There are 2 things that pull me into Nightingale’s writings in this moment in time:
- Her clarity of nursing’s domain and disciplinary distinctions from medicine
- Her statement: “nursing is to put the patient in the best condition for nature to act upon him”
Why are these topics of interest to me?
Because we’re not good at either of them. 
#1. Let’s start here, Nursing’s Disciplinary Distinctions from Medicine
I’ve always been struck when nurses …
- refer to themselves as part of the “medical profession”
- define their practice in medical or clinical terms, e.g., giving treatments and meds, carrying out orders, etc.
- describe nursing practice in terms of assessment, diagnosis, planning, implementation and evaluation
All of these actions are important, but is that it? Is that who and what we are?
Decades ago, I thought these depictions of nursing’s domain were education related, a lack of a robust exploration of nursing’s scope and domain.
However, recently, I accept the reality of these nurses’ perspectives …
Because it’s true, our practice environments are pretty much all medical and clinical tasks.
Why is this important now?
Because the job demands and work environments are driving nurses out of nursing.
“The pace and complexity in nurses’ jobs leave too many nurses feeling disconnected from their original purpose in being a nurse.”
“Our practice environments create confusion, frustration and a sense of lack of control that can lead nurses to blaming their jobs and organizations, their leaders, their peers, and at its worst, blaming their patients. These reactions contribute to nurse burn out, compassion fatigue, moral distress (Kester and Wei 2018) and even depression. Nurses’ depression rates are double that of the general public (Magtibay et al. 2017).” from Getting Real About Caring, p 10, p 87
But read closely, besides the demands of the job, what else is driving our despair?
Our Ongoing Identity Crisis
Our disciplinary identity confusion causes despair. Period. Stop. Nurses are in a role tug-a-war everyday, and always have been.
And nursing’s fundamental struggle for a Disciplinary Distinct Identity becomes more haunting as medical science and clinical demands mount.
We know down deep that our contributions to people and society are wide and deep and life changing.
But our words to describe what we do come from a different toolbox,
and we don’t share these words often, and rarely explore their thoughts and experiences in work settings.
Nurses learn to compartmentalize who they are from what they do quickly once in practice settings.
The academics have the words that clearly describe the discipline of nursing.
But those in the real world are overwhelmed, trying to survive in a healthcare system
that morphs their roles and functions around the needs of medicine and business.
No wonder nurses’ verbal accounts of “what we do” sound like extensions of medicine or words from a virtue script.
Oh, but listen to this …
Listen to Nightingale’s clarity:
“It is often thought that medicine is the curative process. It is no such thing.”
The function of surgery and medicine is removal of obstructions to normal bodily functions.
“Surgery removes the bullet out of the limb, which is an obstruction to cure, but nature heals the wound.
“So it is with medicine; the function of an organ becomes obstructed; medicine, so far as we know, assists nature to remove the obstruction, but does nothing more.
“Neither can do anything but remove obstructions; neither can cure; nature alone cures.
“And what nursing has to do in either case, is to put the patient in the best condition for nature to act upon him.” Notes on Nursing. p74-75
I find this statement so clear and soothing. It’s definitive and tells me what and how to be a nurse.
But in our work environments, loss of discipline identity makes work fulfillment a moving target.
#2. Back to nature, “Nursing Is to Put the Patient In the Best Condition For Nature to Act Upon Him”
This is the job that I want. Are you hiring?
Nightingale’s notion that we are all here to serve nature, so that nature can act upon and cure the patient just feels solid. This is exactly how nature works.
According to Nightingale,
“I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet — all at the least expense of vital power to the patient.” Notes on Nursing. p 6.
Nightingale explained that nursing attends to the health – illness continuum. A disease or injury situates the patient at the illness end of the continuum.
Her view of nursing revolved around controlling the health of the environment and use of nature to cure and heal.
Nightingale believed that disease need not be accompanied by suffering.
In watching disease, both in private houses and in public hospitals, the thing which strikes the experienced observer most forcibly is this, that the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different — of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these. Notes on Nursing. p 5
And Nightingale believed in the mind-body effect.
“The effect in sickness of beautiful objects, the variety of objects, and especially of brilliancy of colour is hardly at all appreciated. p33
Such cravings are usually called the ‘fancies’ of patients. And often doubtless patients have ‘fancies’ .. that may contradict… But much more often, their so called ‘fancies ‘ are the most valuable indications of what is necessary for their recovery. And it would be well if nurses would watch these ‘fancies’ closely. p33.
People say the effect is only on the mind. It is no such thing. The effect is on the body, too. Little as we know about the way in which we are affected by form, by colour, and light, we do know this , that they have an actual physical effect. p 34
… these are actual means of recovery.
Volumes are now written and spoken upon the effect of the mind on the body. Much of it is true. But I wish a little more was thought of the effect of the body on the mind.
Be aware “… how the very walls of their sick rooms seem hung with their cares; how the ghosts of their troubles haunt their beds; how impossible it is for them to escape from a pursuing thought without some help from variety.” p34 Notes on Nursing
And yes, there is more. Nightingale wrote 147 books and thousands of letters and official documents.
Back to 2020
Where are we now?
While nursing has been caught in the web of the biomedical model, wellness science has blazed the trail of helping us understand how nature and the mind-body connection acts upon us.
Through this coronavirus pandemic, may all nurses have an abundance of …
- Pure air, water and food (free of toxins and harmful ‘bugs’)
- Clean scrubs and gowns and PPE
- Clean skin that can breathe
- Clean linens and pillows to support breathing
- Warmth and comfort (in between everything else)
- Light and sunshine through open windows and outdoors
- Visual varieties of colors and flowers (in between everything else)
- Taking walks
- Hugging family, even virtually
🙏