Battle to keep a light burning for modern nursing

FLORENCE NIGHTINGALE – the lady with the lamp – stands as one of the most iconic symbols of nursing worldwide. On International Nursing Day, the image of her tending to the needs of soldiers during the Crimean war epitomises what many feel ‘real’ nursing is about.

The art of nursing expressed through the caring role, often set in contrast to the scientific endeavours of medicine – with its focus on cure and treatment – elevates nurses and the work we do to a special place in the hearts and minds of the public.

Ours is the profession which is there by the bedside, supporting, encouraging and caring for people at their worst times.

At the same time, this image of nursing restricts and constrains what many see as the boundaries of our work. In the shadow of the lamp is the history of nursing as a scientific, inventive and brave profession.

Nursing did not start in the clinical, organised walls of a hospital – instead some of the very first nurses in England were the Female Sanitary Inspectors and lady visitors of the 18th century. These women worked in the most squalid and poorest areas of the cities, advising families on everything from cleanliness, sanitation and care of children to providing social support and welfare advice. They would document the living situation of the disadvantaged who lived in areas where doctors could not (or would not) visit, and provided evidence of how the other half lived in Victorian England.

It is thanks to the scientific evidence provided by these women that we are able to see how being poor had an impact on health and reinforces how attempts to reduce inequalities, alongside care, was embedded in nursing from its inception.

Florence Nightingale herself was more than just an excellent nurse. She was a social reformer and skilled statistician who developed theories which challenged the beliefs that only the unfortunate suffered illness and identified that infection and poor practice were often the key factors in death at the time.

She used her statistical knowledge to prove her points and developed hospital administration systems we still use today. Her challenge to the establishment was political as well as professional, lobbying to ensure that care was provided to all the sick, irrespective of religion, and not simply to those who were members of the Church of England.

At the same time as Nightingale was challenging the British establishment and her compatriot, a black nurse named Mary Seacole was challenging society’s understanding of race, ability and equality by providing nursing care on the battlefields of Crimea.

Much has been written about the relationship between these two formidable nurses – what must also be recognised is the silence about their impact as women in a gender-biased health system.

As we move forward to the 21st century, nurses are plagued and challenged to ‘prove’ their caring nature exists. Degree-level qualification has been the basic expectation in Australia, USA and other countries outside the UK, yet was proclaimed here to be the ‘end of caring in nursing’ by the public and private sectors.

The failures exposed by the Mid Staffs inquiry and others somehow became synonymous with the demise of caring in nursing, and the profession was blamed for moving away from the ‘essence’ of its work.

But the challenges we face in the 21st century require nurses to fully explore the art, science and political aspects of our profession. Health, like life, is globally shared and solutions to issues such as increasing frailty, the healthcare burden and shortage of qualified professionals must be similarly viewed.

Nurses and midwives are ideally placed to lead and engage in the political as well as clinical strategic discussions needed to improve health and wellbeing.

The recent All-Party Parliamentary Group on global health, chaired by Lord Nigel Crisp, identified the need to harness and develop nursing political leadership if we are going to achieve global health. Only through this universal profession can we ever hope to improve health, promote gender equality and support economic growth on a global scale.

Utilising the contribution of nurses and midwives outside the ‘caring’ role may be challenging, not just for nursing, but for the general public and the wider healthcare profession. But history tells us that it’s something we must do if we truly wish to improve the health and life of the population.

Stepping out and being judged for our contribution beyond the shadow of the lamp is a responsibility as well as a right for my profession. Our unease with nurses as a politically informed, scientifically-driven profession is misplaced. The apolitical ‘caring’ platform that we believe nursing is built on is, in fact, set on sand, not concrete.