Although Florence Nightingale became an expert in many areas of health care, including hospital design and public health, it is her contribution nationally and internationally to the development of nursing as a profession for which she will best be remembered.
Nightingale's establishment of the world's first modern secular school of nursing at St Thomas's Hospital, London, in 1860 marked the start of a nursing revolution that ultimately led to the creation of a new profession for women. Her experiment in the formal education of nurses spread beyond the boundaries of Britain to be emulated worldwide. This prompt adoption by many nations of her school of nursing concept was facilitated through the activities of those who became known as the Nightingale disciples.
Background
Civilian nursing was not high on Nightingale's agenda after her return from the Crimean War, nonetheless the public outpouring of gratitude had resulted in the creation of the Nightingale Fund, equivalent to about £5.7 million today. When a decision was made to rebuild St Thomas's Hospital on a site across the Thames from the Palace of Westminster, Nightingale decided that this was the perfect opportunity to use the fund to develop the first purpose-built school of nursing within its grounds. Until the new hospital site became available, she used a building within the grounds of the old hospital site near London Bridge. The first 25 probationers commenced their one-year training course in 1860, but in 1862 the school was moved to Surrey Gardens near the Oval Cricket Ground, where it stayed for 8 years. In 1870, the purpose-built Nightingale Home and Training School for Nurses opened within the grounds of the new St Thomas's Hospital, remaining there until its amalgamation into King's College (part of the University of London) in 1996. It is situated on the south side of Waterloo Bridge adjacent to the old Royal Waterloo Hospital for Children and Women.
Nightingale was too ill and preoccupied with other health-related ventures to run the school herself and Sarah Wardroper, a matron of St Thomas's, became its first superintendent. After Wardroper's death in 1892 Nightingale (1892) wrote a glowing eulogy in the British Medical Journal, in which she commended her for the successful training of more than 500 nurses. In her tribute, Nightingale stressed that 50 of the school's graduates were working as matrons or superintendents in hospitals across the UK and abroad, where similar schools of nursing had been established.
Graduates of the school disseminated its successes
The Nightingale disciples soon promulgated the St Thomas's School of Nursing achievements. These graduates included:
Linda Richards, 1841–1930
In 1872, Linda Richards enrolled in a new nurse training programme, which had been established at the New England Hospital for Women and Children in the US, becoming its first graduate in 1873. In 1877, she was invited to pursue further training in Great Britain and enrolled as a pupil at the St Thomas's school after personally meeting Florence Nightingale. After completing a period of training at the Nightingale school, she returned to the US to establish high-quality, professional Nightingale-type nurse training schools across the country. She is also credited with the foundation of the first nurse training school in Japan within the Doshisha Hospital, Kyoto (Hannik, 2020).
Lucy Osburn, 1836–1891
Osburn was the daughter of a well-known Egyptologist. She was well educated and spoke several languages and, like Nightingale, had shown an interest in nursing from an early age. Also like Nightingale, she spent 4 months observing nursing practice at the Kaiserwerth hospital in Germany and, in 1866, much against her parents' wishes, enrolled as a probationer at the Nightingale school of nursing.
In 1868, Osburn was appointed lady superintendent at the Sydney Infirmary following a personal appeal by an influential Australian politician to Florence Nightingale for help with staffing the infirmary. Osburn, accompanied by five trained sisters, arrived at the infirmary on 5 March. She set about transforming nursing practice and is now widely regarded as the founder of modern nursing in Australia. Although she suffered a number of trials and tribulations in her new role, Osburn successfully established nurse training based on Nightingale principles across New South Wales (Griffiths, 1974).
Rebecca Strong, 1843–1944
Strong was widowed at a young age and was motivated to pursue a nursing career. Aged just 20 years she was accepted as a probationer at the St Thomas's nursing school in 1867. Following training she worked at the Royal County Hospital in Winchester and then at the British Army Royal Victoria Hospital at Netley near Southampton. In 1874, she was appointed matron of Dundee Royal Infirmary and, in 1879, matron of Glasgow Royal Infirmary. She is now widely regarded as the founder of modern nursing in Scotland.
Strong quickly found that nurse training in Glasgow was suboptimal and devoted her energies to making improvements. Perhaps her unique contribution, built on Nightingale's initial work, was to initiate the block apprenticeship training programme, which soon became commonplace throughout schools of nursing everywhere. Her programme involved short bursts of theoretical input within the school of nursing followed by periods of nursing practice.
She is also credited with introducing the concept of the preliminary training school (PTS), which persists worldwide in one form or another in schools of nursing to this day. Her development of the PTS, which was initiated at Glasgow's Royal Infirmary in 1893 represented the first attempt at providing a theoretical preclinical course for student nurses (Nutting 1901; Weir, 1996). Later, she became a strong supporter of state registration for nurses. Many readers will remember spending their first 3 months of training in the PTS classroom before being let loose on the wards (Parry, 2014).
Alice Fisher, 1839–1888
After the death of her academic father, Fisher enrolled as a probationer at the Nightingale School of Nursing in 1872. After completing her studies she successfully secured a series of senior nurse leadership positions, first at Addenbrooke's Hospital in Cambridge, then the Radcliffe Infirmary in Oxford, and subsequently the Birmingham General Hospital.
In 1884, she immigrate to the US to take up a senior position at Philadelphia General Hospital, where she was appointed superintendent. There she established a nurse training school, with the first pupils entering service on hospital wards in 1885. Uniquely, Fisher invited citizens of Philadelphia to sit in on classes and in this way attracted hospital patronage from wealthy members of the public. This helped establish the hospital as one of the finest in the US. Fisher died prematurely at the age of 49, but she is still remembered as a Nightingale disciple who helped promote modern nurse education (Lynaugh, 1990).
Angélique Lucille Pringle, 1846–1920
One of Nightingale's most influential, and perhaps her favourite, disciple was Angélique Lucille Pringle from Scotland. Along with Rebecca Strong, she is credited with revolutionising nurse education in Scotland. This nursing pioneer travelled extensively as a young woman and reportedly crossed the Sahara desert by camel.
She returned to Britain in 1868 at the age of 22, enrolling as a probationer in the Nightingale's School of Nursing. She was subsequently identified as one of the school's most outstanding probationers. After training, this most able of Nightingale's protégés became matron of the Royal Infirmary of Edinburgh in 1872. In her 14 years as the matron, she transformed nurse education, and was undoubtedly helped when the Edinburgh Royal Infirmary became a sister institution of St Thomas's, with the two exchanging nursing services.
When Sarah Wardroper was no longer fit enough to work, Nightingale requested that Pringle should return to St Thomas's to become the new matron in 1887. However, after only 3 years in the post, Pringle resigned after converting to Catholicism. She subsequently travelled extensively to many countries, including Ireland, where she advised on nursing issues (Redpath, 2018; King's College London, 2020).
The next steps
These and other Nightingale disciples ensured the consolidation of the embryonic nursing profession, preparing it for further development in years to come. They went on to disseminate modern nursing in hospitals across the world. However, despite the success of Nightingale's reforms to nurse education, there was still no standardised length of training for nurses and no statutory qualification leading to registration, which was still decades away. Nightingale herself was not supportive of state registration, but she had ensured that nursing had become a respectable profession and vocation.
In the latter decades of the 19th century it became increasingly important for nurses to be trained and the teaching hospitals attracted the highest calibre probationers. Hospital nursing badges were introduced by the nursing schools in the 1860s, which signified where a nurse had trained. It quickly became apparent that there was more kudos linked to where a nurse had trained than what she had been taught (Sullivan, 2008).
At the time of Wardroper's death in 1892, the initial Nightingale era was over. It was time for other nurses to pick up the gauntlet that was now professional nursing. Although Nightingale had ensured that Dickens's character Sairey Gamp was truly dead and buried, nursing was still an unregulated profession and anyone could claim to be a nurse prior to 1919.
Subsequent to the launch of the first nursing school at St Thomas's Hospital, other hospitals opened their own nursing schools but standards for training lacked consistency.