1. Hassmiller, Susan B. PhD, RN, FAAN


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Editor's note: This blog post is one in a series, "In Florence's Footsteps: Notes from a Journey" (, in which Susan B. Hassmiller retraced crucial steps in Florence Nightingale's innovative career.


Here at the home of Florence Nightingale, Embley Park, approximately 100 people have convened to study the impact of the "Lady with the Lamp." The lady herself was multifaceted, and so is this crowd of scholars. There are nurse leaders, of course, but also museum curators, historians, educators, and biographers. They are all interested in their own piece, but also in how their piece fits into the bigger whole of Nightingale's life. Today we heard Professor Thomas from the University of Southampton School of Business discuss her contributions as an applied statistician.


Representing mortality. Early in her life, Nightingale identified the need for hospitals and health care systems to collect and use data to improve care. She asked, what use are statistics "if we don't know what to make of them?" She is credited with developing the famous "coxcomb" illustration, which was a multidimensional way of depicting mortality rates. She used statistics at Scutari Hospital (also called Selimiye Barracks) in Turkey to guide her actions and used statistics and data in the London Times to convey the travesty of the Crimean War.


Institutional and cultural barriers. But Nightingale didn't just rely on data to get more of what she needed for the soldiers-she also used storytelling . . . a lesson that's not lost on me in terms of affecting policy today. However, and this is a big however, just as they do today, politics, context, and culture reigned supreme. High-ranking physicians and military officers felt threatened by her (the chief medical officer tried three times to deport her!), and even with excellent data displays and storytelling (and many times because of it), she struggled mightily to overcome barriers and rise above being disparaged. That was a constant theme throughout her life.


I now know that Nightingale made the greatest impact not while she was at Scutari, but after the war when she applied statistics to help her change massive military and hospital systems, the Poor Law in Britain, India's health care system, Civil War hospitals in the United States, and more.


She also became the first woman ever to be an invited member of the Royal Statistical Society and in 1874 became an honorary member of the American Statistical Association. She was also credited with bringing statistics, as a major course of study, to the Oxford University curriculum. To all of this she said, "What we want is to teach the men who govern the country to use statistics."