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

Moving Beyond Florence: Why We Need to Decolonize Nursing History

When I suggested the “Beyond Florence” series to the team at Nursing Clio, I didn’t set out to “cancel” Florence Nightingale.

In my introductory essay, I described the environment that gave rise to my concerns about how nursing history was being represented in both the year of COVID-19 and the International Year of the Nurse and Midwife. I had already suggested elsewhere the problems with focusing too much on Nightingale, concerns that extend to the limited focus of traditional nursing history scholarship itself.[1] As a historian (who works in a school of nursing) my goal is to educate future nurses and health care providers about the complex and fraught history of modern western health care systems in relation to racism and inequality. So the purpose of this series was to make space for alternative stories, stories about marginalized people and the lack of care they endure, stories about pioneers in nursing and midwifery who sought to challenge the racism and inequality that people like Nightingale and the system she helped create have bequeathed us. There are plenty of celebratory (and some critical) histories of nurses like Nightingale. Plenty of people have dealt with her legacy for nursing, some nurse historians more thoughtfully and nuanced than others.[2] There is no need to repeat this work – it is easily accessible and you need only conduct a quick Google search to find it. Our Call for Bloggers for this series instead asked for essays that would tell other stories, that would illuminate hidden histories, that would, in fact, go “Beyond Florence.”

We received ideas in abundance. The essays published in this series demonstrate the exciting new research of both established and emerging scholars, including nurses, historians, activists, and clinicians. These writers recognize that the terrible and unjustifiable inequalities that face nurses and their patients today are the result of a long and terrible history of health care that has exploited, manipulated, and ignored minorities and people of color. This is a direct result of the heteronormative white supremacy with which modern medicine is complicit – one which historians of nursing and medicine can no longer shy away from.

I expected some resistance, and it came thick and fast. On Twitter, authors, supporters, and I were accused of “cancel culture” – of wanting to tear down traditions and rewrite history. Our response to these tweets has been “Well, yes, and thank you, because it needs to be rewritten.” But we have also reminded critics that our goal was not to cancel the canon but to highlight alternative stories and bring nuance to a field so white as to be blinding. I live and work every day with this resistance, so I am somewhat inured to it.

But even I was taken by surprise by the outright attacks and poisonous vitriol of some Florence defenders who took particular exception to one essay about the racist beliefs of Nightingale herself. One retired professor, a self-appointed custodian of Nightingale (who is neither a nurse nor a historian), has taken to trolling the author, a junior academic, sending her and her academic supervisors damaging and demanding emails. Most recently, this professor began sending incessant emails to the entire Nursing Clio editorial team demanding that we publish a response or engage in some kind of debate with her. This behavior also doesn’t surprise me, because it’s emblematic of the very problem some of our essays have described, and it demonstrates the entitlement and violence at the heart of health care systems built on white supremacy.

This objection that some have to “Beyond Florence” is that they perceive our aim as trying to replace or erase the significance of Nightingale, rather than appreciating it as an attempt to add to our understanding of her, and of nursing history more broadly. Some have explicitly reacted to our claim that Nightingale was racist by rising to defend the “Lady with the Lamp” from this “outrageous” perfidy, but it is not even an outrageous claim. Not only did our author base her essay on Nightingale’s own writing about Indigenous people (I too have encountered her disturbing work on Australian Aboriginal people in my own research), but also other nurses themselves have made the same claims and have written extensively about the problematic legacy of racism and colonialism in the profession and in its historiography.[3]

We have also been accused of practicing a kind of “presentism” (again by someone who is not a historian). We have been accused of carrying our own values back into an analysis of the past, as if history was simply “facts” that can be presented without comment. But all good history is analytical, shaped by the concerns, perceptions, and theoretical leanings of the historian who writes it. If our role as historians is not to judge the past to some extent, then what exactly are we doing?

Oil painting.
Mary Jane Seacole (née Grant) (Albert Charles Challen, oil on panel, 1869 / Wikimedia Commons)

But leaving that charge aside, our accusers also refer us to other evidence from Nightingale’s time that supposedly exonerates her of these “heinous” charges. The problem with this evidence is that it comes from Nightingale herself or her supporters. Our accusers make a mistake here that is common in most white-centered history – they think the only evidence that counts is the evidence of other white people. It is no coincidence that one of these scholars has also denigrated Mary Seacole, a Black Jamaican nurse and a Nightingale contemporary. Seacole herself saw her rejection by Nightingale as racist, in the same way that the subjects of empire, colonialism, and enslavement knew their oppressors to be. The greatest evidence for a charge of racism against a white upper-class Victorian woman concerned with civilization, sanitation, and cleanliness is that she was indeed a woman of her time. Nightingale was deeply embedded in the colonial enterprise, which was by its very nature racist. Her writings against the Maori and the Aboriginal Australian are heavy and sickening with the arrogance and hubris of the English in the 1800s who believed that “the Natives” were theirs to civilize or let die out.[4] The medical enterprise added weight to the task by creating race as a biological thing in which Blackness was marked by savagery, lack of intellect, and emotional inferiority, attitudes which have traveled almost entirely uninterrupted down the centuries into modern health care systems.[5]

My point here is that we did not seek to, or even need to, “cancel” Nightingale. But we absolutely must bring a decolonizing perspective to our understanding of her. That is, we need to recognize that medicine and nursing were important tools of colonialism that led to the neglect and abuse of millions of people. She was not the right symbol for a truly international year of the nurse and midwife because she represents the continuation of colonizing practices in nursing and health care today. The evidence of the damage caused by the racism of white supremacist health care systems lies strewn all about us, in the overrepresentation of minorities and people of color in the death rates of a global pandemic, in the tragic outcomes for Black mothers in the United States, in the exploitation of immigrant health care workers.

And Nightingale needs decolonizing because what she represented for past generations of white women is not relevant for a modern profession that now needs to move quickly to come up with solutions to these problems, which are an effect of its own history. The purpose of the histories presented in this series is to demonstrate that many other people in the history of nursing have recognized the racism in the profession, that they had and do have solutions that could have made things different. The protestations of the establishment professoriate, who seek to gatekeep and punch down, are also irrelevant to a new generation of health care clinicians and historians who are not scared to address racism head-on.

These new essays and approaches have been met with joy and gratitude from the majority of readers, representing a new generation of health care and history scholars who seek to unwind the problems they have inherited and demand new historical (and contemporary) role models who look and think like them. I am proud, and the entire Nursing Clio team is proud, to support this exciting new work and look forward to more of the same.

Notes

    1. Kylie M. Smith, “Facing History of the Future of Nursing,” Journal of Clinical Nursing 29, nos. 9–10 (2020): 1429–31.
    2. Siobhan Nelson and Anne Marie Rafferty, Notes on Nightingale: The Influence and Legacy of a Nursing Icon (Cornell University Press, 2010); Mark Bostridge, Florence Nightingale: The Woman and Her Legend (Penguin, 2015).
    3. For just a few examples, see Calvin Moorley, Philip Darbyshire, Laura Serrant, Janine Mohamed, Parveen Ali, and Ruth De Souza, “Dismantling Structural Racism: Nursing Must Not Be Caught on the Wrong Side of History,” Journal of Advanced Nursing 76, no. 10(2020): 2450–53; Judith Anne Barber, “‘Concerning Our National Honour’: Florence Nightingale and the Welfare of Aboriginal Australians,” Collegian 6, no. 1 (1999): 36–39; Tiffany Shellam, “‘A Mystery to the Medical World’: Florence Nightingale, Rosendo Salvado and the Risk of Civilisation,” History Australia 9, no. 1 (2012): 110–135.
    4. Florence Nightingale, “Note on the Aboriginal Races of Australia: A Paper Read at the Annual Meeting of the National Association for the Promotion of Social Science,” held at York, September, 1864. (London: Emily Faithfull, 1865).
    5. Warwick Anderson, The Cultivation of Whiteness: Science, Health, and Racial Destiny in Australia (Duke University Press, 2006); Rana A. Hogarth, Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780≠1840 (University of North Carolina Press, 2017).

About the Author

10 Comments

G Loehr RN, CNM, NP

I was in a BSN program in Chicago 1987-1989. I brought a critical feminist method with me and was shot down immediately. The conservatism and lack of quality intellectual discourse in nursing culture appalled me. I learned to shut up and never again try to become a writer in nursing. I am happy you are doing this work. It is much needed.

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Natalie SD

Thank you so much for this entire series. It was long overdue, but what a triumph of scholarship, history and resistance. Inspiring and meaningful, I believe this series will hold a special place in nursing history, as one of many turning points in a broader paradigm shift that brings all of nursing forward.

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janetlynnegolden

This has been a tremendous series of essay and I congratulate you and all of those who work so hard to make Nursing Clio such a powerful historical resource.

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Cath

I studied nursing in Melbourne, Australia and the first thing that ALL the lecturers did in our first weeks of classes was to tell us that Nightingale was done, that she did not represent us and that their opinion of her legacy was one of shame and damage that nurses were still trying to rectify to this day (they also acknowledged that she did bring positives). I’m not ashamed to admit that I entered the nursing profession in part because of a children’s picture book titled “The Lady of the Lamp” but as a feminist young woman I was so proud to hear my lecturers explain in detail why we needed to do better than they had and than those before them had done. They were mostly speaking from a gendered perspective rather than a race perspective but the point still stands.

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Jane Hopkins Walsh

Thank you for this amazing and enlightening series. I look forward to revisiting these important articles, sharing them and digging into the references for more.

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Suzanne Fernandes

I have been a nurse for thirty nine years and have witnessed both individual racism as well as systemic racism among nurses and health systems. Acts of cruelty and shame directed towards patients, families of patients as well as the environmental service employees who work so hard to provide the supplies and keep our
environments safe and clean. I am so proud of the nursing profession overall but we clearly have work to do. We must educate staff on cultural sensitivity, racial bias and trauma informed care in order to create caring and culturally sensitive health care environments.

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Ann Mostofi, MSN, RN

I find your approach refreshing, open, and accepting of Nursing as a multicultural body of professional s who believe in caring for all. Keep up your good work. thank you for reminding us of our obligation to inclusivity and awareness of our own institutionalized racism.

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