By Sue Hassmiller, PhD, RN, FAAN (this is the 4th in a series of posts by Hassmiller retracing Florence Nightingale’s influential and innovative career) 

Seeing the famous St. Thomas’ Hospital today, I thought Florence Nightingale would roll over in her grave with disgust! What were they thinking, I asked the tour guide? Well, she said, it was the ‘60s. No excuse, I barked back! Prince Charles doesn’t like it either, if that makes you feel any better, she responded.

Applying best practices. The most visually prominent buildings in the hospital now consist of a couple of plain, brown, nondescript, blocklike structures—not anything like Nightingale, once the most famous hospital designer in the world, would have had it. Or, rather, did have it. Her friend, Queen Victoria, laid the first stone and Florence Nightingale contributed to the design and relocation of the St. Thomas’ Hospital of the mid-1800s, with the intention of applying best practices she had brought back from the Crimean War as well as her own research and statistics. 

Nightingale was much sought after as a master designer of hospitals; architects, physicians, and royalty from around the world asked her advice. And here was supposed to be her masterpiece . . . but her version of St. Thomas’ is just about gone.

Physical, spiritual, mental health needs. Nightingale envisioned the relocated and rebuilt St. Thomas’ as a beautiful series of pavilions where different patients with different ailments lay. She connected the pavilions with corridors so that it was one massive, beautiful structure. She knew that big windows would provide light and cross-ventilation for patients, and that wards would be open with all nurses watching over all patients, so there would be no “that’s not my patient” nonsense. She called for porches on the fronts of all pavilions so all patients who were able could convalesce looking at the river. She designed reading rooms and chapels to take the patients’ minds off of their sickness. 

Nightingale always had physical, spiritual, and mental health needs in mind when designing her hospitals. She believed that bad design in hospitals could undermine the best nursing and medical care. 

Why don’t we learn? So here we are, in the 21st century, still making those claims, with some listening and some not. Why isn’t everyone listening? I did see remnants of Nightingale’s once-renowned version of St. Thomas’, now stripped of the patients who deserved to be there and deserved to be cared for in the way she hoped. I looked through the windows of a standing pavilion, now attached to the ugly brown structure, and saw men sitting at desks piled high with papers and single computers. I asked who had the privilege of sitting in that hallowed ground. The guide said it was the accounting department. I (inwardly) snarled at every last one of them and left hoping they would truly understand where they were sitting. I am not sure they did.

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