chapter 15 | Nursing Yesterday and Today 241she was described as a “sensitive, introspective, and
somewhat morbid child” (Schuyler, 1992). She was
driven to improve herself and the world around her.
When she expressed an interest in becoming a
nurse, her parents objected strenuously. They
wanted her to assume the traditional role of a
well-to-do woman of the time: marry, have chil-
dren, and take her “rightful” place in society.
Becoming a Nurse
In the fall of 1847, Nightingale left England for a
tour of Europe with family friends. In Italy, she
entered a convent for a retreat. After this retreat,
she believed that she had been called by God to
help others and became more determined than ever
to pursue nursing.
In 1851, Nightingale insisted on going to
Kaiserswerth, Germany, to obtain training in nurs-
ing. Her family gave her permission on the condi-
tion that no one would know where she was. When
she returned from Kaiserswerth, she began to work
on her plan to influence health care.
Nightingale soon left for France to work with
several Catholic nursing sisters. While in France,
she received an offer from the committee that reg-
ulated the Establishment for Gentlewomen
During Illness, a nursing home in London for
governesses who became ill. She was appointed
superintendent of the home and soon had it well
organized, although she did have some difficulties
with the committee.
Because of her knowledge of hospitals,
Nightingale was often consulted by social reform-
ers and by physicians who also recognized the need
for this new type of nurse. She was offered a posi-
tion as superintendent of nurses at King’s College
Hospital, but her family objected so strongly that
she remained at home until she went to Crimea.
The Need for Reform
Fortunately for Nightingale, it was fashionable to
become involved in the reform of medical and social
institutions in the middle of the 19th century. After
completing the reorganization of the nursing home,
she began visiting hospitals and collecting informa-
tion about nurses’ working conditions. She began to
realize that, to improve nurses’ working conditions,
she would first have to improve the nurses.
Up to this time, the guiding principle of nursing
had been charity. Nursing services in Europe were
provided primarily by the family or by members of
religious orders. However, Catholic organizations
experienced a decline during the Reformation
when the government closed churches and monas-
teries. Hospitals were no longer run for charitable
reasons but as a social necessity. Nursing lost its
social standing when the religious orders declined
and became a form of domestic service. Nurses
were no longer recruited from “respectable” classes
but from the lower classes of society, women who
needed to earn their keep. Other women who could
no longer earn a living by gambling or selling
themselves also turned to nursing. Many had crim-
inal backgrounds. They lacked the spirit of self-
sacrifice found in the religious orders. They often
abused clients and consoled themselves with alco-
hol and snuff.
The duties of a nurse in those days were to take
care of the physical needs of clients and to make
sure they were reasonably clean. The conditions in
which they had to accomplish these tasks were far
from ideal. Hospitals were dirty and unventilated.
They were contaminated and spread diseases
instead of preventing them. The same bedsheets
were used for several clients. The nurses dealt
with people suffering from unrelenting pain, hem-
orrhage, infections, and gangrene (Kalisch &
Kalisch, 2004).
To accomplish the needed reforms, Nightingale
realized that she had to recruit nurses from higher
strata of society, as had been done in the past, and
then educate them well. She concluded that this
could be accomplished only by organizing a school
to prepare reliable, qualified nurses.The Crimean War
A letter written by war correspondent W.H.
Russell comparing the nursing care in the British
army unfavorably with that given to the French
army created a tremendous stir in England. There
was demand for change. In response, the Secretary
of War, Sir Sidney Herbert, commissioned
Nightingale to go to Crimea (a peninsula in
southeastern Ukraine) to investigate conditions
there and make improvements.
On October 21, 1854, Nightingale left for
Crimea with a group of nurses on the steamer Vectis
(Griffith & Griffith, 1965). They found a disaster
when they arrived. The hospital that had been built
to accommodate 1700 soldiers was filled with more
than 3000 wounded and critically ill men. There
was no plumbing, no sewage disposal facilities.