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• Before the 1800s, there was no official training for nurses - they learned from family or other nurses. Nursing often relied on natural treatments.
• In the 1800s, attitudes to nursing changed and it began to be considered a profession. Official training and nursing colleges were set up.
• Florence Nightingale nursed soldiers during the Crimean War and made a lasting impact on the nursing profession.

Florence Nightingale was born in 1820. She was named after the Italian city Florence, where she was born.

She grew up in England in a wealthy family. Her family’s wealth and her parents’ attitude to girls’ education meant that she and her sister were well educated - which was unusual for the time. She studied a variety of subjects, including history, mathematics, languages and literature.

Nightingale wished to become a nurse but her family disapproved. At the time it was rare for wealthy women to work, especially in a job that was widely thought to be for people in a lower social class. There was also an expectation, within society, that wealthy women should get married and have children.

At the time most nurses received no formal training but Nightingale did receive some training. In 1844 when she enrolled as a nursing student in a hospital in Germany. After this, Nightingale returned to England. She took a nursing job in a hospital, where she worked to improve the unsanitary conditions.

In 1853, while Florence Nightingale was working in a hospital on Harley Street in London, a journalist from The Times newspaper, William Howard Russell, wrote reports about conditions the soldiers faced during the Crimean War.

He wrote, ‘there is no attention paid to decency or cleanliness, the smell is appalling.’

In another report he said, ‘Are there no devoted women among us, able and willing to go forth and minister to the sick and suffering soldiers of the East in the hospitals at Scutari?’

Reports like these may have persuaded Nightingale to travel to Crimea to help wounded soldiers.

In November 1854, Florence Nightingale arrived in Scutari on the Black Sea, which is in modern-day Turkey. She arrived with a group of 38 nurses from England ready to help the British soldiers who were fighting in Crimea. Britain was at war with Russia for control of the Ottoman Empire in a conflict that lasted from 1853 - 1856. This conflict was called the Crimean War.

Some historians believe Nightingale was personally asked to go to improve nursing for the wounded soldiers by the Secretary of State for War at the time, Sidney Herbert. Nightingale had been friends with Herbert for several years. Nursing wasn’t a highly regarded career in the early 1800s:

• Pay in hospitals was low. For example, in Manchester, wages received by workers in cotton mills were higher than those paid to nurses.
• Many nurses were illiterate.
• Nurses who worked in workhouses often had no training and were not paid.

Nightingale wrote to Herbert from Crimea saying she wanted more trained nurses to be sent to help her, and not people who lacked the professionalism of the original team she had brought with her.

When Nightingale and her nurses arrived at the hospital in Scutari, they found:

• Staff who were tired from working long hours and therefore not able to care for patients properly
• Not an adequate number of nurses to treat the wounded soldiers
• A shortage of beds
• Unclean and unhygienic conditions in which to treat patients
• A lack of medicines to treat soldiers’ wounds
• Poor sanitation. The Scutari hospital was built over poorly maintained sewers. This meant raw sewage leaked into the hospital.

Also, the conditions in which the soldiers lay were making their injuries worse. Nightingale found that wounds were exposed, with no adequate dressings to prevent infection. There were accounts of flies landing on wounds. It was noted that bed sheets and other surfaces had lice and maggots on them. Diseases like typhus and cholera were widespread in the hospital.

In 1855, the British government ordered a report to be produced on the conditions wounded soldiers faced in the Crimean war.

The report highlighted several other problems, including:

• surgeons having too many patients
• poor quality food being served
• staff were being asked to take on too many different roles
• too many staff were unqualified for the medical roles they were carrying out

Nightingale knew this was not an environment in which to nurse people back to health. She focused on cleanliness and hygiene, directing her nurses to scrub and clean the hospital. She insisted that soldiers have clean sheetsthat were changed regularly and that they lay on beds, not on the floor.

Nightingale would walk the hospital at night, checking on the soldiers and offering them comfort and care. This earned her the nickname ‘The Lady with the Lamp’ following a newspaper report in The Times that said,

When all the medical officers have retired for the night, and silence and darkness have settled down upon these miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.

Florence Nightingale's use of statistics

Florence Nightingale also devised a way to record and compare information on casualties and the impact of poor hospital conditions. This was called a rose diagram and is similar to a pie chart. This method has since been used by other statisticians to compare data.

Historians have debated how much of the reduction in mortality rates in the Crimean war was down to her measures. A different interpretation is that the improvements in clean water supply and cleaning out of sewers played a more important role in improving survival rates.

Nightingale was a well-known figure for her role during the Crimean War. Queen Victoria exchanged letters with her, and newspapers reported on her work. She was a high-profile figure in a prominent position who could bring about significant long-term change to the status of the nursing profession when she returned to Britain.

When Florence Nightingale came back from the Crimean War, she wanted to improve the standards of British hospitals. She wanted to make nursing consistent, more professional and ensure that high standards of care were met. Nightingale set out her ideas in a book called Notes on Nursing. This is seen by many historians as setting out some of the key principles in developing the nursing profession.

In 1860, Nightingale set up a nursing training school at St Thomas’ Hospital in London. Trainee nurses were taught the methods and ideas Nightingale had introduced in Crimea. This was significant in raising the status and professionalism of nursing.

British hospitals were still facing problems, such as patients dying from infections because doctors were not properly washing their hands or equipment. Patients were catching diseases on wards due to a lack of hygiene.

By the time Nightingale died in 1910, there were over 60,000 properly trained nurses in Britain. Nursing became a highly skilled and well-respected profession.

Florence Nightingale died in 1910, aged 90. Her life and work has been remembered in several ways.

• The nursing school at St Thomas’ Hospital, was named after her, and it is now part of Kings College, London.
• A statue of Nightingale was installed in central London in 1915.
• Seven Nightingale hospitals were set up and named after her during the Covid-19 pandemic to cope with increased patient numbers in the NHS.
• When people in the United States of America qualify as nurses they take the Nightingale Pledge.