Florence Nightingale: The Crucial Skill We Forget to Mention

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When we talk about the diversity of what nurses do, there is no better example than Florence Nightingale herself.

She was an expert clinician working in hospitals in Europe and London and caring for soldiers in military hospitals during the Crimean War. She was a quality improvement expert, implementing improvements in military hospitals that had a major impact on patient outcomes. Her work as an educator created the very foundation of nursing as a profession. She was a researcher and epidemiologist, using statistical arguments to support the changes she demanded. She was a public health advocate, campaigning for improvements that benefited the health of populations globally. She was our first nursing theorist, defining an environmental model of health care still used today.

But you are probably aware of all of this. Florence’s contributions to nursing and health are well known. What often gets left out though, and is of great importance to the history of nursing and how we practice today, is that Florence Nightingale was a writer.

In fact, Florence was a prolific writer. She published hundreds of articles and books, along with letters and editorials, pamphlets and briefs. If she lived today, I’m sure we’d be reading her regularly on the op-ed pages of the New York Times.

Suppose Florence hadn’t been a writer? Think about it . . . what would we know of her theories without Notes on Nursing? What would have been lost if she hadn’t written about her work in epidemiology, her research on hospital design, her efforts to improve sanitation and lower rates of infection? It’s incalculable.

But all this wasn’t lost—because, along with all her other wisdom, she was wise enough to understand the importance of communicating through writing what nurses do.

Today nurses continue to do work that has a major impact on health care and patient outcomes. But how much of that is getting lost because nurses don’t think of themselves as writers, because they don’t see writing as a part of what nurses do?

I worked with a group of nurses at a medical center here in New York to help them write and publish articles about the quality improvement projects they had completed. I was amazed by the work they’d done—work that had changed patient outcomes, lowered readmission rates, and improved their own working conditions. Patients discharged from the transplant unit were now going home with more confidence and less fear. Patients with congestive heart failure were able to better self-manage their care, and thus stay home with their families instead of being readmitted to the hospital again and again. Fewer mothers were having C-sections because the OB staff were working as a more cohesive interprofessional team.

The issues they were addressing aren’t unusual. Transplant staff everywhere are struggling with how to prepare their patients for discharge when the hospital stay has grown so much shorter and their needs continue to be so great. I’m sure each of you have stories of poor teamwork that has negatively affected patient care. And there isn’t a hospital in the country that isn’t trying to get their readmission rates down—with efforts to do so placed on the already overburdened shoulders of its nurses.

The nurses at this hospital aren’t the only ones who have come up with solutions and improved the way they provide care. Across the country and the world, nurses are confronting problems and devising solutions that make things better in their hospital, on their units, for their patients. But far too often that is where it stays: that information, those solutions, the knowledge gained, does not go any further than that individual unit or facility.

This has important implications for nursing and health care. Instead of building on each others’ efforts and moving forward, we’re facing the same challenges over and over again, in isolation. We are making mistakes that others have already worked through. We are missing opportunities to improve the lives of our patients and enhance our working conditions.

And something else is lost when nurses don’t write about what they do—the opportunity to let other health care providers and the public know the real scope of our role in health care. Few people are aware of the true contribution that nurses make to health care both at the bedside and beyond. There is still a lack of understanding about the complexity of nurses’ roles as clinicians, let alone the work we do in the policy arena, on social justice issues, with community health (locally, nationally, and globally), and in developing innovative models of care.

We often complain about our image not being what it should be. It is our responsibility to change that. And one of the most effective ways is communicating what we do through writing and publication.

So, to this year’s graduates and all you seasoned nurses out there—share your work. Make writing an integral part of your nursing practice. It is a powerful tool for improving patient care. Somewhere, other nurses will read your words, talk about your ideas, and even better, translate them into their own nursing practice. Your work will make a difference, not only for your patients but also for patients you will never meet. And the world will begin to know what it is that nurses do.

If Florence could do all this writing with everything else she had going on, and even through years of her own debilitating illness, then surely we can too.

(This post is adapted from a recent talk given by the author at the induction ceremony for the Delta Zeta chapter of the Sigma Theta Tau International Honor Society of Nursing.)