Florence Nightingale’s Influence on Nursing and Her Legacy for Evidence-Based Practice Today
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Get it written →Discussion: Florence Nightingale’s influence on nursing
How has nursing been influenced by Florence Nightingale over time?
- How does Nightingale’s legacy for 21st-century nursing practice create an environment for evidence-based practice in the current inpatient or community setting?
- Discuss a nursing situation that validates your thoughts.
Who was Florence Nightingale?
Florence Nightingale (1820–1910) is widely regarded as the founder of modern nursing. Born into a wealthy British family, she pursued nursing at a time when it was considered unsuitable for women of her class. In 1854, during the Crimean War, she led a team of nurses to the British military hospital at Scutari (in present-day Istanbul), where soldiers were dying in large numbers, more from infectious diseases such as cholera, typhus and dysentery than from battle wounds. Through sanitation, ventilation, nutrition and careful record-keeping, and with the government’s Sanitary Commission, conditions and death rates improved dramatically (Fee & Garofalo, 2010). Her nighttime rounds earned her the name “The Lady with the Lamp.”
Clean air, water, drainage, cleanliness and light
Modify the environment to support the body’s natural healing
Polar area (“coxcomb”) diagrams; first woman elected to the Royal Statistical Society (1858)
Nightingale Training School at St Thomas’ Hospital, London (1860)
Notes on Nursing (1859) defined nursing as distinct from medicine
Hospital design, army and public health reform, nursing in workhouses and homes
How Nightingale has influenced nursing over time
| Era | Influence |
|---|---|
| 1850s–1860s | Crimean War reforms showed that nursing care and sanitation could save lives. Notes on Nursing (1859) and the Nightingale Training School (1860) established nursing as a trained, respected profession for women. |
| Late 1800s–early 1900s | Nightingale-model schools spread worldwide, including the first U.S. training schools in 1873. Nursing education became formal, with structured curricula, supervised practice and standards of conduct. |
| 20th century | Her Environmental Theory became the first nursing theory, inspiring later theorists who built on the person–environment–health–nursing metaparadigm. Hospital design emphasized ventilation, light and cleanliness. Public health and district (home) nursing expanded. |
| 21st century | Her legacy lives on in infection prevention, patient safety, quality improvement, nursing informatics, health policy advocacy and evidence-based practice. In 2020, the bicentenary of her birth, the World Health Organization designated the International Year of the Nurse and the Midwife, and International Nurses Day is celebrated on her birthday, May 12. |
Environmental Theory
Nightingale believed that nursing should “put the patient in the best condition for nature to act upon him” (Nightingale, 1860). She identified environmental factors that nurses must manage: fresh air (ventilation), pure water, efficient drainage, cleanliness and light, along with warmth, quiet, nutrition, and attention to the patient’s emotional state. These principles still guide care today: hand hygiene, infection prevention, noise reduction, sleep promotion, early mobility and healing hospital design.
Nightingale’s legacy and evidence-based practice in the 21st century
Evidence-based practice (EBP) integrates the best research evidence with clinical expertise and patient values and preferences to guide decisions (Melnyk & Fineout-Overholt, 2023). Long before the term existed, Nightingale practiced its core elements:
| Nightingale’s practice | Modern EBP environment |
|---|---|
| Collected and analyzed mortality data to identify causes of death | Nurse-sensitive quality indicators, infection surveillance, dashboards and nursing informatics |
| Used visual statistics (polar area diagrams) to persuade leaders | Data visualization to communicate quality outcomes to stakeholders and drive change |
| Observed patients closely and documented findings systematically | Standardized assessments, early warning scores and EHR documentation |
| Changed practice based on evidence (sanitation reduced deaths) | Translating research into protocols and care bundles; quality improvement cycles such as PDSA |
| Emphasized the environment and prevention | Infection prevention bundles, hand hygiene, sleep and noise reduction, social determinants of health |
| Advocated for policy and systems change | Nurses on hospital committees, shared governance, Magnet designation and health policy advocacy |
| Formal education and training | Lifelong learning, BSN and graduate education, and EBP competencies |
In practice, Nightingale’s legacy creates an environment for EBP in three ways (Karimi & Masoudi Alavi, 2015):
- A culture of inquiry: she modeled asking “why are patients dying?” and searching for answers in data. Today, nurses are encouraged to question routines (“we’ve always done it this way”) and to ask clinical questions in PICOT format.
- Data as a tool for nursing: she proved nurses can collect, analyze and act on data. Modern units track falls, pressure injuries and infections and use these data to improve care.
- Nursing autonomy and leadership: she established nursing as a profession with its own body of knowledge, giving nurses the authority to lead EBP projects and nurse-driven protocols.
In community settings, her emphasis on sanitation, health education, home nursing and population data underpins public health nursing, home health, disease surveillance and efforts to address social determinants of health.
A nursing situation that validates this legacy
Example situation; describe a real experience from your own practice in your discussion.
Inpatient example: reducing catheter-associated urinary tract infections (CAUTIs). On a medical-surgical unit, the infection prevention team’s monthly data showed a rise in CAUTIs. Like Nightingale reviewing mortality records at Scutari, the nurses examined the data and found that many urinary catheters remained in place days longer than needed, often because no one reassessed whether they were still indicated.
Searching the literature, the team found evidence that reminder systems and nurse-driven stop orders significantly reduce catheter use and CAUTI rates (Meddings et al., 2010). The unit adopted a nurse-driven catheter removal protocol: nurses assess the need for each catheter every shift using evidence-based criteria and remove it without waiting for a physician order when criteria are no longer met. Staff were educated on aseptic insertion, maintenance, perineal hygiene and hand hygiene, which are direct descendants of Nightingale’s cleanliness principles. Over the following months, catheter days and CAUTI rates fell, and results were shared on a unit dashboard.
This situation shows Nightingale’s legacy at work: observing a problem, using data to understand it, applying evidence to change practice, controlling the environment to prevent infection, and empowering nurses to lead improvement.
Community alternative: a public health nurse notices high rates of childhood asthma visits in one neighborhood, maps cases, identifies environmental triggers such as mold and secondhand smoke in older housing, and partners with housing agencies and families on home assessments and education, echoing Nightingale’s focus on healthy homes, clean air and population data.
Sample discussion post
Florence Nightingale transformed nursing from untrained caregiving into a respected, educated profession. During the Crimean War, she showed that sanitation, ventilation and careful record-keeping could dramatically reduce deaths, and she used statistics and visual diagrams to persuade leaders to reform hospitals (Fee & Garofalo, 2010). Her book Notes on Nursing and the Nightingale Training School established nursing education, and her Environmental Theory, which focuses on fresh air, clean water, cleanliness, light and quiet, remains relevant today. Nightingale’s legacy creates an environment for evidence-based practice because she modeled a culture of inquiry, used data to identify problems and guide decisions, and established nursing’s authority to change practice (Karimi & Masoudi Alavi, 2015). Today, nurses use quality data, research and patient preferences to improve care (Melnyk & Fineout-Overholt, 2023). On my unit, rising CAUTI rates led us to review infection data and the literature, which supported nurse-driven catheter removal protocols (Meddings et al., 2010). After implementing the protocol and reinforcing hand hygiene and catheter care, our CAUTI rates decreased. This experience shows that Nightingale’s approach of observation, data, environmental control and nurse leadership is still the foundation of evidence-based nursing.
Related reading: the application of data to problem-solving, finding evidence for a nursing intervention, PDSA practice improvement and philosophy of nursing practice.
Conclusion
Florence Nightingale’s influence runs through every era of modern nursing, from the hospital reforms of the Crimean War to nursing education, theory, public health and quality improvement. Her insistence on observation, data, a healing environment and professional nursing knowledge laid the foundation for evidence-based practice. Whether nurses are reducing infections in a hospital or improving housing conditions in a community, they continue her work of using evidence to protect patients and improve health.
References
Fee, E., & Garofalo, M. E. (2010). Florence Nightingale and the Crimean War. American Journal of Public Health, 100(9), 1591. https://doi.org/10.2105/AJPH.2009.188607
Karimi, H., & Masoudi Alavi, N. (2015). Florence Nightingale: The mother of nursing. Nursing and Midwifery Studies, 4(2), e29475. https://doi.org/10.17795/nmsjournal29475
Meddings, J., Rogers, M. A. M., Macy, M., & Saint, S. (2010). Systematic review and meta-analysis: Reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clinical Infectious Diseases, 51(5), 550–560. https://doi.org/10.1086/655133
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Nightingale, F. (1860). Notes on nursing: What it is, and what it is not. D. Appleton and Company.
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