1. Brown, Theresa PhD, RN


Gillian Gill's biography reveals the woman behind the legend.


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All nurses know Florence Nightingale as "the Lady with the Lamp," a Victorian woman born in 1820 who defied her family's expectations and the era's established gender roles to dedicate herself to transforming nursing into a respected profession for women. This mythical Nightingale was a selfless trailblazer, and in many ways the real flesh-and-blood woman was, too. But as Gillian Gill shows in her absorbing book, Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale (Ballantine Books, 2004), Florence very much knew her own mind, and her drive is what makes her important for nursing today. (Gill uses Nightingale's first name throughout the book, perhaps as a way to emphasize her individuality, as will I.)

Figure. Theresa Brow... - Click to enlarge in new window Theresa Brown

The first half of the book recounts the Nightingale family history, with particular focus on Florence's upbringing and family relationships. The immediate family consisted of Florence, her older sister Parthenope (known as Parthe), and their parents Fanny and William Edward Nightingale (known as WEN); the extended family network included aunts, uncles, nieces, nephews, and cousins. The families were upper middle class and financially stable, which meant that Florence and Parthe lived in large, comfortable homes and were cared for by servants. For a man of his time, WEN was unusually open minded about women's education, and from childhood the sisters spent time studying languages, philosophy, history, and contemporary and classical literature, sometimes in the original Greek and Latin.


Even as a young girl, Florence showed great independence of mind. But intellectual independence in women wasn't prized by society at large. Gill concludes that Florence was born the wrong sex for the time she was living in: "Flo should have been a boy. She did everything so well except the things that counted for a genteel young girl. Her brilliance of mind, her thirst for education, her self-absorption, her intractability would have been seen as normal in a boy."


To achieve a life as an independent woman, Florence had to break from her family and with tradition. She refused an excellent offer of marriage after a long courtship, angering her parents. During extended trips abroad, she visited not only ancient ruins and museums but also health care facilities (such as there were) in defiance of her father's wishes. In 1853, she agreed to serve as superintendent of nursing for the Institution for Ill Gentlewomen, a private clinic for sick governesses, even though several of the women trustees found her "willingness to leave home[horizontal ellipsis] unnatural, her interest in matters surgical and medical most indecorous."


By this time, Florence had devised a plan to reinvent nursing as an acceptable and important profession for women, and she felt God was directing that work. As Gill notes, her goal was "to take charge of a hospital or infirmary and there train an elite corps of women supervisors who would gradually revolutionize patient care in the whole of the public hospital system." In 1854, shortly after the Crimean War broke out, she took a group of nurses to the Crimea to staff British army hospitals.


The Nightingale legend grew from her work in those hospitals, where she did indeed walk the wards at night with a lamp. The wards were putrid and squalid, and offered almost no care to wounded soldiers who weren't officers. Florence instituted cleanliness, triaged the wounded based on severity of need rather than rank, and standardized care. In so doing she saved lives, modernized nursing, and earned the respect and dedication of enlisted men and nurses alike, all while spending many an eight-hour shift doing bedside nursing.


After returning to England, Florence continued to work intensively on reforming military health care. Involved in many projects, she isolated herself socially, even refusing to see her parents and sister for several years. Yet she died in 1910 well cared for and much beloved by the members of her extended family.


Nightingales reveals a complicated, impassioned, and sometimes difficult woman-and that is the great appeal of this book. The usual portrayal of Florence Nightingale as a saintly legend obscures her ambition to relieve suffering on a grand scale by improving health care. Good nursing is often associated with selflessness. Nightingales shows the value of throwing some ego, drive, and obstinacy into the mix. Like Florence, the best modern nurse is probably a bit of a rebel, too.