Deep as was the desire of Miss Nightingale to institute plans for the
training of hospital nurses, her health, after her return from the
army service, was so impaired, that to undertake the task herself was
impossible. The fund of $250,000 had been placed in charge of a board
of trustees and invested for the purpose of establishing a school of
which she expected to be the superintendent. Her health, however,
grew worse rather than better, and after two years had passed, she
wrote to the Chairman of the Council of the Nightingale Fund, of her
inability to carry out the plans. It became necessary to find other
persons through whom she might work, without having to carry the
everyday details. Her choice fell on St. Thomas’ Hospital--largely
because “the matron of the hospital, Mrs. Wardroper, was a woman
after Miss Nightingale’s own heart, strong, devoted to her work,
devoid of all self-seeking, full of decision and administrative
ability.” Of this remarkable woman, Mrs. Wardroper, who for
twenty-seven years was superintendent of the Nightingale School, Miss
Nightingale has left a character sketch:
[A]“I saw her,” she says, “first, in October, 1854, when the
expedition of nurses was sent to the Crimean war. She had been then
nine months matron of the great hospital in London, of which for
33 years, she remained head, and reformer of nursing. Training was
then unknown; the only nurse worthy of the name that could be given
to the expedition was a ‘Sister’ who had been pensioned some time
before and who proved invaluable. I saw her next after the conclusion
of the war. She had already made her mark; she had weeded out the
inefficient, morally and technically; she had obtained better women
as nurses; she had put her finger on some of the most flagrant blots,
such as the night nursing, and where she laid her finger, the blot
was diminished as far as possible, but no training had yet been
thought of.
“Her power of organization, her courage and discrimination in
character, were alike remarkable. She was straightforward, true,
upright. She was decided. Her judgment of character came by
intuition, at a flash, not by much weighing and consideration. Yet
she rarely made a mistake, and she would take the greatest pains in
her written delineations of character required for record, writing
them again and again in order to be perfectly just. She was free from
self-consciousness; nothing artificial about her. She did nothing,
and abstained from nothing because she was being looked at. Her whole
heart and mind were in the work she had undertaken.
“She was left a widow at 42 with a young family. She had never had
any training in hospital life for there was none to be had. Her force
of character was extraordinary. Her word was law. * * * She knew
what she wanted and did it. She was a strict disciplinarian; very
kind, often affectionate rather than loving. * * * She was a thorough
gentle-woman, nothing mean or low about her; magnanimous and generous
rather than courteous. All this was done quietly. She had a hard life
but never proclaimed it. What she did was done silently.”
[A] British Medical Journal, Dec. 31. 1892.
Such was Miss Nightingale’s estimate of the first superintendent of
a training school for nurses organized according to her own ideas.
Mrs. Wardroper retired in 1887 and died in 1892. The plans for the
training school were of Miss Nightingale’s making--the carrying
of them out devolved almost wholly on Mrs. Wardroper, and on the
Resident Medical Officer of the hospital, R. G. Whitfield.
There were two essential principles to the plan: The nurses were to
have their technical training in hospitals specially organized for
the purpose. They should live in a home fit to form their moral life
and discipline. Plans for lectures were carefully made and carried
out, and a “Monthly Sheet of Personal Character and Acquirements”
of each nurse was arranged by Miss Nightingale herself, for the
Matron to fill in. The character record was to be noted under five
heads: punctuality, quietness, trustworthiness, personal neatness and
cleanliness, and ward management.
The records in regard to nursing technique were made out on forms
carefully prepared by Miss Nightingale under numerous headings, with
copious subheadings. At her request, the Resident Medical Officer
prepared a form of General Directions which were to aid the nurses in
taking notes of the medical and surgical cases in the hospitals.
The school opened June 24th, 1860. The course of training was to
extend over one year. The writer has in her possession a copy of
the first set of “Rules and Regulations for Probationers Under the
Nightingale Fund”--and they bear a close resemblance to regulations
in force today. She laid foundations which have stood the test of
time.
In the first report of the Committee in charge of the training
school, one finds the details of the qualifications expected, set
forth as follows, with the added statement that all important details
for the working of the plan have been suggested by Miss Nightingale,
or submitted to her for approval:
“DUTIES OF PROBATIONERS UNDER THE
NIGHTINGALE FUND.”
You are required to be
Sober
Honest
Truthful
Punctual
Quiet and Orderly
Cleanly and Neat.
You are expected to become skilful in--
1. In the dressing of blisters, burns, sores, wounds, and in applying
fomentations, poultices, and minor dressings.
2. In the application of leeches, externally and internally.
3. In the administration of enemas for men and women.
4. In the management of trusses and appliances in uterine complaints.
5. In the best method of friction to the body and extremities.
6. In the management of helpless patients, i.e., moving, changing,
personal cleanliness, of feeding, keeping warm (or cool), preventing
and dressing bedsores, managing position of.
7. In bandaging, making bandages and rollers, lining of splints, etc.
8. In making the beds of patients, and removal of sheets whilst
patient is in bed.
9. You are required to attend at operations.
10. To be competent to cook gruel, arrowroot, eggflip, puddings,
drinks for the sick.
11. To understand ventilation, or keeping the ward fresh by night
as well as by day; you are to be careful that great cleanliness is
observed in all the utensils; those used for the secretions as well
as those required for cooking.
12. To make strict observation of the sick in the following
particulars:
The state of secretions, expectorations, pulse, skin, appetite;
intelligence, as delirium or stupor; breathing, sleep, state of
wounds, eruptions, formation of matter; effect of diet or of
stimulants, and of medicine.
13. And to learn the management of convalescents.
IDEALS OF TRAINING.
Her ideals of training, what she hoped training might accomplish,
are embodied, in part at least, in the following quotations from her
writings at a later period.
What is training? Training is to teach the nurse to help the patient
to live. Nursing the sick is an art and an art requiring an organized
practical and scientific training; for nursing is the skilled servant
of medicine, surgery and hygiene. A good nurse of twenty years ago
had not to do the twentieth part of what she is required by her
physician or surgeon to do now; and so after the year’s training she
must be still training under instruction in her first and even second
year’s hospital service. The physician prescribes for supplying the
vital force, but the nurse supplies it.
Training is to teach the nurse how God makes health and how He makes
disease.
Training is to teach a nurse to know her business, that is to observe
exactly in such stupendous issues as life and death, health and
disease.
Training has to make her not servile, but loyal to medical orders and
without the independent sense or energy of responsibility which alone
secures real trustworthiness.
Training is to teach the nurse how to handle the agencies within
our control which restore health and life, in strict intelligent
obedience to the physician’s or surgeon’s power and knowledge, how to
keep the health mechanism prescribed to her in gear.
Training must show her how the effects on life of nursing may be
calculated with nice precision, such care or carelessness, such a
sick rate, such a duration of case, such a death rate.
In 1871, St. Thomas’ Hospital removed to the large new buildings
in its present location near the Houses of Parliament, London,
and with the occupation of the new building, the number of nurses
and probationers in the Nightingale School greatly increased. New
problems in management were created and Miss Nightingale feared that
her high ideals for the nurses were not being realized as fully
as she desired. Her health having improved, she determined on a
closer supervision of the school, by herself. One result of this
supervision, as she herself afterward stated, was that “the training
school became a Home--a place of moral, religious and practical
training--a place of training character, habits, and intelligence,
as well as of acquiring knowledge.” She knew as much, probably, as
any hospital superintendent knows today, of the problem of securing
the right kind of young women to be trained, and she was fully
convinced that a good nurse must be first of all a good woman. When
applications came to her from smaller cities and towns for trained
nurses to take charge of the nursing, she was accustomed to reply,
“Have you sent me any probationers? I can’t stamp material out of the
ground.”
Her character sketches, as preserved among her papers, of some of
the probationers she had to deal with in those days, show her keen
insight into human nature. “Miss A. Tittupy, flippant, pretension-y,
veil down, ambitious, clever, not much feeling, talk-y, underbred,
no religion, may be persevering from ambition to excel but takes the
thing up as an adventure.” “Nurse B. A good little thing, spirited,
too much friends with G., shares in her flirtations.” “Miss X. More
cleverness than judgment, more activity than order, more hard sense
than feeling, never any high view of her calling, always thinking
more of appearances than of the truth, more flippant than witty,
more petulance than vigor.” These are typical of her notes written
after personal conversation with different probationers. The great
necessity of some such notes is shown in the enormous demand that
had been created for trained nurses for other hospitals--to fill
responsible positions where they would have the choosing and training
of other nurses. These demands came to her unceasingly in the earlier
years of trained nursing.
Through her influence an assistant superintendent of the Nightingale
training school had been appointed to whom was given the title of
Home Sister. The duties of the Home Sister were varied, but among
other things she was expected to supplement the lectures and bedside
teaching and demonstration by regular classes. She was also to
“encourage general reading, to arrange Bible classes, to give wider
interests to the nurses,” in order, as Miss Nightingale said, to keep
them above the mere scramble for a remunerative place. She regarded
the influence of the Home Sister on the moral and spiritual side of
the school as more important than her technical instruction.
It is stated that the besetting sin of the Nightingale Nurses in
those earlier days was self-sufficiency. “They knew,” says a writer,
“that their training school was the first of its kind, and they were
apt to give themselves airs.” This tendency in them was vigorously
combated by Miss Nightingale. The picking and choosing of places or
cases in order to select the one which afforded the prospects of an
easy time, she especially condemned.
“Our brains are pretty nearly useless,” she said, in one of her
annual addresses to the nurses, “if we only think of what we want and
should like ourselves; and not of what posts are wanting _us_, or
what our posts are wanting _in_ us. What would you think of a soldier
who, if he were put on duty in the honorable post of difficulty,
as sentry, may be, in the face of the enemy (and we nurses are
always in the face of the enemy, always in the life and death of our
patients)--were to answer his commanding officer, ‘No, he had rather
mount guard at the barracks or study musketry;’ or if he had to go as
pioneer, or on a forlorn hope, were to say, ‘no that don’t suit my
turn’.”
It was her custom for some years to issue an annual address to the
nurses of the Nightingale School, and for many years the authorities
of the school insisted on every probationer studying the first of
these addresses, issued in 1872, the year in which she began her
closer supervision of the details of training. In these addresses
she dwelt strongly on the ideals of nursing she had from the
beginning--that it requires a strong sense of vocation or a special
call; that it needs a religious basis; that it is an art; that there
must be constant progress or stagnation; that the nurse should be
extremely careful of her moral influence. She had no use for the
woman who thought she was making a sacrifice in taking up nursing;
nor for the woman who thought any kind of service which had to do
with nursing was beneath her--neither had she any patience with the
sentimental “ministering angel” type of nurse. “If we have not true
religious feeling and purpose,” she said in one of her addresses,
“hospital life, the highest of all things _with_ these becomes
_without_ them, a mere routine and bustle and a very hardening
routine and bustle.”
No one who studies Miss Nightingale’s life and ideals can be left
in doubt, that, in her mind, in the choice of nurses, the first and
greatest thing to be considered was the character of the applicant.
She did not undervalue education but she believed that the spirit of
the woman was of supreme importance.
It is absolutely certain that it was not her medical or surgical
knowledge, (though this was in advance of the times) that accounted
for the remarkable and enduring influence which she exerted, _and
is still exerting_--even though we may seem to have shifted the
emphasis from some things which to her were of tremendous importance,
and placed it on other things which, to her mind, were of secondary
consideration. It is an interesting exercise to analyze the varying
qualities in her great and beautiful life which still exerts its
influence on countless other lives. But after all, the secret of her
success must be summed up in that combination of qualities, that
subtle something which we call Personality. Her studious avoidance
of honors of all kinds, her purity of motive, the absolute lack of
self-seeking, of honor, prestige or profit for herself, her courage,
tact and quiet perseverance are qualities on which nurses of the
twentieth century may wisely meditate. Nothing is more needed among
nurses today, than that her spirit, her ideals of life and character,
may be perpetuated. Few of us can render any greater service to our
generation than to exert ourselves to keep her spirit alive in the
nursing profession.
Author’s note.--For many of the facts, which form the foundation
of this sketch, the author is indebted to the authorized biography
entitled “The Life of Florence Nightingale,” by Sir Edward Cook,
published in two volumes by the McMillan Co., 1913. Quotations have
been made from clippings, in several instances, in which the name
of the journal in which they first appeared has been lost. Grateful
acknowledgment is hereby made for all such unknown sources of aid
used in preparing these biographical notes.
Transcriber’s Note:
Words may have inconsistent hyphenation in the text. These have been
left unchanged, as were obsolete and alternative spellings. The book
uses spaced asterisks as ellipses.
Words and phrases in italics are surrounded by underscores, _like
this_. One footnote was moved to the end of the related citation.
Printing errors, such as partially printed letters and punctuation,
were corrected. Final stops missing at the ends of sentences and
abbreviations were added.
The following items were changed:
“witnesseses” to “witnesses,” ... shame other witnesses.
“nuse’s” to “nurse’s” ... which a nurse’s attention...