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Then a good woman should be thorough. Thoroughness in a nurse is a matter of life and death to the patient.

Florence Nightingale

Florence Nightingale

Statistician, social reformer and founder of modern nursing

B: 12 May 1820, Florence, Italy

D: 13 August 1910, London, England, United Kingdom

What makes a good nurse

When: May 1881

Where: A letter

Audience: Trainee nurses at St Thomas' Hospital

The ‘Lady with the Lamp' — Florence Nightingale — is a symbol of care and compassion, making the rounds of wounded soldiers during the Crimean War.

In 1860 she established a secular school for nursing at St Thomas' Hospital in London and set about professionalising the role of the nurse for women. Her legacy continues in the profession with the Nightingale Pledge and the Florence Nightingale Medal.

In 1881, in a letter to trainee nurses at St Thomas' Hospital — women typically as young as sixteen — Nightingale set down her advice. Only snippets of her recorded voice remain, so you will have to use your imagination to bring her words to life. Access your best Downtown Abbey–inspired English aristocratic accent, pitch your voice quite high, clip your vowels a little and you've got it. Now imagine yourself in a room full of fresh-faced new recruits — all young women. Florence is at the front, the master-trainer, sharing her wisdom.

Extracts from her advice are included here. Reading this advice today is at once challenging, amusing and infuriating. Parts of this address are likely off-putting — especially all the talk about obedience and what makes a good woman. But if you can contextualise that, and look beyond the anachronistic nature of the language, there is much to recommend Florence Nightingale's advice to young nurses.

WHAT SHE SAID

To our beginners, good courage

… To be a good nurse one must be a good woman, here we shall all agree. It is the old, old story. But some of us are new to the start.

What is it to be ‘like a woman'? ‘Like a woman' — ‘a very woman' is sometimes laid as a word of contempt; sometimes as a word of tender admiration.

What makes a good woman is the better or higher of their nature:

Quietness

Gentleness

Patience

Endurance

Forbearance

With:

Her patients

Her fellow workers

Her supervisors

Her equals.

We need above all to remember that we come to learn, to be taught. Hence we come to obey.

No one ever was able to govern who was not able to obey.

No one ever was able to teach who was not able to learn.

The best scholars make the best teachers — those who obey best, the best rulers.

… You are here to be trained for nurses — attending on the wants of the sick — helpers in carrying out doctor's orders (not medical students, though theory is very helpful when carried out by practice). Theory without practice is ruinous to nurses.

Then a good woman should be thorough. Thoroughness in a nurse is a matter of life and death to the patient.

Or, rather, without it she is no nurse. Especially thoroughness in the unseen work. Do that well and the other will be done well too. Be as careful in the cleaning of the used poultice basin as in your attendance at an antiseptic dressing. Don't care more about what meets the eye and gains attention.

‘How do you know you have grace?' said a minister to a housemaid.

‘Because I clean under the mats' was the excellent reply.

If a housemaid said that, how much more should a nurse, all whose vessels mean patients.

***

Now what does ‘like a woman' mean when it is said in contempt?

Does it not mean what is petty, little selfishnesses, small meannesses; envy; jealousy; foolish talking; unkind gossip; love of praise.

Now while we try to be ‘like women' in the noble sense of the word, let us fight as bravely against all such womanly weaknesses.

Let us be anxious to do well, not for selfish praise, but to honour and advance the cause, the work we have taken up.

Let us value our training, not as it makes us cleverer or superior to others, but inasmuch as it enables us to be more useful and helpful to our fellow creatures, the sick, who most want our help.

Let it be our ambition, good nurses, and never let us be ashamed of the name of ‘nurse'.

***

This to our beginners, I had almost said. But those who have finished their year's training be the first to tell us they are only beginners — they have just learnt how to learn and how to teach.

When they are put into the responsibility of nurse or sister, then they know how to learn and how to teach something every day a year, which, without their thorough training, they would not know.

This is what they tell me.

Then their battle cry is ‘be not weary in well-doing'. We will not forget that once we were ignorant, tiresome probationers.

We will not laugh at the mistakes of beginners, but it shall be our pride to help all who come under our influence to be better women, more thorough nurses.

What is influence? The most mighty, the most unseen engine we know.

The importance of one year or two in the work, over one month in the work is more mighty, altho' narrow than the influence of statesmen or sovereigns. The influences of a good woman and thorough nurse with all the new probationers who come under her care is untold.

This it is — the using such influences, for good or for bad, which either raises or lowers the tone of a hospital.

We all see how much easier it is to sink to the level of the low, than to rise to the level of the high — but dear friends all, we know how soldiers were taught to fight in the old times against desperate odds, standing shoulder to shoulder and back to back.

Let us each and all, realising the importance of our influences on others — stand shoulder to shoulder and not alone in the good cause.

But let us be quiet.

What is it that is said about the learner? Women's influence ever has been and ever should be quiet and gentle in the working like the learner. Never noisy or self-asserting.

Let us seek all of us rather to be good rather than clever nurses.

Now I am sure we will all give a grateful cheer to our matron and to our home sister and our medical instructors.

God bless you all, my dear, dear friends and I hope to see you all, one by one, this year.

HOW SHE DID THAT

Use contrast for clarity

Communication always involves some sort of transfer of meaning, and this transfer can be risky. The opportunity for things to get lost or misinterpreted is great. So many elements get in the way — the differing perspectives of the speaker and the audience, the use of language (including vague terminology or jargon), and varying expectations of what is required in any given situation.

In this address, we see several instances of Nightingale seeking to clarify her own meaning. She obviously wants to make sure that she limits the opportunity for misunderstanding as much as possible. This trait has likely developed over her many years spent teaching.

Even though the subject matter of this address is general — she is not teaching us how to change a bedpan or clean a wound — it is still important to be understood. For this, Nightingale effectively and repeatedly employs the technique of contrast. She provides her definition of what it means to be a nurse, explaining what it is and then what it is not.

She takes back the power of the previously pejorative phrase ‘like a woman' and redefines it in the positive — much like the modern reinterpretation of what it means to ‘run like a girl'. Nightingale prescribes three successive aspirations for the trainee nurse: to do your best, to value training, and to be a good nurse. For every piece of advice, she contrasts the opposite driver of the ambition so as to illuminate her true meaning. ‘Let us be anxious to do well, not for selfish praise, but to honour and advance the cause …' Try this technique of providing counterexamples to make sure your audience does not misinterpret your meaning.

Emphasise the nature of learning and leadership

Despite the anachronistic and in so many ways ‘unfeminist' tone of this address, we can tell that Florence Nightingale holds her audience and their chosen profession in high regard. She bestows upon them some inspirational ideas about the nature of lifelong learning and the role of a leader.

We can take from her message that it is our duty to always be the student. Long after basic training is finished, we must be open to learning. That is the only way to become a teacher. She then connects her thinking to the role of the leader. If you are to lead — to command — you must learn to be a good follower. This is a lesson, buried in an antiquated document, that would benefit many aspiring leaders today.

There is a lesson here for those times you need to step into the role of trainer, teacher or facilitator, as most of us will from time to time. Learning to learn will help you better appreciate how to teach. Practising the art of ‘follower-ship’ will make you a better leader.

Encourage high virtue

If Florence Nightingale's new recruits, perhaps in their late teens, were raised in today's world, they might extract from this address the advice that they should be ‘living their best life’ — not in a post-worthy way, but in a way that allows what's best in you to shine. Your ‘best life’ should be intrinsically motivated.

This is the right context to impart the wisdom of experience and that is indeed what the audience will be expecting. Nightingale lists the virtues she believes are required: quietness, gentleness, patience, endurance, forbearance. Then she highlights the one she considers to be the ultimate virtue — thoroughness — and spends some time expounding on the nature of this, possibly overlooked, attribute of the ‘good nurse'.

Nightingale is presumably aiming to set the tone and create a standard for assessment and self-reflection. Though many practical lessons will follow, this is a great place to emphasise the virtues that must underpin all the skills and knowledge these young women will now acquire.

Interestingly, Nightingale links her talk on virtue to her take on the concept of influence. ‘What is influence? The most mighty, the most unseen engine we know.' Young women as influencers? Living their best life? Perhaps Florence Nightingale was ahead of her time after all.