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Mary Spinks, Retired Director, Florence Nightingale Foundation
"You must fight for the changes that are necessary"

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Mary Spinks, Retired Director of the Florence Nightingale Foundation, takes a  look at Florence Nightingale and her Leadership qualities.  In this article, Mary Spinks talks directly to nurses and argues that Florence Nightingale's attributes are very applicable to nurses today as they undertake leadership roles to improve the patient’s experience in various areas of healthcare.

Visible

Florence Nightingale was visible as she walked the wards of the barrack hospital in Scutari, during the Crimean Campaign. She became known as the lady with the Lamp at that time. The soldiers remembered her long after the battles were over and to this day she remains a heroine to them as well as being a heroine to our profession.

Are you visible?  Do you ensure that patients have access to you when needed? How often do we hear “I never found out who was in charge” “I only wanted to ask a few questions before my relative was discharged”

I know time is scarce, but one way of managing time is to do a ward round during visiting hours, or ensure a senior member of your team undertakes such a ward round. I have proof that by doing so, you can reduce the number of complaints by 50 per cent, complaints that may take hours of your time investigating. In my opinion, many complaints originate from lack of communications between the health care professionals and the public that we a re supposed to be caring for.

Compassionate

The Florecence Nightingale Commemoration Service
The 2007 Florence Nightingale Commemoration Service at Westminister Abbey, organised by the Florence Nightingale Foundation.

She showed great compassion to the soldiers, many of who were dying. As well as looking after the soldiers, she was responsible for the other British nurses who went with her to that war.

The overall public perception of nurses is that we are compassionate and caring but recent television coverage; some undercover, challenges this. If we do not ensure that those we lead, as well as ourselves, are compassionate and caring, we risk loosing the respect of the public. The excuse that we have expanded roles and have not time for the basic care of patients is a sad indictment on our profession.

It is also important that you care for the staff and ensure that they are supported. You will run a happier ship if you give praise now and then. That does not mean that you ignore bad practice but handle situations that need correction sensitively.

Being a leader demands that you do the things that are right not the things that are popular.

Tenacious

Florence Nightingale was tenacious in ensuring that the soldiers had the care, food and blankets required, even when it meant cutting through the red tape and annoying those in charge of the stores. When she returned from the Crimea, she used every means in her power to ensure that a Royal Commission into the British Army was set up, after the disastrous consequences of that war, when 16,000 died from disease against 4,000 in battle. 

Do we show the same tenacity today in assuring quality of care or do we back off when the going gets tough? As the largest group of health workers we have got to question our ability to influence and to change things.

Knowledgeable

She was knowledgeable, she had been well educated and she used that education to state her case, and win it, so that she could improve the care of the sick and the lot of the armed forces.

We now have a better-educated nursing workforce and I witness this every year in the standard of applications that we receive from those applying for scholarships.

We should, therefore, have a better standard of care with evidence-based practice the norm, in our daily working lives. Do you see evidence of patients being more satisfied with their care, and if not, why not? Better education should lead to improvements in the delivery of care and the well being of the community.

Being knowledgeable also means being politically aware. It means knowing who to lobby when you want to implement change and having the correct facts and figures to hand so that you can state your case effectively.

Visionary

Florence Nightingale  was a visionary and used that vision to set up the first training school for nurses at ST. Thomas’ Hospital. Her vision on what was needed for the safe and holistic care of patients resulted in her being consulted, until she died in 1910, by Governments from across the world, on the building of hospitals. Her experience at Scutari taught her the importance of hygienic conditions, good food, ventilation, clothing and bedding.

Her vision brought about Social Reform in the armed forces. Her vision of the need for Research and Development was instrumental in ensuring change.

What vision do you have for the Health Service of the future? If you became Minister of Health, the leader for health care what would you suggest should change.

Bringing vision closer to home, a good place to start maybe looking at your own area of care. What changes would improve standards and where are resources being wasted? We all know that there are practices that are outdated but remain because of staff interests.

Let us keep those leaderships qualities before us and look at some of the teachings of Florence Nightingale. Are there lessons to be learnt from them?

“IT MAY SEEM A STRANGE PRINCIPLE TO ENUNCIATE AS A FIRST REQUIREMENT IN A HOSPITAL, THAT IT SHOULD DO THE SICK NO HARM."

Does this ring a bell when we hear that the targets to decrease hospital-acquired infections have not been met? I am concerned at the number of people, including myself, who are afraid to go into hospital for fear of catching MRSA or other nasty infections.

Why so we have patients, especially elderly people, becoming malnourished while in hospital? Why is it, that having two pillows on your bed, is being in the lap of NHS luxury.

Florence Nightingale preached holistic care; that nursing was about looking after the whole person; hygiene, food, clothing and bedding.

She would have been appalled that so-called “non-nursing duties” were put into the hands of outside contractors to save money. The money saved must be a pittance compared with the cost of hospital-acquired infection, and the suffering it brings.

There were no antibiotics in the days of Florence Nightingale, therefore, hygiene was essential. As many of the antibiotics become useless in the fight against some of the more virulent bugs, it is necessary to revert to the teachings of Florence Nightingale.

It is up to you, as leaders of the nursing workforce, to reverse the situation and I believe that this is now happening.

The Director of Nursing at the Royal Wolverhampton Hospitals NHS Trust, recently wrote in the Nursing Standard that new commodes and mattresses led to dramatic fall in infections. She wrote that strong leadership was essential in changing staff attitudes and behaviour.

She had, no doubt, to do her homework and state her case to secure the finance to fund the new equipment. She wrote that replacing them not only proved effective, but also saved the trust money. Within six weeks of  buying the new commodes, the Trust  had saved three times their costs in reduced lengths of stay and in the associated cost of infections. The same applied in replacing the mattresses.

A staff nurse, Lindsey Bradley, at Cardiff and Vale NHS Trust, introduced a simple red tray at meal time that made a real difference to nutrition for vulnerable patients by alerting staff that the red tray signified the need for assistance when meals are served. Another nurse, Anne Marie Tunney, a lecturer at the University of Ulster, introduced yellow napkins, in hospitals in Northern Ireland to achieve the same result. 

These are just two initiatives lead by nurses that have improved care and will help restore patient confidence in hospitals. There must be others. As a leader, you need to share innovative practices for the good of patients everywhere.

Education

Over the years, we have seen many changes in nursing, not least in the area of nurse education and training. Now education is based in Universities and those being educated have student status.

Florence Nightingale was well educated for a woman of her day. However, the opportunity to make use of her education, in a practice way, was denied her until at the age of 30 when she went to Kaiserwerth, near Düsseldorf to train as a nurse.

In 1851, she wrote a booklet on Kaiserwerth:WHILE THE INTELLECTUAL FOOT HAS MADE A STEP IN ADVANCE, THE PRACTICAL FOOT HAS REMAINED BEHIND."

Is this still true today? Are we in danger of educating ourselves and becoming academics without ensuring that practice is influenced and if necessary improved?

What is your role as leaders in educating the next generation of nurses? It may be that you think it has got nothing to do with you and that it should be left to the Deans and nurse lecturers in Universities. I disagree.

The gap between theory and practice has always being a matter of concern. Theory and practice must not become divorced just as we must ensure that educators and practitioners do not become divorced but work together for the good of patients and students.

You, as leaders, must take the lead on this. After all you provide the clinical placements that are crucial if we want to have safe, competent practitioners in the future.

Research

The other area, in which you need to make your voices heard, is Research.

In her Notes on Nursing, she wrote: IN DWELLING UPON THE VITAL IMPORTANCE OF SOUND OBSERVATIONS, IT MUST NEVER BE LOST SIGHT OF WHAT OBSERVATION IS FOR. IT IS NOT FOR THE SAKE OF PILING UP MISCELLANEOUS INFORMATION OR CURIOUS FACTS BUT FOR THE SAKE OF SAVING LIFE AND INCREASING HEALTH AND COMFORT.”

The nursing profession has collected an amazing amount of information and facts that are now lying on library shelves gathering dust.  All research must lead to development. If not, what is the point?

Funds are being allocated to nursing research, but one must question whether the monies involved are being spent to ensure that patient care is improved and developed, or instead to satisfy the “pet subject” of the researcher.

There must be areas of care that you would like researched and you should have access to nurse researchers to carry out this work.

A fundamental factor that must be avoided at all cost is the perception that research is for academics and that nurses in practice are too busy to apply the finding of research. It is vital that you, the nurse leaders have input into what research is taking place, because, after all, nursing remains a practice-based professions.

I end with my favourite quotation from Florence Nightingale: FOR US WHO NURSE, OUR NURSING IS A THING, WHICH, UNLESS WE ARE MAKING PROGRESS EVERY YEAR, EVERY MONTH, EVERY WEEK, TAKE MY WORD FOR IT, WE ARE GOING BACK."

We must not stagnate, we will not be able to in this ever-changing world of health care. As leaders, you must fight for the changes that are necessary to improve the delivery of care. The higher up you go, the more you can influence. The going may be tough, but the satisfaction of achieving change for the better is great.

For more information, go to: The Florence Nightingale Foundation

FN statue

At the Crimean War Memorial in London, UK with Dr. Susan Hassmiller, Senior Advisor for Nursing at the Robert Wood Johnson Foundation, taken on her 2010 Nightingale Journey. This statue is one of only two of non-royal women in Central London.

Flo with Desmond Tutu

Archbishop Desmond Tutu at the 2010 Nightingale Centenary opening of the Florence Nightingale Museum in London, UK