Honoring Florence Nightingale on International Nurses Day

United States - Scott #1190 (1961)
United States – Scott #1190 (1961)

On May 12 each year, International Nurses Day (IND) is celebrated around the world to mark the anniversary of Florence Nightingale’s birth and also to celebrate the contributions nurses make to society. Each year, a theme is chosen for International Nurses Day. The theme for 2018 is “A Voice to Lead: Health Is A Human Right.” Each year, a kit is prepared and distributed that contains educational and public information materials for use by nurses everywhere.

In 1953, Dorothy Sutherland, an official with the U.S. Department of Health, Education and Welfare, proposed that President Dwight D. Eisenhower proclaim a “Nurses’ Day”; he did not approve it. In 1965, the International Council of Nurses (ICN) — a federation of more than 130 national nurses associations founded in 1899 which was the first international organization for health care professionals — organized the first International Nurses Day in 1965. In January 1974, May 12 was chosen to celebrate the day as it is the anniversary of the birth of Florence Nightingale, the founder of modern nursing.

International Nursing Day is celebrated differently around the world. In London, a service is held in Westminster Abbey during which a symbolic lamp is taken from the Nurses’ Chapel in the Abbey and handed from one nurse to another, thence to the Dean, who places it on the High Altar. This signifies the passing of knowledge from one nurse to another. At St Margaret’s Church at East Wellow in Hampshire, where Florence Nightingale is buried, a service is also held on the Sunday after her birthday.

Poster supporting International Nurses Day on May 12, 2018.
Poster supporting International Nurses Day on May 12, 2018.

In the United States, National Nursing Week is held each year from May 6 to 12. This was first observed from October 11-16, 1954, in honor of the 100th anniversary of Florence Nightingale’s mission to Crimea. President Nixon later proclaimed a “National Nurse Week” in 1974. In 1982, President Reagan signed a proposal officially designating May 6 as “National Recognition Day for Nurses,” now known as National Nurses Day or National RN Recognition Day. In 1990, the American Nurses Association (ANA) expanded the holiday into the current National Nursing Week.

In 1997, at the request of the National Student Nurses’ Association, the ANA designated May 8 as National Student Nurses Day. In 2003, the ANA designated the Wednesday within National Nurses Week as National School Nurse Day. The National Association of School Nurses, however, claims that National School Nurse Day has been recognized since 1972.

The Canadian Minister of Health instituted National Nursing Week in Canada in 1985, celebrated each year during the week that includes May 12.

Since 2012, Nurse Jobs Ireland (an Irish nurse recruitment agency) has launched a weeklong pro-bono campaign to celebrate nurses from May 6 to 12 every year. This week-long celebration uses digital platforms such as Twitter and Facebook to promote the great work nurses do using the hashtag #CelebrateNurses. The public leave their positive comments and thanks on the Celebrate Nurses website where they are collated into an ebook which is shared in medical facilities throughout Ireland.

Nurses in Phuket, Thailand, hold a candle-lighting ceremony.
Nurses in Phuket, Thailand, hold a candle-lighting ceremony.

In each of the Australian states and territories, various nursing ceremonies are conducted during the week of May 6-12. The Australian Nurse of the Year is announced at a ceremony at one of the state’s capital cities.

Each year on International Nurses Day, nurses in Chinese hospitals recite the Florence Nightingale Pledge. In 2007, 5000 nurses gathered in Yichun in East China’s Jiangxi Province for this ceremony.

The President of India honours nursing professionals with the “National Florence Nightingale Award” every year on May 12. The award, established in 1973, is given in recognition of meritorious services of nursing professionals characterized by devotion, sincerity, dedication and compassion.

Singapore celebrates Nurses Day on August 1. Back in the 1800s, a thriving Singapore found itself in need of providing better healthcare and medical services to a growing population. While there were several hospitals, there was a lack of nurses to support the doctors. French nuns from the Convent of the Holy Infant Jesus were trained to become nurses to fulfil this need, as they were seen as the only educated European women in Singapore who could undertake this challenge.  August 1, 1885, marks the beginning of the development of nursing in Singapore when these nuns began their nursing duties in the General Hospital at the Sepoy Lines in the Outram area.

Nurses in Thailand.
Nurses in Thailand.

Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health care providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurse practitioners are permitted by most jurisdictions to practice independently in a variety of settings. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.

Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family and other team members, that focuses on treating illness to improve quality of life. In the United States and the United Kingdom, advanced practice nurses, such as clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe medications and other therapies, depending on individual state regulations. Nurses may help coordinate the patient care performed by other members of a multidisciplinary health care team such as therapists, medical practitioners and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.

Before the foundation of modern nursing, members of religious orders such as nuns and monks often provided nursing-like care. Examples exist in Christian, Islamic and Buddhist traditions amongst others. Phoebe, mentioned in Romans 16 has been described in many sources as “the first visiting nurse”. These traditions were influential in the development of the ethos of modern nursing. The religious roots of modern nursing remain in evidence today in many countries. One example in the United Kingdom is the use of the historical title “sister” to refer to a senior nurse in the past.

During the Reformation of the 16th century, Protestant reformers shut down the monasteries and convents, allowing a few hundred municipal hospices to remain in operation in northern Europe. Those nuns who had been serving as nurses were given pensions or told to get married and stay home. Nursing care went to the inexperienced as traditional caretakers, rooted in the Roman Catholic Church, were removed from their positions. The nursing profession suffered a major setback for approximately 200 years.

Henry Hering
Florence Nightingale. Photograph by Henry Hering, circa 1860.

Florence Nightingale laid the foundations of professional nursing after the Crimean War which was fought from October 1853 to February 1856 in which the Russian Empire lost to an alliance of the Ottoman Empire, France, Britain and Sardinia. Nightingale’s Notes on Nursing (1859) became popular. Her model of professional education, having set up the first school of nursing that is connected to a continuously operating hospital and medical school, spread widely in Europe and North America after 1870. Nightingale was also a pioneer of the graphical presentation of statistical data.

Florence Nightingale was born on May 12, 1820, into a rich, upper-class, well-connected British family at the Villa Colombaia, in Florence, Tuscany, Italy, and was named after the city of her birth. Florence’s older sister Frances Parthenope had similarly been named after her place of birth, Parthenope, a Greek settlement now part of the city of Naples. The family moved back to England in 1821, with Nightingale being brought up in the family’s homes at Embley, Hampshire and Lea Hurst, Derbyshire.

Florence inherited a liberal-humanitarian outlook from both sides of her family. Her parents were William Edward Nightingale, born William Edward Shore (1794–1874) and Frances (“Fanny”) Nightingale née Smith (1789–1880). William’s mother Mary née Evans was the niece of Peter Nightingale, under the terms of whose will William inherited his estate at Lea Hurst, and assumed the name and arms of Nightingale. Fanny’s father (Florence’s maternal grandfather) was the abolitionist and Unitarian William Smith. Nightingale’s father educated her.

Blue plaque to Florence Nightingale in 8 South St, Mayfair, London. Photo taken on October 26, 2012.
Blue plaque to Florence Nightingale in 8 South St, Mayfair, London. Photo taken on October 26, 2012.

In 1838, her father took the family on a tour in Europe where he was introduced to the English-born Parisian hostess Mary Clarke, with whom Florence bonded. She recorded that “Clarkey” was a stimulating hostess who did not care for her appearance, and while her ideas did not always agree with those of her guests, “she was incapable of boring anyone.” Her behavior was said to be exasperating and eccentric and she had no respect for upper-class British women, whom she regarded generally as inconsequential. She said that if given the choice between being a woman or a galley slave, then she would choose the freedom of the galleys. She generally rejected female company and spent her time with male intellectuals. However, Clarkey made an exception in the case of the Nightingale family and Florence in particular. She and Florence were to remain close friends for 40 years despite their 27-year age difference. Clarke demonstrated that women could be equals to men, an idea that Florence had not obtained from her mother.

Nightingale underwent the first of several experiences that she believed were calls from God in February 1837 while at Embley Park, prompting a strong desire to devote her life to the service of others. In her youth she was respectful of her family’s opposition to her working as a nurse, only announcing her decision to enter the field in 1844. Despite the intense anger and distress of her mother and sister, she rebelled against the expected role for a woman of her status to become a wife and mother. Nightingale worked hard to educate herself in the art and science of nursing, in the face of opposition from her family and the restrictive social code for affluent young English women.

Florence Nightingale by Charles Staal, engraved by G. H. Mote, used in Mary Cowden Clarke's Florence Nightingale (1857)
Florence Nightingale by Charles Staal, engraved by G. H. Mote, used in Mary Cowden Clarke’s Florence Nightingale (1857).

As a young woman, Nightingale was described as attractive, slender and graceful. While her demeanor was often severe, she was said to be very charming and possess a radiant smile. Her most persistent suitor was the politician and poet Richard Monckton Milnes, but after a nine-year courtship she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing.

In Rome in 1847, she met Sidney Herbert, a politician who had been Secretary at War (1845–1846) who was on his honeymoon. He and Nightingale became lifelong close friends. Herbert would be Secretary of War again during the Crimean War, when he and his wife would be instrumental in facilitating Nightingale’s nursing work in the Crimea. She became Herbert’s key adviser throughout his political career, though she was accused by some of having hastened Herbert’s death from Bright’s Disease in 1861 because of the pressure her program of reform placed on him. Nightingale also much later had strong relations with academic Benjamin Jowett, who may have wanted to marry her.

Nightingale continued her travels (now with Charles and Selina Bracebridge) as far as Greece and Egypt. Her writings on Egypt in particular are testimony to her learning, literary skill and philosophy of life. Sailing up the Nile as far as Abu Simbel in January 1850, she wrote of the Abu Simbel temples,

Sublime in the highest style of intellectual beauty, intellect without effort, without suffering … not a feature is correct—but the whole effect is more expressive of spiritual grandeur than anything I could have imagined. It makes the impression upon one that thousands of voices do, uniting in one unanimous simultaneous feeling of enthusiasm or emotion, which is said to overcome the strongest man.”

Florence Nightingale by Goodman, circa 1858. Published in The Life of Florence Nightingale by Edward Cook, 1913.
Florence Nightingale by Goodman, circa 1858. Published in The Life of Florence Nightingale by Edward Cook, 1913.

At Thebes, she wrote of being “called to God”, while a week later near Cairo she wrote in her diary (as distinct from her far longer letters that her elder sister Parthenope was to print after her return): “God called me in the morning and asked me would I do good for him alone without reputation.” Later in 1850, she visited the Lutheran religious community at Kaiserswerth-am-Rhein in Germany, where she observed Pastor Theodor Fliedner and the deaconesses working for the sick and the deprived. She regarded the experience as a turning point in her life, and issued her findings anonymously in 1851; The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc. was her first published work. She also received four months of medical training at the institute, which formed the basis for her later care.

On August 22, 1853, Nightingale took the post of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London, a position she held until October 1854. Her father had given her an annual income of £500 (roughly £40,000/US$65,000 in present terms), which allowed her to live comfortably and to pursue her career.

Florence Nightingale’s most famous contribution came during the Crimean War, which became her central focus when reports got back to Britain about the horrific conditions for the wounded. On October 21, 1854, she and the staff of 38 women volunteer nurses that she trained, including her aunt Mai Smith, and 15 Catholic nuns (mobilized by Henry Edward Manning)[18] were sent (under the authorization of Sidney Herbert) to the Ottoman Empire. Nightingale was assisted in Paris by her friend Mary Clarke. They were deployed about 295 nautical miles (339 miles or 546 km) across the Black Sea from Balaklava in the Crimea, where the main British camp was based.

Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Üsküdar in Istanbul). Her team found that poor care for wounded soldiers was being delivered by overworked medical staff in the face of official indifference. Medicines were in short supply, hygiene was being neglected, and mass infections were common, many of them fatal. There was no equipment to process food for the patients.

This frail young woman […] embraced in her solicitude the sick of three armies.
— Lucien Baudens, La guerre de Crimée, les campements, les abris, les ambulances, les hôpitaux

Florence Nightingale, an angel of mercy, with her candle making the night round of the wards at Scutari hospital, Ottoman Empire, during the Crimean War. Colored mezzotint, c. 1855, by Tomkins after Butterworth. Lettering reads:
Florence Nightingale, an angel of mercy, with her candle making the night round of the wards at Scutari hospital, Ottoman Empire, during the Crimean War. Colored mezzotint, c. 1855, by Tomkins after Butterworth. Lettering reads: “when all the medical officers have retired for the night, and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds” letter from Scutari, in the Times, February 1855. Iconographic Collections

After Nightingale sent a plea to The Times for a government solution to the poor condition of the facilities, the British Government commissioned Isambard Kingdom Brunel to design a prefabricated hospital that could be built in England and shipped to the Dardanelles. The result was Renkioi Hospital, a civilian facility that, under the management of Dr Edmund Alexander Parkes, had a death rate less than 1/10th that of Scutari.

Stephen Paget in the Dictionary of National Biography asserted that Nightingale reduced the death rate from 42% to 2%, either by making improvements in hygiene herself, or by calling for the Sanitary Commission. For example, Nightingale implemented handwashing and other hygiene practices in the war hospital in which she worked.

During her first winter at Scutari, 4,077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds. With overcrowding, defective sewers and lack of ventilation, the Sanitary Commission had to be sent out by the British government to Scutari in March 1855, almost six months after Nightingale had arrived. The commission flushed out the sewers and improved ventilation. Death rates were sharply reduced, but she never claimed credit for helping to reduce the death rate. In 2001 and 2008, the BBC released documentaries that were critical of Nightingale’s performance in the Crimean War, as were some follow-up articles published in The Guardian and the Sunday Times. Nightingale scholar Lynn McDonald has dismissed these criticisms as “often preposterous”, arguing they are not supported by the primary sources.

Nightingale still believed that the death rates were due to poor nutrition, lack of supplies, stale air and overworking of the soldiers. After she returned to Britain and began collecting evidence before the Royal Commission on the Health of the Army, she came to believe that most of the soldiers at the hospital were killed by poor living conditions. This experience influenced her later career, when she advocated sanitary living conditions as of great importance. Consequently, she reduced peacetime deaths in the army and turned her attention to the sanitary design of hospitals and the introduction of sanitation in working-class homes.

The Lady with the Lamp. Popular lithograph reproduction of a painting of Nightingale by Henrietta Rae, 1891.
The Lady with the Lamp. Popular lithograph reproduction of a painting of Nightingale by Henrietta Rae, 1891.

During the Crimean war, Nightingale gained the nickname “The Lady with the Lamp” from a phrase in a report in The Times:

She is a “ministering angel” without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.

The phrase was further popularized by Henry Wadsworth Longfellow’s 1857 poem “Santa Filomena”:

Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.

The Nightingale Fund was established in the Crimea on November 29, 1855, for the training of nurses during a public meeting to recognize Nightingale for her work in the war. There was an outpouring of generous donations. Sidney Herbert served as honorary secretary of the fund and the Duke of Cambridge was chairman. Nightingale was considered a pioneer in the concept of medical tourism as well, based on her 1856 letters describing spas in the Ottoman Empire. She detailed the health conditions, physical descriptions, dietary information, and other vital details of patients whom she directed there. The treatment there was significantly less expensive than in Switzerland.

Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas’ Hospital on July 9, 1860. The first trained Nightingale nurses began work on May 16, 1865, at the Liverpool Workhouse Infirmary. Now called the Florence Nightingale School of Nursing and Midwifery, the school is part of King’s College London. She also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury near her sister’s home, Claydon House.

Nightingale wrote Notes on Nursing (1859). The book served as the cornerstone of the curriculum at the Nightingale School and other nursing schools, though it was written specifically for the education of those nursing at home. Nightingale wrote “Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognized as the knowledge which every one ought to have — distinct from medical knowledge, which only a profession can have”.

Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale spent the rest of her life promoting and organizing the nursing profession. In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote: “The book was the first of its kind ever to be written. It appeared at a time when the simple rules of health were only beginning to be known, when its topics were of vital importance not only for the well-being and recovery of patients, when hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing”.

As Mark Bostridge has demonstrated, one of Nightingale’s signal achievements was the introduction of trained nurses into the workhouse system in Britain from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff. In the first half of the 19th century, nurses were usually former servants or widows who found no other job and therefore were forced to earn their living by this work.

Illustration in Charles Dickens' Martin Chuzzlewit. Nurse Sarah Gamp (left) became a stereotype of untrained and incompetent nurses of the early Victorian era, before the reforms of Nightingale. From page 269 in the 1867 U.S. edition of The Life and Adventures of Martin Chuzzlewit, by Charles Dickens, with original illustrations by S. Eytinge, Jr. Boston: Ticknor and Fields, 1867.
Illustration in Charles Dickens’ Martin Chuzzlewit. Nurse Sarah Gamp (left) became a stereotype of untrained and incompetent nurses of the early Victorian era, before the reforms of Nightingale. From page 269 in the 1867 U.S. edition of The Life and Adventures of Martin Chuzzlewit, by Charles Dickens, with original illustrations by S. Eytinge, Jr. Boston: Ticknor and Field, 1867.

Charles Dickens caricatured the standard of care in his 1842–1843 published novel Martin Chuzzlewit in the figure of Sarah Gamp as being incompetent, negligent, alcoholic and corrupt. According to Caroline Worthington, director of the Florence Nightingale Museum, “When she [Nightingale] started out there was no such thing as nursing. The Dickens character Sarah Gamp, who was more interested in drinking gin than looking after her patients, was only a mild exaggeration. Hospitals were places of last resort where the floors were laid with straw to soak up the blood. Florence transformed nursing when she got back [from Crimea]. She had access to people in high places and she used it to get things done. Florence was stubborn, opinionated and forthright but she had to be those things in order to achieve all that she did.”

Though Nightingale is sometimes said to have denied the theory of infection for her entire life, a 2008 biography disagrees, saying that she was simply opposed to a precursor of germ theory known as contagionism. This theory held that diseases could only be transmitted by touch. Before the experiments of the mid-1860s by Pasteur and Lister, hardly anyone took germ theory seriously; even afterwards, many medical practitioners were unconvinced. Bostridge points out that in the early 1880s Nightingale wrote an article for a textbook in which she advocated strict precautions designed, she said, to kill germs. Nightingale’s work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organizing field medicine. Her ideas inspired the volunteer body of the United States Sanitary Commission.

In the 1870s, Nightingale mentored Linda Richards, “America’s first trained nurse”, and enabled her to return to the United States with adequate training and knowledge to establish high-quality nursing schools. Richards went on to become a nursing pioneer in the U.S. and Japan.

Florence Nightingale (middle) in 1886 with her graduating class of nurses from St Thomas' outside Claydon House, Buckinghamshire
Florence Nightingale (middle) in 1886 with her graduating class of nurses from St Thomas’ outside Claydon House, Buckinghamshire

By 1882, several Nightingale nurses had become matrons at several leading hospitals including, in London (St Mary’s Hospital, Westminster Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables at Putney) and throughout Britain (Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary and Liverpool Royal Infirmary), as well as at Sydney Hospital in New South Wales, Australia.

In 1883, Nightingale became the first recipient of the Royal Red Cross. In 1904, she was appointed a Lady of Grace of the Order of St John (LGStJ). In 1907, she became the first woman to be awarded the Order of Merit. In the following year, she was given the Honorary Freedom of the City of London.

From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography cites brucellosis and associated spondylitis as the cause. Most authorities today accept that Nightingale suffered from a particularly extreme form of brucellosis, the effects of which only began to lift in the early 1880s. Despite her symptoms, she remained phenomenally productive in social reform. During her bedridden years, she also did pioneering work in the field of hospital planning, and her work propagated quickly across Britain and the world. Nightingale’s output slowed down considerably in her last decade. She wrote very little during that period due to blindness and declining mental abilities, though she still retained an interest in current affairs.

The grave of Florence Nightingale in the churchyard of St Margaret's Church, East Wellow, Hampshire. Photo taken by David Martin on September 17, 2007.
The grave of Florence Nightingale in the churchyard of St Margaret’s Church, East Wellow, Hampshire. Photo taken by David Martin on September 17, 2007.

On August 13, 1910, at the age of 90, she died peacefully in her sleep in her room at 10 South Street, Mayfair, London. The offer of burial in Westminster Abbey was declined by her relatives and she is buried in the graveyard at St Margaret’s Church in East Wellow, Hampshire, near Embley Park. She left a large body of work, including several hundred notes that were previously unpublished. A memorial monument to Nightingale was created in Carrara marble by Francis William Sargant in 1913 and placed in the cloister of the Basilica of Santa Croce, Florence.

In 1912, the International Committee of the Red Cross instituted the Florence Nightingale Medal, which is awarded every two years to nurses or nursing aides for outstanding service. It is the highest international distinction a nurse can achieve and is awarded to nurses or nursing aides for “exceptional courage and devotion to the wounded, sick or disabled or to civilian victims of a conflict or disaster” or “exemplary services or a creative and pioneering spirit in the areas of public health or nursing education”.

The Nightingale Pledge is a modified version of the Hippocratic Oath which nurses recite at their pinning ceremony at the end of training. Lystra Gretter and a Committee for the Farrand Training School for Nurses in Detroit, Michigan, created the pledge in 1893 as a statement of the ethics and principles of the nursing profession. It included a vow to “abstain from whatever is deleterious and mischievous” and to “zealously seek to nurse those who are ill wherever they may be and whenever they are in need.” In a 1935 revision to the pledge, Gretter widened the role of the nurse by including an oath to become a “missioner of health” dedicated to the advancement of “human welfare”—an expansion of nurses’ bedside focus to an approach that encompassed public health.

The Nightingale Pledge
The Nightingale Pledge

Nurses have recited the pledge at pinning ceremonies for decades. In recent years, many nursing schools have made changes to the original or 1935 versions, often removing the “loyalty to physicians” phrasing to promote a more independent nursing profession, with its own particular ethical standards.

During the Vietnam War, Nightingale inspired many U.S. Army nurses, sparking a renewal of interest in her life and work. Her admirers included Country Joe McDonald of Country Joe and the Fish, who later assembled an extensive website in her honor.

Four hospitals in Istanbul are named after Nightingale: Florence Nightingale Hospital in Şişli (the biggest private hospital in Turkey), Metropolitan Florence Nightingale Hospital in Gayrettepe, European Florence Nightingale Hospital in Mecidiyeköy, and Kızıltoprak Florence Nightingale Hospital in Kadiköy, all belonging to the Turkish Cardiology Foundation.

Other important nurses in the development of the profession include:

  • Agnes Hunt from Shropshire was the first orthopedic nurse and was pivotal in the emergence of the orthopedic hospital The Robert Jones & Agnes Hunt Hospital in Oswestry, Shropshire.
  • Agnes Jones, who established a nurse training regime at the Brownlow Hill infirmary, Liverpool, in 1865.
  • Linda Richards, who established quality nursing schools in the United States and Japan, and was officially the first professionally trained nurse in the U.S., graduating in 1873 from the New England Hospital for Women and Children in Boston.
  • Clarissa Harlowe “Clara” Barton, a pioneer American teacher, patent clerk, nurse, and humanitarian, and the founder of the American Red Cross.
  • Saint Marianne Cope, a Sister of St Francis who opened and operated some of the first general hospitals in the United States, instituting cleanliness standards which influenced the development of America’s modern hospital system.
After the Battle of Gravelotte. The French Sisters of Mercy of St. Borromeo arriving on the battle field to succor the wounded.
After the Battle of Gravelotte. The French Sisters of Mercy of St. Borromeo arriving on the battle field to succor the wounded.” Unsigned lithograph, 1870 or 1871.

Catholic orders such as Little Sisters of the Poor, Sisters of Mercy, Sisters of St. Mary, St. Francis Health Services, Inc. and Sisters of Charity built hospitals and provided nursing services during the 19th century. In turn, the modern deaconess movement began in Germany in 1836. Within a half century, there were over 5,000 deaconesses in Europe.

Formal use of nurses in the modern military began in the latter half of the nineteenth century. Nurses saw active duty in the First Boer War, the Egyptian Campaign of 1882 and the Sudan Campaign of 1883.

Hospital-based training came to the fore in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians and educational providers.

Nursing sisters at a Canadian military hospital in France voting in the Canadian federal election, 1917.
Nursing sisters at a Canadian military hospital in France voting in the Canadian federal election, 1917.

Many nurses saw active duty in World War I, but the profession was transformed during the second World War. British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the U.S. Army and Navy than any other occupation. The Nazis had their own Brown Nurses, 40,000 strong. Two dozen German Red Cross nurses were awarded the Iron Cross for heroism under fire.

The modern era saw the development of undergraduate and post-graduate nursing degrees. Advancement of nursing research and a desire for association and organization led to the formation of a wide variety of professional organizations and academic journals. Growing recognition of nursing as a distinct academic discipline was accompanied by an awareness of the need to define the theoretical basis for practice.

Nursing in Thailand, then known as Siam, began in the late 19th century. The Faculty of Nursing at Mahidol University in Bangkok was founded under the patronage of Her Majesty Queen Sripatcharintra, the Queen of King Rama V, as the first nursing school in Thailand on January 12, 1896. The late King Bhumibol Adulyadej (Rama 9)’s father — Prince Mahidol of Songkha — brought in American nurse-educators to revise the existing programs in 1926 with support from the Rockefeller Foundation. Two Thai nurses were sent to the United States to study nursing at Simmons College in Boston, Massachusetts.  One of these was Sangwan Talabhat, who graduated from the school in 1913 and who became King Rama IX’s mother — Somdet PraSri Nakarindra Boromarachachonnanee, or Her Royal Highness Grandmother of the Thai people.

Nurses in Thailand conduct a Royal ceremony.
Nurses in Thailand conduct a Royal ceremony.

In the 19th and early 20th century, nursing was considered a women’s profession, just as doctoring was a men’s profession. With increasing expectations of workplace equality during the late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remains well below that of female physicians in the early 21st century.

The United States Post Office Department issued Scott #1190 through the Washington, D.C., post office on December 28, 1961, to honor the U.S. nursing profession.  In 1798, New York Hospital attending surgeon Dr. Valentine Seaman (1770-1817) recognized the need for a specially trained group of women to assist the doctors at his hospital. As a result, he began one of America’s first nurse training programs. Seaman instructed a class of about 24 women in anatomy, physiology, childcare, and mid-wifery. Two years later, some of his lectures were published with the title, Midwives’ Monitor and Mothers’ Mirror.

Designed by Alfred Charles Parker, the 4-cent blue, green, orange, and black stamp features a young woman lighting the traditional candle, symbolizing her dedication to the profession. It was printed on the Giori press by the Bureau of Engraving and Printing and issued in panes of fifty stamps each, perforated 11. An initial printing of 100 million stamps was authorized with a total of 145,350,000 actually issued.

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