Lessons from the life of Florence Nightingale

by Charlotte A. Aikens

The Nightingale Training School For Nurses

Chapter IV.

Deep as was the desire of Miss Nightingale to institute plans for the training of hospital nurses, her health, after her return from the army service, was so impaired, that to undertake the task herself was impossible. The fund of $250,000 had been placed in charge of a board of trustees and invested for the purpose of establishing a school of which she expected to be the superintendent. Her health, however, grew worse rather than better, and after two years had passed, she wrote to the Chairman of the Council of the Nightingale Fund, of her inability to carry out the plans. It became necessary to find other persons through whom she might work, without having to carry the everyday details. Her choice fell on St. Thomas’ Hospital—largely because “the matron of the hospital, Mrs. Wardroper, was a woman after Miss Nightingale’s own heart, strong, devoted to her work, devoid of all self-seeking, full of decision and administrative ability.” Of this remarkable woman, Mrs. Wardroper, who for twenty-seven years was superintendent of the Nightingale School, Miss Nightingale has left a character sketch:

[A]“I saw her,” she says, “first, in October, 1854, when the expedition of nurses was sent to the Crimean war. She had been then nine months matron of the great hospital in London, of which for 33 years, she remained head, and reformer of nursing. Training was then unknown; the only nurse worthy of the name that could be given to the expedition was a ‘Sister’ who had been pensioned some time before and who proved invaluable. I saw her next after the conclusion of the war. She had already made her mark; she had weeded out the inefficient, morally and technically; she had obtained better women as nurses; she had put her finger on some of the most flagrant blots, such as the night nursing, and where she laid her finger, the blot was diminished as far as possible, but no training had yet been thought of.

“Her power of organization, her courage and discrimination in character, were alike remarkable. She was straightforward, true, upright. She was decided. Her judgment of character came by intuition, at a flash, not by much weighing and consideration. Yet she rarely made a mistake, and she would take the greatest pains in her written delineations of character required for record, writing them again and again in order to be perfectly just. She was free from self-consciousness; nothing artificial about her. She did nothing, and abstained from nothing because she was being looked at. Her whole heart and mind were in the work she had undertaken.

“She was left a widow at 42 with a young family. She had never had any training in hospital life for there was none to be had. Her force of character was extraordinary. Her word was law. * * * She knew what she wanted and did it. She was a strict disciplinarian; very kind, often affectionate rather than loving. * * * She was a thorough gentle-woman, nothing mean or low about her; magnanimous and generous rather than courteous. All this was done quietly. She had a hard life but never proclaimed it. What she did was done silently.”

[A] British Medical Journal, Dec. 31. 1892.

Such was Miss Nightingale’s estimate of the first superintendent of a training school for nurses organized according to her own ideas. Mrs. Wardroper retired in 1887 and died in 1892. The plans for the training school were of Miss Nightingale’s making—the carrying of them out devolved almost wholly on Mrs. Wardroper, and on the Resident Medical Officer of the hospital, R. G. Whitfield.

There were two essential principles to the plan: The nurses were to have their technical training in hospitals specially organized for the purpose. They should live in a home fit to form their moral life and discipline. Plans for lectures were carefully made and carried out, and a “Monthly Sheet of Personal Character and Acquirements” of each nurse was arranged by Miss Nightingale herself, for the Matron to fill in. The character record was to be noted under five heads: punctuality, quietness, trustworthiness, personal neatness and cleanliness, and ward management.

The records in regard to nursing technique were made out on forms carefully prepared by Miss Nightingale under numerous headings, with copious subheadings. At her request, the Resident Medical Officer prepared a form of General Directions which were to aid the nurses in taking notes of the medical and surgical cases in the hospitals.

The school opened June 24th, 1860. The course of training was to extend over one year. The writer has in her possession a copy of the first set of “Rules and Regulations for Probationers Under the Nightingale Fund”—and they bear a close resemblance to regulations in force today. She laid foundations which have stood the test of time.

In the first report of the Committee in charge of the training school, one finds the details of the qualifications expected, set forth as follows, with the added statement that all important details for the working of the plan have been suggested by Miss Nightingale, or submitted to her for approval:

“DUTIES OF PROBATIONERS UNDER THE NIGHTINGALE FUND.”

You are required to be

Sober
Honest
Truthful
Punctual
Quiet and Orderly
Cleanly and Neat.

You are expected to become skilful in—

1. In the dressing of blisters, burns, sores, wounds, and in applying fomentations, poultices, and minor dressings.

2. In the application of leeches, externally and internally.

3. In the administration of enemas for men and women.

4. In the management of trusses and appliances in uterine complaints.

5. In the best method of friction to the body and extremities.

6. In the management of helpless patients, i.e., moving, changing, personal cleanliness, of feeding, keeping warm (or cool), preventing and dressing bedsores, managing position of.

7. In bandaging, making bandages and rollers, lining of splints, etc.

8. In making the beds of patients, and removal of sheets whilst patient is in bed.

9. You are required to attend at operations.

10. To be competent to cook gruel, arrowroot, eggflip, puddings, drinks for the sick.

11. To understand ventilation, or keeping the ward fresh by night as well as by day; you are to be careful that great cleanliness is observed in all the utensils; those used for the secretions as well as those required for cooking.

12. To make strict observation of the sick in the following particulars:

The state of secretions, expectorations, pulse, skin, appetite; intelligence, as delirium or stupor; breathing, sleep, state of wounds, eruptions, formation of matter; effect of diet or of stimulants, and of medicine.

13. And to learn the management of convalescents.

IDEALS OF TRAINING.

Her ideals of training, what she hoped training might accomplish, are embodied, in part at least, in the following quotations from her writings at a later period.

What is training? Training is to teach the nurse to help the patient to live. Nursing the sick is an art and an art requiring an organized practical and scientific training; for nursing is the skilled servant of medicine, surgery and hygiene. A good nurse of twenty years ago had not to do the twentieth part of what she is required by her physician or surgeon to do now; and so after the year’s training she must be still training under instruction in her first and even second year’s hospital service. The physician prescribes for supplying the vital force, but the nurse supplies it.

Training is to teach the nurse how God makes health and how He makes disease.

Training is to teach a nurse to know her business, that is to observe exactly in such stupendous issues as life and death, health and disease.

Training has to make her not servile, but loyal to medical orders and without the independent sense or energy of responsibility which alone secures real trustworthiness.

Training is to teach the nurse how to handle the agencies within our control which restore health and life, in strict intelligent obedience to the physician’s or surgeon’s power and knowledge, how to keep the health mechanism prescribed to her in gear.

Training must show her how the effects on life of nursing may be calculated with nice precision, such care or carelessness, such a sick rate, such a duration of case, such a death rate.

In 1871, St. Thomas’ Hospital removed to the large new buildings in its present location near the Houses of Parliament, London, and with the occupation of the new building, the number of nurses and probationers in the Nightingale School greatly increased. New problems in management were created and Miss Nightingale feared that her high ideals for the nurses were not being realized as fully as she desired. Her health having improved, she determined on a closer supervision of the school, by herself. One result of this supervision, as she herself afterward stated, was that “the training school became a Home—a place of moral, religious and practical training—a place of training character, habits, and intelligence, as well as of acquiring knowledge.” She knew as much, probably, as any hospital superintendent knows today, of the problem of securing the right kind of young women to be trained, and she was fully convinced that a good nurse must be first of all a good woman. When applications came to her from smaller cities and towns for trained nurses to take charge of the nursing, she was accustomed to reply, “Have you sent me any probationers? I can’t stamp material out of the ground.”

Her character sketches, as preserved among her papers, of some of the probationers she had to deal with in those days, show her keen insight into human nature. “Miss A. Tittupy, flippant, pretension-y, veil down, ambitious, clever, not much feeling, talk-y, underbred, no religion, may be persevering from ambition to excel but takes the thing up as an adventure.” “Nurse B. A good little thing, spirited, too much friends with G., shares in her flirtations.” “Miss X. More cleverness than judgment, more activity than order, more hard sense than feeling, never any high view of her calling, always thinking more of appearances than of the truth, more flippant than witty, more petulance than vigor.” These are typical of her notes written after personal conversation with different probationers. The great necessity of some such notes is shown in the enormous demand that had been created for trained nurses for other hospitals—to fill responsible positions where they would have the choosing and training of other nurses. These demands came to her unceasingly in the earlier years of trained nursing.

Through her influence an assistant superintendent of the Nightingale training school had been appointed to whom was given the title of Home Sister. The duties of the Home Sister were varied, but among other things she was expected to supplement the lectures and bedside teaching and demonstration by regular classes. She was also to “encourage general reading, to arrange Bible classes, to give wider interests to the nurses,” in order, as Miss Nightingale said, to keep them above the mere scramble for a remunerative place. She regarded the influence of the Home Sister on the moral and spiritual side of the school as more important than her technical instruction.

It is stated that the besetting sin of the Nightingale Nurses in those earlier days was self-sufficiency. “They knew,” says a writer, “that their training school was the first of its kind, and they were apt to give themselves airs.” This tendency in them was vigorously combated by Miss Nightingale. The picking and choosing of places or cases in order to select the one which afforded the prospects of an easy time, she especially condemned.

“Our brains are pretty nearly useless,” she said, in one of her annual addresses to the nurses, “if we only think of what we want and should like ourselves; and not of what posts are wanting us, or what our posts are wanting in us. What would you think of a soldier who, if he were put on duty in the honorable post of difficulty, as sentry, may be, in the face of the enemy (and we nurses are always in the face of the enemy, always in the life and death of our patients)—were to answer his commanding officer, ‘No, he had rather mount guard at the barracks or study musketry;’ or if he had to go as pioneer, or on a forlorn hope, were to say, ‘no that don’t suit my turn’.”

It was her custom for some years to issue an annual address to the nurses of the Nightingale School, and for many years the authorities of the school insisted on every probationer studying the first of these addresses, issued in 1872, the year in which she began her closer supervision of the details of training. In these addresses she dwelt strongly on the ideals of nursing she had from the beginning—that it requires a strong sense of vocation or a special call; that it needs a religious basis; that it is an art; that there must be constant progress or stagnation; that the nurse should be extremely careful of her moral influence. She had no use for the woman who thought she was making a sacrifice in taking up nursing; nor for the woman who thought any kind of service which had to do with nursing was beneath her—neither had she any patience with the sentimental “ministering angel” type of nurse. “If we have not true religious feeling and purpose,” she said in one of her addresses, “hospital life, the highest of all things with these becomes without them, a mere routine and bustle and a very hardening routine and bustle.”

No one who studies Miss Nightingale’s life and ideals can be left in doubt, that, in her mind, in the choice of nurses, the first and greatest thing to be considered was the character of the applicant. She did not undervalue education but she believed that the spirit of the woman was of supreme importance.

It is absolutely certain that it was not her medical or surgical knowledge, (though this was in advance of the times) that accounted for the remarkable and enduring influence which she exerted, and is still exerting—even though we may seem to have shifted the emphasis from some things which to her were of tremendous importance, and placed it on other things which, to her mind, were of secondary consideration. It is an interesting exercise to analyze the varying qualities in her great and beautiful life which still exerts its influence on countless other lives. But after all, the secret of her success must be summed up in that combination of qualities, that subtle something which we call Personality. Her studious avoidance of honors of all kinds, her purity of motive, the absolute lack of self-seeking, of honor, prestige or profit for herself, her courage, tact and quiet perseverance are qualities on which nurses of the twentieth century may wisely meditate. Nothing is more needed among nurses today, than that her spirit, her ideals of life and character, may be perpetuated. Few of us can render any greater service to our generation than to exert ourselves to keep her spirit alive in the nursing profession.

Author’s note.—For many of the facts, which form the foundation of this sketch, the author is indebted to the authorized biography entitled “The Life of Florence Nightingale,” by Sir Edward Cook, published in two volumes by the McMillan Co., 1913. Quotations have been made from clippings, in several instances, in which the name of the journal in which they first appeared has been lost. Grateful acknowledgment is hereby made for all such unknown sources of aid used in preparing these biographical notes.