“What nursing has to do is put the patient in the best condition for nature to act upon them,” said Florence Nightingale. The mother of modern nursing was born May 12, 1820 in Florence, Italy, and passed on this day, August 13, 1910 in London England. As the founder of the science, her philosophy of managing the patient changed the face of nursing forever.
Today, the 108th anniversary of her death, marks a wonderful time to reflect upon the life and work of the woman who more than anyone else can also be properly credited with building the framework for modern healthcare leadership. In her groundbreaking work in Crimea, the “Lady with the Lamp” crafted guidelines for hospital administration and the use of statistics which still serve as the basis for clinical leadership today.
In a very real sense, her innovative approaches make Nightingale the architect of the modern hospital. With the exception of high-tech medicine evolution over the past half century, virtually every department in today’s hospitals and every clinician office can trace the roots of their standards back to those first introduced by Florence Nightingale.
In 1853, the Crimean War broke out….The British Empire was at war with the Russian Empire for control of the Ottoman Empire. During this time of open conflict, no fewer than 18,000 soldiers were admitted into military hospitals across the war zone. The English were in an uproar about the neglect of their soldiers, who not only lacked sufficient medical attention due to under-staffing, the conditions in these hospitals were appalling, inhumane and unsanitary.
In late 1854, Florence Nightingale was a highly regarded superintendent living in London when she received an urgent letter from the Secretary of War, Sidney Herbert. He requested she organize a corps of skilled nurses to tend their sick in Crimea.
Nightingale rose to the call, assembling a team of 34 nurses. Though they we’re made aware of the horrid conditions, not one was truly prepared for the reality of what they faced upon arriving in Scutari – the base hospital in Constantinople.
The hospital was built on a large cesspool which contaminated the water and the hospital itself. Patients were lying in their own feces on stretchers strewn throughout the hallways. Rodents and bugs scurried over them. More soldiers were dying from controllable infectious disease, like typhoid and cholera, than from their injuries.
The no nonsense Nightingale quickly set to work. She and her team procured scrub brushes and cleaned every surface within Scutari. She then spent every waking moment caring for the sick, and, at night, moved through the halls carrying a lantern ministering to patient after patient. The soldiers who were inspired, comforted and healed by her compassion took to calling her the “lady with the lamp”. To others, she became me known as “The Angel of Crimea”.
Her work reduced the hospital’s deaths by two-thirds. In addition to vast improvements in cleanliness, Nightingale also created many patient programs that significantly contributed to a healthy, healing environment – both physically and psychologically – using the application of statistics.
13 Leadership Lessons from the Lady with the Lamp
Follow Your North Star
Born into wealth, Florence could easily have settled into a life of Victorian ease at her family’s country mansion; instead, she chose a path of arduous commitment to caring for others. Nightingale found something more than just a job to do – she was on a mission. She did not inquire about pay and benefits before leading her team of young nurses off to the Crimea, where they endured working conditions that would be beyond intolerable in today’s world.
Her devotion to her calling changed the work of healthcare forever while ensuring she never experienced burnout. Her legacy reminds us caring for the sick is more than just a business – it’s a mission, and that being a caregiver is more than just a job – it should be a calling. The first duty of healthcare leadership is inspiring this commitment, beginning with our own examples.
Many of the problems in today’s healthcare system stem from the fact too many clinics and hospitals focus more on their business plans rather than on their missions, and far too many healthcare professionals have jobs rather than a calling. Nightingale might encourage a re-commitment to the things that really matter – those passions that hopefully attracted our idealistic younger selves into healthcare in the first place. Create a compelling mission for your team, and lead others with that mission front of mind at all times.
Nightingale was courageous and unstoppable. She did not allow opposition from the British aristocracy or the antiquated views of military leaders to prevent her from doing her work. When she ran into a wall, she found a way around or over, even to the extent of going directly to the English public for funding support and to the Queen for political backing.
With a never ceasing, never ending single minded focus to Exceed Expectations, it is always important to remain resolute and thrive, even when facing challenges or obstacles. If the mission is compelling enough and routinely rallied around, you Will ensure your ongoing efforts lead to ultimate success.
Build a Culture of Discipline
Less well-known than Nightingale’s contributions to hospital and nursing practice was her pioneering work in the field of medical statistics. Her painstaking efforts to chart infection and death rates among soldiers at Scutari gave weight to her demands for improved sanitary conditions first at military hospitals, and later in civilian institutions. She demonstrated that if you want to be effective, it’s not enough to know that you’re right – you must be able to demonstrate that you’re right with the facts.
Be Truly Present
Long before Daniel Goleman coined the phrase “social radar” in his book Emotional Intelligence, Nightingale appreciated that awareness and empathy are central to quality patient care (and to effective leadership). In Notes on Nursing, she wrote: “The most important practical lesson that can be given to nurses is to teach them what to observe – how to observe… If you cannot get the habit of observation one way or another you had better give up being a nurse, for it is not your calling, however kind and anxious you may be.”
In today’s fast-paced healthcare environment, it’s important that caregivers and healthcare leaders stop for a moment for a quick mental reminder to really be in the moment with patients and team members, and not mentally off onto the next chore. It is critical leaders apply the “social radar” principle when interacting with everyone.
Set the Stage
Nightingale’s environmental theory was “the act of utilizing the environment of the patient to assist in recovery”. This involves the nurse’s initiative to configure the environmental settings appropriate for the gradual restoration of a patient’s health and acknowledges external factors associated with the patient’s surroundings affect life and biological and physiologic processes and development.
Just as important is creating a work environment for your staff that encourages peak performance. Without doubt, the greatest influence in life is our environment – it affects our moods, our ability to perform, our effectiveness, our health, our peace of mind, our sense of wellbeing, and our beliefs. Our environment impacts everything.
It is critical leaders create an environment where the teams they guide are challenged, supported and more energized than ever before. Build a workplace that reinforces the mindset of peak performance, which empowers the team to drive the results you want, and routinely encourages everyone to take the necessary steps to create remarkable success. Take the initiative to set the stage and configure physical and psychological environments that unleash greatness.
Maintain Mutual Respect
Nightingale cared passionately about the nurses under her wing and the soldiers under her care. As one example, she was adamant, in her hospital, triage would be performed on the basis of the patient’s medical condition and not his rank in the military, social standing, or religion – a precept that was quite radical in Victorian England. Many of the specific techniques in her ground-breaking work Notes on Nursing are now outdated, but her absolute commitment to patient dignity and a spirit of mutual respect in the workplace remains essential.
Choose your Attitude
Nightingale would have agreed with the statement, “Attitude is everything”. She had an intuitive understanding that emotions are contagious, and would never have tolerated the gossip, complaining, and other forms of toxic emotional negativity prevalent in many work environments today. Toxic negativity is the emotional and spiritual equivalent of cigarette smoke, and, in its own way, just as harmful.
To promote a more positive and productive workplace culture, we must raise our attitudinal expectations and lower our tolerance for deviation from those expectations. Even in the horrendous circumstances that prevailed at Scutari, Nightingale insisted people be treated with dignity. One thing is certain: she would never have tolerated, much less condoned, the gossip and the complaining hallways and in the “Coffee-Clutch” today. In one of the many letters she delivered to newly graduated nurses from the Nightingale School of Nursing, Florence wrote:
“Prying into one another’s concerns, acting behind another’s back, backbiting, misrepresentation, bad temper, bad thoughts, murmuring, complaining. Do we ever think of how we bear the responsibility for all the harm that we cause in this way?”
Guide with Encouragement
In her quiet and dignified manner, Nightingale was a cheerleader devoted to encouraging qualified young women to enter her profession – even though the work was hard and the pay was low. One suspects she would have had harsh words for doctors and nurses of our era who are telling the next generation to stay out of healthcare because they themselves are working too hard, not making enough money, and not having enough fun.
Aspire to Improve Passionately
Nightingale never rested on her laurels; instead, she continuously raised the bar. After proving a more professional approach to nursing care would improve clinical outcomes, she helped found the first visiting nurses association, chartered the first modern school of professional nursing, created a blueprint for the modern hospital, and used her writings to create professional standards for hospital management.
She remained active until the end of her life at the age of 90. Her commitment to never-ending improvement shines like a lamp across more than a century, inspiring us to work our way through the challenges of today and never lose sight of the better world we need to create for tomorrow.
Create and Model Loyalty
Nightingale was a team-builder who cared passionately about the nurses under her wing and the soldiers under her care. She was a demanding leader, but also showed uncompromising commitment to the people she led.
Upon her return to England from Scutari she personally endeavored to make sure that every nurse who had served with her there would find employment upon their return home. Her legendary loyalty to the soldiers she served was reflected in the fact that when she was buried, her coffin was escorted by octogenarian veterans of the Crimean War honoring their debt to the lady with the lamp.
Nightingale’s contemporaries reported she had a wonderful sense of humor and was often able to defuse tense situations with the light touch of laughter. She might reflect, if she could laugh in the hell-on-earth environment of the Scutari Barrack Hospital, then no matter what the world throws at us, we can’t forget the restorative and healing power of laughter.
Maintain Open Collaboration
We are constantly hearing about the “healthcare crisis”, and we are likely to be hearing those two words in sound bites for decades to come. What would Nightingale tell us about dealing with this perennial drain on our wellbeing? Sara Rutledge, a nurse who’s a character in Joe Tye’s book The Florence Prescription: From Accountability to Ownership, put it this way: “We need to see opportunities where others see barriers. We need to be cheerleaders when others are moaning doom-and-gloom. We need to face problems with contrarian toughness because it’s in how we solve those problems that we differentiate ourselves from everyone else.”
Difficulty is the common thread woven into every great achievement. To encourage innovation and accountability, foster open collaboration and even embrace contrarian opinions. We will always achieve far more working together. When we are fully transparent with one another, facilitate a culture of trust and mutual respect and make room for and learn from opposing ideas, we will grow. Together, we must support the mission and growth of the team at all times.
Display and Encourage Initiative
Nightingale attributed her success to the fact she “never gave or took any excuse.” When told there was no money to repair a burned-out wing of the Scutari Barrack Hospital that was scheduled to receive hundreds of new casualties, she hired a Turkish work crew and before anyone could stop her, had the wing refurbished. The acid test of an “empowering” workplace is whether people – regardless of job title – can take the initiative to do the right thing for patients and coworkers without seeking permission or worrying about recrimination.
A concluding thought
Equip, enable, empower and encourage your people. They will take care of the patients and customers, and that will take care of the results. In this way, we can create a better healthcare world, confidently confront the challenges we face with courage and determination, and ensure we are making wellness a priority for all.
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Adapted from the following works:
100 Day Challenge, by Gary Ryan Blair
10 Leadership Lessons from Florence Nightingale, by Joe Tyre