“The lady with the lamp” and her contributions to modern nursing

Florence Nightingale, 1856

Florence Nightingale, 1856


The largest profession, and the profession that is consistently ranked as the most trusted profession in the United States, is that of nursing. The foundations of nursing practiced across the world were pioneered by the greatest figure in nursing history, Florence Nightingale. She helped to define nursing practice by suggesting that nurses did not need to know all about the disease process like the medical field. They needed to know how to care for a patient through the environment, helping the patient deal with symptoms and changes in function related to illness.

Early Life and Training

Florence Nightingale was born May 12, 1820, in Florence, Italy and was named after the city of her birth. She died on August 13, 1910, at the age of 90 after living a long, productive life in which her ideas and contributions helped to shape the way nursing is practiced in the western world. Florence Nightingale was born to an upper-class English family. Her father William Shore Nightingale was a wealthy landowner and her mother Frances Nightingale a socialite who hailed from a family of wealthy merchants. From a young age Florence Nightingale assisted the poor and ill people in the village neighboring her estate, and by the age of 16 she considered nursing to be her life’s calling.

In the Victorian era, nursing was considered a lowly and menial profession in England, and Florence Nightingale’s refusal to marry at age 17 to pursue it disappointed her parents. In July 1850 Nightingale enrolled for 2 weeks of training and enrolled again in July 1851 for 3 more months at the Institution of Protestant Deaconesses at Kaiserswerth, Germany. There she learned basic nursing skills such as the value of patient observation and good hospital organization.

This training and later experiences helped Nightingale form her revolutionary theories. These theories were further enhanced at Middlesex hospital for governesses, where Nightingale worked as a superintendent. She struggled there to control a cholera outbreak and the unsanitary conditions that aided in the rapid spread of the disease. She made it her mission to improve the hygiene practices of the facility, which ended up significantly reducing mortality at the hospital.

The Crimean War and the Development of Nursing Practice

The Crimean War of 1853 catapulted Nightingale and her methods to fame. During the war a scandal broke out about the lack of sufficient medical attention and the unsanitary and inhumane conditions to which injured soldiers were being subjected. The poor reputation earned by previous female nurses was the main cause of the lack of adequate staff.  In an effort to better the treatment of the injured soldiers, Secretary of War Sidney Herbert asked Nightingale to organize a corps of nurses to tend to and assist the sick and injured. On arrival in Scutari, the British base hospital in Constantinople, Nightingale found patients lying on their own excrement, rodents and other pests scurrying among them, and a complete lack of sanitary conditions, which made infectious diseases the number one killer of soldiers rather than battle wounds.

Faced with this daunting task, Nightingale implemented some concepts that are at the core of nursing practice to this day:

Paper lantern used by Florence Nightingale, 1855

Paper lantern used by Florence Nightingale, 1855

  • Infection control – She did this by cleaning the entire hospital from top to bottom and requiring proper hygiene, such as clean linens, for the soldiers. This is incredible because at the time microbes and the chain of infection was not known.
  • Self-care (requiring patients to do things for themselves in order to gain independence and promote healing) – Nightingale required the least infirm patients at the hospital to assist in cleaning it.
  • Assessment – She made rounds at night with her lamp, talking to and assessing the condition of her patients. Nursing assessments are the core of nursing, and all nursing actions are based on them. With that in mind, it’s only fitting that her habit of making assessment rounds was the reason why the soldiers nicknamed her the “the lady with the lamp.”
  • Therapeutic communication – During her rounds Nightingale talked to her patients, offering them empathy and compassion in their moment of despair.
  • Spiritual nursing – Nightingale ministered to patients who were dying, bringing them comfort in their last hour.
  • Public health advocacy – Nightingale wrote an 830 page report analyzing and proposing reforms for military hospitals operating under poor conditions.

The implementation of these concepts in the battle field hospital setting by Florence Nightingale reduced the death rate at the hospital by two thirds.

Recognition and Role in Nursing Education

After the war she returned home to a hero’s welcome and was awarded the “Nightingale Jewel,” a brooch with an engraved dedication from Queen Victoria, for her service in the Crimea. She was also granted a prize of $250,000 from the British government and used the money to establish St. Thomas’ Hospital and the Nightingale Training School for Nurses. Her work lifted the reputation of nursing from lowly and menial to a respectable profession to which many upper-class women aspired.

In 1859 Florence Nightingale published a 136 book page entitled Notes on Nursing: What it is and What it is Not. The book was meant to give hints for thought on how to nurse a sick patient rather than to serve as a comprehensive manual on how to become a nurse. The book covers topics vital to nurses today such as confidentiality, cleanliness, observation (assessment), quality and safety. The P.I. Nixon Medical Historical Library owns a copy of this book.


Front cover of Notes on Nursing: What it is Not. P . I. Nixon Medical Historical Library

Front cover of Notes on Nursing: What it is  and What it is Not.  P. I. Nixon Medical Historical Library


Title Page of Notes on Nursing: What is is and What it is No. P . I. Nixon Medical Historical Library

Title Page of Notes on Nursing: What is is and What it is Not. P. I. Nixon Medical Historical Library


For more information on the Nixon Library and Nightingale’s book, contact the Special Collections Department, at SpecialCollections@uthscsa.edu or 210-567-2403.

1. “Top 50 Occupations with the Largest Employment.” Career One Stop. Viewed 6 Feb 2015. http://www.careerinfonet.org/oview3.asp?level=overall&id=1&nodeid=5

2. “Nurses Once Again Top Gallup’s Annual Survey of Most Trusted Professionals.” Advance Healthcare Network. 13 Dec 2013. Viewed 6 Feb 2015. http://nursing.advanceweb.com/News/National-News/Nurses-Once-Again-Top-Gallups-Annual-Survey-of-Most-Trusted-Professionals.aspx

3. Potter, P., & Perry, A. (2013). Fundamentals of nursing. (8 ed., p. 44). St. Louis: Elsevier.

4. Selanders, L. (29, October 2014). Florence nightingale. Viewed 2/6/2015. http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale

5. Florence nightingale. Viewed 2/6/2015. http://www.biography.com/people/florence-nightingale-9423539

6. Notes on Nursing. Wikipedia. http://en.wikipedia.org/wiki/Notes_on_Nursing. Viewed 2/6/2015.

7. Harris, M. (2002). Remembering florence nightingale. Home Healthcare Nurse, 20(5), 291-293. Viewed 2/6/2015. http://www.nursingcenter.com/lnc/journalarticle?Article_ID=270233

Florence Nightingale, 1856. N.d. Photograph. National Army MuseumWeb. 6 Feb 2015. <http://www.nam.ac.uk/online-collection/detail.php?acc=1980-07-137-1>.

Paper lantern used by Florence Nightingale, 1855. N.d. Photograph. National Army MuseumWeb. 6 Feb 2015. <http://www.nam.ac.uk/online-collection/detail.php?acc=1962-12-29-1>.


Manasseh “Manny” Ngigi, Nursing School student