It’s been said that history doesn’t repeat, but it does often rhyme. And as we’re learning during COVID-19, lessons from the past can be a guide to help us navigate a modern pandemic — if we listen to the rhythm of history.
For a little more than two years in the middle of the 19th century, Great Britain, France, the Ottoman Empire, and Sardinia fought the Russian Empire for control of territory around the Black Sea. In the course of that conflict, the four allied armies lost a combined 16,237 troops to disease — four times the number that died from combat wounds. Over half the disease-related deaths were from cholera or dysentery, partly because the armies weren’t prepared to battle an invisible enemy that was more lethal than Russian bullets.
Enter Florence Nightingale, who acted as the catalyst for the overhaul of army medical facilities by writing a detailed letter to the head of a London hospital. Nightingale’s personal account of widespread disease, infection, and death convinced what had been an apathetic British government to pay for the construction of an entire prefabricated hospital facility, then ship it from England to Turkey. This eased overcrowding and improved sanitation. Nightingale also implemented handwashing protocols. Death rates dropped thanks to her work.
Every May, during National Nurses Week, we honor Nightingale, the founder of modern nursing. Due to COVID-19, and the fact that this year is Nightingale’s 200th birthday, the American Nurses Association extended the observance to last an entire month. At a time when nurses are regularly risking their lives to treat patients, a month of recognition is more than appropriate. And believe it or not, we actually need to take some time to single out nurses for their contributions: For all the talk today that nurses are heroes, far too many of them aren’t being treated that way. In fact, health systems are reportedly disciplining nurses who raise concerns about safety in hospitals during COVID-19. This decision could have disastrous consequences because nurses are one of the most important links in the patient safety chain.
Nightingale became a hero in her own time for sounding the alarm about hospital conditions, and many today are following her lead. Thousands of complaints have already been filed with the Occupational Safety and Health Administration (OSHA)—stories of nurses being denied proper protective equipment, like N95 masks, and having their own health and safety compromised because of grossly inadequate protection protocols. Some nurses have also filed lawsuits, and many have participated in protests to express outrage over unsafe working conditions. But while Florence Nightingale’s public pleas for sanitation improvements were met with swift action from governments and leaders, today’s nurses are facing punishment and even losing their jobs for speaking out. That response is not only short-sighted, removing critical frontline workers during a crisis, but is also disrespectful to the people working hardest to combat this disease.
Health systems ignore nurses at their own risk. After all, nurses spend much more time with patients than doctors do, listen to patient needs, and administer a significant percentage of care. Their interactions with patients and their reporting of problems are essential to improving safety throughout a health system.
As a former emergency department and intensive care unit nurse, I’m worried about the message being sent when health systems discipline nurses who made safety concerns public. What if the next Nightingale is afraid to speak up, or worse — was already fired? If we really want to honor Nightingale and all the nurses who follow in her footsteps, let’s not just call them heroes. Let’s treat them like it, too. Let’s listen to nurses and take their concerns seriously. Without their feedback, we can’t flatten the curve.
Inge Garrison is a former emergency and critical care nurse.
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