Florence Nightingale: The Crucial Skill We Forget to Mention

“Suppose Florence hadn’t been a writer? Think about it…”

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

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.)

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2016-11-21T13:02:32+00:00 May 13th, 2015|career, Nursing, nursing perspective|11 Comments

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  1. Julie A April 18, 2016 at 5:47 pm

    While I never stopped to think about it this blog has made a very interesting and valid point; nurses of today don’t share their knowledge or experiences the way they should. Florence Nightingale set the foundation of nursing but just as the blog states, if she wouldn’t have written any of her ideas or theories then who would we be today? What would our foundation be? Writing our experiences, theories and the wisdom we have acquired throughout the years will not only educate future nurses but also benefit our patients. We must not neglect or put aside the future generations of nurses. Although it seems as if there are never enough hours in the day to juggle work, education, and family we need to acknowledge the importance of passing on our knowledge and the need to better our profession. After all like the blog says, if Florence Nightingale made time surely we could also.

  2. Marielys November 22, 2015 at 1:07 am

    Florence Nightingale was the perfect example of what a nurse should be. She made a difference. She looked after her patients’ health and well-being. But most importantly, she shared her findings and passed on her knowledge and experience. Our profession strengthens when we share our research and publish the things we do every day that make a difference for our patients and ourselves.

  3. Melanie Sosa-Suarez July 15, 2015 at 9:11 am

    Thank you for this inspirational blog. As a former educator myself, I find that writing can be a very instrumental tool for disseminating useful information, yet very few of us nurses take advantage of this formidable device. As a recent student nurse, I was encouraged to keep a journal of my daily nursing encounters to use for reflection and growth. I have found that this has given me greater insight into the nursing experience and believe that the knowledge gained from these entries will someday serve to enrich the nursing experience for others as well.

  4. tiffany June 27, 2015 at 2:17 am

    This article has shown me the importance of writing adn communication. This sense of nursing is lost among the tiring, busy, and long work days. Life tends to get in the way and many of us forget whats really important. I had not realized before this article how writing about different situations in the hospital setting can greatly improve a patient’s stay. It makes sense to write about what implementations hae been taken for the different issues in healthcare and which ones actually worked. By publishing trials and errors other hospitals and staff can avoid a non owrking issue and save time and effort. In the end the patient is the one that benefits the most out of nurses writings.

  5. Betsy Martinez June 20, 2015 at 7:54 pm

    As a former news writer and now a registered nurse, I can completely relate to this blog. Similarly to nurses, writers are among the most underappreciated, but highly needed professions. It is not until one needs a writer or needs a nurse that one truly values the importance of a writer or a nurse. Without nurses who write, research would not be published, legislation would not be created, and textbooks would not be published, and so on. It is important for nurses to write down what we do. From daily notes to patient education pamphlets, nurses who write know the importance of communication.

  6. Eileen Spillane May 25, 2015 at 1:28 pm

    Thank you for this article. We talk so much of Nightingale’s impact but rarely do we focus on the writing. I write to help nurses find balance and I allow nurses to share their stories. I welcome you to share your story about the work you do getting nurses published.
    If you or anyone you know has a story to share, feel free to reach out to me (Eileen@thebalancednurse.com)
    Lets use our bold voices to be heard!

  7. Marianna Crane May 24, 2015 at 3:51 pm

    Reblogged this on Marianna Crane: nursing stories and commented:
    Read this wonderful post about all the compelling reasons nurses need to write.

  8. Dr. Susan Penner May 17, 2015 at 11:11 am

    This is something I point out to my nursing students. I’m sure there have been many nurses who over the past have made contributions to nursing care, but Florence was the first, at least in Western culture, to write and publish her ideas.

  9. Regina Wysocki May 14, 2015 at 10:52 am

    Love this article. It is so very true that nurses have a wealth of information to contribute to the literature. I don’t think many of us think of publishing as something that is important or necessary, but it really does help to change the public perception of what nurses do.

  10. Regina Wysocki May 14, 2015 at 10:50 am

    Reblogged this on The 21st Century Nurse and commented:
    Great article about the importance of nurses publishing their work:

    “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.”

  11. Lois Roelofs May 13, 2015 at 9:41 pm

    Agree! Absolutely nurses should write. Even in retirement, I get asked about what nurses really do.

Comments are moderated before approval, but always welcome.

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