The Conflicted Legacy of Florence Nightingale: Racism, Reform, and Nursing History

Every year in May, Nurses Week commemorates the birthday of Florence Nightingale, who many consider to be the mother of modern nursing. But Nightingale’s legacy has grown more complicated as scholars take a harder look at who she was beyond being a symbol for nurses. And in the last several years, nurses have been calling out Florence Nightingale’s racism.

Nightingale was a statistician and advocate for clean facilities, and she’s celebrated in nursing schools through pinning ceremonies, scholarships, and more. But her writing portrays views that are in stark contrast with professional nursing values like inclusivity, humanity, and altruism. She held prejudices against Indigenous people and other people of color. She supported British colonialism that led to the genocide of Indigenous peoples, and one of her contemporaries, Mary Seacole, believed Nightingale rejected her help out of racism.

What’s the history of Florence Nightingale’s racism? What was the context for her pioneering work and prejudice? And what, if anything, can modern nurses learn from her story?

Florence Nightingale’s Care and Colonialism: A Brief History

Florence Nightingale was born in Italy in 1820 to a wealthy English family. As a young woman, she felt called to care for others, and in the 1850s she learned basic nursing skills in a training program that totaled 14 weeks. At the time, nursing was seen as a vocation for poor women, and Nightingale was one of the first wealthy women to pursue this work.

Her wealth and status likely helped her establish herself in a short time. She practiced for a few years, and by 1954, she was personally asked by the British secretary of state to lead a group of nurses to Turkey. Here, they’d be tasked with improving care for soldiers wounded during the Crimean War.

But Nightingale left one nurse behind. Mary Seacole, a Jamaican nurse, requested to be a part of Nightingale’s group via a letter to her assistant. She was hastily rejected. Seacole believed this decision to be rooted in racism, but that didn’t stop her from serving during the war. Seacole also went to Crimea, paying her own way to Turkey to care for the wounded and ill, and earning herself a reputation as a kind and adventurous nursing leader.

Forming a Symbol

When Nightingale arrived in Crimea, the state of the wards was filthy. The soldiers were overcrowded, staff was uncooperative, and the supplies inadequate. She worked to clean up the facilities, get proper supplies, and create standards of care. She became known as The Lady with the Lamp, as she would carry a gas lamp through the dark wards at night, attending to soldiers at all hours. She also kept meticulous records on the causes of illnesses, staff efficiency, and more, and a Royal Commission was eventually established based on her data.

But a major point of Nightingale’s fame was later revealed to be false — at the time, her work was reported to reduce mortality by 2%, earning her fame back home in England. In reality, the British government altered these numbers, and the mortality rate was much higher than reported. Still, the standards of care she worked towards are the foundation for basic care today, and likely still improved soldiers’ lives.

Nightingale and her contemporaries believed in the “miasma” theory, which theorized that sickness came from bad air corrupting the body. She believed cleanliness was a symbol for purity and health. Filth wasn’t only physical, but a moral matter as well. During Nightingale’s time, British colonialists used this theory to justify destroying Indigenous health and wellness rituals. Nightingale’s beliefs about cleanliness stemmed from a belief system that condemned other groups and would later show up in her writings about colonialism.

Post-War Nightingale

The Crimean War ended in 1856, and Nightingale returned home sick with brucellosis. She met with Queen Victoria and Prince Albert to discuss the state of the British military, using her record keeping to support reform. She also began a career advocating for stricter educational and training standards for nurses.

Education is perhaps the largest contribution Nightingale made to the nursing profession. She formalized non-religious nursing education by opening the first formal school for nurses in 1860, and she helped set up training for nurses and midwives in infirmaries. By creating the first education standards for nurses, she spurred interest from wealthier women and helped form nursing into the profession it is today.

But Nightingale’s fame and political leverage were also an avenue for perpetuating damaging ideologies about Indigenous people and others. She believed British colonialism to be a worthwhile project, even though she knew that it destroyed Indigenous people’s health and lives. Indigenous traditions didn’t conform to her rigid ideologies of cleanliness and purity, and she didn’t see Native groups as people who deserved autonomy and respect.

From 1861 to 1868, she advised the governor of New Zealand during the brutally repressive era of anti-colonial uprisings among the Maori people. In 2020, New Zealand’s nurses didn’t celebrate her birthday because of her association with oppressive colonialism. In their words, her writing discussed “Indigenous peoples in the South Pacific in a racist, paternalistic and patronizing way.”

Nightingale had similar thoughts about Australia and Canada, where colonialism also decimated native peoples. In a report published in 1863, Nightingale responded to the death toll: “Every society which has been formed has had to sacrifice large proportions of its earlier generation to the new conditions of life arising out of the mere fact of change.” To Nightingale, the deaths of Indigenous people at the hands of colonialism were necessary for the expansion of British rule.

Although Nightingale’s school was in England, her teachings reached the United States during the Civil War. White, middle-class American women read her Notes on Nursing and streamed to the frontlines. In this book, she outlined basic nursing skills as well as several ideologies that don’t hold with modern nursing thought. She believed in a strict class system and imagined two tiers of nursing — one for “ladies,” and another for women who needed to earn a wage.

Despite the place she holds in nursing lore, written records paint an unflattering view of Florence Nightingale. Racism, colonialism, and moral cleanliness are not part of modern nursing beliefs. Some nursing scholars are wondering if Nightingale should continue to be a worldwide symbol for the profession, since many of her ideas go against professional values. Others are adapting nursing school traditions, like the Nightingale Pledge, to be more aligned to modern values. But what do Nightingale’s writings reveal about early nursing and today’s medicine?

Racism and Nursing History

Nightingale made contributions to the nursing profession and become one of the most famous nurses in history, yet her beliefs about Indigenous peoples make her a problematic character. Her imperialist writings reflect the racism and colonialism that formed modern medicine that still persist. From the early days of Nightingale, nursing has centered on white women, and today, more than 80% of nurses are white.

Throughout the rest of the 19th and 20th centuries, racist and colonialist beliefs have persisted in nursing. Mary Elizabeth Carnegie, the first Black president of the American Academy of Nursing, lamented in her 1986 book the fact that Black nurses’ contributions to the profession have been minimized throughout history. Another scholar, Darlene Clark Hines, wrote that racism in the nursing profession was a foundational structure for American healthcare. She described a “seemingly endless confrontation” as Black nurses fought for education and recognition in the profession.

Since gaining independence, America relied on Black nurses during times of conflict, yet minimized their expertise during peace. It wasn’t until 1946 that the nationally segregated boards of nurses agreed to unify, and nearly 80 years later, inequality persists in the profession.

Beyond Florence Nightingale: Racism in Modern Medicine

Nightingale was a complicated person who helped and harmed during her time. It may seem easy to shrug off her actions as a product of history. But the racism that Nightingale exhibited wasn’t just common in the 1800s — it’s still affecting people today. You can see it in the ways that people of color are treated in modern medicine, as clinicians and as patients.

These are just a few disturbing statistics that reveal the ways that racism is still pernicious in modern medicine and nursing:

• COVID-19 risk: American Indian, Alaskan natives, Hispanics, and Black people are around three times as likely to be hospitalized with COVID-19 compared to their White counterparts, and about twice as likely to die as a result.
• Chronic illness: Racial and ethnic minorities are about two times more likely to be diagnosed with a chronic illness than White people.
• Perinatal care: Black mothers are three times as likely to die during childbirth compared to White mothers.
• Infant care: Black babies are more than twice as likely to die in infancy compared to White babies.

Clinicians are also impacted by racism. In a survey by the American Nurse Association, 63% of nurses shared that they have experienced acts of racism in the workplace. In addition, 64% said that despite challenging this racism, nothing has changed.

What Today’s Nurses Can Learn From Florence Nightingale’s Racism

As a nurse, you have the power to address racism in the nursing profession and create new nursing traditions. Here are three ways you can start combating inherent and structural racism in nursing:

• Learn about the essential role that Black and Indigenous nurses have played in the history of the profession. These include Mary Seacole, Lucy Higgins Nichols, and Susie Walking Bear Yellowtail.
• Take implicit bias training to learn about unconscious biases that impact patients and clinicians.
• Follow the AMA’s top 10 ways to address racism in nursing.

Find Nursing Opportunities

Florence Nightingale’s racism reminds us of how far history has come in some ways, and how far we have to go in others. Every day as a nurse is an opportunity to strive for better care for all. If you’re striving for a better career, you might want to start getting personalized job updates from IntelyCare to find a position that matches your values.