Florence Nightingale Medal: ensuring that nurses receive the recognition they deserve

11-08-2010 Interview

In crisis situations, nurses often have to work in conditions not unlike those that existed in Florence Nightingale's day. Sabine Helbig, the ICRC's head nurse, describes the challenges facing nurses in countries afflicted by armed conflict and natural disaster and talks about the legacy of Florence Nightingale and the medal instituted in memory of her work.

 News release:  

  Haiti: three Haitians awarded prestigious Florence Nightingale Medal

 Features:   Florence Nightingale: her legacy continues

  Haiti: Port-au-Prince’s Florence Nightingale

  Afghanistan: following in the footsteps of Florence Nightingale

  Joyce Hood – continuing the Nightingale legacy


  Joyce Hood bringing medical care to the elderly in South Ossetia

  Haitian Nightingale Medal winner Jude Célorge saving lives in Cité Soleil


  Florence Nightingale Medal brochure

  Florence Nightingale Medal poster

  ©American Red Cross/Talia Frenkel    
  ©ICRC/P. Yazdi/so-e-00360    
  Bakool region, Garanswayn, Somalia. A nurse examines a sick child while his mother looks on at a clinic run by the Somali Red Crescent Society.    
  ©ICRC/M. Kokic    
  Kandahar, Afghanistan. An ICRC teaching nurse examines a child in the paediatric ward of Mirwais Hospital.    
  ©Japanese Red Cross    
  Japan. Presentation ceremony for the Florence Nightingale award.    
  Sabine Helbig, ICRC head nurse    
     What is the Florence Nightingale Medal?  

The Florence Nightingale Medal is the highest international distinction that can be awarded to a nurse. It recognizes exceptional courage and devotion to caring for victims of a conflict or natural disaster , or exemplary services or a creative and pioneering spirit in the areas of public health or nursing education.

A total of 1,340 exceptional nurses from around the world have received the medal, named after the leading reformer and pioneer of modern nursing, since it was first awarded in 1920. Past recipients have come from countries as diverse as Botswana, Russia, Afghanistan, Ecuador, Azerbaijan and Mongolia, but they have been united in spirit and in their determination to continue Florence Nightingale's legacy, which has been an inspiration to countless nurses throughout the world.

Qualified male or female nurses and nursing aides who are active members or regular helpers of a National Red Cross or Red Crescent Society or of an affiliated medical or nursing institution are eligible to receive the medal. Candidates must be nominated through their National Red Cross or Red Crescent Society. A final selection is made by the ICRC, which awards the medal every two years.

At the ICRC, we want to ensure that nurses receive the recognition they deserve. We encourage people to contact their National Red Cross or Red Crescent Society if they know an exceptional nurse who should be considered for the medal.

 What are the greatest challenges facing nurses and nursing aides working in countries afflicted by armed conflict or natural disasters?  

They face many challenges, so let me just mention some of the main ones.

Security issues, first of all, can definitely be a major challenge. Of course, the issues are not the same in a natural disaster and in armed conflict. In a natural disaster, nurses and other health-care workers are typically concerned about the stability of the structures they are using. They have to be sure they are sturdy and can accommodate increased numbers of sick a nd wounded people.

In an armed conflict, nurses and nursing aides often have to perform their tasks amid shelling and gunfire, or nearby explosions. Naturally, they are concerned about their safety and that of their patients, but even if they are frightened they have to focus on doing their job. The fighting can make it dangerous for them to go to and from work, and they may find themselves confined to a specific area for their own protection and safety.

Another challenge frequently faced by nurses in these kinds of crises is that of treating wounds they have not encountered before. When this happens, they have to be able to'think on their feet'in order to respond quickly and appropriately. In addition, when the casualty toll is high, nurses and nursing aides cannot usually devote the same amount of time to individual patients that they would under normal circumstances. And they have to work longer hours and cope with fatigue. If co-workers flee the area – because of heavy fighting, for example – nurses also have to deal with a lack of much-needed support.

Nurses and nursing aides working in their own countries in crisis situations have the added burden of worrying about the safety and well-being of their families and communities, which can be emotionally draining. They might even have to treat people they are personally acquainted with, some of whom may have severe injuries or wounds. When that happens, it can be a real challenge to remain impartial.

It takes a strong commitment to the ideals of nursing to overcome challenges such as these.

 Nursing is at the heart of the International Red Cross and Red Crescent Movement. How do nurses and nursing aides ease the suffering of people affected by war or natural disaster?  

The contribution of nurses in crisis situations cannot be underestimated. Nursing has been a core activity of the International Red Cross and Red Crescent Movement from the very beginning, in 1859, when Henry Dunant and the women in Castiglione, Italy, worked side by side to care for the soldiers who had been wounded at the Battle of Solferino. That experience taught Henry Dunant the importance of committed and qualified nursing volunteers. He subsequently worked tirelessly to establish relief societies with nurses to care for wounded soldiers in wartime.

Without nurses and nursing aides, it would be practically impossible to care for wounded and sick people, and few of them would survive. Surgery, for example, can only be performed if nurses are available to provide post-operative care. In hospitals, nurses and nursing aides are responsible for changing dressings, making sure strict standards of hygiene are adhered to and, in some countries, seeing to it that patients receive proper nutrition, which is essential for maintaining a strong immune system.

Not only do nurses treat and comfort patients, but they also often support the families by keeping them informed and advising them on how to care for their loved ones. They provide the human touch that is essential to any recovery.

 The pressure on nurses in crisis situations is extreme. What does it take to work as a nurse in these situations?  

In a crisis, everyone is under pressure. Courage, compassion and commitment – the qualities recognized by the Florence Nightingale Medal – are needed to deal with situations for which few people are prepared. And to cope and do the job effectively, nurses also need to be mature, calm and flexible.

Nursing is a vocation. To be a nurse, you have to have a strong sense of responsibility and a genuine desire to help people. To work as a nurse in crisis situations, you a lso need to be willing to do whatever is required. You need to be able to handle pressure and to deal spontaneously with problems.

 Florence Nightingale devoted her life to improving health care and promoting the nursing profession. How does her legacy continue today?  

Florence Nightingale was ahead of her time. And what's amazing is that we are still following her advice 150 years later. Today, some of her ideas may seem to be common sense, but at the time they were progressive. We now have the science to understand the impact of germs and the need to practise proper hygiene. But Florence Nightingale saw what was needed merely on the basis of careful observation, and her efforts were instrumental in changing attitudes and behaviour with respect to hygiene in health-care systems around the world.

Florence Nightingale's creativity was as impressive as her legendary organizational skills. She carefully assessed problems, analysed them and was able to think about them in novel ways in order to find solutions. In an armed conflict or natural disaster, these skills are essential. Assessment and analysis of patient needs are fundamental to the work of nurses.

Although in developed countries nurses have the tools and equipment needed to treat their patients, in countries still developing, especially if the health-care system has collapsed in a crisis, nurses continue to work in conditions that may not be far from those that were usual in Florence Nightingale's day.

Florence Nightingale was truly devoted to ensuring that nurses receive professional training and are recognized for their role. In many countries around the world the status of nursing is low. It is therefore necessary to continue Nightingale's work to ensure that nurses are provided with the skills they need and that their contributions are recognized. Achieving this aim will require one of the qualities highlighted by the Florence Nightingale Medal: commitment.

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