new approaches at the time. Some of these methods are still used to share data today.

Nightingale went on to impact rural life in India starting with a thorough statistical analysis of the impacts of sanitation, hygiene, and public health. She then used the data to lobby for the creation of a Royal Commission to investigate the issue.

Nightingale continued throughout her life improving sanitation, hygiene and living conditions for people throughout the British empire. Historians believe that the changes she lobbied for and had enacted contributed to an increase in the average life expectancies in Britain of close to 20 years between 1871 and the mid-1930’s.

Wrapping it up

I grew up knowing the name of Florence Nightingale as a well-respected nurse, but not understanding the why. I found that taking the time to even briefly glimpse the impact this great woman had on those she touched during her life and through today to be both humbling and inspiring.

It is easy in our busy world to get caught up in the activities of today. It can be refreshing to see the stories of those who came before and made this remarkable world possible through their energy, drive, and leadership.

Check out more blogs in the Learning From History Leadership Series where I cover other historical figures such as General John Buford, Harriet Tubman, and Abraham Lincoln.

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Evans Kerrigan

Evans Kerrigan works tirelessly in both corporate and public sectors as a dynamic business consultant, presenter, and coach. With over 30 years of experience working with multi-national organizations such as Cisco, Sun Blue Cross Blue Shield, BP, State of Arizona and King County Washington, Evans has been at the forefront of change management--building healthy organizations and creating great places to work. His contributions to these organizations have been credited with increasing employee engagement scores, dramatic reductions in costs and improvement in efficiencies and revenue, resulting in improved operational excellence.