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Leadership Lessons from Florence Nightingale

“Florence Nightingale Receiving the Wounded at Scutari” a painting by Jerry Barrett (who was at the Scutari Barrack Hospital – that’s him looking out the window) completed in 1858, just two years after the end of the Crimean War

National Nurses Week is a wonderful time to reflect upon the life and work of the woman who more than anyone else can be credited with starting it all. While she is widely remembered as The Lady with the Lamp who more than any other person defined what it means to be a nurse and established nursing as a legitimate profession, Nightingale was also the first professional hospital administrator who did more to define that role than any other.

She was also in a very real sense the architect of the modern hospital. With the exception of high-tech medicine that has evolved over the past half century, virtually every department in today’s hospitals can trace its roots back to innovations first introduced by Florence Nightingale. Today I’ll share seven lessons from the work of Florence Nightingale – lessons that she herself would more likely have described as calls to action.

Lesson 1 – Mission

Florence Nightingale something more than just a job to do – she was on a mission. She did not inquire about pay and benefits before leading her team of young nurses off to the Crimea, and endured working conditions that would be considered intolerable in today’s world. Yet she never experienced “burnout,” and through devotion to her calling she changed the world of healthcare forever.

Some of the problems in today’s healthcare system stem from the fact that too many hospitals focus more on their business plans rather than on their missions, and too many healthcare professionals have jobs rather than a calling. Nightingale would encourage a re-commitment to the things that really matter, those things that hopefully attracted our idealistic younger selves into healthcare in the first place.

Lesson 2 – Courage

Nightingale was courageous and she was unstoppable. She did not allow opposition from the British aristocracy or the antiquated views of military leaders to prevent her from doing her work. When she ran into a brick wall, she found a way around or over, even to the extent of going directly to the English public for funding support and to the Queen for political backing.

The most important three words in my book are “Proceed Until Apprehended” because that was Nightingale’s attitude about getting things done. And in most cases you will find, as she did, that if you proceed fast enough, by the time anyone tries to apprehend you, you’ve already accomplished what you set out to do

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Lesson 3 – Discipline

Less well-known than Nightingale’s contributions to hospital and nursing practice was her pioneering work in the field of medical statistics. Her painstaking efforts to chart infection and death rates among soldiers at Scutari gave weight to her demands for improved sanitary conditions first at military hospitals, and later in civilian institutions. She demonstrated that if you want to be effective, it’s not enough to know that you’re right – you must be able to demonstrate that you’re right with the facts.

Lesson 4 – Empathy

Long before Daniel Goleman coined the phrase “social radar” in his book Emotional Intelligence, Nightingale appreciated that awareness and empathy are central to quality patient care (and to effective leadership). In Notes on Nursing she wrote: “The most important practical lesson that can be given to nurses is to teach them what to observe – how to observe… If you cannot get the habit of observation one way or another you had better give up being a nurse, for it is not your calling, however kind and anxious you may be.”

In today’s fast-paced healthcare environment, it’s important that caregivers stop for a moment outside each patient’s doorway for a quick mental reminder to really be in that room with the patient, and not mentally off on the next chore. And in the same way, it’s important for managers to apply the “social radar” principle when interacting with the people for whom they are responsible.

Lesson 5 – Respect

Nightingale cared passionately about the nurses under her wing and the soldiers under her care. As one example, she was adamant that in her hospital triage would be performed on the basis of the patient’s medical condition and not his rank in the military, social standing, or religion – a precept that was quite radical in Victorian England. Many of the specific techniques in her ground-breaking work Notes on Nursing are now outdated, but her absolute commitment to patient dignity and a spirit of mutual respect in the workplace still rings out with crystal clarity.

One thing is certain: she would never have tolerated, much less condoned, the gossip and the complaining that is so prevalent in hospital hallways today. In one of the many letters she wrote to newly graduated nurses from the Nightingale School of Nursing Florence wrote:

“Prying into one another’s concerns, acting behind another’s back, backbiting, misrepresentation, bad temper, bad thoughts, murmuring, complaining. Do we ever think of how we bear the responsibility for all the harm that we cause in this way?”

Lesson 6 – Encouragement

In her quiet and dignified manner, Nightingale was a cheerleader devoted to encouraging qualified young women to enter her profession – even though the work was hard and the pay was low. One suspects that she would have had harsh words indeed for doctors and nurses of our era who are telling the next generation to stay out of healthcare because they themselves are working too hard, not making enough money, and not having enough fun.

Lesson 7 – Aspiration

Nightingale never rested on her laurels, but rather continuously raised the bar. After proving that a more professional approach to nursing care would improve clinical outcomes, she helped found the first visiting nurses association, chartered the first modern school of professional nursing, created a blueprint for the modern hospital, and through her writing helped establish professional standards for hospital management. She remained active virtually until the end of her life at the age of 90. Her commitment to never-ending improvement shines like a lamp across more than a century, inspiring us to work our way through the challenges of today and never lose sight of the better world we need to create for tomorrow.

A concluding thought

Charles Dickens was a contemporary of Florence Nightingale; the opening line he penned for his classic novel A Tale of Two Cities certainly applies to our world today – it is the best of times, it is the worst of times. Were she alive in our era, Nightingale no doubt would have focused on the best-of-times side of the ledger, and implored us to remember that we can transcend every obstacle, that we can create a better world, if we confront the challenges with courage and determination and refuse to make excuses or to quit trying.

For More on the Nightingale Legacy

This slide show summarizes the legacy of Florence Nightingale, the Lady with the Lamp, who not only established nursing as a bona fide profession but was also in a very real sense the architect of the modern hospital.  Then it profiles the most important lessons that can be learned from her leadership, in her own words and in the words of those who have written about her.  Finally it invites today’s healthcare leaders to take The Florence Challenge for a culture that is Emotionally Positive, Self Empowered, and Fully Engaged.

Learn more about how to respark the Spirit of Florence in your organization at this website:

The Florence Challenge

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