International Nurses Day, commemorating Florence Nightingale’s birth on 12 May 1820, was established by the International Council of Nurses in 1974. At that time, British nursing was a dominant influence in the International Council of Nurses (ICN), the World Health Organization (WHO) and many countries, especially the Commonwealth – the former territories of the British Empire. I’ve joined Nurses Day celebrations in countries as diverse as Uganda and Uzbekistan, where I received a Florence Nightingale medal. Her enduring status as a global icon is inextricably linked with a long-held, and in many respects well-deserved, respect for British nursing.
The world has moved on, however, and this is an opportune moment to consider the implications of her legacy. She defied Victorian conventions to transform many aspects of public health as well as nursing and midwifery, but she was also a woman of her time. A devout Christian, her rich, privileged family included aristocrats, members of parliament and high-ranking army officers. Denied a full role in public life because of her gender, she made clever political use of these influential connections. Some were prominent activists for the rights of women and animals, and opposed slavery, which she called ‘the open sore of the world’ (Bostridge 2008).
Her lifespan coincided with the expansion and consolidation of the vast Empire, proudly coloured pink on the world map hanging in every British schoolroom. Enslavement was one dimension of the mixed imperial legacy. Another, also still influential, was the imposition of styles of nursing practice, education and management based on the Christian, white British model and values that she promoted and helped to shape.
Working for the ICN and WHO I saw the legacy in many countries, especially former British colonies. The outward signs included starched caps, deference to doctors and matrons, and crucifixes on the ward wall. It sidelined and weakened valid, strong, local ways of working and relating, such as community solidarity, holistic understandings of health and the wisdom of indigenous healers. These issues are not just historical, but play out every day everywhere, including in the UK.
When I became a nursing student in 1976 in multi-ethnic East London, our teaching hospital consultants and managers were mostly posh white men, while the nurse managers and ward sisters were mainly middle-class white women. Some enrolled nurses and many nursing auxiliaries were female and black, Asian and minority ethnic. Some had probably responded to the NHS’ appeal to Caribbean women to train in the UK to alleviate staff shortages in the 1960s. They were thrown into an often-hostile environment where racism was worsening. A government report asserted without shame that ‘coloured workers’ failed to find employment because of their ‘irresponsibility, quarrelsomeness and lack of discipline’ (Olusoga 2021).
There has been progress, including the gradual emergence of many strong and expert black, Asian and minority ethnic nursing and midwifery leaders in the UK and elsewhere. Yet sexist and racist subcultures, bullying and misogyny still exist, even – shockingly – in our own RCN (Carr 2022). So how can we accelerate change? Active support for the RCN’s Equality, Diversity and Inclusion agenda should be a golden thread running through everything we do. Rejoining the ICN and reviewing our other international activities provides a timely opportunity to engage with and learn from a wide range of fellow professionals in the UK and worldwide.
We Fellows can draw on our diversity and deep individual experience to consider how best to contribute to these big issues. Each of us must challenge racism and bias in ourselves and others, conscious or unconscious. With open minds and humility, we could start with honest analysis of the Nightingale legacy in postcolonial contexts, and ask what restorative justice might look like.
References
Bostridge, Mark (1980). Florence Nightingale. Penguin Books.
Carr, Bruce (2022). Independent review of the culture of the Royal College of Nursing. RCN.
Olusoga, David (2021). Black and British: a forgotten history. Picador.
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