Revisiting Florence Nightingale

By Theresa Brown, RN - November 21, 2023

As a new nurse I experienced a fair amount of bullying at my first job, which is not unusual. My preceptor at one point told me that the other nurses on the floor expected new nurses to be more submissive. She was trying to be helpful, but I didn’t take the hint. “I don’t do submissive,” I said. Six months later I transferred to a different floor where I could work and learn without belligerent co-workers making the job even harder than it already was.

This anecdote relates to Florence Nightingale in that I’ve lately come across criticisms of her that blame her, and her mythos as the “founder” of modern nursing, for the problems of rigid hierarchies in nursing, along with sexism and racism. This column will consider the strict behavior standards enforced by Nightingale, and an upcoming column will address racism in nursing as it bears on Nightingale. The 2 issues overlap, but teasing out the arguments separately reveals both as entrenched problems in nursing that connect with Nightingale, but also reflect the deeper problem of nursing’s ongoing inability to transcend such problematic behaviors.

Despite Nightingale’s status as an icon for nurses, I didn’t learn about her in nursing school, but a few years after graduating I read Gillian Gill’s Nightingale biography called Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale. Reading it, I was impressed with Nightingale’s contributions to improved medical care during the Crimean War. Nightingale was one of the first clinicians to implement the idea of triage—classifying and treating soldiers (patients) according to who was the most seriously injured rather than giving British Officers care first regardless of need. Nightingale gave intense care to enlisted men as well as officers, saving their lives and earning their admiration and respect. The book also credits Nightingale’s focus on cleanliness, hands-on care, and sanitation and lauds her impressive work as a statistician.

But Nightingale had trouble getting along with the other nurses working for and with her in the Crimea, according to Nightingales. The chapter titled “Woman Trouble” describes Nightingale’s authoritarian approach to managing her all-female nursing staff: “Nightingale’s goal as superintendent was to ensure that… all the women obeyed orders and worked hard…. She also expected the other women to respect her authority, and she demanded discipline. This system, as she herself referred to it, tended to rub the other women the wrong way.” Nightingale also enforced an “antifraternization policy” designed to keep nurses from developing romantic relationships with doctors or soldiers.

The expectation of obedience from nurses combined with hard work and rigid control of personal behavior feels very contemporary even though Nightingale worked in Crimea in 1854. Any working nurse who has been criticized for hair dyed an “unnatural” shade, the “wrong” color shoes, or having more than one earring in each ear (real examples from my own nursing work), knows that nurses’ appearances continue to be judged and regulated by managers. Any nurse who’s skipped lunch and bathroom breaks (and who hasn’t?) knows that overwork continues to be integral to the job.

In her new book Taking Care: The Story of Nursing and Its Power to Change Our World, journalist and author Sarah DiGregorio offers a compelling critique of Nightingale as a promoter of rigid ideas about appropriate female behavior for nurses, along with racism in nursing. I spoke with DiGregorio, who believes that Nightingale enforced those ideas in response to unwelcoming male doctors in the Crimea: “She responded to the delicacy of her political situation by structuring her nursing corps in a way that would not threaten the powers-that-be.”

All of that makes sense—for 1854. Nightingale worked in the Crimea almost 200 years ago, but nurses’ work environments remain hierarchical and extremely burdensome. Is that the troubled legacy of Florence Nightingale, or an issue in the practice of nursing that needs to be addressed head on, as so many nurses’ unions are now doing?

Consider this story, with details left vague on purpose. A nursing faculty member told me she hated it when students called-off for scheduled hospital days. She then complained about a suicidal nursing student she’d taken to get help on a day when the student had clinical in the hospital. The faculty member was convinced that the student threatened suicide for one reason only: “to get out of clinical.”

It’s an appalling anecdote, in part because the instructor showed no empathy at all. She felt fully justified in her contempt, same as the nurses who bullied me in my first job felt submissiveness was their due. And maybe those ideas came from Florence Nightingale, but it’s hard for me to blame her for their continuation in 2023. I venture to say that the phrase “Nurses eat their young” results from failures in teaching and leadership at least as much as the standards set by Nightingale. She made her mark, for good and ill, but reconceptualizing nursing as less hierarchical and rule-bound depends on nurses right now, imagining and fighting for a different future for nursing.

For a few samples of the criticisms of Nightingale see:

The defiance of Florence Nightingale

What do we do about Florence Nightingale?

Angel of mercy or power-crazed meddler? Unseen letters challenge view of pioneer nurse