In the early 1850s, Nightingale returned to London, where she took a nursing job in a Middlesex hospital for ailing governesses. Her performance there so impressed her employer that Nightingale was promoted to superintendant within just a year of being hired. The position proved challenging as Nightingale grappled with a cholera outbreak and unsanitary conditions conducive to the rapid spread of the disease. Nightingale made it her mission to improve hygiene practices, significantly lowering the death rate at the hospital in the process. The hard work took a toll on her health. She had just barely recovered when the biggest challenge of her nursing career presented itself.
In October of 1853, the Crimean War broke out. The British Empire was at war against the Russian Empire for control of the Ottoman Empire. Thousands of British soldiers were sent to the Black Sea, where supplies quickly dwindled. By 1854, no fewer than 18,000 soldiers had been admitted into military hospitals.
At the time, there were no female nurses stationed at hospitals in the Crimea. The poor reputation of past female nurses had led the war office to avoid hiring more. But, after the Battle of Alma, England was in an uproar about the neglect of their ill and injured soldiers, who not only lacked sufficient medical attention due to hospitals being horribly understaffed, but also languished in appallingly unsanitary and inhumane conditions.
In late 1854, Nightingale received a letter from Secretary of War Sidney Herbert, asking her to organize a corps of nurses to tend to the sick and fallen soldiers in the Crimea. Nightingale rose to her calling. She quickly assembled a team of 34 nurses from a variety of religious orders, and sailed with them to the Crimea just a few days later.
Although they had been warned of the horrid conditions there, nothing could have prepared Nightingale and her nurses for what they saw when they arrived at Scutari, the British base hospital in Constantinople. The hospital sat on top of a large cesspool, which contaminated the water and the hospital building itself. Patients lay on in their own excrement on stretchers strewn throughout the hallways. Rodents and bugs scurried past them. The most basic supplies, such as bandages and soap, grew increasingly scarce as the number of ill and wounded steadily increased. Even water needed to be rationed. More soldiers were dying from infectious diseases like typhoid and cholera than from injuries incurred in battle.
The no-nonsense Nightingale quickly set to work. She procured hundreds of scrub brushes and asked the least infirm patients to scrub the inside of the hospital from floor to ceiling. Nightingale herself spent every waking minute caring for the soldiers. In the evenings she moved through the dark hallways carrying a lamp while making her rounds, ministering to patient after patient. The soldiers, who were both moved and comforted by her endless supply of compassion, took to calling her “the Lady with the Lamp.” Others simply called her “the Angel of the Crimea.” Her work reduced the hospital’s death rate by two-thirds.
In additional to vastly improving the sanitary conditions of the hospital, Nightingale created a number of patient services that contributed to improving the quality of their hospital stay. She instituted the creation of an “invalid’s kitchen” where appealing food for patients with special dietary requirements was cooked. She established a laundry so that patients would have clean linens. She also instituted a classroom and a library, for patients’ intellectual stimulation and entertainment. Based on her observations in the Crimea, Nightingale wrote Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, an 830-page report analyzing her experience and proposing reforms for other military hospitals operating under poor conditions. The book would spark a total restructuring of the War Office’s administrative department, including the establishment of a Royal Commission for the Health of the Army in 1857.
Nightingale remained at Scutari for a year and a half. She left in the summer of 1856, once the Crimean conflict was resolved, and returned to her childhood home at Lea Hurst. To her surprise she was met with a hero’s welcome, which the humble nurse did her best to avoid. The Queen rewarded Nightingale’s work by presenting her with an engraved brooch that came to be known as the “Nightingale Jewel” and by granting her a prize of $250,000 from the British government.
Nightingale decided to use the money to further her cause. In 1860, she funded the establishment of St. Thomas’ Hospital, and within it, the Nightingale Training School for Nurses. Nightingale became a figure of public admiration. Poems, songs and plays were written and dedicated in the heroine’s honor. Young women aspired to be like her. Eager to follow her example, even women from the wealthy upper classes started enrolling at the training school. Thanks to Nightingale, nursing was no longer frowned upon by the upper classes; it had, in fact, come to be viewed as an honorable vocation.