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Florence Nightingale and the future of nurse education

Mary Spinks
The Florence Nightingale Foundation

In a letter to probationer nurses at St Thomas' Hospital, written in 1872, Florence Nightingale wrote:

"For us who nurse our nursing is a thing, which, unless we are making progress in it, every year, every month, every week, take my word for it, we are going back."

There is no doubt that the nursing and midwifery professions have progressed over the years. We have witnessed the transfer of nurse education to universities and we have seen nurses extending and expanding their roles to meet the challenges in the delivery of healthcare in a continuously changing world. Change is most noticeable in community care, where many services that were previously located in hospitals, have moved to clinics and surgeries as well as being delivered in a person's home. The roles of community nurses have changed to ensure that patient care is improved and enhanced.
But what of the future? To bring about meaningful change requires the acquisition of new skills, and this requires education and training. The budget is in the hands of the Strategic Health Authorities but is no longer ringfenced for this purpose.
Recently, Lord Philip Hunt, spokesman for health in the House of Lords, said in answer to a question asked by the President of the Florence Nightingale Foundation, that £360m pounds from education and training budgets had funded overspending in NHS Trusts. This is a significant sum of money and the question must be asked whether these funds will be put back into education and training. If not, who will fund education and training in the future to ensure that staff are safe practitioners?
Maybe the time is right to rethink how education and training resources are being used and if, in fact, this can improve patient care.
In 1851, while studying at Kaiserwerth in Germany, Florence Nightingale wrote:

"While the academic foot has taken a step in advance … the practical foot has remained behind."(1)

Is this still true today? Are nurses in danger of educating themselves and becoming academics, without influencing and improving nursing practice? Better educated nurses are needed to cope with advances in technology, interventions and treatments, but the outcome must be better patient care and an enhanced quality of life for the community.
It is easy to understand that nurses aspire to gain status and all that goes with it. However, the profession must remember that it holds the respect of the public due to its efforts to care and undertake basic nursing.
The nursing profession is struggling to provide evidence-based practice and care and requires research and nurse researchers to carry this out.
In her nursing notes, Florence Nightingale wrote:

"In dwelling upon the vital importance of sound observations, it must never be lost sight of what observation is for. It is not for the sake of piling up miscellaneous information or curious facts but for the sake of saving life and increasing health and comfort."(2)

The nursing profession has collected an amazing amount of information and facts that are now lying on library shelves gathering dust. Research and development are put together for a reason. All research must lead to development. If not, what is the point?
Funds are being allocated to nursing research, but one must question whether the monies involved are being spent to ensure that patient care is improved and developed, or instead to satisfy the "pet subject" of the researcher.
A fundamental factor that must be avoided at all costs, is the perception that research is for academics and that nurses in practice are too busy to apply the findings of research. It is very important that the nurses have input into what research is taking place, because, after all, nursing remains a practice-based profession.
Theory and practice must not become divorced, just as we must ensure that educators and researchers do not become divorced from practitioners, but instead work together for the good of patients and students.

Practical medical education
After Florence Nightingale returned from the Crimean Campaign, where she was appalled by the conditions that soldiers endured, she persuaded the government to set up the "Royal Commission on the Health of the British Army". Practical medical education was one of the four central areas investigated and reviewed. She outlined what should be taught in medical education and senior doctors implemented her proposals.
Florence Nightingale achieved this in 1860. Would she be surprised to find that nearly 150 years later, more has not been done to bring together doctors, nurses and other healthcare workers in the field of education? It is important not to waste scarce resources on separate curriculum for various groups and to replicate subjects such as anatomy and physiology throughout lecture rooms.
The outcome of more integrated education between professional groups is likely to be better relationships, greater appreciation and respect for each other's role, and less tribal warfare, from which the health service continues to suffer.
What better time than now, to develop more integrated courses for all healthcare workers. Some progress has been made but it is patchy. If we are to make the best use of the remaining education and training resources, we have a responsibility to look at this more closely and engage in more lateral thinking.
Florence Nightingale was an educator in the very broadest sense of the word. She reformed nursing education but she was also involved in the education of doctors, soldiers and women in the workhouse.

The Florence Nightingale Foundation
The Florence Nightingale Foundation - a living memorial to Florence Nightingale - advances the study of nursing and promotes excellence in nursing practice. The Foundation raises funds to provide scholarships for nurses and midwives to study at home and abroad, to promote innovation in practice and to extend knowledge and skill to meet changing needs. It promotes the special contribution of nursing to society's health and encourages international understanding and learning between nurses.
Research scholarships are awarded each year to assist nurses and midwives who are undertaking further education. Funds are available for evidence-based practice modules within a degree programme; a research-based component of a graduate programme; or a research dissertation. All applicants need to be committed to evidence-based practice and have current clinical links to service and education. The standard of application has improved greatly over the years reflecting improvements in nurse education.
Travel scholarships are awarded for study projects that allow nurses to review best practice in patient care at centres of excellence in the UK and abroad. These grants allow individuals to develop personally as well as improve patient care by extending their knowledge and skills to meet changing healthcare needs.
Each successful scholar writes a report and these reports are distributed widely, thus allowing the scholars to share with others the knowledge they have gained. The foundation's website ( contains a summary of each report thus allowing their content to be made available to a wider, worldwide audience.
Scholars are frequently invited to speak at conferences, home and abroad, on the subject they have studied. Many reports are published in the nursing press and in research journals.
In selecting its scholars, the Foundation follows the example of Florence Nightingale by paying special attention to the outcome of research and projects being undertaken, to ensure that there are benefits to patients, clients and the community. It is important that such research and projects link into the present policies and procedures in healthcare so that practice is improved.
Nurses and midwives spearhead many of the new initiatives that are introduced into the health service. Good examples are the introduction of nurse-led clinics in general practitioner surgeries and clinics, walk-in centres, nurse practitioners and triage nurses. Specialist nurses working in the community have made a great difference to the lives of people living with chronic diseases.
Meeting the future healthcare challenges means becoming more open to change and increasing our awareness of global trends and issues in healthcare, for which education and research is required.
In remembering the words of Florence Nightingale, we must not stagnate but go forward. Education and training budgets may have been raided, but the opportunities are there through the Florence Nightingale Foundation and its scholarships.

Examples of Florence Nightingale Foundation travel scholarships 2007
"Evaluation of anger management at The State Hospital"
Carolin Walker, Clinical Nurse Specialist, The State Hospital, Carstairs, visiting the USA

"The treatment and prevention of diabetic foot ulceration using pressure relieving techniques -
a comparison"
Kathleen Eccles, Diabetes Specialist Footcare Nurse, Royal Blackburn Hospital,
visiting Australia and the USA

"Comprehensive children's community nursing - exploring models for provision within the UK"
Angela Walsh, Children's Community Nursing Manager, Cockermouth Hospital, Cumbria,
visiting centres in the UK

"Sexual quality of life in women who have undergone female genital mutilation"
Comfort Momoh, Female Genital Mutilation/Public Health Specialist, St Thomas' Hospital London, visiting Kenya, Senegal, Ghana or Nigeria

"Brain cooling fact-finding and information sharing visit to Tokyo" Bridget Harris, Research Nurse, ICU, Western General Hospital, Edinburgh, visiting Japan


  1. Nightingale F. The Institution of Kaiserwerth on the Rhine, for the practical training of deaconesses. London: Colonial Ragged Training School; 1851.
  2. Nightingale F. London: Churchill; 1859.