Florence Nightingale, American Nursing and Health Care

by Lynn McDonald, for the Nightingale Society

Florence Nightingale (1820-1910) is well known as the founder of the modern profession of nursing—her training school, the first in the world, opened in 1860. She was already famous then as the heroine of the Crimean War (1854-56), leader of the first team of British nurses to nurse in war.

What she did for the United States is now little known, but she was famous there in her lifetime—the Crimean War and her own work were well covered by the press. Poet Henry Wadsworth Longfellow celebrated her in a poem, “Santa Filomena”:

Lo, in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom
And flit from room to room.

Her example inspired women to volunteer, on both sides, to nurse in the American Civil War.

In 1860, Nightingale published her most famous book, Notes on Nursing, which was promptly re-published in the U.S., and serialized in the Saturday Evening Post. She had begun publishing on hospital reform in 1858, to bring out a full book-length account, Notes on Hospitals, in 1863. They were used by both the Northern and the Confederate Armies during the Civil War. Her hospital forms were sent to the Northern Army—she thought that if they had been better used, the death rate would have been lower. The largest Confederate hospital, Chimborazo, outside Richmond, VA, the capital of the confederacy, was built on her principles—huts with good ventilation and well spaced.

While many women nursed during the Civil War, this did not lead to the founding of a nursing school or profession, as Crimean War nursing had in England. In 1872, Nightingale was approached for advice by a doctor at the Bellevue Hospital, New York—a committee had condemned the hospital for its numerous defects. She worked out a detailed plan for how to set up a school and introduce trained nursing into the hospital. The first three schools in the U.S. opened around 1873, all based on her principles, but not her nurses: the New York Training School, at Bellevue; the New England Hospital for Women and Children Training School in New Haven, Conn., and the Boston Training School at Massachusetts General Hospital.

Roman Catholic nuns had been giving nursing services before the Civil War, and had founded many hospitals, but they did not require nurse training or found training schools until late in the 19th century.

Hospital Design: Nightingale was an advocate of the “pavilion” model of hospital design, as a means to minimize cross-infection. She gave extensive advice on the design of Johns Hopkins University hospital, which opened in 1879.

Cholera: In 1883, when a cholera epidemic was expected, Nightingale was approached for advice by the New York Herald. She produced “Scavenge! Scavenge! Scavenge!” which urged vigorous clean-up measures. Her advice was repeated in British newspapers and American and British public health journals. It was revived in 1892 when another cholera epidemic was expected.

Advances in Nursing: Nightingale was asked to send a paper to the world congress on charities held in Chicago in 1893. Her “Sick-nursing and Health-nursing” was an important statement on the state of nursing in the early 1890s, or 30 years after her school opened and Notes on Nursing appeared. It shows how much the technical requirements of nursing had advanced. It also shows continuity on the core principle of environmental influences on health: air and water quality, ventilation, hygiene, nutrition. The paper gives Nightingale’s much-cited, definition of health as “not only to be well, but to be able to use well every power we have.”

That paper also continues Nightingale’s theme that the goal for both “sick” nursing and “heath” nursing is “to put us in the best possible conditions for Nature to restore or to preserve health. The congress also facilitated nursing organization—meetings held at it led to the formation of the American Nurses Association. Also in 1893, the New Jersey Training School for Nurses awarded Nightingale its first degree in nursing, MSN.

Universal Access to Health Care: Nightingale did not play any role in the United States in debates over who should pay for health care and what role government should play. She did in her own country, and this influenced policy elsewhere. As early as 1866, she set out as a goal that the poorest sick should have access to quality care, as good as in the best civil hospitals in the suburbs. She did much to improve access in the transformation of the dreaded workhouse infirmaries into real hospitals—getting them professional nurses and (for some) a training school, and a well-designed building.

The single-payer system for hospital and medical care in the U.K. dates to 1948, when the National Health Service came into effect. The Poor Law itself, the foundation of the old workhouse system, was also abolished then—Nightingale had advocated its effective end in 1866.

By Lynn McDonald, PhD, LLD (hon), professor emerita, editor of the 16-volume, peer-reviewed, Collected Works of Florence Nightingale, and three short books: Florence Nightingale at First Hand (2010), Florence Nightingale: A very brief history (2017), and Florence Nightingale, Nursing and Health Care Today (2018).

See also www.nightingalesociety.com. For short articles, available for free, see cwfn.uoguelph.ca/.

Some further connections between Nightingale and the U.S.A.

The faith connection: Nightingale’s nursing was based on a “call to service,” which she believed to have come from God. That call, in turn, followed from an earlier sense of conversion, or commitment, influenced by a book by an American minister and educator, Jacob Abbott, The Corner-stone, “the book that converted me in 1836,” as she described it to a friend late in life.

Nightingale Nurses in the United States: “Nightingale nurses,” meaning those trained at the Nightingale School in London, were important in starting professional nursing in the U.S. and training schools for it. Alice Fisher did this in 1885 at the Blockley Hospital, Philadelphia (later the Philadelphia General Hospital). Louisa Parsons, in 1889, became the first (trained) superintendent of nursing at the University of Maryland Hospital; she nursed later in the Spanish-American War and the Boer War.

Influential Americans Nightingale knew:

  • Samuel Gridley Howe, an expert on the blind, and Julia Ward Howe, author of Battle Hymn of the Republic, named their first daughter after her, in 1845 (before she was well known).
  • Harriet Beecher Stowe, author of Uncle Tom’s Cabin, wrote Nightingale in 1872 on nursing issues.
  • John Shaw Billings, Civil War doctor and designer of Johns Hopkins University Hospital, sought her advice on the plans.
  • Linda Richards, first American trained nurse, met with her in 1877, got English nursing experience, then introduced trained nursing into numerous American hospitals, then later in Japan—she learned Japanese and spent 5 years there.
  • Canadian-born Isabel Hampton (later Robb), the first superintendent of nursing at Johns Hopkins, sought Nightingale’s advice and met with her in England. Robb later wrote several of the most influential books on nursing of the 20th century.
  • Edward Jarvis, president of the American Statistical Association, met with her in 1861 in London, when there for the International Statistical Congress.
  • Joseph M. Toner, president of the American Medical Association, met with her in London in 1881.
  • Alfred Worcester, first professor of hygiene at Harvard University, and founder of the Waltham Training School, near Boston, author of two books on nursing, sought her assistance. Worcester was instrumental in convincing doctors in Ottawa to accept district nursing in 1897.
  • Canadian-born Charlotte Macleod, trained in nursing in the U.S., became the first principal of the Waltham Training School, and later a nursing leader in Canada.