This month, nurses around the world honor the birth of Florence Nightingale (1820-1910). Known as the “Lady with the Lamp” and the founder of professional nursing, she established schools of nursing and midwifery. Nightingale’s best-known publication, Notes on Nursing (1859) is a classic text for nursing care. The importance Nightingale gives to nutrition, sanitation and the careful observation of patients is still relevant to nursing practice.
Less known is that Nightingale possessed considerable administrative skills. She was a leader in hospital design and management. Her book, Notes on Hospitals (1863) shows her considerable knowledge about hospital construction. Notes on Hospitals also shows Nightingale’s understanding of high-quality, cost-effective patient care.
For example, Nightingale makes the following statement:
“…if, by any sanitary means or improved treatment, the duration of cases could be reduced to one-half, the utility of the hospital would be doubled, so far as its funds are concerned.” (Notes on Hospitals, pg. 160).
It was clear to Nightingale that improving patient care leads to reduced hospital length of stay and to greater savings and profitability.
In Notes on Hospitals, Nightingale develops forms and guidelines for reporting hospital mortality, morbidity and surgical outcomes. She recommends methods for reporting admissions, discharges, patient census and length of stay. Nightingale even advises “that the average cost of each in- and out-patient be noted” (page 165). She explains how these statistics help in identifying concerns such as high-cost preventable diseases.
More than a century before jargon such as “value-based care” became popular, Nightingale understood the relationship between costs and outcomes. Nightingale knew that good nursing care not only protects the patient’s health, but the hospital’s financial health.
Nurses today face many of the same challenges as Nightingale. We share her concerns about patient outcomes and increasingly scarce resources. There is a long tradition linking nursing to cost-effective health care. As we remember Nightingale, we should also remember that nurses share a history of contributions to health care policy, financing and leadership.