Congratulations, Nurses: Thoughts on Nursing and Comparisons with Nursing in Florence Nightingale’s Time

Pat Stricker, RN, MEd
Former SVP, Clinical Services
TCS Healthcare Technologies

Happy Belated Social Work Month!

I want to take this opportunity to apologize to all social workers for forgetting to congratulate you in March during Social Work Month. I have no excuse for not recognizing and thanking you for your incredible dedication and service at that time, other than the fact that I guess my mind was on the horrible coronavirus pandemic that was overwhelming us. I would now like to belatedly congratulate each of you on the outstanding work you do each day and for the close working relationship that has been established between the social workers and case managers. What a dynamic duo!

I also want to belatedly congratulate the National Association of Social Workers (NASW) on their 65th anniversary. NASW is the largest social work membership organization in the world, with more than 120,000 members. It has been working since 1955 to enhance the professional growth and development of its members, to create and maintain professional standards and to advance sound social policies. Congratulations and we look forward to many more years of the NASW/CMSA partnership.   

Social work is such a challenging and rewarding profession. Social workers (SW) have the knowledge, skills, and abilities to truly impact lives and enhance quality of life. They are there to help families and children in times of distress. They help clients who have just been diagnosed with a terminal illness, and they hold the hand of those dying alone with no family or friends. They are there to help clients who are experiencing pain, grief, sorrow and suffering. They are there to help clients find strength and drawn on the power from within to overcome their adversities. They act as strong advocates for their clients and provide them with education and resources to help them deal with their issues. They show clients that they are not alone, that they are being listened to and that their lives really matter. In addition, they are also there to bring hope, joy and laughter to clients. Social workers really do make a difference every day. They are sometimes the forgotten “essential workers” and deserve to be recognized. Thank you to all the social workers for all that you do!     

Happy Nurses Month!

I would also like to recognize and congratulate all nurses this month as we celebrate National Nurses Month (May 6 was National Nurses Day, and the week of May 6-12 was National Nurses Week).

Nurses and all other healthcare workers have certainly come to the forefront of healthcare the past few months in the battle against the coronavirus pandemic. They have played vital roles in not only caring for the patients, but standing in for patients’ families that have not been able to be with their loved ones. Nurses have always been known for their dedication, commitment, compassion and caring, but never more so than now. They are truly making invaluable contributions to the health care delivery system during this unprecedented time. We owe them our everlasting gratitude!   

2020: the Year of the Nurse and Midwife

Interestingly enough, 2020 was designated by the World Health Organization (WHO) as the “Year of the Nurse and Midwife” to commemorate the 200th anniversary of Florence Nightingale’s birth and to celebrate the vital role that nurses and midwives perform in providing healthcare services. The WHO’s goal was to highlight their work and their ability to overcome challenges. Little did they know that the challenges that nurses were to face this year would be so overwhelming and unprecedented.

In announcing the initiative, the Director-General of WHO, Dr. Tedros Adhanom Ghebreyesus, noted that “Nurses and midwives are the backbone of every health system: in 2020 we’re calling on all countries to invest in nurses and midwives as part of their commitment to health for all.” He went on to say that nurses are the "bridge" of healthcare, essential links between the people in communities, the healthcare team and the complex healthcare systems. He also noted that they are on the “front lines” of healthcare and are key to achieving universal health coverage (UHC), a WHO initiative to bring adequate healthcare to people across the globe. The WHO had no way of knowing just how critically essential this vital nursing role would become this year in all countries throughout the world. 

(NOTE: You can read more detail about the “2020: Year of the Nurse and Midwife” in the January 2020 CMSA Newsletter article).

WHO and the International Council of Nurses (ICN) conducted a three-year NursingNow! campaign from 2018 to 2020 to raise the profile and status of nursing. It culminated in April, 2020 with the release of the first State of the World’s Nursing 2020 Report that provides the most up-to-date information on the global nursing workforce by country: number and types of nurses, education, regulation, practice, leadership, and gender demographics. The report presents a compelling case for employers and businesses to invest in nursing education, jobs, and leadership. It also highlights their policy goals for the next 3-5 years showing how nurses will help WHO achieve their “Triple Billion” goals to: 

• Promote Healthier Populations – 1 billion more people enjoying health and well-being
• Address Health Emergencies -  1 billion more people better protected from health emergencies
• Achieve Universal Health Coverage - 1 billion more people benefitting from UHC

The State of the World’s 2020 Report has graphic reports for each country, including the United States.  

Some of the key U.S. healthcare demographic data shows:

• Total U.S. population (2019):  329,064,917
• Life expectancy (2016):  76.0 years for males and 81.0 years for females
• Current healthcare expenditures of GDP (2017):  17.1%
• Current healthcare expenditures per capita (2017): $10,246

Key nursing data shows:

• Professional nurses: 3,703,000 (78%) and nursing associates: 1,026,338
• Female nurses: 89%
• Foreign born nurses: 15.7%
• Nurses under the age of 55:  69%    Over the age of 55: 31%
• New graduates each year: 281,893
• Nurses per 10,000 population: 145.5 (no estmated shortage was identified)

Florence Nightingale’s 200th Birthday

It was interesting to note that 2020 was selected for the “Year of the Nurse and Midwife” to coincide with the 200th anniversary of Florence Nightingale’s birth. It’s only fitting to take a look at the history of Florence Nightingale and how it correlates with Nurses Month and what is going on the world today.

Florence was born into a wealthy, upper class family in Florence, Italy on May 12, 1820. She was always a compassionate, caring person, and as she grew she decided she wanted to become a nurse. However, her parents were against this, because at that time nursing was considered a lowly job for elderly women, not for a respectable Victorian woman. She disagreed and decided to study nursing in Germany, where she learned not only to care for the sick, but also about the importance of patient observation and hospital organization.

She returned to Great Britain to practice nursing and quickly rose to supervisory positions. In 1854, at the age of 34, Florence was asked by the British Prime Minister of War to supervise a program introducing 38 female nurses into military hospitals in Turkey to care for British soldiers fighting in the Crimean War. When Florence and the nurses arrived, they found a chaotic, filthy scene with contaminated water. During the first winter, more than 4,000 soldiers died, with more dying of infectious diseases, like cholera and typhoid, than of their war wounds. She and the nurses not only cared for the soldiers, but they spent a great deal of time cleaning the soldiers’ clothes and bedding, as well as the entire environment. Part of that included seeing to it that the sewers were cleaned and a dead horse, found in the water supply, was removed. After that, the mortality rate started to decrease, confirming Florence’s  belief about the link between filth and illness. She continued to stress this concept and educate others about cleanliness for the rest of the time she worked in public health.

After the war, she studied sanitary conditions at hospitals in Great Britain and Constantinople and confirmed again that improved sanitation was key to reducing the death rates. She presented her data in pie-like, analytical charts (very advanced for that time period) to the officials, and they agreed to update the hospitals and install a new water system. In 1858, she became the first “female fellow” in the Royal Statistical Society, quite an accomplishment for a woman in that time period.

She was often bedridden and unable to continue her role as a clinical nurse due to contracting Brucellosis while working abroad. However, she continued to work, gathering healthcare data, conducting surveys, implementing investigative commissions, and writing outcome reports throughout her life. She was not only a very caring and compassionate nurse, but also a respected statistician, ambitious healthcare reformer, passionate social advocate and enthusiastic visionary. No wonder she is known as the “Mother (and Founder) of Modern Nursing” and why we continue to honor her today.    

Let’s take a look at a brief history of how we began to honor her and how National Nurses Day, Week, and Month have evolved over the years. As you will see most of the days honoring nurses are centered around dates that were related to Florence Nightingale.  

• 1954 – The first Nurse Week celebration, in honor of Florence Nightingale, was observed on October 11-16, the 100th anniversary of her mission to Turkey in the Crimean War.
• 1974 – In January the International Council of Nurses proclaimed May 12, Florence Nightingale’s birthday, as “International Nurse Day,” and in February, President Nixon issued a proclamation designating that time period as “National Nurse Week.”
• 1978 – May 6 was declared “Nurses Day” by Brendon Byrne, Governor of New Jersey, and the date was listed in the national calendar of annual events.
• 1981 – The American Nurses Association (ANA) and other various nursing organizations supported a joint resolution of the U.S. Congress, and President Ronal Reagan signed a proclamation designating May 6, 1982, as “National Recognition Day for Nurses.”
• 1990 –  ANA expanded the recognition from a day-long celebration to “National Nurses Week,” beginning on May 6 and ending on May 12, Florence Nightingale’s birthday. 
• 1994 –  The dates of May 6-12 were designated as the official permanent dates for “National Nurses Week” each year.
• 2020 – The “Year of the Nurse and Midwife” was designated by the World Health Organization. This year coincided with the 200th anniversary of Florence Nightingale.  

I can’t help but think about what we are going through today and how it relates to Florence Nightingale’s work in the Crimean War. She and her nurses were fighting to save the soldiers under very difficult circumstances. They were caring for the needs of the soldiers but had limited and inadequate clean supplies to work with. They were working very diligently, but more soldiers were dying of infections and infectious diseases than of their war wounds. This was because the nurses did not have clean supplies or adequate treatments or medications (antibiotics and vaccines were not yet developed). And there was little they could do for them but provide care and comfort and be there for those who were dying, standing in for their loved ones who were not able to be there.    

This is similar to what our nurses are facing today. Instead of a war, there is an unprecedented influx of coronavirus patients arriving at hospitals, so many in some cases that it is hard for the nurses to keep up with the number of admissions. Many of the patients are critically ill with respiratory infections or organ failures and they require ventilators and ICU beds. A great number of the patients are dying because they do not have specific treatments, medications (or vaccines) to treat the coronavirus infections, because they have not been developed yet. There is a lack of adequate equipment, like ventilators and personal protective equipment (PPE), so they create innovative ways to work around that – ventilators are adapted to allow it to be “shared” between two patients and nurses find ways to re-use their PPE or substitute garbage bags for gowns to try to protect themselves. And as with Florence Nightingale and her nurses, today’s nurses are also there with those who are dying, standing in for their family members who are not able to be there.

That describes a little bit of what the nurses working on the front line went through 200 years ago and what they are going through today. I can’t even imagine how incredibly hard these nurses are working and how terribly difficult it must be emotionally. They are demonstrating: dedication, commitment, passion, caring, competence, compassion, courage, diligence, responsibility, resilience, perseverance, empathy, concern, integrity, work ethic, strength, conviction, respect, reliability, creativeness, flexibility, adaptability, teamwork and professionalism. They are truly HEROES!!           

And while today’s unprecedented work situation and the qualities needed to work in that situation are being demonstrated by the front-line nurses, these same qualities are being demonstrated day by day (to a lesser degree) by all nurses in their own work environment. They too are HEROES!! 

Congratulations to all nurses everywhere, and thank you for your caring and commitment.

Memorable Nursing Quotes

I would like to close with some quotes from Florence Nightingale and others who describe what it is like to be a nurse:

• I am of certainly convinced that the greatest heroes are those who do their duty in the daily grind of domestic affairs whilst the world whirls as a maddening dreidel. –  Florence Nightingale
• I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results. – Florence Nightingale
• Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation as any painter's or sculptor's work…It is one of the Fine Arts: I had almost said, the finest of Fine Arts. – Florence Nightingale
• Save one life and you’re a hero, save one hundred lives and you’re a nurse.  –  Anonymous
• Nursing is great for so many reasons, but there is one reason that means more than any poll results, amount of money, or job security: Nurses make a difference.  –  Brittany Wilson, RN, BS