The Brilliance of Florence Nightingale

By Robert Burney, MD

U.S. Department of State

Director, Quality Improvement

Florence Nightingale managed to transform the nursing profession in a total career of less than 3 years. She entered nursing school at the age of 31 and then went to the British military hospital in Scutari, Turkey where the British were fighting the Crimean war. The army was not happy to have her (a woman) and hindered her efforts in many petty ways (like refusing to provide food for her nurses.)

When she arrived, the mortality in the hospital was 43%. An injured soldier had a better chance for survival if left to die on the battlefield than if transported to the hospital.  The leading cause of death was infection related to the poor general sanitation in the hospital.  Six months later, the mortality rate was 2%.  And when she left, conditions (and statistics) were better in the Scutari hospital than in military hospitals in England.

Her father was a mathematician, and she was well schooled in statistics. Among her unsung accomplishments was the invention of polar graphs which she used to document improvement in the hospital. "She clearly identified the link between measurement and improved healthcare." (Mary Nundringer RN).

Currently an award for quality in healthcare is named for her. Florence herself wrote, "What we want is not so much . . . facts, as to teach the men who govern the use of statistical facts."

The sentimental image of her with the lamp was real. To prevent her nurses from "socializing" with the patients, she banned them from the hospital at night and made rounds by herself, carrying her lamp.

1. She came from a wealthy family and could afford to buy food for her nurses.
2. Friends in high places, including the London Times which published her letters and graphs.
3. Her passion for measurement. Her objective, factual presentations in the Times and elsewhere led to dramatic reforms within the army healthcare system, despite the protestations of the line officers.

In a sense, we are fighting the same battle today--the importance of measurement, and the use of data in decisions.

The JCAHO published a book about her, Florence Nightingale: Measuring Hospital Care Outcomes. 1999. It should be available through their web site, www.jcaho.org. Among other things, it documents the number of dead animals (including horses) she removed from the hospital. It's a fascinating book that every nurse should read.

Robert Burney MD
Director, Quality Improvement