Conversations with Nightingale: Thoughts by One of her Disciples

Section: Editorial

How to quote

Grinspun D. Conversaciones con Nightingale: pensamientos de una de sus discípulas. Metas Enferm sep 2020; 23(7):3-6. DOI:


Doris Grinspun


N, MSN, PhD, LLD (hon), Dr (hc), FAAN, O.ONT. Chief Executive Officer. Registered Nurses’ Association of Ontario (RNAO). Canadá.

Contact email:

Florence Nightingale said in 1859: “There is no magic in the word association… We must never forget that the ‘individual’ makes the association. What an association is depend on its members. A nurses’ association can never be a substitute for the individual nurse. It is she, who must, each in her own measure, give life to the association, while the association helps her” (1). Her words still resonate in our times, particularly today after our great fight, still unfinished, against COVID-19.

I wonder if Nightingale would be satisfied, today, with our individual and collective action. What follows are some of my thoughts during an imaginary conversation with Nightingale.

Nightingale spoke at length about the role of nurses. What would she say if she witnessed the constant references to our professionals as “heroes”? In the past months, since the start of the pandemic, public praise to the “heroes” of COVID-19 has exceeded all “emotional thermometers”. Undoubtedly, this is well deserved by our point of care Nursing professionals; they have given everything, even their lives, with over 600 nurses throughout the world who have died as a consequence of COVID-19.

But I imagine that Nightingale would not have liked to be called a “heroine”. She was a woman who fought for a Nursing practice based on the best evidence at the time: to keep hygiene measures, fresh air, and a calm environment for the body to make the most of its natural defenses. She was also a leader who focused heavily on advancing healthcare reforms using evidence and power with a superior intellectual capacity. Undoubtedly she would have preferred for her or for us to be called: “clinical experts”, “advocate for important causes”, “leader in health systems”, and “promoter of the Nursing profession”.

If Nightingale lived today, and could watch our nurses as leaders in clinical practice, applying scientific rigour and being active as researcher, administrators and educators, she would advise us to smile gracefully to those public members who call us heroes. Coming from the public, she would add, this praise is important to nurture us and provide the energies necessary to continue our work. But, she would insist that the relevant authorities, executives, administrators and politicians, don’t call us “heroines”! What we expect from them is that nurses and Nursing be represented in all organizational decisions, and on the decision-making structures related to health, healthcare, social and economic policies.

Undoubtlessly, Nigthingale would tell us that the Banksi drawing, showing a child who chooses a nurse as his hero instead of Batman, will inspire a new generation of Nursing students, and therefore must not be disregarded. But as many of us, she would demand reforms in the Nursing Education Programs, calling for integrated programs that deliver graduates with outstanding clinical expertise and agents for social change.

Nightingale would be proud of our current actions, but not satisfied. She would demand that we expand our influence to the political and social arenas. She was a woman who already at 34 years old, stressed the need for a double function to lead patient care and to fight to improve the healthcare conditions at her time (many of which still exist). Her dream, the “Nightingale Dream”, was that Nursing could act as an agent for social change. This requires a collective entity acting as catalyst in order to channel the individual effort of many; and the “nurses’ association” mentioned in opening quote must assume that role.

How do we build an “association of nurses” according to Nightingale’s vision? In my conversation with her, I say that for me, membership in a Nursing association is the source of its vitality, it is what defines an association led by its own members. Membership in a Nursing association must be strong in numbers, strong in diversity (with representation of all genders, ages, sectors, roles, social classes, races, cultural origin as well as ethnic and religious, sexual orientation, etc.); a solid membership in terms of commitment, integrity, passion and voice. This must be a membership which, even if extended throughout a whole community, region or country, will be unified by one mission - to advocate for healthy public policies, promote excellence in Nursing practice, and encourage nurses to have an active influence and shape those decisions which affect the profession and the public we serve. This type of membership gives voice to the collective, while the collective powers each member to amplify her/his/they voice. Nightingale concurs: “We must never forget that the individual makes the association… while the association helps her” (1).

In this year 2020, 200 years since the birth of Florence Nightingale, and the International Year of Nurse and the Midwife, as designated by the World Health Organization (WHO) and the International Council of Nurses (ICN), it is essential to reflect and make decisions about the type of profession we want to be. From my perspective, although I am extremely proud of the scientific achievements of Nursing and our great contribution in the clinical realm, I am also concerned and saddened by how little we have advanced as a collective in terms of our contribution to mobilize health reforms and ensure health for all. Even more, in many places around the world, we are going backwards. There are many factors, but I want to point out at the most important: the lack of collective Nursing organizations which are socially committed.

To fulfill “Nightingale’s dream” means to get intensely involved in our collective organizations, to make the existing ones effective and democratic, and to mobilize them; and to create new organizations if necessary. In my conversations with Nightingale, we also discussed the role of Nursing as a social movement. This is the case of Nursing Now, that has served to catapult nurses individually and as a group like never before. The RNAO has proudly joined Nursing Now and contributed with four webinars in English and Spanish about RNAO’s Best Practice Guidelines and also about COVID-19 (2). On May, 12th we also gave the Nursing Now inaugural awards in Ontario (3).

Nursing as a social movement is the case of the professional association of nurses in Ontario, RNAO, which I am proud to lead for the past 24 years. In these two decades we have transformed the association from a quiet to a restless entity, from passive to active membership, from a weak to a potent voice. Grounded in values of health for all, and arguing with evidence and courage, we have influenced healthy public policies important for the profession and the healthcare system (4).

Colleagues, nurses and nursing students: regarding Nursing and health, let’s continue with our individual work of evidence-based care, humanism and courage; this is what we do and will always continue doing. In addition, let’s act collectively to advance health, social and economic policies that will improve health for all. Let’s mobilize our associations, and with these, our collective voice though active participation in shaping public policies, publications and reports, mass media, social networks, participations in the streets of protests and corridors of power. This is our social duty as nurses. This is an outstanding debt with Florence Nightingale and our debt with the world’s people.


  1. McDonald L. Florence Nightingale: The Nightingale School (Collected Works of Florence Nightingale, Volume 12). Waterloo, Ontario: Wilfrid Laurier University Press; 2009. p. 865. Todas las citas de Florence Nightingale fueron traducidas del inglés por la autora.
  2. RNAO. COVID-19 Webinars. Registered Nurses’ Association of Ontario. RNAO [internet] junio 2020 [citado 10 ago 2020 ]. Disponible en:
  3. RNAO. Nursing Now Ontario Awards Ceremony. Registered Nurses’ Association of Ontario. RNAO [internet] junio 2020 [citado 10 ago 2020 ]. Disponible en: Disponible en:
  4. Grinspun D, Botros M, Mulrooney LA, Mo J, Sibbald GR, Penney T. Scaling Deep to Improve People’s Health: From Evidence-Based Practice to Evidence-Based Policy. In: Grinspun D, Bajnok I (eds.). Transforming Nursing Through Knowledge: Best Practices for Guideline Development, Implementation Science, and Evaluation (Chapter 18, p. 465-94). Indianapolis, IN, USA: Sigma Theta Tau International Honor Society of Nursing; 2018.