Nurses Week: Building on Florence Nightingale’s Example

Nurse Leader Insider, May 10, 2018

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By Jennifer Thew, RN

If you had to name a famous nurse, who would it be? Florence Nightingale, of course. Nightingale's invaluable work saving lives and laying the foundation of the nursing profession has captured the hearts and minds of both nurses and the general public. Even though she was born almost two centuries ago, the founder of nursing remains the face of nursing.

However, I often wonder if focusing on the past causes us to overlook the current ways nurses are shaping the nursing profession and leading changes in healthcare.

So this National Nurses Week, which culminates on May 12—Nightingale's birthday—I encourage you to keep the following saying in mind, "You don't know where you're going until you know where you've been," and take some time to reflect on the contributions of nurses both past and present.

The following are highlights from Nightingale's biography by the Florence Nightingale Museum paired with HealthLeaders Media stories featuring the work of modern-day nurses. Nurse leaders have built upon the foundations laid by the 'Lady with the Lamp' to drive the profession, patient care, and healthcare delivery forward.

When Nightingale arrived in Scutari, Turkey to provide care to soldiers injured in the Crimean War, she found unsanitary conditions and a lack of medical supplies at the military hospitals. She took steps to improve the conditions and cleanliness of the hospital environment.

Nurses can still be counted on to improve quality and outcomes, enhance an organization's culture, and build relationships with patients, colleagues, and the community. In the March/April HealthLeaders magazine cover story, Your Nurses Can Fix the Hospital, three nurse leaders share their thoughts on how nurses can influence change in healthcare and be drivers of innovation.

Advocates for change
After the war, Nightingale became an advocate for improving Britain's civil hospitals, communicating the need for reform by using statistics to show that more men had died from infections than from their injuries. According to her biography, Nightingale wrote some 13,000 letters as part of her campaigns, and corresponded with Queen Victoria for over thirty years.

In a recent interview with HealthLeaders, Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association in Silver Spring, Maryland, encourages nurses to continue the push for change through advocacy.

"One of the conclusions that I've made in the last several years is—I don't say this in a negative way—but we often put forward the excuse that 'I'm too busy to get involved in policy work or advocacy because I'm always busy taking care of patients,' " Cipriano says. "To me, if we really believe it's important for nurses to influence the changes in healthcare, we need to find a way to support each other and to get the people on the front lines in front of the policymakers and in front of decision-makers in our organizations."

Educating nurses
Another of Nightingale's achievements was establishing the first professional training school for nurses, the Nightingale Training School. Education of nurses is still a hot topic.

Research, particularly that by Linda H. Aiken, PhD, FAAN, FRCN, of the University of Pennsylvania School of Nursing, has shown that having more nurses with bachelor's degrees improves patient outcomes.

In its 2010 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (now the National Academy of Medicine) recommended 80% nurses should have at least a BSN by 2020.

While new research by Chenjuan Ma, PhD, associate professor at NYU Rory Meyers College of Nursing, has found that this goal will not likely be reached within the next two years, there has been an increase in BSN-prepared frontline nurses in U.S. hospitals—57% in 2013 compared to 44% in 2004.

"From my perspective, I think it's more important to look at how much effort we have put in to increase the number of nurses with baccalaureate degrees or how much progress we have made to increase the number of nurses with baccalaureate degrees," she says.

Additionally, New York State became the first state to pass a law requiring new nurses to earn a bachelor's degree within 10 years of initial licensure.

Hospital planning and organization
Nightingale also had a hand in hospital design, though her Nightingale wards—one large room with multiple beds—is in direct contrast to the current move toward private patient rooms.

During the design of its 615,000-square-foot patient tower set to open in 2019, ProMedica Toledo Hospital in Ohio conducted research to identify and refine ways to improve nursing care and efficiencies, including the walking distances of nurses on the floors during a shift.

Researchers shadowed ICU nurses and intermediate-level medical-surgical nurses and assessed the existing floor plan, used a parametric modeling tool, and created heat maps to provide a graphic representation of what a nurse's 12-hour shift looked like in terms of workflow and walking distances.

"One of the big [revelations] was around our whole process of medication passing," says Deana Sievert, RN, MSN, metro regional chief nursing officer and vice president for patient care services at ProMedica.

The architects used this information to design a unit that would cut down on walking time.

"We were able to take them from a three-mile journey on their shift to 1.5 miles. We cut in half the steps that they were taking," says Alison Avendt, OT, MBA, vice president of operations.

After the tower opens, more research will be done to see how the design is affecting workflow.

"Everybody wants to give the nurse as much time as possible to be with the patient [and] try to take away the things that are not value-added in the nurse's day," Avendt says.

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