Especially Notes on Nursing turned out to be a useful text book for what Nightingale had in mind: the improvement of nursing through the organisation of training for nurses. With the theoretical knowledge she had built up through the years, Nightingale had a clear image of how nursing could be raised to higher level. According to nursing historian Lynn McDonald, Nightingale’s training program was based on 10 principles .
Here are the principles:
- Nursing is an independent health care profession, with a specific function of patient care different from medicine and requiring its own distinctive training.
- Nurses take their medical instructions from qualified doctors, but obedience must be “intelligent”, meaning exercised with discretion, in contrast with the unquestioned obedience required in the military or in a religious order.
- In a hospital the nursing staff constitutes a separate department, headed by a matron or superintendent, who is responsible to the hospital board, not the medical staff.
- Wards are under the charge of a wardsister, who is responsible for the work of the nurses under her, and the work and training of probationers assigned to her ward.
- Nursing hierarchy has a fixed scheme from matron to probationers. Salaries are adapted to this, and are suitable for the nurses’ responsibilities.
- Nursing is fundamentally an art, which must be learned by guided practice in the hospital ward. The wardsister is largely responsible for this instruction. Lectures and assigned readings by medical instructors are supplementary to learning in the wards. Examinations are conducted by the medical instructors, in collaboration with the home sister.
- Probationers live in a nurses’ home, under the direction of the home sister. The home provides meals, shelter, company, moral guidance and possibly spiritual help. The home sister organizes classes and monitors the written material. She is responsible for the probationers’ health and moral welfare.
- A training school produces a desirable “esprit de corps”. Nurses who train together work more effectively together than nurses brought together from different schools.
- To introduce modern nursing in hospitals, a minimal number of qualified nurses must be employed, not just one.
- The severity of the nursing profession demands good salary, a pension and a allowance in case of illness. The work requires maturity, so that probationers must be of adult age before they begin their training: twenty-three was the initial requirement at St. Thomas’ Hospital.