Jenifer Wilson-Barnet on Florence Nightingale's Florence Nightingale to her Nurses .
These letters to the probationers and nurses at St. Thomas' (written between 1830 and 1900) are less well known than other Nightingale works but seem to have enduring relevance to nursing and have been thought-provoking to me at several stages in my career. They provide wise counsel but also expose the Nightingale philosophy, influential to the traditions of nursing. Admittedly her well-known fervour for cleanliness, fresh air and food and self-denial of nurses is apparently replaced by her religiosity, but the humanity and caring expressed is very moving.
As a student nurse, I discovered the letters in the library at Hyde Park Corner (now the most expensive hotel bedroom in London). In accepting the responsibilities of developing the discipline and future nurses, Nightingale still has a great deal to offer. My dog-eared copy of this little book provides humorous moments as well as explanations of why nursing is less advanced and valued than many believe it deserves. Currently there is a refreshing resurgence of continued education in nursing. Yet while eschewing the need for qualifications, Nightingale was unequivocal over the need for nurses's own intellectual development and continued learning. "All that any training is to do for us is: to teach us how to train ourselves, how to observe ourselves, how to think out things for ourselves . . .'' Training was thus seen as an education for life: "There is no end - no end in what we may be learning every day." However, at that time, the gratitude and adoration afforded the medical superintendent, who taught medicine, surgery and anatomy, determined the curriculum for the next 70 years. If only nursing teaching had been given the same value we may be more certain, knowledgeable and influential today. In producing her cadre of lady sisters, the philosophy of nursing care was disseminated but not the emerging science and empirical data that Nightingale urged all nurses to collect.
When I review these notes at the start of an academic year, to pass on some of her sentiments to the new intake, her personality and beliefs are apparent. She was quite assertive on the subject of men, all her nurses being women. She must have had a humorous side when saying, "Hospital nurses have charge of their patients in a way that no other woman has charge: in the first place no other woman is in charge really of grown-up men. On how careful she ought to be especially the night nurses, to show them what a true woman can be."
In these days of scientific evaluation, nursing care must be measured and costed. Yet again, Nightingale's lessons on the true value of nursing are useful. Recent research supports her view that the manner, presentation and style of the nurse can alter the reaction to care and the course of a patient's condition. Taught to question rather than criticise, Nightingale nurses probably benefited a lot from their annual missives. While rejecting sentimentality but encouraging a genuine feeling for caring and compassion, Nightingale is still au courant.
Jenifer Wilson-Barnett is professor of nursing and midwifery, Kings College London.