The Culture and Politics of Health Care Work

The Influence and Legacy of a Nursing Icon

Sioban Nelson, Anne Marie Rafferty, Sioban Nelson, Anne Marie Rafferty

• Publisher: ILR Press
• Year: 2011
• ISBN:
  9780801462108
• Topic: Medicine
• Subtopic: Nursing

Florence Nightingale remains an inspiration to nurses around the world for her pioneering work treating wounded British soldiers during the Crimean War; authorship of Notes on Nursing, the foundational text for nursing practice; establishment of the world's first nursing school; and advocacy for the hygienic treatment of patients and sanitary design of hospitals.

In Notes on Nightingale, nursing historians and scholars offer their valuable reflections on Nightingale and analysis of her role in the profession a century after her death on 13 August 1910 and 150 years since the Nightingale School of Nursing (now the Florence Nightingale School of Nursing and Midwifery at King's College, London) opened its doors to probationers at St Thomas' Hospital.

There is a great deal of controversy about Nightingale—opinions about her life and work range from blind worship to blanket denunciation. The question of Nightingale and her place in nursing history and in contemporary nursing discourse is a topic of continuing interest for nursing students, teachers, and professional associations. This book offers new scholarship on Nightingale's work in the Crimea and the British colonies and her connection to the emerging science of statistics, as well as valuable reevaluations of her evolving legacy and the surrounding myths, symbolism, and misconceptions.

Contributors: Judith Godden, University of Sydney; Carol Helmstadter, RN (Toronto); Joan E. Lynaugh, University of Pennsylvania; M. Eileen Magnello, University College London; Lynn McDonald, University of Guelph; Sioban Nelson, University of Toronto; Anne Marie Rafferty, King's College, London; Rachel Verney, Florence Nightingale School of Nursing and Midwifery (Visiting Associate, August 2009); Rosemary Wall, King's College, London

1

THE NIGHTINGALE IMPERATIVE

SIOBAN NELSON

I solemnly pledge myself before God and in the presence of this assembly: To pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my profession. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.
(The Nightingale Pledge)

On 15 August 1945, a short time after the emperor’s national radio broadcast announced the unconditional surrender of Japan, a group of nurses at a military hospital in Hiroshima gathered at the order of their commanding officer, the chief medical officer. The young women, exhausted and terrified after nearly two weeks of unimaginable horror, had helplessly witnessed the mass destruction and human suffering following the dropping of the world’s first atomic bomb, “Little Boy,”at 8:15 a.m. on 6 August. Over those nine days they had seen thousands die (piteously begging for water), they had nursed patients through horrific burn and trauma injuries, and finally, as a mysterious rash began to appear on the bodies of survivors, they had watched as many began to suddenly collapse and die. But the darkest hour came with the emperor’s broadcast of surrender. It was an announcement that caused disbelief, panic, and then despair in the city. Such a wave of suicides swept the military hospitals and bases that nurses were forced to hide knives and swords from the men. With the unthinkable capitulation of Japan to its enemies, it seemed that the world was sinking into chaos. All shared the dread of an occupying army and the fear of American soldiers, who were expected to exact a terrible retribution on Japan’s citizens. In a preemptive act to restore order to the hospital and dissuade the nurses from running home to their families, the chief medical officer at the Hiroshima Army Red Cross Hospital gathered the nurses and gave them a surprising order: he commanded that they recite the Nightingale Pledge.1 His tactic worked. According to veteran nurses interviewed by Ryoko O’Hara in her compelling study of nursing at the center of the cataclysm, the pledge seemed to settle the nurses’ terror, to remind them of their duty and purpose, and to give them the courage to continue. Under orders, the nurses recited the pledge aloud twice a day for the next week.2

How is it that the foreign words, written in 1893 by American nurses in honor of an Englishwoman, could hold such power for Japanese nurses at the very height of nationalist and anti-Western feeling in Japan? What is it about Nightingale and what she represents for nurses around the world that allows the very idea of Nightingale to transcend era and culture to give identity and meaning to professional nursing? Why was the Nightingale story such a fundamental scaffold for the development of nursing around the world, and how did that universal framework function to drive the local nursing agenda, even in situations as exceptional and anti-British as defeated Japan? This chapter is an attempt to answer those questions. In exploring these concerns I am less interested in the elements of the Nightingale story per se and more concerned with the persistent prominence of Nightingale in nursing history and in the identity narratives of nurses around the world. What I am endeavoring to uncover is the role the idea of Nightingale has played as a transnational unifying discourse for nurse reformers over time and the way in which the Nightingale narrative continues to be invoked as a legitimizing discourse by nurses across the world to advance the nursing profession and to reform health care.

Over the past one hundred fifty years the Nightingale story has provided discursive energy to power a wide range of nursing stories, offering a consistent reference point for stories that relay the development of national nursing professions or education initiatives, or heroic national stories of war service or nursing during disasters. The secret to the impressive shelf life of the Nightingale ideal, the fact that Nightingale has become synonymous with nursing (of the selfless and dedicated kind), I argue, is a testimony to the malleability of her story to fit multiple audiences and political agendas.

Stories of historical figures are always stories of their times, and enduring figures such as Florence Nightingale have managed to move beyond the locale that produced them to enter the sustaining realm of identity politics, where they remain an integral part of the key stories that are told and retold for successive generations. In her methodological essays in The Uses and Abuses of History Margaret MacMillan, Canadian historian and warden of St. Antony’s College, Oxford, argues that history plays a major role in the legitimation of ideas, political movements, and nations.3 Examples abound of the way history can be mustered as a powerful mechanism to silence opposition, justify tyranny, or harness emotion. Common offenders are political leaders. President George W. Bush’s supporters found solace through the invocation of parallels with President Harry Truman, who was much maligned by contemporaries but respected by posterity. The Truman analogy was a face-saving salve for the Bush dynasty (despite the fact Truman was a Democrat!).4 Likewise, Russian leader Josef Stalin’s assertion of his destiny to finally fulfill the mandate of the czarist empire, through the expansion of Soviet territory after World War II, provided a patriotic and unifying discursive claim to justify acts of Soviet aggression and self-interest.5

MacMillan also points to less profound but no less problematic uses of history. She warns against the dangers of conjuring up an imagined and uncomplicated past full of nostalgic renderings of history that reduce historical actors to easily recognizable good or bad characters, and smooth out the uncomfortable wrinkles of the past by recounting clear injustices with unambiguous remedies. When compared with the complexity and ethical ambiguity of the present, these kinds of histories provide the discursive equivalent of comfort food. For instance, MacMillan sees the recent surge in popularity of movies, novels, and television programs telling World War II stories as symptomatic of contemporary moral ambiguity over the war in Iraq and fears of terrorism. World War II, she argues, was the last good war. Good fought evil, and good prevailed. Today a confused and anxious Western world takes comfort in the noble narrative of World War II, when our parents or grandparents knew what they were doing and why.6

For nurses, the uses and abuses of history are just as widespread. There are multiple nursing histories that chronicle a progressivist narrative of reform and development—the “steady progress toward the light”view of history that offers a comforting pat on the back to the visionaries and energetic leaders of the past. Among these are the classic “before and after”images popular in the nineteenth century that compare the drunken, dirty, and dishonest nurse, characterized by Charles Dickens as Sairey Gamp, with the young, bright, and honest “Nightingale”who has transformed nursing and the hospital. There are also tales of dedication and selflessness in wartime and other emergencies when nurses had a major role, perhaps the only women to have done so, in landmark national events such as frontline nurses during World War I or the Vietnam War or as POWs during World War II. But of all the stories one encounters when reading nursing history what stands head and shoulders above the rest is the overriding theme of Florence Nightingale and the movement for the reform of nursing that began with her work in the Crimean War. Whether the topic is education or practice, the profession or hospital reform, the beginning of the new day for nursing, from which all our current days are measured, is the time Nightingale spent in Crimea and Turkey ground-testing her ideas on the scientific management of the sick. This dramatic episode in British history fueled Nightingale’s remarkable worldwide reputation as the founder of modern nursing and launched her as one of the great stars of the Victorian era.

The link between the first formal training school for nurses at St. Thomas’ Hospital, London, which was established by Nightingale in 1860, and the future development of nursing around the world was a strategic one. Both the idea of formal training for nurses and the ideal of the Nightingale nurse merged over the course of the nineteenth century as the message was spread in three waves. First, there was the phenomenal orb of Nightingale’s personal influence. The views of Nightingale, a leading thinker and respected member of the English intelligentsia, were sought on all manner of issues: military nursing and hospital design, the medical education of women, the management of Aboriginal health in Western Australia, and sanitation issues all around the world. She also fielded endless requests for information on nursing and nursing education and hospital management. She advised both Linda Richards, America’s first trained nurse, and Elizabeth Blackwell, America’s first woman doctor. She gave detailed advice on hospital and sanitary organization during the American Civil War, as well as advised, and was subsequently decorated by, both sides during the Franco-Prussian War.7 She was a prolific correspondent and provided sound and well-researched advice to all. Her influence in and of itself over the course of her ninety-year life was immense.

Second, we may add to this realm of influence the impact of the Nightingale nurses trained at St. Thomas’ who on graduation took with them this particular brand of nursing and hospital management to new hospitals and infirmaries in Britain and throughout the empire (with mixed success; see chapters 3 and 5). Following these St. Thomas’ Nightingales came the third wave, late in the nineteenth century, of nurses who were products of the schools established by the first-wave Nightingales, providing a steady stream of English Nightingales to the colonies and beyond.

Thus Nightingale created a movement in the true sense of the term, and the power and legitimacy of these Nightingales stemmed from the authentic connection with the woman herself. By the dawn of the twentieth century, when Nightingale, in her eighties, was still engaged in correspondence, there had been more than thirty years of her personal influence and that of her nurses in all corners of the world. Remarkably, it would have been inconceivable for a conversation on nursing and hospital reform to have occurred anywhere in the world without her views being taken into account one way or another. It is thus no surprise to find that the story of Nightingale turns up in all parts of globe, from the discussions on the organization of nursing in the British colonies to the debates over nursing reform in pre-World War I France, from missionary outposts in Japan to the Catholic countries of Latin America.8 It is not simply a question of the legacy of Nightingale, what one finds in late nineteenth- and early twentieth-century developments in nursing is a Nightingale imperative. Both the first wave reformers of nursing in the nineteenth century and members of newly established professional communities in the twentieth century were driven by this Nightingale imperative to see themselves as part of a self-conscious movement to establish the profession of nursing worldwide.

The English Nurse: Nightingale in the British Empire

The British social reform movement (1870 to 1930) spearheaded key social and political reforms in the areas of health, education, public policy, and the development of democracy. Although the movement for nursing reform tended for the most part to avoid political association, it encapsulated a number of the core tenets of a progressive agenda: advancing the role of women so that they were able to play a vital part in the development of society, improvement in education, health reform, and progress in civic institutions. Responding to Nightingale’s clarion call, under the banner of nursing and service to humanity, women were finally able to take a leading part in reforming a key nineteenth-century social institution—the hospital—and advancing the health of the nation.

As a monumental figure of Victorian England, a reformer and veteran of the Crimean War, Nightingale provided a quintessentially British figure around whom colonizers and colonized could share a common memory and a cause to advance both their societies and the empire as a whole.9 Across the British Empire the agenda espoused by Nightingale for the reform of nursing was embraced with enthusiasm as colonists were eager to share the glory of one of the empire’s leading lights. It was for this reason that the Nightingale Fund for the reform of nursing, set up during the Crimean War (1853-56), was so generously subscribed to by colonists, such as the people of the Colony of New South Wales (Australia), and why Nightingale was continually besieged with requests to send a team of her new nurses to advance the reform of hospitals and nursing. For Nightingale, the generosity of the public toward the Nightingale Fund had created a debt that, in her own words, she would “feign repay”through the export of trained nurses charged with establishing nursing schools throughout the empire.10

In the late 1860s, when Nightingale was at the height of her post-Crimean prominence and graduates from St. Thomas’ were just beginning to make an impact in the British world, Hilary Bonham Carter created a series of statues in the likeness of Nightingale which were sent to select places around the world. These statues were a small prop in the “Englishization”of nursing that took place in the last three decades of the nineteenth century as part of the nursing reform movement. Over that period, nursing moved from being generally synonymous with menial and degraded labor to a popular and esteemed feminine profession with champions from the highest echelons of society. Nightingale’s own prestige and vocational integrity were key elements in this process. Respectable nursing became English nursing, and trappings and icons that symbolically connected nursing to Nightingale proliferated. Enthusiasm for nursing reform not only brought progressive British developments to the periphery of the empire (and throughout the world) but also signified an affirmation of British values.

The Sydney Infirmary in New South Wales, Australia, began as a convict institution—that is, convict inmates served as nurses for the original penal settlement of Sydney. In 1868, when the Nightingal...

Table of contents

• FOREWORD
• INTRODUCTION
• 1 THE NIGHTINGALE IMPERATIVE
• 2 NAVIGATING THE POLITICAL STRAITS IN THE CRIMEAN WAR
• 3 THE DREAM OF NURSING THE EMPIRE
• 4 RHETORIC AND REALITY IN AMERICA
• 5 MYTHOLOGIZING AND DE-MYTHOLOGIZING
• 6 THE PASSIONATE STATISTICIAN
• 7 AN ICON AND ICONOCLAST FOR TODAY
• NOTES
• CONTRIBUTORS