The Pioneers of Modern Nursing

Florence Nightingale

Founder of modern nursing: teacher, author, statistician, occupational health and safety advocate

Nightingale was the major founder of the modern profession of nursing, and health care pioneer, who became famous for leading the first team of British women to nurse in war–the Crimean War of 1854-56.

While Nightingale was famous in her lifetime, and for a long time after it, she is little known today and often mis-represented. She wrote a lot! Not just her most famous book, Notes on Nursing; published in 1860, the same year that her training school opened.

Here are some key points on her work and legacy:

  • Nightingale wanted nursing to be an independent profession; nurses would take medical instructions from doctors, but no doctor would hire, fire, discipline or promote a nurse, decisions for senior nurses.
  • Her vision for the profession included a career path, with increases in salary and responsibility, and made nursing a well-paying profession. Giving superintendents power to hire, discipline, etc., was to remove it from doctors, then 100% male when nurses were 100% female, and an unspoken measure to prevent sexual harassment of vulnerable women nurses.
  • Nightingale consistently argued for good salaries and working conditions for nurses, holidays of at least a month per year; decent pensions; good living conditions during training; and hospital design to save nurses’ energy for patient care. Hospitals should hire cleaners, and nurses ensure that the job was done.
  • “Army nurses,” before Nightingale’s time, were recruited from among the wives and widows of privates and non-commissioned officers (doctors were always officers), were paid less than cooks and laundresses, and reported to a sergeant. They did not even speak to a doctor. The belief that Nightingale wanted nurses to be “subordinate to doctors” misses the point, for when her nursing school started, in 1860, women lacked even a high school education, let alone university. Doctors had university/medical qualifications.)
  • Nightingale succeeded in improving the status of nurses, from being a “domestic” service occupation in the 1861 Census, to being grouped with “medicine” in 1901 In the army, nurses became “officers,” like doctors.
  • She did pioneering work on occupational health and safety as early as 1858. In 1871, she published a pioneering study of maternal mortality post-childbirth, Introductory Notes on Lying-in Institutions. Throughout her life, she worked with doctors, architects, engineers and statisticians to achieve great reforms.
  • Nightingale worked to turn the terrible workhouse infirmaries into real hospitals, calling for the same quality of care available to the rich also for the poor.
  • Hand washing is the single most effective means of infection control known–Nightingale began urging it in 1860. Hospital architects are turning back to Nightingale for her insights on sunlight and gardens in healing.
  • Her writing is now available in a 16-volume Collected Works of Florence Nightingale, collected from more than 200 archives world wide.

Don’t want a 16-volume series? See the 200-page paperback with highlights: Lynn McDonald, Florence Nightingale at First Hand (London: Bloomsbury 2010) and Florence Nightingale, Nursing and Health Care Today (New York: Springer, 2018) 267 pages.

Kofoworola Abeni Pratt

From the First Black Nurse in the NHS to Minister of Health for Lagos State

Family: Born in Lagos, where she lived many years, Kofoworola Abeni Scott (1915-1992) married Olu Pratt, a pharmacist, who later qualified in medicine in Edinburgh. The wedding took place on 3 June 1941, at the Cathedral Church of Christ, Lagos. Of the couple’s three sons, the first, born in eastern Nigeria, died in infancy. The second, Babatunde, was born in Lagos in 1943 (he qualified in medicine at St. Bart’s in 1978), the third, Olufemi, born at Guy’s Hospital, London, was baptized at St Martin-in-the-Fields Church (he qualified in aeronautical engineering, in 1974). Mrs Pratt and her husband went back and forth between England and Nigeria, and he also to a post in Cameroon.

Education: Church Missionary School Girls School, Lagos, with senior Cambridge certificate, 1933; Teacher’s diploma, 1935; Teacher Training College, Ibadan; 1946 started nurse training at the Nightingale School at St Thomas’, SRN 1949, with distinction; Midwifery certificate 1950; Tropical medicine certificate, 1951: Ward sister’s course, RCN, with distinction in Psychology, on a scholarship from the Nightingale Fund; Nursing administration certificate, WACN, Hospital Nursing Administration, diploma, RCN 1957.

Positions held: teacher, CMS Girls School, Lagos (secondary) 1936-40; staff nurse Evelina Children’s Hospital (Guy’s) 1952; charge nurse, St Thomas’ 1953; medical ward sister, UCH at Adeoyo Hospital 1954, administrative sister, UCH Ibadan 1955-57, asst. deputy matron 1955-63, matron UCH 1964-65; chief nursing officer (federal) 1965-72; commissioner for Health, Lagos State, 1973-75.

Nursing leadership: co-founder, Professional Association of Trained Nurses of Nigeria, 1956, president 1957-73; leader, 1st Nigerian delegation to the International Council of Nurses (ICN) Congress Rome, 1957, and 2nd, 1961; member, Administrative Committee and Board of Directors, 3rd vice-president, ICN, 1965-69; foundation fellow, West African College of Nursing; (occasional) co-editor, The Nigerian Nurse.

Pratt was instrumental in getting university training in nursing started in Nigeria, initially at the University of Ibadan, beginning in 1965, next at the University of Ife.

Click the link to download a digital copy of the biography An African ‘Florence Nightingale’: The Life of Chief (Mrs) Dr Kofoworola Abeni Pratt [Justus A. Akinsaya, Ibadan: Vantage, 1987].