A reasonable response. Nightingale's rules were an important step in raising standards for professional nursing, which was held in very low esteem (it was often a role filled by the completely untrained, with low or no sanitation practices) in mid-nineteenth-century England. But nearly three centuries later, it's up to us to see that these rules respond better to a changed situation.
Hi Beth--Sorry for my slow response; I got busy with kids and Thanksgiving, which was fun. But to your point--thank you for raising the issue of what Nightingale was up against with the nurses she had to work with and how minimal to nonexistent their training was. She accomplished a lot, all while navigating a patriarchal culture that didn't want female nurses in the Crimea. I appreciate you providing this important historical context for Nightingale's work. I couldn't get into this question in the column, but for me the real issue is why such persistently harsh treatment of nurses persists within nursing. That's the question we need to be answering.
It seems especially sad and ironic that in nursing this senseless and cruel rigidity is an extension of strictness that is a benefit in other areas. It is important to be strict about hygiene, handwashing, following safety procedures, checking and double-checking meds, etc. The problem comes when strictness starts to invade spheres where it has no business being. Forbidding certain hair and shoe colors?! Oof!
Similarly, it is so strange to me that some nurses demand submissiveness from new nurses, when nurses have rightly changed the hospital culture that had demanded they be submissive to doctors. You’d think they would engage in some self-reflection!
Happy Thanksgiving to you and your family, Theresa!
Happy Thanksgiving to you and yours, Mari! Sorry for my slow response--I got pleasantly caught up in all the holiday fun, and lots and lots of cooking. Your observations here are so smart. I remember a nursing instructor telling me that when she trained there was a right and a wrong way to do everything, including washing out bedpans! You make an excellent point that one wants strictness in certain things like medication doses, doing procedures, etc, but it's a mistake to then transfer that punctiliousness over into all of nursing, including earrings. There's probably some phrase that covers that kind of behavior, but I don't know it. Yes also to your thoughts about submissiveness. Nurses will complain about high-handed doctors to no end and then be terrible to each other. it reveals something unhealthy in the profession and I wish nursing professors and managers would try to root it out. Instead, professors of nursing (as I show in the column) often showcase the worst of these behaviors. SIGH.
I'm just now reading the 2008 Nightingale biography by Mark Bostridge. It is far less a hagiography than anything I've read previously. The good, the bad, the ugly. She was an incredibly accomplished woman, but some of the accomplishments attributed to her have been mightily embellished. Ands she was clearly a product of her social status and time. I think it's the most thoroughly researched Nightingale biography to date.
Hi Nancy--apologies for my slowness. Thanksgiving was a lot of fun, and pleasantly preoccupying! Thanks for the tip about this biography. Nightingale was incredibly accomplished, and problematic as we are learning, but it may be her status as an icon, endowed with saintlike qualities, that has led to some of the backlash against her. Of course she had her flaws, as we all do, and was up against tremendous obstacles in her work to legitimize nursing. I really appreciate your comments and how they suggest we can take Nightingale off her pedestal and still revere her for what she accomplished while also critiquing the negative imprints she may have left on nursing.
I, too, had a lot of thoughts when I read the Flo biography. I found her rigidity to be quite disturbing and that is what (to me at least) persists in Nursing. An unwillingness to explore possibilities and alternatives is what I see and hear from so many in our profession to this day
Thanks for this and apologies for my slow response--I had a turkey to bake, bread to rise, and fun to be had talking with the kids since all three were home for the holiday. I 100% agree with you about the rigidity in nursing and find it very frustrating. Nursing faculty and managers say they want nurses able to think critically, but then get unreasonably angry when nurses actually think and use their brains, especially if they think critically about problems in the system and what could be improved. The idea that all nurses should "keep our heads down" is endemic, as you know, and so detrimental to individual nurses and the profession overall. From what I've seen, unions do a good job helping nurses see that they have good ideas and are worthy of support and respect on the job. I really appreciate your smart comments about this persistent problem in nursing.
I do not think Florence Nightingale can be blamed for the abysmal treatment you experienced when you started your nursing career. Nightingale’s behavior must be put in the historical context. We are fortunate that she developed our profession. Nurses should be more sensitive and never treat anyone the way you describe being treated. Four years ago I was a patient at Memorial Sloan Kettering. I observed that the nurses there were treated with care and respect. It was then reflected in the patient care they provided. I was so impressed that the nurses dressed in ways pleasing to them, had tattoos, and often playfully colored hair and multiple earrings. The focus and how they were judged was based upon the superlative care that they all provided. It is the responsibility of all nurses to be kind and respectful of their colleagues. That is the professional way to practice.
Hi Patricia--Excellent points. Really. Sorry for the slowness of my response--Thanksgiving cooking and being with kids has taken up all my time over the past few days (in a good way). However, I read your comment right away and was so impressed with it. It makes perfect sense that people treat others the way they are treated--respect begets respect, and likewise with disrespect. I agree with you that it's not fair to blame Nightingale for the problems with bullying and disrespect in nursing, whether it comes from other nurses or nurse managers or nursing professors. Fundamentally, nurses need to demand thoughtful and supportive treatment from each other and from managers and administrators. That is easier said than done in this health care environment, but we can begin by showing each other the care and concern we strive to give patients. I really appreciate you taking the time to tell your story here. Thank you!
Theresa, this latest column was a thoughtful view of a situation I saw at times in my hospital work, along with interactions I witnessed between doctors and the nursing staff. While I often knew how to engage in the latter scenarios, I was unsure of how (and whether) to proceed in the former. I would appreciate your thoughts on that, especially since the prevailing sentiment in healthcare now is that we are all team players, even though there are different “team” chains of command.
Hi Lou, Sorry for my slow response--I got caught up in Thanksgiving preparation, cooking, eating, and then relaxing. Twas fun. But to your question...I have seen that it's hard for MDs to intervene when nurses are being unfair to each other, or even when nursing management isn't supporting nurses. I'm honestly not sure what the best thing to do is, but if there is a nursing manager who cares about such issues, talking to that person might help. Approaching hospital administration might help, too. There's all kinds of data that shows that bullied health care workers make choices that don't promote safety and hospital managers should care about that, but they let these behaviors fester and I don't know why. Maybe they just don't care that much. If physicians decided to promote more professionalism in the workplace and got nurses to join them, that might make a difference. People say that culture will eat strategy for lunch and I believe that. So maybe what's needed is a commitment to a new culture. That would be a lot of work, but worth it. Thank you for caring so much! And Happy Thanksgiving!
I appreciate very much your thoughtful response, Theresa. I also like what you wrote about culture over strategy, that sounds like the way to proceed for a long-term solution.
A reasonable response. Nightingale's rules were an important step in raising standards for professional nursing, which was held in very low esteem (it was often a role filled by the completely untrained, with low or no sanitation practices) in mid-nineteenth-century England. But nearly three centuries later, it's up to us to see that these rules respond better to a changed situation.
Hi Beth--Sorry for my slow response; I got busy with kids and Thanksgiving, which was fun. But to your point--thank you for raising the issue of what Nightingale was up against with the nurses she had to work with and how minimal to nonexistent their training was. She accomplished a lot, all while navigating a patriarchal culture that didn't want female nurses in the Crimea. I appreciate you providing this important historical context for Nightingale's work. I couldn't get into this question in the column, but for me the real issue is why such persistently harsh treatment of nurses persists within nursing. That's the question we need to be answering.
It seems especially sad and ironic that in nursing this senseless and cruel rigidity is an extension of strictness that is a benefit in other areas. It is important to be strict about hygiene, handwashing, following safety procedures, checking and double-checking meds, etc. The problem comes when strictness starts to invade spheres where it has no business being. Forbidding certain hair and shoe colors?! Oof!
Similarly, it is so strange to me that some nurses demand submissiveness from new nurses, when nurses have rightly changed the hospital culture that had demanded they be submissive to doctors. You’d think they would engage in some self-reflection!
Happy Thanksgiving to you and your family, Theresa!
Happy Thanksgiving to you and yours, Mari! Sorry for my slow response--I got pleasantly caught up in all the holiday fun, and lots and lots of cooking. Your observations here are so smart. I remember a nursing instructor telling me that when she trained there was a right and a wrong way to do everything, including washing out bedpans! You make an excellent point that one wants strictness in certain things like medication doses, doing procedures, etc, but it's a mistake to then transfer that punctiliousness over into all of nursing, including earrings. There's probably some phrase that covers that kind of behavior, but I don't know it. Yes also to your thoughts about submissiveness. Nurses will complain about high-handed doctors to no end and then be terrible to each other. it reveals something unhealthy in the profession and I wish nursing professors and managers would try to root it out. Instead, professors of nursing (as I show in the column) often showcase the worst of these behaviors. SIGH.
I'm just now reading the 2008 Nightingale biography by Mark Bostridge. It is far less a hagiography than anything I've read previously. The good, the bad, the ugly. She was an incredibly accomplished woman, but some of the accomplishments attributed to her have been mightily embellished. Ands she was clearly a product of her social status and time. I think it's the most thoroughly researched Nightingale biography to date.
Hi Nancy--apologies for my slowness. Thanksgiving was a lot of fun, and pleasantly preoccupying! Thanks for the tip about this biography. Nightingale was incredibly accomplished, and problematic as we are learning, but it may be her status as an icon, endowed with saintlike qualities, that has led to some of the backlash against her. Of course she had her flaws, as we all do, and was up against tremendous obstacles in her work to legitimize nursing. I really appreciate your comments and how they suggest we can take Nightingale off her pedestal and still revere her for what she accomplished while also critiquing the negative imprints she may have left on nursing.
I, too, had a lot of thoughts when I read the Flo biography. I found her rigidity to be quite disturbing and that is what (to me at least) persists in Nursing. An unwillingness to explore possibilities and alternatives is what I see and hear from so many in our profession to this day
Thanks for this and apologies for my slow response--I had a turkey to bake, bread to rise, and fun to be had talking with the kids since all three were home for the holiday. I 100% agree with you about the rigidity in nursing and find it very frustrating. Nursing faculty and managers say they want nurses able to think critically, but then get unreasonably angry when nurses actually think and use their brains, especially if they think critically about problems in the system and what could be improved. The idea that all nurses should "keep our heads down" is endemic, as you know, and so detrimental to individual nurses and the profession overall. From what I've seen, unions do a good job helping nurses see that they have good ideas and are worthy of support and respect on the job. I really appreciate your smart comments about this persistent problem in nursing.
I do not think Florence Nightingale can be blamed for the abysmal treatment you experienced when you started your nursing career. Nightingale’s behavior must be put in the historical context. We are fortunate that she developed our profession. Nurses should be more sensitive and never treat anyone the way you describe being treated. Four years ago I was a patient at Memorial Sloan Kettering. I observed that the nurses there were treated with care and respect. It was then reflected in the patient care they provided. I was so impressed that the nurses dressed in ways pleasing to them, had tattoos, and often playfully colored hair and multiple earrings. The focus and how they were judged was based upon the superlative care that they all provided. It is the responsibility of all nurses to be kind and respectful of their colleagues. That is the professional way to practice.
Hi Patricia--Excellent points. Really. Sorry for the slowness of my response--Thanksgiving cooking and being with kids has taken up all my time over the past few days (in a good way). However, I read your comment right away and was so impressed with it. It makes perfect sense that people treat others the way they are treated--respect begets respect, and likewise with disrespect. I agree with you that it's not fair to blame Nightingale for the problems with bullying and disrespect in nursing, whether it comes from other nurses or nurse managers or nursing professors. Fundamentally, nurses need to demand thoughtful and supportive treatment from each other and from managers and administrators. That is easier said than done in this health care environment, but we can begin by showing each other the care and concern we strive to give patients. I really appreciate you taking the time to tell your story here. Thank you!
Theresa, this latest column was a thoughtful view of a situation I saw at times in my hospital work, along with interactions I witnessed between doctors and the nursing staff. While I often knew how to engage in the latter scenarios, I was unsure of how (and whether) to proceed in the former. I would appreciate your thoughts on that, especially since the prevailing sentiment in healthcare now is that we are all team players, even though there are different “team” chains of command.
Thank you, and Happy Thanksgiving.
Hi Lou, Sorry for my slow response--I got caught up in Thanksgiving preparation, cooking, eating, and then relaxing. Twas fun. But to your question...I have seen that it's hard for MDs to intervene when nurses are being unfair to each other, or even when nursing management isn't supporting nurses. I'm honestly not sure what the best thing to do is, but if there is a nursing manager who cares about such issues, talking to that person might help. Approaching hospital administration might help, too. There's all kinds of data that shows that bullied health care workers make choices that don't promote safety and hospital managers should care about that, but they let these behaviors fester and I don't know why. Maybe they just don't care that much. If physicians decided to promote more professionalism in the workplace and got nurses to join them, that might make a difference. People say that culture will eat strategy for lunch and I believe that. So maybe what's needed is a commitment to a new culture. That would be a lot of work, but worth it. Thank you for caring so much! And Happy Thanksgiving!
I appreciate very much your thoughtful response, Theresa. I also like what you wrote about culture over strategy, that sounds like the way to proceed for a long-term solution.