In Gallup polls for over 20 years, the public has rated nursing as the most trusted—not the most influential—profession. Florence Nightingale might say we’ve wasted the public’s trust since we haven’t intentionally translated the power inherent in that trust into influence. What can we learn from her about trust, power, and intention to maximize our influence beyond the bedside and into board rooms, financial markets, and legislative halls of power?
Foundational underpinnings
The foundational underpinnings of Nightingale’s knowledge base were laid during her childhood education in the then male-centric subjects of mathematics, Greek, and philosophy alongside traditional female-centric areas related to household management. Her upper-class family was committed to social reform, providing her with entrée to contemporary thought leaders. Discourse with them honed her ability to deliberate social issues and related policies and demonstrated the value of building and maintaining a complex network of relationships.
Nursing foundation
Nightingale’s intentional pursuit of preparation in nursing, despite her parents’ objections, honed her observational and documentation skills. An early experience during a cholera outbreak proved foundational to her thinking about infection control. A later opportunity with the Institution for Ill Gentlewomen required her to learn how to negotiate; hire and fire personnel; and manage contracts, finances, and logistical operations. She built her reputation in London’s medical circles on her nursing knowledge and organizational abilities.
Scutari
Nightingale learned to handle public scrutiny in Scutari during the Crimean War, where she received a mandate to reduce the death rate among British soldiers. The press, the public, and the even Queen of England scrutinized her performance. Physicians who resented her presence attempted to thwart every change she proposed regarding the care of the wounded and their environments. For example, rather than prioritizing officers, Nightingale proposed triaging so that the most severely injured would receive treatment first.
Nightingale grounded her innovations in evidence and clinical expertise as well as the documented results. According to McCauley and Hayes, she extended concepts of good household sanitation (regular servings of nutritious foods and clean water, linen, and flooring) to hospital settings, challenging current practices and placing her among the first to link human health to environmental conditions.
Dissemination of results
Nightingale revolutionized science by collecting and analyzing data and using the resulting evidence to expand practice changes. She used her epidemiological and statistical skills to create polar diagrams describing reduction in mortality rates subsequent to practice changes. Anticipating that resentful physicians and politicians would try to make her successes their own, she managed her own story by disseminating these diagrams and accompanying notes in letters to many, including the Queen.
Lessons for today
Like Nightingale, as noted by Wilmoth and Shapiro, nurses must have an excellent clinical foundation and be intentional about their ongoing professional and leadership development to extend their knowledge and skills to other fields. Knowledge in finance, economics, or technology expands expertise, aids in building a broad network, and supports thought and fluency using concepts and terms familiar to occupants of power-filled boardrooms. The ability to communicate in writing and in speaking to various audiences can prove essential.
Although membership in organizations such as the American Nurses Association is a must to ensure influence within nursing, engaging organizations beyond the profession enhances wider influence. Relationships matter, and influential leaders take the time to cultivate and maintain them. The ability to network across disciplines helps build influence to translate evidence-based innovations and improve lives.
Translate trust into influence
Nightingale’s life provides an exemplar for nurses who aspire to be influential leaders. She strategically networked and communicated. She was a political figure who used her power to lead change. Nightingale wasn’t perfect, but she broke barriers, challenged the status quo, disrupted healthcare, and embraced science. She helped establish the scientific foundations of nursing.
Nightingale translated the trust placed in her into the power to influence and lead change at a time when most women were powerless. Nurses in the 21st century must do the same.
Margaret Chamberlain Wilmoth, PhD, MSS, RN, FAAN; Major General, US Army (retired), is a professor at University of North Caroilna Chapel Hill.
References
McCauley L, Hayes R. From Florence to fossil fuels: Nursing has always been about environmental health. Nurs Outlook. 2021;69(5):720-31. doi:10.1016/j.outlook.2021.06007
Saad L. Americans’ ratings of U.S. professions stay historically low. Gallup News. January 13, 2025.news.gallup.com/poll/655106/americans-ratings-professions-stay-historically-low.aspx#:~:text=Judges%20(from%2038%25%20very%20high,change%20of%20%2D4%20to%200 .
Wilmoth MC, Shapiro SE. The intentional development of nurses as leaders: A proposed framework. J Nurs Adm. 2014;44(6):333-8. doi:10.1097/NNA.0000000000000078
