Lessons from the life of Florence Nightingale

by Charlotte A. Aikens

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.