Episode 21: Florence Nightingale
Florence Nightingale was born on May 12, 1820, in Florence, Italy. Her dad educated her in arts and math and Florence absolutely loved it. In February 1837 Florence felt a call from God telling her to devote her life to the service of others which she translated to being a nurse. In 1847 Florence was hanging out in Rome and she met, Sidney Herbert, a politician, and they became BFFs. He was Secretary of War during the Crimean War. He authorized her to be a volunteer nurse during the war and she saw first hand the chaos and unsanitary conditions at the military hospital. She set out to completely revolutionize the systems and designs. After the war Florence wrote articles and books about her findings and thoughts on hospital design, offering solutions based on her research. Today we call this evidence-based design and it's something healthcare designers continue to do. She consulted on countless hospital designs and created her own hospital standards called the Nightingale Ward. Her basic principles of the importance of sunlight, cross ventilation, separation of program, and the idea of basing design on research and data, the way she did, remains true to this day. Florence passed away on 13 August 1910, at the age of 90.
Caryatid: Ellen Taylor, AIA
Ellen is the Vice President for Research of The Center for Health Design. She is an architect leading the charge in healthcare design. She has a bachelor’s degree in architecture from Cornell University, a Global Executive MBA degree from Columbia University and London Business School, and a Ph.D. in design, patient safety, and human factors from Loughborough University in England. Ellen is a world-regarded writer and speaker. In 2017 she won the HCD10 Researcher Award. It recognizes significant contributions to the industry of healthcare design. Ellen serves on the Editorial Advisory Board of the Health Environments Research & Design Journal and the American Journal of Infection Control. Also, she is currently a board member for the AIA Academy of Architecture for Health Knowledge Community.
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This transcript was prepared during the development of the episode.
Final recorded episode may deviate slightly from the content presented below as changes, edits, or improvements may be made during the recording and editing process.
Norgerie: Ciao a tutti! Welcome to season three of She Builds Podcast, where we share stories about women in the design and construction field, one lady at a time. This season we will be discussing ladies who influence the built environment in professions outside of architecture. I’m excited to branch out of our architecture comfort zone and learn about these other professions and different perspectives. What about you ladies?
Jessica: heck yeah… SEASON THREE LET’S DO THIS! I feel like this season will be somewhat non- traditional for us.
Lizi: Agreed, but I am excited about it and how it will play out.
Jessica: Before we start, one more thing. We can’t continue without saying thank you for supporting us. We wouldn’t have made it this far without all of you.
Norgerie/Lizi: Thank you listeners!
Norgerie: Today we will be discussing Florence Nightingale, a pioneer of healthcare architecture design. I’m Norgerie Rivas, missing my family and Puerto Rico, in Houston Texas.
Jessica: Hi, I’m Jessica Rogers missing the Miami Sunshine and family …. Based out of rainy Washington DC
Lizi: Hi, I’m Lizi Raar, missing family and friends in Michigan from San Francisco.
Jessica: Quick disclaimer. The three of us are not historians, nor are we experts on this subject. We are just sharing stories about the information we find. If we get our facts a little mixed up, please forgive us, send us a comment and we will all continue learning.
Norgerie: Ok, today’s episode is special in a number of ways, one of them is that this will be our first listener suggestion episode. It comes to you thanks to a great fan, Sara Shumbera.
Jessica: yayyy!!! Sara is awesome and I like that we are hearing from our community. We are telling y'all we want to hear from you!
Lizi: Yes! Reach out, leave comments, tell us your thoughts.
Norgerie: Sara’s work and passion focuses mainly on healthcare architecture. Because of this, she asked if we could do an episode on Florence. Thank you very much for the suggestion Sara, I really enjoyed researching Florence and was super surprised by all that she achieved and all the information out there!
Jessica: Yeah, at first I guess we only thought of her as a nurse? We were just a little skeptical about discussing someone so outside of the profession of construction, but then Norgerie argued that there was a connection to be made
Norgerie: Yes, it's pretty fascinating how much she contributed to healthcare architecture, some sources name her the architect of modern hospitals but I’ll let you be the judge. Today I am only going to be able to scratch the surface but I really hope it inspires all of you out there to search for more information because there’s a TON to know about her.
Jessica: is that wifi? Because I’m feeling a connection!
Lizi: OOOOOOOO
Norgerie: YEAAAAAA! So listeners, be sure to keep sending us your suggestions and you just might hear an episode based on your nomination.
Lizi: Yeah, it depends on our focus for the season and how much information we can find about the suggested ladies.
Norgerie: All right let's start. The time was May 12, 1820. The place Florence, Italy.
Jessica: Oh, she’s from Florence, I love Florence.
Lizi: Perfetto, oggi parliamo di una persona italiana.
Jessica:Va bene, ANDIAMO!
Norgerie: Well she was just born in Florence, her parents happened to be there, but they were british and they moved her back to England a year later, so I wouldn't call her Italian. Her parents had a thing for naming their children per the city they were born in. Thus Florence, and her older sister Parthenope. What would your names be if you parents had done this?
Jessica: my name would be Miami! what what!!!
Lizi: My name would be Melbourne.
Norgerie: Mine would be Bayamón, I don’t know how I feel about that.
Jessica: these all feel like names for rappers
Lizi: hahaha
Norgerie: Well, back to Florence, Her family was well connected. Her dad, William Edward Nightingale was actually born William Edward Shore but his mom’s brother left him the Nightingale estate, and he took on the Nightingale last name.
Jessica: Oh that reminds me of Eileen Grey episode 15
Norgerie: Right I thought of her too! So Florence’s mom Frances, was the daughter of politician, abolitionist, and unitarian William Smith. Florence had a family in high places on both sides.
Jessica: Wow that’s impressive! But can we take a moment to talk about how privileged she was to have parents of that caliber, to provide these connections and offer these opportunities. And I like that her grandpa was an abolitionist, it’s refreshing considering the time period.
Norgerie: Florence was also lucky because her dad believed in educating women. He taught both his daughters history, math, Italian, literature, philosophy, and Florence absolutely loved it. She loved collecting and analyzing data which is something she put to good use later in life.
Lizi: That’s so great! Like we mentioned in Season 1, something that a lot of our ladies have in common is someone who supported them and told them they could do these things even if it wasn’t typical for society of that time.
Jessica: yeah and to have that kind of education, we will see was probably super helpful.
Norgerie: In February 1837 Florence felt a call from God telling her to devote her life to the service of others which Florence translated to being a nurse. Her family said: uuuhhh nah girl.
Lizi: Wait didn’t we just get done talking about how great her family was for supporting her???
Norgerie: well the support mostly came from her dad, her mom and sister were more traditional. They didn’t mind women being educated but they didn't think it needed to go further than that.
Jessica: what were they saying nah to? To God talking to her or to her being a nurse?
Norgerie: Definitely to her being a nurse, but maybe to both?
Lizi: I take back my praise of her parents, I’ll praise just her dad .
Jessica: I mean yeah! I’m also assuming in this time period girls from high society in the 1800s were expected to just marry and pop out more high society babies. Society women didn't have jobs outside of the home, it would get in the way of procreating and throwing parties. They wouldn’t be helping the needy and the poor
Norgerie: Rumor has it Florence was pretty so, finding a husband in those days would have been no problem. In fact she had a 9 year romance with the politician and poet Richard Monckton Milnes but Florence the heartbreaker, in the end said no thank you because she felt marriage would get in the way of her calling from God, you know how it is.
Jessica: I would say she was career driven but it seems more than that …. I mean with calling from God and all
Lizi: Yeah that seems like a path you maybe don’t ignore.
Norgerie: In 1847 Florence was hanging out in Rome minding her own business and she met, Sidney Herbert, a politician that was on his honeymoon, and they became BFFs. He was Secretary of War during the Crimean War. Remember that because it will become important later.
Jessica: noted
Lizi: Locking it away.
Norgerie: Three years later she went to Germany for nurse training. During that time, her dad, who we know is in the business of supporting her education, gave her 500 pounds a month which is $65,000 today, so that she could live comfortably and focus on doing her thing.
Lizi: daaaang!
Jessica: ummm must be nice! I would be eating gelato all day
Norgerie: Florence’s time to shine came during the Crimean War. Britain joined the war against Russia on the side of the Ottoman Empire. In 1854, Florence’s buddy Sidney authorized her to be sent as a volunteer nurse to modern day Istanbul.
Jessica: Between Italy and Istanbul we have been in up and down her stomping grounds.
Lizi: So true.
Norgerie: Now what Florence found when she got there was total chaos, I mean it's war but still, the patients were low on medicine and food, hygiene didn't exist, everyone getting infections left and right, she called it “Kingdom of Hell.”
Jessica: let’s just say it was cray
Norgerie: So Florence was like I need to do something about this. And she started observing, gathering data, today people recognize that she was a pioneer in graphical representation of statistics. She actually developed her own pie chart, the Nightingale Rose diagram.
Lizi: Woah that’s really cool. She sounds organized, and I appreciate that attention to detail.
Jessica: oohhhh
Norgerie: She was real smart, she wanted to have empirical evidence of things, the death rates, how long were people sick, how things were laid out, what procedures were in place and with that information she started making changes. She introduced sanitation concepts like dressing wounds, cleaning patients and their clothes. Something that seems so obvious today was so novel then.
Jessica: such a basic concept and so effective … here is your reminder listeners to wash your hands…. There is still a panorama going on
Norgerie: She was hardcore dedicated. When all the medics would leave for the night, Florence would walk around with a little lamp checking up on the sick and they started calling her “The Lady with the Lamp”. That's also the name of a 1951 movie about her life and achievements.
Jessica: Well I guess that’s different from a Lady and the Tramp”?
Lizi: Yeah, there wasn’t much nursing in that one if I remember correctly. More spaghetti.
Norgerie: Eventually Florence sent a letter to The Times newspaper asking for the government to get their act together and send the resources needed for their wounded soldiers.
Lizi: Taking matters into her own hands. Love it.
Jessica: why does this sound so familiar?
Norgerie: Cause its different times, same BS.
Jessica: sounds like it.
Norgerie: Britain’s response was to build a prefabricated hospital and send it to the Dardanelles. They called Renkioi Hospital. There Florence put into practice good habits like improved ventilation, making people wash their hands, and the death rate fell to 1/10th of what it was before. Can you imagine something as simple as washing your hands saving lives?
Lizi: This is eerily relevant.
Jessica: Remember to soap for 20 seconds and run water for 10 seconds afterwards, you can sing the happy birthday song to help
Norgerie: So this convinced Florence of something she suspected, poor living conditions were killing patients and after the war she really got to work. She did so many things we won't have a chance to fully discuss, for example, she helped modernize the profession of nursing, and advised the government on Army and Public Healthcare reform. She was really leaving her mark.
Jessica: This is all great but I have to wonder if it was because of her status and the people that she knew like politicians that allowed her to make so many changes and influence.
Norgerie: Of course that didn't hurt. Well, most importantly for us on this episode today, Florence focused her attention to sanitary hospital designs.
Lizi: Yeahhhh bring on the architecture.
Jessica: oh yes architecture
Norgerie: Let me tell ya Florence was no fan of architects, I quote “In building or extending a hospital, it is to be taken for granted that the object in view is to benefit and not injure the sick”
Lizi: Oh snap! Florence throwing shade.
Jessica: I mean it sounds like straight facts to me.
Norgerie: It gets better, here’s another lovely quote “I know no class of murderers who have killed so many people as hospital architects. At this moment, there are many diseases less fatal in the most wretched homes than in hospitals, i.e. hospitals secure a higher mortality.”
Jessica: Daaaaaang
Lizi: Tell us how you really feel Florence
Norgerie: She complained that doctors were complicit in these murders because they didn't pay enough attention to the hospital building designs, so there you go.
Lizi: Ok, she’s spreading the blame around now.
Jessica: everyone is at fault. The designers, the doctors, the patients that don’t wash their hands
Norgerie: True, she actually had a lot of respect for designers she considered good like Douglas Galton. He did the plans for Herbert Hospital. She called it the best military hospital in the world.
Lizi: So not everyone was in danger from her tongue lashing I guess
Jessica: Well at least it seems that there is at least one hospital that is saving lives and not murdering patients?
Norgerie: Let's talk about the Herbert Hospital, our old buddy Sidney authorized it to get built and gave it his name, sounds fair.
Jessica: Sure
Norgerie: It was one of the firsts hospitals built in the 1800s to be a hospital. During that time England had been converting existing buildings into hospitals which does not sound ideal.
Lizi: Hospital TI??? That sounds…. bad.
Jessica: Sorry I’ve been out of the game for a minute…. TI?
Lizi: Tenant Improvement. It’s a type of project where you’re renovating a space within the existing shell or exterior. For example in an office building, you could renovate one office space completely, but it wouldn’t change the exterior of the building or the surrounding office spaces/tenants.
Norgerie: Hospital TI, Bad News Bears… In 1865 Herbert Hospital was opened. The design was influenced by Florence’s ideas and it became a model for hospital designs for the next century.
Jessica: Wow, okay but maybe Florence was a little biased when she called it the greatest. JAJAJAJA
Norgerie: Florence was writing articles and books about her findings and thoughts on hospital design, offering solutions based on her research. Today we call this evidence based design and it's something healthcare designers continue to do.
Lizi: Wow that’s really cool now much she influenced healthcare design.
Norgerie: Eventually her reputation grew and architects were coming to her asking her to review their plans. Florence advocated for efficient hospital designs that would avoid wasted space and without holes where people could get harassed.
Lizi: Keeping it efficient and safe
Jessica: Harassed?
Norgerie: Oh speaking of safety she also argued that children’s wards should be in areas that were frequented often not isolated on the top floor. So everyone could keep an eye on the kids.
Jessica: Well if there were such things as “harassment” going on? I would want them to be safe.
Lizi: Yeah no kidding.
Norgerie: Florence thought hospitals should have a lot of sunlight and outside spaces for exercise. She called it a pavilion model where sunlight filled most spaces. She proposed full height windows at specific intervals with beds between them to get good ventilation without creating drafts.
Jessica: I mean natural light can help anyone’s mood, these concepts seem like that could have been really innovated for the time too
Lizi: Definitely.
Norgerie: She wrote on Notes on Nursing about the importance of the environment, ventilation, and sunlight for healing and good health in general.
Jessica: I mean environment, ventilation, and sunlight… These are just basic design principles today.
Lizi: For sure. Things that today we think of a basic now, but weren’t back then.
Norgerie: She also talked about the importance of gardens in hospital design. They provided fresh air, gave patients a place to exercise, could be used as apothecaries, they were pretty useful.
Jessica: Yeah you could grow herbs for natural remedies. I like it!
Lizi: ooooo that sounds lovely.
Norgerie: A lot of these ideas are still true today. We know how important sunlight and visual stimulation is. Hospitals today usually have welcoming atriums and green spaces. Patients, people in general but specially patients need “variety.” Florence touched on that in Notes on Nursing. She said ideally patients would be able to see flowers and green spaces from their windows.
Jessica: It's also something positive and reassuring you know? To see something beautiful grow.
Norgerie: With all the concepts we’ve discussed, ventilation, sunlight she developed ideal dimensions for rectangular wards, 30ft by 120ft for 32 patients with ceiling heights between 16-17ft. It was later called the Nightingale Ward and it became the model of pavilion style design.
Jessica: oooh interesting
Lizi: So cool!
Norgerie: She also thought hospitals shouldn’t be more than two floors, and no more than 100 patients under one roof, less was better for her. She understood hospitals needed space for supplies and staff but she wanted it to efficient, the more space the more errors. Which makes me think about Memorial City in Houston, its a HUGE hospital complex with all these different towers and buildings, a mall, its crazy! I think if Florence saw that today she would faint.
Jessica: hahaha she probably would! But also the population was definitely a lot less back then.
Lizi: But today’s technology is so different we can have those spaces today but still keeping in mind all of Florence's core principles.
Norgerie: Right, we would just need to explain that to her.
Jessica/Lizi: Yeah
Norgerie: She also often asked for nurses to have access to suitable break rooms with a kitchenette and individual private bedrooms that had windows and were open to the outside.
Jessica: I think people would want something like this for their basic working environment…. Well back when we would work in offices
Lizi: Right.
Norgerie: Florence was not above dealing out unsolicited advice as well. The Royal Victoria Hospital on the south coast of England was designed to look magnificent. At that time, it was the longest hospital in the world and it looked impressive from the sea.
Lizi: I hear a but coming
Norgerie: BUUUUT it was on the corridor system, with double wards on each side, which means
Jessica: No cross ventilation
Norgerie: Exactly, errybody, patients, visitors, staff were exposed to the same air all of the time. Florence sent letters to an architecture journal critical of the designs. I’m actually embarrassed that architects weren't designing better spaces but this is an example of the end users and the client usually more insights into what spaces need and we really need to listen to them.
Jessica: I agree.
Lizi: For sure. You really have to speak with end users and clients to fully understand the spaces and needs.
Norgerie: Florence consulted on a bunch of designs, check out the show notes for the link to a list.
Lizi: Nice
Norgerie: Two projects worth mentioning, number ONE St Thomas Hospital with a pavilion style of seven buildings connected by walkways and TWO Johns Hopkins University Hospital. In 1876 the civil war doctor John Shaw Billings, who was hired to be the architect, asked Florence for advice. The building had to be solace for the sick and an ornament to the city.
Jessica: It sounds like an interesting design problem to have.
Lizi: Yeah
Norgerie: John sent Florence five rough plans and Florence sent back 12 pages of comments, which John took into account. When it opened in 1889 the toilets were pretty separated from the wards and separately ventilated, the building for pathology was separate from the building of the sick but alive people. Each patient had a separate room with its own ventilation and a vestibule between the room and the central corridor. He tried really hard to avoid cross contamination, with the technology they had at the time, which was not much.
Jessica: WOW, it somewhat sounds like the basic design of hospitals today…. And the fact that he took all of her comments into consideration… that’s something.
Lizi: Yeah for sure. She was clearly respected with regards to hospital design and the fact that these things are now basic design standards shows that.
Norgerie: We have to realize this lady was totally revolutionizing the game with all her sunlight, cross ventilation, patient care ideas. She might not have been the very first one to think of those but she was one of the first that made it happen on a large scale. She was a pioneer in her field and she achieved reform. What amazes me the most is that her ideas became the norm in her lifetime.
Jessica: She was able to change so much - which in turn helped so many people.
Lizi: Clearly
Norgerie: Today hospitals have changed a lot, like we very briefly touched on before, but her basic principles of the importance of sunlight, cross ventilation, separation of program, and the idea of basing design on research and data, the way she did, remains true. So ladies how do you feel about Florence now, did I convince you about her contributions to the building industry?
Jessica: Yes this lady literally changed hospital design! She sounds amazing!
Lizi: Agreed, she made huge contributions and I am so glad we talked about her!
Norgerie: I agree. Now it’s time for our caryatid! Lizi please remind us what this is.
Lizi: Sure, a Caryatid is a stone carving of a woman, used as a column or a pillar to support the structure of a Greek or Greek-style building. In each episode we present a “caryatid” -- a woman who is working today, furthering the profession through their work, and who ties in to the historical woman of our episode.
Norgerie: Drum roll please… Ellen Taylor
Lizi and Jessica: (applause) Yeay!
Norgerie: Ellen is the Vice President for Research of The Center for Health Design. She is an architect leading the charge in healthcare design. In 2017 she won the HCD10 Researcher Award. It recognizes significant contributions to the industry of healthcare design.
Jessica: woooooah
Norgerie: She has a bachelor’s degree in architecture from Cornell University, Global Executive MBA degrees from Columbia University and London Business School, and a PhD in design, patient safety and human factors from Loughborough University in England.
Lizi: Dang. Degrees on degrees.
Norgerie: Ellen is a world regarded writer and speaker. She has worked on Pebble Partner projects, leading grant-funded research programs supported by the Agency for Healthcare Research and Quality and the California Health Care Foundation, among others.
Jessica: She is way beyond an architect, that’s awesome!
Lizi: Yeah that’s super cool that she’s worked on such a range of things.
Norgerie: She is the Vice Chair for FGI's Health Guidelines Revisions Committee (HGRC) and serves on the HGRC Executive Committee of the Steering Committee.
Jessica: Committees on committees on committees
Norgerie: And I am not done yet, Ellen serves on the Editorial Advisory Board of the Health Environments Research & Design Journal and the American Journal of Infection Control. Ellen is currently a board member for the AIA Academy of Architecture for Health Knowledge Community. Some people call Ellen, a rockstar. She is an inspiration.
Jessica: Florence revolutionized healthcare design and Ellen, although she isn’t revolutionizing the same way, she is improving it to make it more efficient and in turn make it better for the patients
Lizi: Exactly, it sounds like Ellen is following in Florence’s footsteps trying to make a difference and to keep bettering healthcare design.
Jessica: this was an awesome caryatid
Norgerie: Ok, so last season we said our goodbyes in different languages and that was fun, so today in the spirit of the birthplace of Florence Nightingale I’ll be saying our goodbyes in Italian. If y’all don't object.
Jessica: Do it!
Lizi: yeahhhhhhh
Norgerie: Before we sign off we want to say grazie CMYK for the music, John W our technical producer. And grazie mille a tutti for listening! We hope you enjoyed learning about Florence and Ellen, along with our banter, and that you are inspired to find out more about them and other amazing professional ladies. Again, Grazie!
Jessica: Please let us know what you thought of our episode. If you’ve enjoyed it please help us spread the word. Tell your amici, your neighbors, your co-workers, give us 5 stars on Itunes, write us a review, this will all help us reach a wider audience and for more people to learn about these amazing ladies with us.
Lizi: We are excited to hear from you and for you to come back and keep learning about women bosses with us. You can email us your thoughts at shebuildspodcast@gmail.com, leave a comment on our website shebuildspodcast.com, or follow us on instagram and facebook @shebuildspodcast, and on twitter @shebuildspod. Ciao, Ci Sentiamo, Arrivederci
References
“Ellen Taylor, PhD, AIA, MBA, EDAC.” The Center for Health Design, www.healthdesign.org/about-us/meet-team/ellen-taylor-aia-mba-edac. Accessed 6 Jan. 2021.
Findlay, Jane. “The Healing Landscape - The Influence of Florence Nightingale on Hospital Design.” Fira Landscape Architecture and Urban Design, 26 Mar. 2020, www.fira-la.com/the-healing-landscape-the-influence-of-florence-nightingale-on-hospital-design.
McDonald, Lynn. “SAGE Journals: Your Gateway to World-Class Research Journals.” SAGE Journals, 8 June 2020, journals.sagepub.com/action/cookieAbsent.
Wikipedia contributors. “Florence Nightingale.” Wikipedia, 4 Jan. 2021, en.wikipedia.org/wiki/Florence_Nightingale.
Zilm, Frank. “Florence Nightingale.” Health Architecture, WikiFoundry, 23 June 1990, healtharchitecture.wikifoundry.com/page/Florence+Nightingale.
Images, in order of appearance
Zilm, Frank. Health Architecture, 23 June 1990, http://healtharchitecture.wikifoundry.com/page/Florence+Nightingale
Richardson, Ruth, “View of St Thomas's Hospital.” King’s College London, Nov 2010, https://kingscollections.org/exhibitions/specialcollections/nightingale-and-hospital-design/st-thomass-hospital
Richardson, Ruth, “A Nightingale Ward.” King’s College London, Nov 2010, https://kingscollections.org/exhibitions/specialcollections/nightingale-and-hospital-design/florence-nightingale-and-hospital-design
Richardson, Ruth, “Ventilation Design.” King’s College London, Nov 2010, https://kingscollections.org/exhibitions/specialcollections/nightingale-and-hospital-design/the-herbert-hospital
McDonald, Lynn. “Table 1.” 8 June 2020, https://journals.sagepub.com/doi/full/10.1177/1937586720931058
