1. Callister, Lynn Clark PhD, RN, FAAN

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During 2010 we celebrate the International Year of the Nurse, in conjunction with the 100th year anniversary of the passing of nursing icon Florence Nightingale. While her work in Scutari during the Crimean War is often the focus of her amazing contributions, we less often hear about her significant role in global maternal and child health (Dunn, 1996).


When she returned to England in 1856, she established the Nightingale School of Nursing at St. Thomas Hospital in 1860; the following year she started a midwifery school at King's College. At this time, midwives received 1 to 3 months training, but Nightingale insisted that was insufficient and lobbied for a 2-year comprehensive education for midwives, which included anatomy, physiology, and pathology. She was also adamant that giving birth was "not a disease, but an entirely natural condition" (McDonald, 2005, p. 259). Nightingale, our hero for nursing in general, had a forward-thinking vision of educated nurses and midwives, of the implementation of a model of midwifery care, of safe motherhood with identification of risk factors for maternal morbidity and mortality, and of the philosophy of giving birth as a normal event. Her vision still needs to be fully realized over a century later, for far too many women still die in childbirth, especially in sub-Saharan Africa and southeast Asia. Their children are at greater risk for morbidity and mortality as well. A 2007 cover of The Lancet articulates the needs for maternal health that Nightingale recognized long ago, "Since the human race began, women have delivered for society. It is time now for the world to deliver to women" (Starrs, 2007, p. 1287).


When the midwifery school was closed in 1867 because of an outbreak of puerperal sepsis, Florence began her study of the causes of maternal mortality, which was published in 1871 in Introductory Notes on Lying-in Institutions. She wrote:


"There is a large amount of preventable mortality in midwifery practice, and that, as a general rule, the mortality is far, far greater in lying-in hospitals than among women lying-in at home for every two women who would die if delivered at home, fifteen must die if delivered in hospital" (Nightingale, 1971, p. 108).


Risk factors identified by Nightingale, in addition to birth site, were the proximity of postpartum units to postmortem rooms where medical students often performed autopsies and then came directly to examine postpartum women without washing their hands; failure to isolate infected women; use of the same bedding for multiple patients; lack of proper ventilation; and failure to practice what it now called universal precautions. Nightingale's discoveries were revolutionary in her time and place, for Semmelweis' findings about infections in Vienna hospitals had not yet been published. There were no other published works by a midwife or a nurse addressing the issues of high maternal mortality rates and safe childbirth at this time in history.


Florence Nightingale was willing to risk scorn to improve the delivery of care to women and newborns and save lives. She demonstrated critical thinking, a revolutionary philosophy of birth, groundbreaking ideas for increasing education of midwives, a passion for statistics, and a focus on evidence-based healthcare that offer a framework for improving care of women and children today.


As we celebrate Florence Nightingale's contributions through the International Year of the Nurse and the 2010-2020 United Nations Global Decade for a Healthy World proposal, this is an opportunity for 10 million nurses around the world to consider what lessons we learn from her life and her work as a visionary nurse. To sign a declaration supporting these initiatives, see In addition, the Nightingale Initiative for Global Health ( features 21st century Nightingales who are committed to promoting healthy outcomes.




Dunn, P. M. (1996). Florence Nightingale. (1820-1910): Maternal mortality and the training of midwives. Archives of Disease in Childhood. Fetal and Neonatal Edition, 74, F219-F220. [Context Link]


McDonald, L. (2005). Florence Nightingale on women, medicine, midwifery, and prostitution. Waterloo: Wilfried Lauarier University Press. [Context Link]


Nightingale, F. (1971). Introductory notes on lying-in institutions. London: Longmans & Green. [Context Link]


Starrs, A. M. (2007). Delivering for women. The Lancet, 370, 1285-1287. [Context Link]