Teacher, nurse, statistician, author, advocate for health care and occupational health and safety
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
by Lynn McDonald, 2021
Kofoworola Abeni Pratt (1915-92) was an outstanding nursing leader, well recognized for her work in her home country, Nigeria, but scarcely known in the United Kingdom, despite her significant British connections and international reputation. She was the first Black person to train at the Nightingale School, then based at St Thomas’ Hospital, London, starting in 1946. Then, when the National Health Service was launched in July, 1948, she was on duty—the first Black nurse in the NHS.
Her background and education
Née Kofoworola Abeni Scott, she was born into a privileged Lagos family, early converts to Christianity. She was given a good education in a Church Missionary Society girls’ school, after which she obtained a teaching certificate and taught History at the secondary level for five years. She wanted to become a nurse, but, like Nightingale, was prevented by her family, on account of the unseemly reputation of nurses. In the case of Nigeria, the higher posts were reserved for British expatriate women, with the menial tasks accorded to Nigerians (the practice of the Colonial Nursing Service).
In 1941, the then Miss Scott married a Nigerian pharmacist, Eugene Samuel Oluremi (Olu) Pratt, who shared her faith and strongly supported her aspiration to become a nurse. The couple were married in the Scotts’ and Pratts’ family church, the Cathedral Church of Christ, Lagos, where Mrs Pratt was active in cathedral governance and women’s organizations.
Olu Pratt made the introduction for his wife to the matron at St Thomas’ Hospital in 1946—he had gone to London ahead of her to apply for medical studies for himself. The matron accepted her, subject to the arrival of the required documents, which proved to be in order.
St Thomas’ had been bombed in the war, so that, on Mrs Pratt’s arrival in 1946, its departments were in temporary quarters in other parts of London. She, as well as doing the regular training, getting excellent marks, went on to obtain extra certificates in midwifery (and worked as a midwife), tropical diseases, the ward sister’s course, and, on a return trip, hospital nursing administration, these last two at the Royal College of Nursing. Pratt later won grants to enable her to travel to see nurse training in other countries. In the United States, she was impressed by training based at universities. She would later lead in the introduction of university-based training in Nigeria, achieved in 1965.
Professional nursing in Nigeria
Encouraged by British “Nightingale nurses,” Pratt returned to Nigeria in 1955 to become the first Nigerian ward sister, then, successively, the first Nigerian assistant matron, deputy matron, and, in 1964, matron, at the top hospital in Nigeria, University College Hospital, Ibadan. This transition from expatriate nurses, doctors, other professionals and administrators to Nigerians was called “Nigerianization”. It began with the approach of independence, which was gained in 1960.
After a mere two years as matron at UCH, Ibadan, although enough to demonstrate her ability as an administrator. Pratt took on a greater challenge, as chief nursing officer for the Federation of Nigeria, the first Nigerian in the post. Her domain became the whole country, the largest in Africa, sixth largest in the world. She led in the establishment of other nursing schools and did some of the training herself.
Throughout, Pratt was, unusually for the time, both a wife and mother, with two sons, one born in Nigeria and one while she was training in London. Her husband obtained British medical qualifications, to return to practise in Nigeria.
From nursing to political leadership in health care
Pratt, like Nightingale, saw the importance of political action in the achievement of healthcare reform. Thus, in 1973, when she was offered the post of “Commissioner of Health”—in practice, the Minister for Health for Lagos State, then under military rule—she accepted. During her time in office (only two years) she saw to the expansion of healthcare services, the building of more hospitals, and the equipping of boats to take healthcare services to villages best accessible by water. She made the provision of better conditions for nurses a priority, culminating in the building of a fine nurses’ residence, long delayed by previous governments, dubbed the “Nurses’ Hilton.” Pratt was the first nurse to become Minister of Health for her country or state.
She received many honours, was named “chief,” awarded the Order of the Federal Republic of Nigeria, an honorary doctorate of laws and the Florence Nightingale Medal,; she was appointed a fellow both of the Royal College of Nursing and the West African College of Nursing. She died in Lagos in 1992, predeceased by her husband, Dr Olu Pratt, in 1985.
A biography of Pratt
An excellent biography was published about her, An African ‘Florence Nightingale’: a biography of Chief (Dr) Mrs Kofoworola Abeni Pratt. The author, Justus A. Akinsanya, was a distinguished Nigerian-born nursing academic, whose career was mainly in the U.K. Unluckily, the book soon became an “orphan book,” that is, the publisher went out of business and the author died. A PDF link is available on the website of the Nightingale Society. It is otherwise effectively unavailable.
Mrs K.A. Pratt: Role model
Mrs Pratt’s career makes her a fine role model not only for Black and minority ethnic nurses, but ALL nurses who aim high.
What the Nightingale Society Is
What It Is
- The Nightingale Society is committed to promoting knowledge of Nightingale’s work and its relevance in nursing, public health, hospitals, statistics and broader social reform issues today; It encourages scholarly work on other contributors to nursing and public health, especially to improve the diversity of recognized leaders;
- It will publicly defend Nightingale’s reputation when attacked, notably as by the campaign to replace Nightingale by Mary Seacole as the ‘pioneer nurse,’ at St Thomas’ Hospital;
- It advocates the fuller coverage of Nightingale’s contributions to society in school curricula.
What It Is Not
- It does not oppose the honouring of Seacole for her own contribution, at an appropriate site;
- While it supports the inclusion of Seacole in the school curriculum, it does not support the pairing of Nightingale and Seacole, who made very different contributions.
Individual supporters are asked to sign the declaration and indicate any work they might be willing to undertake for the society, such as drafting or co-signing letters, disseminating information to other persons and organizations, organizing sessions on Nightingale in conferences or special events for the discussion of these concerns.
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