key: cord-285741-1n7kwx91
authors: Homer, Caroline; Bucknall, Tracey; Farrell, Tanya
title: What would Florence think of midwives and nurses in 2020?()
date: 2020-08-20
journal: Women Birth
DOI: 10.1016/j.wombi.2020.07.009
sha: 
doc_id: 285741
cord_uid: 1n7kwx91

nan

What would Florence think of midwives and nurses in 2020? $ When 2020 was declared by the World Health Organization to be the International Year of the Nurse and the Midwife none of us imagined what the year would really bring. Before February-March 2020, we enthusiastically looked forward to local, national and international celebratory events including, for midwives, conferences like the Congress of the International Confederation of Midwives and for nurses, the launch of the State of the World's Nursing Report. Much excitement was anticipated for 2020 but then COVID-19 happened as a global pandemic and touched all of our lives in many ways. This year is like no other and our professions have been impacted in ways we never anticipated.

The year, 2020, was selected as the International Year of the Nurse and the Midwife as it coincides with the 200th anniversary of the birth of Florence Nightingale. Florence Nightingale has been described as a caring and trailblazing British nurse, statistician, social reformer and leader of improved health care who is widely regarded as the founder of modern nursing. The year was also in recognition that strong nursing and midwifery workforces are key to the achievement of universal health coverage. With more than 50% of the global health workforce being nurses and midwives, strengthening these professions is one of the most important things to improve global health. Yet, in many countries and contexts, nurses and midwives are undervalued and unable to fulfil their true potential. The aim for 2020 was to ensure that all nurses and midwives operate in an environment where they are safe from harm, respected by each other, by medical colleagues and community members, have access to a functioning health-care service and where their work is integrated with other health-care professionals [1] .

While the COVID-19 pandemic took away the ability to celebrate 'our' year in the way we planned, it has ultimately shone a giant light on the incredible work of midwives and nurses and has provided an opportunity to lead and showcase our true worth more than ever beforethis has been real visibility and commemoration.

Florence Nightingale was born on 12 May 1820 (which is why we celebrate International Nurses Day on 12 May) into a wealthy and well-connected British family in Florence, Italy, and was named after the city of her birth. Given northern Italy had experienced very high numbers of people ill and dying of COVID-19 recently, this link seems even more poignant.

The accounts show that young Florence lived an early life of privilege including travel, meeting people in powerful positions and having time to write as would have been usual for a woman of her class. In 1852, in her early thirties, she wrote an essay of protest against the restrictive life of upper class English women. This essay called Cassandra [2] , highlighted what she saw as the emptiness of women's liveshow their time was not valued, they were not allowed to enter professions or use their minds, but were expected to take rides and entertain anyone who came to visit at any time.

Florence's most famous contribution to nursing came during the Crimean War. In October 1854, she and the 38 women volunteer nurses that she trained and 15 Catholic nuns were sent to Scutari where there was a hospital of sorts. Whilst there is some controversy about the extent of her leadership, some assert that she reduced the death rate from 42% to 2%. Notably her focus on handwashing after Semmelweis, a Hungarian doctor working in Vienna who advocated for the importance of hand washing to reduce sepsis-related deaths in the maternity unit. Highlighting the importance of handwashing is another strong link to work focus today.

Florence was an entrepreneur and an opportunist. In 1855, the Nightingale Fund was established for the training of nurses during a public meeting to recognise Nightingale for her work in the war with an outpouring of generous donations. This Fund was used to establish the Nightingale Training School at St Thomas' Hospital in 1860 (now the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King's College London). The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary.

Much of Florence's work after the Crimea War focussed on the importance of cleanlinesshandwashing, sanitation and the analysis of epidemiological data to make decisions about the provision of health care. Florence was definitely a leader who expected high standards. One quote from Notes on Nursing which highlights this: if a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease but of the nursing" [3] .

Looking at all of this through a 2020 COVID-19 lens, Florence's actions and her books have direct relevance today. For example, Notes on Nursing published in 1859 [3] amongst other things says that every nurse ought to wash her hands very frequently. The Notes of Nursing for the Labouring Classes [4] in 1861 reiterated the need for cleanliness, care and support and the importance of having well trained and qualified nurses to improve outcomes. She was courageous, bold, a visionary thinker with the tenacity to make changes happen and keep focussed on the 'patient'.

What would Florence think about todaya COVID-19 world where nurses and midwives are again at the front and centre of what is happening in every country. Nurses and midwives across the world are stepping upmaking changes, rethinking practices, working out how to deliver care differently, how to keep patients, and in maternitywomen, babies and families, at the centre of care providing compassion and empathy while protecting themselves and their co-workers. We see nurses and midwives all over the country with passion and desire to make this the best it can be the safest for all. Nurses and midwives are coming out of retirement and from other roles in the professions, volunteering to learn new skills, to take on new challenges, showing leadership and being at the decision making tables. Changes are happening fastsome are good, some may not last beyond COVID-19, some are scary as we test new things without our usual 'checks and balances'.

When Florence arrived at Scutari almost 166 years ago, it must have been a messsolders dying of sepsis and infections such as typhoid, cholera and dysentery, a lack of medical equipment, a lack of food, poorly trained staff and an actual war not far away. She must have wondered where to starta bit like the position we are in at this momentso much to do and possibly so little time.

What would Florence think of nurses and midwives in 2020 in the midst of a global pandemic? We believe she would be impressed with our level of education and our knowledge, skills and capacity to take on this challenge. She would marvel at our level and high standard of education, our capacity to lead research, practice improvements and our key contribution to national and international policy directions and leadership. She would be impressed by the new ways of educating and skilling up nurses and midwivesusing online, skills laboratories, simulation and virtual reality and at the speed to which these changes have been embraced. She would be impressed that we can capture, analyse and understand data better and have research to back up decisions on patient care, disinfection, sanitation, isolation, staffing models and so much more. She would be amazed to see data graphics in every newspaper including the pie graphs that she pioneered 150 years ago. She is also likely to be impressed that we are everywhere nurses and midwives make up over 50% of the global health workforce and are the backbone of every modern hospital.

Florence would be proud of usof the millions of midwives and nurses all over the world courageously stepping up and stepping forward to deliver the best patient care in hospitals, health facilities and in the community. Nurses and midwives are stepping up and stepping forward in an uncertain world to ensure that all people get the very best nursing and midwifery care that they deserve in every part of their life. She would be proud of the nursing and midwifery leadership yet probably disappointed with the lack of recognition. In many countries, nurses and midwives have been leading and coordinating the planning and guideline development although that has often been unrecognised and not showcased in any capacity.

Florence would probably also be busily writing letters and meeting people in power to demand better conditions for 'her' nurses and midwivesbetter access to personal protective equipment which is sadly lacking in many contexts, better data collection of COVID-19 infection and deaths in health care workers, especially midwives and nurses and better research funding to study improved ways of tracking and supporting close contacts, supporting workforce planning including managing the furloughing of staff and testing new and old intervention to improve outcomes. We think she would also demand that midwives and nurses are around every health policy and decision making table in the world.

We have Florence's batonthis year more than any other in the past 200 years is our moment to make her proud, to do what we know we can do bestto be the best nurses and midwives we can. This will be like no other international celebrationmaybe not much champagne, a few less parties or conferences to show how great we are but a celebration nonetheless. This is the real thingthe real way to celebrate the International Year of the Nurse and the Midwife and we know we can and will do it.

Available from:, World Health Organization

Notes on Nursing

Notes on Nursing for the Labouring Classes