Photos of nurses from different countries and time periods, with BEYOND FLORENCE written across their faces

Beyond Florence: Valuing Nurses in the History of Health Care

Before COVID-19 was even a blip on the horizon, the World Health Organization had declared 2020 the Year of the Nurse and Midwife. This year was chosen because 2020 marks 200 years since the birth of the so-called Mother of Modern Nursing, Florence Nightingale.

But Nightingale is a problematic figure for nursing. There is little doubt of her impact; her innovations in practice and education have contributed to what we now know as the profession of nursing signified by the RN: the registered nurse. Yet, a focus on Nightingale has often obscured or elided tensions within the history of nursing. These are tensions that run along race, class, and gender lines because modern professional nursing in the Nightingale tradition was deliberately developed as a profession for white, middle class women. That history continues to impact who is able to become a nurse today, and how nurses are seen within the healthcare field.

It also impacts how nurses are seen in the history of health care. To focus only on Florence, or to claim her as the most important nurse of all time, hides the contribution of other types of nurses, and nursing care, and it reinforces the white, Anglocentric view of what it means to be a nurse. To be uncritical of her is to reify the colonizing and biopolitical hegemonies of white, western medicine. This is a history, and a discourse, that requires deconstruction.

2020 is also the year that will be remembered for a once-in-a-century event, the COVID-19 pandemic. Many people are drawing historical parallels between this pandemic and the Spanish Flu pandemic of 1918. For once, the history of medicine is front and center in the public discourse as historians write and speak about lessons that could have been learned but were lost because of the unwillingness of our government and policy to engage with history. To some, it may seem that history is irrelevant to the current situation because the science is so different, technology more advanced, the virus newer and more cunning. Historians, of course, understand that the point of history is not to cure a virus or create a vaccine, but to document the policy failures and successes, to make comparisons across the globe, and to bear witness to the experience of those who live and die through such events.

In the current situation, nurses are everywhere, all over our TV screens, heroes in scrubs, warriors on the front line, risking their own lives to take care of others. For most people who survive the virus, it will be the nursing care they remember. That’s why nursing is continually voted the most trusted profession. And yet, nursing care is bundled into the cost of the room, as though nurses are a piece of the furniture. How will history remember them, if it even remembers them at all?

The same dynamics are playing out in the flurry of academic activity around the history of pandemics. As historians of medicine strive to make their voices heard in the media today, to make claims to expertise and authority about the history of public health, too often the history of nurses is being obscured. Public health in particular was historically always the domain of the nurse, and not simply at the behest of doctors and medicine. Nurses had ideas of their own, established clinics of their own, walked the streets and climbed the rooftops day and night to provide care to people who could not afford hospitals, who couldn’t be cured, who were too small or unimportant for the doctor to notice. Yet, we are not seeing them in the history work that’s making the rounds on Twitter and Facebook and in the Zoom workshops and webinars springing up, especially in relation to the history of pandemics. These events focus on the “heroic” technologies of diagnosis and cure, usually by white male physicians. Very rarely do they consider the everyday work of nurses without whom many more millions would have died. Too often, I see an advertisement for an event that bears the face of the nurse, only to discover it is not about nursing or nurses at all, or that one speaker out of 20 is a nurse or a historian of nurses.

As a historian of nursing, you get used to this erasure. You get used to the photos that historians of medicine use in their conference presentations or on their book covers with the name of the doctor supported by the six nameless nurses in the background. You get used to people claiming heroic innovations that were enacted by, you guessed it, nurses. You get used to publishers wondering if your book would be of interest to anyone except nurses. This is not just a problem of the history of medicine, it is a problem of patriarchy, where the work of women (because nurses have been mostly women) is not valued. Caring work is considered essential, yet somehow also already natural and, therefore, not worth paying for, as Susan Reverby has so carefully documented.1

What has changed in the 33 years since Reverby published her call to arms for nurses and historians? There is now an abundance of literature about the history of nurses, both modern and traditional, American and global. You could (and some of us do) build an entire semester’s curriculum using only sources about the history of nurses. Much of this work has focused on the actions of white women, as nurse historians seek to write nurses back into the history of medicine. That worthy work has made an impact on nurses and historians of health care who seek to explore the intersection of women and health, but it needs to do more. It needs to expand to include the work of minority women, traditional healers, and health care providers who exist in the liminal spaces.

As we see the central role that nurses provide in the midst of a crisis, the desperate demand for their work and care, we also see a society that is willing to pay them less and send them to work with garbage bags and homemade masks as equipment. To understand how this came about, and how we can change it for the future, we need the history of nursing in all its tensions, complexity, and richness to be front and center in our discourse today.

Notes

  1. Susan M. Reverby, Ordered to Care: The Dilemma of American Nursing, 1850–1945 (Cambridge University Press, 1987). Return to text.

About the Author

One Comment

Susan E Shapiro

Thanks for this important reflection. I have described nursing as “everyday work,” not in the sense of being commonplace, but in the sense that nurses do the work that patients need every day…i.e. ensuring that patients have the resources they need – through their hands-on care, advocacy, teaching, care coordination, etc. – to successfully implement the multi-disciplinary care plan. It’s hard work, it can be frustrating, it requires knowledge gleaned from multiple disciplines, and it requires huge sacrifices of nurses’ time, energy, emotion, and at times physical well-being. You’re correct in your observation that our work doesn’t “count,” inasmuch as no one has figured out how to describe a “unit dose” of nursing or how to charge separately for nurses’ work…except when nurses can bill like physicians (and that’s a much larger discussion for another time). All that said, many of us – I hope most of us – get enormous satisfaction from knowing we’ve made a real difference in the lives of our patients, families, communities, and nation. I am so grateful for your work and that of your colleagues who are telling the REAL stories of ALL the women and men who paved the way for nursing and health care. Brava!

Reply

Share your Thoughts