A new biography of Florence Nightingale is reported as portraying her as “not so saintly”, on the grounds that she didn’t do much sitting by bedsides proffering personal care, rather she excelled as an administrator. Apparently revolutionising the care of the wounded and started a whole profession of disciplined medical care that could be reproduced en masse to improve the survival rates of people post surgery and post infection doesn’t qualify as “saintly”: oh no, only giving men her direct, full, attention by sitting by to wipe a fevered brow would do that.
I don’t know how much of this is the author’s take, and how much is just newspaper spin, but this is what they quote the author as actually saying:
The book’s author, Mark Bostridge, says Nightingale’s success at improving survival rates of injured soldiers was largely down to her executive skills at running hospitals rather than her nursing skills.
If this really a surprise to anybody? Everything I’ve read about Nightingale has stressed her administrative skills and her ability to negotiate the necessary politics in order to get funding, staff and premises. The whole “Lady With The Lamp” legend was because she wandered the wards at night checking how things were running, which the soldiers found reassuring: I’ve never heard much at all that reported her actually by soldier’s bedsides. The idea that she was mostly concerned with whether the nurses were carousing with wounded soldiers may strike us as a prurient intrusion now, but she was acutely aware that if her hospitals could be painted as houses of ill repute then the various people whose political noses she had put out of joint would be only too happy to shut her “experiment” down.
The AAP report makes much of letters from her family that carp about her not being what her public fame describes: right, families never fail to perceive what someone makes of themselves after years away from them, and view it through the filter of old resentments/condescensions, do they?
It’s an enduring stereotype, the saintly nurse by the bedside. It’s certainly been reported as a major source of current patient dissatisfaction with degreed nurses – the idea that the nurses are too busy with the technical and administrative side of ward nursing to sit and listen to them and watch them for the beads of sweat that need wiping from the brow. It’s a very gendered stereotype, don’t you think? The idea that “proper” personal care involves hovering, waiting for any chance to be of aid, rather than having responsibilities elsewhere that also need addressing.
Of course the hospital experience can be very alienating and lonely: the way that today’s nursing care simply does not allow the nurses the time for chit-chat emphasises the impersonality of the experience, and people respond negatively. I note that they tend to blame the nurses personally though, instead of blaming the ethos that personal interaction with patients is not an aspect of hospital care that ought to be allowed time in the schedule, an ethos based purely on the bean-counting approach to medical care. I bet most patients also notice it more when male nurses take a moment to chit-chat, perceiving that as the nurse making a special effort, yet generally just expect the female nurses to chit-chat and resenting it when that’s cut short to get on with other work, perceiving that as the nurse not caring. I wonder if there’s been any studies done.
Categories: gender & feminism, health, history, media, medicine
Hoyden About Town 
Apart from the odd experience of the completely negligent nurse, my overwhelming experience of nurses is of people who are on my side in the doctor-patient battle. And even in that perception, I don’t blame the doctors (well except for that surgeon, he gets to own his own obnoxiousness), just the process that results in a total lack of useful interaction between doctors and patients.
But you’re right, nobody suggests that (traditionally male) doctors should hang about your bedside waiting to be needed. And I suspect that there would actually be more to gain by doctors doing exactly that.
Classic descriptions of nursing ethos vs doctor ethos emphasise care vs cure paradigms. This is still true. Nurses aim to take care of the patient by close observation and response to change; doctors aim to cure the patient by intervention as necessary (ie in response to nurses’ reports). Generally speaking, as long as both sides respect each other’s skills, this system should work
As for studies, they are myriad. There are some studies on identity of male nurses, many studies on patient experience of illness and how they perceive ward staff roles… I can’t point you to any but I can find out if you’d like some ideas where to look. (Hint: my partner is a senior nursing academic involved in teaching nurses how to research.)
“the way that today’s nursing care simply does not allow the nurses the time for chit-chat”
My partner recently spent four nights in hospital (at the Alfred) and all of the nurses had time to talk to both of us, not just about his medical care but also in a chatty way. Perhaps we were just lucky, but four days = quite a few nurses, and even in emergency, where they are very busy, they were really nice (as was, I must add, the emergency room doctor).
Rebekkas last blog post..Zero-waste village
I mis-stated there – most of the nurses I have worked with have been able to find time for some friendly chat as part of their rounds of observation and monitoring change (beautiful summation, M-H).
As a physio, I tended to spend longer slabs of time with some patients while putting them through their physical exercises – sometimes half an hour at a time – which tends to mean that physios (and OTs) end up having long D&M discussions with patients simply to fill up the empty air. We often heard complaints, particularly from older patients, that the nursing staff didn’t have the time to do the same. (I always felt such complaints were not really taking everything into account).
In the old system of nurses being trained on the ward, the most junior nurses were often stationed to observe just a few patients, and part of the way to observe the patients was to interact in conversation. Now that those junior nurses aren’t there (except for clinical training blocs), the graduate nurses have more patients per nurse to supervise, and have to keep moving to do so. That means time for friendly chat, but no time for any longer talks.
To my eye, the move to more academic training for nurses has been a net gain, definitely. It’s this particular aspect of having junior nurses around the ward that some patients feel as a loss, however – and it ties in to that “saintly” thing, totally. The new system feels more impersonal.
I just read an interesting blog entry by a nurse that addressed some of these issues: Nurses’ Voices, Nurses’ Image: Nurses’ Power.
Bits I found particularly worth highlighting:
Sure, nurses care, and nursing is seen by the public as a “caring” profession. However, nurses utilize scientific methods, skilled observation, and keen assessment skills to monitor patients’ progress. Nurses are not just “the caring eyes and ears of doctors”—nurses are skilled professionals fully involved in patient care—and patient cures.
and
While nurses are indeed held in very high esteem by the general public in surveys and polls, most members of that adoring public would be hard pressed to actually describe what it is that nurses do. As Bernice Buresh and Suzanne Gordon make so abundantly clear, it is up to nurses to claim their rightful place of importance in the care provided to patients in a variety of settings. Nurses need to proudly speak of their work with a voice of agency and power, and communicate clearly—to the public, the media, their families, their friends, and their colleagues—that nursing is important, that it is meaningful, and that what nurses do contributes to successful patient care and positive outcomes. We must forgo the teddy-bears, the hearts, the flowers, the useless diminutive statements and self-deprecation, and claim our professionalism for our own.
Well it’s just not appropriately feminine to be an accomplished mathematician…
Administrator? She was a scientist. A brilliant scientist who revolutionized medical research. Why is she demoted to administrator?
I’ve always thought of her as a wily political activist with superior executive skills who initiated a whole new sector of social infrastructure – I never really thought of her as a scientist. That’s really downplayed, isn’t it?
Author Anne Perry uses Nightingale’s influence on nursing in her “Monk” novels. Monk’s love interest Hester is a nurse who trained under Nightingale in the Crimea and is trying to introduce her practices in hospitals back in England after the war and is fighting constant battles against men in authority who disbelieve her because she is a woman, and the odd one who is actively trying to discredit Nightingale. Very interesting.
[inadvertent slip-up on commentor ID corrected – tt]
Just goes to show, people who inspire systemic change are rarely good at only one thing. I didn’t know about the maths, (I did know about the science in general terms), but I’d take issue with the suggestion that she was “demoted” to administrator. An administrator keeps the wheels from falling off an institution. Nothing else works without someone who has executive “administrative” skills. Just because a particular skillset is boring to you doesn’t make it worth less.