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Mary Kenny: How Florence Nightingale healed the public image of nurses

International Year of the Nurse and Midwife celebrates Florence Nightingale, who changed people's perceptions of nurses as drunken and slatternly

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Mary Kenny, writer and author. Photo: Tony Gavin

Mary Kenny, writer and author. Photo: Tony Gavin

Mary Kenny, writer and author. Photo: Tony Gavin

One common promise the main political parties made during the election now ending was the promise of "more nurses" - 5,000 being the number suggested. Great idea. Let's hope it's implemented in this International Year of the Nurse and Midwife, as designated by the World Health Organisation in honour of Florence Nightingale, the woman who launched modern nursing as a profession.

Before Flo Nightingale undertook her formidable campaigns promoting cleanliness, diet, light, fresh air, prevention and - a great favourite of hers - sitting up all night with the chronically ill or dying, nursing was associated with Charles Dickens' rackety figure Sarah Gamp in Martin Chuzzlewit. Sarah Gamp is gin-swigging, incompetent, negligent, and very possibly a back-street abortionist. Nurses had low status and slatternly habits. Some were regarded as part-time prostitutes. Usually poor women, perhaps they had to do what they could do survive.

But Nightingale changed all that. She raised nursing to a serious and respected profession, supported by medical knowledge, enforced by discipline and vocational dedication. Nuns were her first model for the nursing profession - the French Daughters of Charity who had attended the wounded on battlefields since their foundation by Vincent de Paul, as well as Anglican and Lutheran nuns who tended to the poor and sickly. Call the Midwife, which shows nurses working with an order of Anglican nuns in east London, is directly in line with a Nightingale idea. (She was also influenced by Mother Catherine McAuley, founder of the Irish Sisters of Charity.)

Nightingale was born in May 1820, appropriately enough in Florence, where her parents were on the European tour which cultivated and affluent families undertook at the time. Florence and her sister were well educated, and she showed an early aptitude for maths, statistics and data. She was subsequently to invent an early version of the 'pie chart', that cake-shaped diagram which displays percentages in slices. And the care of the sick always interested her: as a child she successfully set a dog's broken paw. At 16, she felt 'God's call' to devote herself to a life of service. Though her parents refused to allow her to join the disreputable 'Sarah Gamp' nurses, she did charitable hospital work which included some nursing skills.

Journalism played a key part in Nightingale's epic mission to Scutari, in Turkey, during the Crimean War: reportage from William Howard Russell exposed the terrible conditions in field hospitals there. Nightingale gathered a band of 38 women, including 24 Anglican and Catholic nuns, and set off for Turkey in 1854. (One-third of the British troops were Irish Catholics, according to Mark Bostridge, Nightingale's most recent biographer.)

The care that Nightingale and her nurses showed for the wounded and dying quickly became a legend: sentimentally, she was depicted as 'The Lady with the Lamp', visiting afflicted soldiers by lamplight. She became an overnight celebrity and she used that renown to reform nursing, founding and designing hospitals, implementing her ideas and rules with her book Notes on Nursing, which became a nursing bible.

She introduced a register of nurses, and insisted on standards of medical knowledge and understanding, as well as care, empathy, and, above all, cleanliness. However, she didn't approve of nurses having to sit formal exams: an over-academic approach would deter working-class women. And exams tested memory, but "not moral and personal character". Nurses today face a host of exams and study projects, and that certainly can discourage non-academic applicants.

Feminists have been ambivalent about Nightingale. Yes, she showed, by example, that women could assume leadership and wield professional power. She also established midwifery - previously neglected - as an important medical profession. Yet nurses could also be stereotypes of women as self-sacrificing martyrs and submissive 'angels'. In fiction, nurses often played second fiddle to doctors. Why shouldn't nurses have the same professional status as doctors? And why shouldn't men be nurses? (They are, too.) Actually, Nightingale was very supportive of Elizabeth Blackwell, who had to battle so hard to qualify as the first woman doctor.

Latterly, Nightingale's reputation has been dented by being seen as a white, privileged woman with, no doubt, a tinge of imperialistic attitudes (though her family had a strong tradition of campaigning against slavery). Mary Seacole, the bi-racial Anglo-Jamaican nurse who also did good works in the Crimea, has been advanced as a more relevant role model for today. Seacole, who used herbal remedies and Caribbean recipes to treat battlefield diseases like dysentery and cholera, certainly deserves merit.

But it was Nightingale who raised the profession of nursing on an international scale, and her health reforms are still relevant today. Despite poor health herself in later years, she lived to be 90, ruling the medical profession from her bed.

Weekend Magazine