Florence Nightingale had a significant impact on nursing and healthcare in the 19th century through establishing nursing as a respected profession, advocating for hygienic hospital conditions, and founding nursing schools. However, some of her views such as opposition to nurse registration and emphasis on social class are now considered outdated. While still an iconic figure, modern scholarship has also revealed flaws in her character such as exaggerating her own accomplishments and bullying behaviors. Overall, Nightingale's emphasis on clinical practice and education remain relevant today, but some of her specific opinions are no longer applicable in the 21st century healthcare system.

1. Relevant or redundant? The Impact of Florence Nightingale in the 21st century Professor Carol HaighManchester Metropolitan UniversityProfessor Debra JacksonUniversity of Western Sydney

2. F.N – a brief History1820 – born1837 – God speaks to her for the first time1844 – Became advocate for poor law reform1845 – decides to become a nurse1847 – had mental breakdown1851 – rejected marriage proposal from Richard Monckton Milnes1853 – dresses herself and does her own hair for the first time1853- took the post of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London,1853 – God gets in touch again1854 – left for Crimea with 38 other women1854 – God speaks to her for the last time1855 - establishment of the Nightingale Fund for the training of nurses1856 – Crimean War ends1857 – Intermittent mental collapse begins1859 – Notes on Nursing published in the UK1860 -Nightingale Training School at St. Thomas' Hospital opens on 9 July.1865 -The first trained Nightingale nurses began work on 16 May at the Liverpool Workhouse Infirmary1907 – awarded Order of Merit1910 - dies

3. A search on Google Scholar using the Search term “Florence Nightingale” shows 33,700 hits“Florence Nightingale and Nurse Education” shows 21,500 hit “ Florence Nightingale in the 21st Century” shows 2, 860 hits across Nursing, medical, historical & philosophicaljournals

4. Nightingale’s relevance to Clinical PracticeNurses at the Zeehan hospital Tasmania, c 1900

5. PatientsWe say….Florence said…..Really good nurses are often distressed because they cannot impress the doctor with the real danger of their patient and quite provoked because the patient will look either so much better or so much worse than he really is when the doctor is there. The distress is legitimate but it generally arises from the not having the power of laying clearly and before the doctor the facts from which she derives her opinionNurses work the "front lines" of a practice. They are the first person to interact with a patient, and are responsible for discovering the source of a patients problem, assessing the situation, and finding a solution. Many times, for non life threatening sickness or easy to treat symptoms, a doctor will not even be required and a nurse can take care of the problem.(http://www.rncentral.com/nursing-library/the-difference-between)

6. NursesFlorence said…..We say….."Research shows that effective workforce planning in nursing greatly influences the quality of patient care – directly effecting factors such as mortality," commented Walter Sermeus, Professor at the Katholieke Universiteit Leuven, Belgium and RN4CAST Project Co-ordinator. (HospitalHealthcare.com 2009)If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food if he has a bed sore it is generally the fault not of the disease but of the nursing

7. NoiseWhat we say…..What Florence said….Of one thing you may be certain anything which wakes a patient suddenly out his sleep will invariably put him into a state of excitement do him more ……mischief than any continuous noise however loud Never to allow patient to be waked intentionally Unnecessary noise then is the most cruel absence of care which can be inflicted either on the sick or wellThe World Health Organization WHO has defined a level of 35 dB as the benchmark for the average constant background noise level in hospital wards. Night time peak values should not exceed 40 dB. However, numerous studies attest to typical peak values of 45 to 60 dB, and occasionally even higher than 80–90 dB, caused by the sound of alarm systems and numerous technical appliances. At 100 to 110 dB, the noise level in the operating theatre is proving to be particularly dangerous for clinical personnel where drills, saws and other items of equipment create a significant risk of noise-related hearing loss.

8. InfectionWhat Florence said...It cannot be necessary to tell a nurse that she should be clean or that she should keep her patient clean seeing that the greater part of nursing consists in preserving cleanlinessWhat we say...Basic hygiene should be considered at the same time as cleaning. This will include not only handwashing, which is recognized as often poorly performed but also hand habits It is also becoming apparent that the sites closer to the patient are more likely to furnish an infection risk than those situated further away

9. Nightingale’s relevance to Nurse EducationGraduation Class 1899 – Nova Scotia

10. Nurse RegistrationNightingale stridently opposed registration for nursesBelieved that the attainment of moral qualities was the main purpose of nurse educationFeared technical skill could surpass moral characterBelieved that nursing would loose its autonomy over who was able to register as a nurse -> possible deterioration of standardsFeared nurses training schools would come under the control of doctorsDid not approve of dependence registration would have on nurses’ ability to pass exams

11. Nightingale and examsDid not oppose exams as such, but believedthey tested only memorythey advantaged upper class over working class women could not test for personal and moral character … “Written exams could not test a nurse’s ability to apply her (sic) knowledge on the ward, her appreciation of the character of each individual case, or the individuality of each patient” (Helmstadter 2007:158)

12. “Nightingale believed only experts – people currently working and training the nurses and who knew them personally - should credential nurses. Thy should be certified individually rather than by a standardized examination” (Helmstadter 2007:162)

13. Hospital MatronsPositioned as the gate-keepers for judging moral qualities Thus the matrons should control who could enter nursing and complete training

14. Becoming a nurse… then and nowHospital-basedMatrons had selection control of studentsApplicants required to attend interview, often with parentsMatrons had control over hospital schools -> could influence decision making around education and the implementation of curriculaMatrons were required to sign-off papers recommending registrationUniversity basedApplicants accepted on the basis of internet-based applicationFace-to-face interview often not requiredUniversities influence decision making around nurse education and the implementation of curriculaUniversity staff sign-off papers recommending registration

15. Universities now controlwho is admitted into preparatory courses leading to registration as a nursepass rates, through policies and measures such as level of pass required, ability to resit if failed subject etcFocus upon the needs of the University rather than the demands/standards of the service

16. Florence Nightingale as a nursing icon

17. Was she as saintly as she liked to appear?Traded upon her social position to influence both the Prime Minister and the War secretarySquandered resources by dismissing good nurses who were already out in ScuatriWas a class snobdisplayed considerable resentment towards people, Crimean doctors in particular, who had dared to rise above their stationnoted for her exaggerated statements and vituperative asides in relation to the senior medical staffLied about some of her colleaguespromoted the damaging assertion that John Hall (Principal Medical Officer in the Crimea) had no adequate medical qualification, when in fact he was an FRCS, by examination, and had an MD from St Andrews

18. Shamelessly took credit for the work of othersNightingale publically stated that she regarded the establishment of a medical statistical branch as one of her most important proposals adopted by the Royal Commission in 1857In fact been Andrew Smith (director general of the army medical department) proposed in 1855 that a board for medical statistics be established formally within his office, a function that it was already performingTook credit for the idea of the need for an army medical schoolThis had been proposed some 50 years previouslyThe death rate began to fall six months after she took charge but only after a sanitary commission was sent out by Lord Palmerston to improve ventilation and clean out the sewers.Nightingale had believed the mortality rates were due to poor nutrition and overworking of soldiers but unpublished letter shows it was not until 1857 that she realised the conditions within the hospitals themselves had caused such a huge number of deaths.Chose to open her training school at St Thomas’s to capitalise upon the work of Mrs Wardroper, the Matron, who had already initiated a programme of reform in 1855

19. Media DarlingThis was the first foreign war to be fully reported in the pressDenounced by John Hall as “publicity seeking meddler”.Had her own Fan clubReclusive in the extreme – only 8 photographs of her surviveDeveloped an inflated idea of her own importance “the War Office cannot turn me out because the country is with me.”

20. So…….RelevantIdeas about patient requirements (cleanliness, quiet etc) Link between clinical need and access to educationEstablishing a personal profileRedundantOpposed to registrationSocial class obsessionsBullying and manipulationInitiated the angel/whore stereotypeSet dangerous parameters in the Dr/Nurse relationship that it took the profession decades to shed

21. A final Word…..“Perhaps the greatest good that has resulted from her noble life has been the setting in motion of a force which has led thousands of women to devote themselves to systematic care of the sick and wounded”.New York Times, August 15th 1910