Few figures in nursing, and in health care itself, are as iconic and esteemed as Florence Nightingale. Her groundbreaking work and relentless efforts to reform nursing remain powerful influences today, even as she combated the bias against women assuming leadership roles in the 19th century. In fact, it may be argued that Nightingale’s entire personal history was at odds with her commitment to reforming patient care and affirming the crucial role of the nurse. Born in 1820, and into a British family of wealth and social stature, Nightingale was fully expected by her family to conform to the Victorian ideal of the well-bred woman. As a girl, she studied piano and drawing, and there was the understanding that, in time, a suitable marriage would enable her to take her place in English society (Cromwell, 2013, pp. 13-14). Nonetheless, and at an early age, Nightingale exhibited intense interests in concerns very much removed from those of the typical, Victorian young lady of means.
Ironically, her mother’s influence set the stage for the concerns of Nightingale which would later distress her parents. Fanny Nightingale, in keeping with a gentlewoman’s role, would visit the poor on the family estates, and young Florence became deeply concerned with alleviating their misery. Equally importantly, Florence began engaging as a child in what would become her hallmark of her care: methodology and study. At the age of eight, for example, she tabulated precisely how many grains of James’ Powder, an all-purpose remedy of the day, were appropriate for different age groups (Cromwell, p. 15). As a young woman, Nightingale’s calling took her to London, where she defiantly addressed the needs of the neglected poor and of prostitutes. Her most impactful affiliations were her position as Superintendent of the Institute for the Care of Sick Gentlewomen in London, for which Nightingale was not paid, and her legendary role in the Crimean War, beginning in 1854 (Godden, Helmstadter, 2013, p. 80). As will be seen, it is difficult to appreciate, even today, how Nightingale’s commitment to improving conditions and care of the wounded and ill had immense consequences, and essentially created the identity of the modern nurse.
Leadership
When the realities of Nightingale’s leadership style are examined, it becomes difficult to categorize it in terms of modern theory. This is largely due to Nightingale’s own understanding of the limitations placed on women in the era, and how such a woman was potentially more impactful by not overtly assuming a leadership role at all. For example, and upon her return to England after the Crimean War, Nightingale had no organization under her authority, nor did she ever make public appearances or speeches.
Instead, her leadership functioned in a “behind the scenes” manner; she did not hesitate to appeal to more prominent officials capable of instituting needed change and, despite holding no public position, she revolutionized health care delivery in the British military and at home (Roussel, Swansburg, & Swansburg, 2006, p. 165). Persistence on Nightingale’s part, as well as a diligent and exhaustive recording of facts, led to Parliament’s passing of the Metropolitan Reform Bill of 1867, along with other reforms addressing the extreme needs of the deprived (Kelly, Tazbir, 2013, p. 198). In a further irony, it is arguable that Nightingale’s “leadership” was chiefly based on leadership of herself, and how she so diligently lobbied for the poor and sick.
Credibility and Moral Intelligence
It seems almost implausible, but an examination of Nightingale’s behaviors and actions throughout her career uniformly supports consistent applications of moral intelligence and an unwavering commitment to credibility. In her work at Scutari and, later, the Crimea itself, Nightingale retained a core focus on the goals of improving hygiene and care administration, and did not allow a lack of official sanctioning impede her. For example, her designation as Superintendent of Female Nurses in the Military Hospitals in Turkey did not carry over to the Crimea. Moreover, Dr. John Hall, Inspector-General of the British hospitals in Turkey, resisted any prospect of Nightingale suggesting or implementing change (Shepherd, 1991, p. 498). Nonetheless, and despite similar forms of suspicion from the leading ward nurses already in place, she adhered to her insistence on attending to patient needs and elevating levels of care, and eventually on the approval of those adversaries.
Then, and more regarding moral intelligence, Nightingale soon found herself in a unique position in the Crimea. In time she was the only woman in the General Hospital, and it is interesting to note how Nightingale perceived and took advantage of her personal status. Writing home, she expressed that the men treated her with deference, and largely because she was a gentlewoman (Shepherd, 1991, p. 504). This then reflects an admirable understanding of the social circumstances in place, and how furthering the work could be better accomplished by allowing certain – and masculine – perceptions go unchallenged. Again, no effort or behavior of Nightingale seems to have deviated from her consistent commitment to serving the needs of the sick and poor.
The Leader and Organizational Cultures
To understand Nightingale’s addressing of varying organizational cultures encountered in her career, it is first helpful to return to the Crimean efforts and reiterate that, in the eyes of Hall and other authorities, she was far from welcome. True to her strategies in effecting change, however, Nightingale communicated with powerful friends in England to advance her standing, and better enable her to do the necessary work. Writing to Sidney Herbert in 1856, for example, she states: “’My usefulness is destroyed…by the uncertainty of the relations to which I am left with the Crimean authorities’” (Cromwell, 2013, p. 167). The ensuing advice and support enabled Nightingale to carry on more effectively, and this echoes her initial struggles with organizations in London years earlier. Hospitals of the era were notoriously badly managed, as nurses were untrained, and often either displaced domestic workers or prostitutes still engaged in the trade (Godden, Helmstadter, 2013, p. 10). Nightingale’s values, along with her indefatigable work, would in time revise this culture and vastly alter the role of the nurse. Another conflict between this leader’s values and an organizational culture goes to when, in 1851, Nightingale trained at Germany’s Kaiserswerth Hospital. The religious emphasis of the institution disturbed her; faith, she perceived, was more important than actual care (Godden, Helmstadter, 2013, p. 70). In developing the Florence Nightingale School for Nursing, then, Nightingale would place significant value on faith, but shift the organizational priority to administering effective and hygienic care.
Personal Reflection
If there is any difficulty in incorporating Nightingale’s values and behaviors within my own leadership practice, it lies in the indomitable energies and unflagging commitment of the woman herself. As I perceive it, Nightingale set a standard that has yet to be equaled. At the same time, however, she provides crucial lessons, and one goes to the power of tenacity. Even facing massive opposition, Nightingale held to her convictions as to what change was necessary, and this degree of belief is vital for a leader in any field. Then, I admire, and would seek to emulate, Nightingale’s legendary dedication to research and gathering information to support her initiatives. The leader equipped with substantial knowledge is the leader better enabled to influence others. Consequently, and while other aspects of Nightingale’s leadership are inspirational, I view her tenacity and commitment to knowledge as most beneficial as I pursue my own leadership practices.
- Cromwell, J. L. (2013). Florence Nightingale, Feminist. Jefferson: McFarland & Co.
- Godden, J., & Helmstadter, C. (2013). Nursing before Nightingale, 1815–1899. Burlington: Ashgate Publishing.
- Kelly, P., & Tazbir, J. (2013). Essentials of Nursing Leadership & Management, 3rd Ed. Belmont: Cengage Learning.
- Roussel, L., Swansburg, R. C., & Swansburg, R. J. (2006). Management and Leadership for Nurse Administrators. Sudbury: Jones & Bartlett Publishers.
- Shepherd, J. A. (1991). The Crimean Doctors: A History of the British Medical Services in the Crimean War, Vol. I. Liverpool, UK: Liverpool University Press.
