242 unit 3 | Professional Issues
Mattresses, walls, and floors were soaked with
human waste. Rats, lice, and maggots thrived in
this filthy environment (Kalisch & Kalisch, 2004).
The nurses went to work. They set up a kitchen,
rented a house and converted it into a laundry, and
hired soldiers’ wives to do the laundry. Money was
difficult to obtain, so Nightingale used the Times
relief fund and her own personal funds to purchase
medical supplies, food, and equipment. After the
hospital had been cleaned and organized, she began
to set up social services for the soldiers.
Nightingale rarely slept. She spent hours giving
nursing care, wrote letters to families, prepared
requests for more supplies, and reported to London
on the conditions she had found and improved.
At night, she made rounds accompanied by an
11-year-old boy who held her lamp when she sat by
a dying soldier or assisted during emergency sur-
gery. This is how she earned the title “The Lady
with the Lamp” from the poet Longfellow (1868).
The physicians and army officers resented the
nurses despite their strenuous efforts and enormous
accomplishments. They regarded the nurses as
intruders who interfered with their work and
undermined their authority. There was also some
conflict between Nightingale and Dr. John Hall,
the chief of the medical staff. At one time, after
Dr. Hall had been awarded the Knight
Commander of the Order of the Bath, Nightingale
sarcastically referred to him as “Dr. Hall, K.C.B.,
Knight of the Crimean Burial Grounds.” When
Nightingale contracted Crimean fever, Hall used
this as an excuse to send her back to England.
However, Nightingale thwarted his resistance and
eventually won over the medical staff by creating an
operating room and supplying the instruments
with her own resources. Although she returned to
duty, she never fully recovered from the fever. She
returned to England in 1865 a national heroine but
remained a semi-invalid for the rest of her life.
A School for Nurses
After her return from Crimea, Nightingale pursued
two goals: reform of military health care and estab-
lishment of an official training school for nurses.
The British public contributed more than
$220,000 (a great sum of money at that time) to
the Nightingale Fund for the purpose of establish-
ing the school.
Although opposed by most of the physicians in
Britain, the Nightingale Training School for
Nurses opened in 1860. The school was an inde-
pendent educational institution financed by the
Nightingale Fund. Fifteen probationers were
admitted to the first class. Their training lasted a
year. Although Nightingale was not an instructor at
the school, she was consulted about all of the
details of student selection, instruction, and organ-
ization. The basic principles on which the
Nightingale school was founded are the following:
1.Nurses should be trained technically in schools
organized for that purpose.
2.Nurses should come from homes that are of
good moral standing.
Her book,Notes on Nursing: What It Is and What
It Is Not,established the fundamental principles
of nursing. The following is an example of her
writing:
On What Nursing Ought To Do
I use the word nursing for want of a better. It has
been limited to signify little more than the admin-
istration of medicines and the application of poul-
tices. It ought to signify the proper use of air, light,
warmth, cleanliness, quiet and the proper selection
and administration of diet—all at the least expense
of vital power to the patient” (Nightingale, 1859).
This book was one of the first nursing textbooks
and is still widely quoted. Many nursing theorists
have used Nightingale’s thoughts as a basis for con-
structing their view of nursing.
Nightingale believed that schools of nursing
must be independent institutions and that women
who were selected to attend the schools should be
from the higher levels of society. Many of
Nightingale’s beliefs about nursing education are
still applicable, particularly those involved with the
progress of students, the use of diaries kept by stu-
dents, and the need for integrating theory into
clinical practice (Roberts, 1937).
The Nightingale school served as a model for
nursing education. Its graduates were sought world-
wide. Many of them established schools and
became matrons (superintendents) in hospitals in
other parts of England, the British Commonwealth,
and the United States. However, very few schools
were able to remain financially independent of the
hospitals and so lost much of their autonomy. This
was in contradiction to Nightingale’s philosophy
that the training schools were educational institu-
tions, not part of any service agency.