Nightingalism From Then To Now: Racism And Privilege In Nursing In Canada

By Yvonne Sam
Contributing Columnist

For White people, there is a markedly gross difference in being anti-racist than it is for people of color. On the side of White people, being antiracist advances with the development of their racial identity and, as such, it is important that they acknowledge and understand their privilege, work to change their internalized racism, and disrupt racism when they see it.

Conversely, for people of color, it means recognizing how race and racism have been internalized, and whether it has been applied to other people of color.

The historiography of nursing remains centered on Whiteness, and even worse, around a single White nurse: Florence Nightingale.  Unfortunately, this does not mean that nurses understand who Nightingale truly was.

Despite the fact that Nightingale serves as the immortalized “Mother of Nursing”,  I recognize that there have been Black  and Indigenous  nurses,  who have been marginalized throughout history, with their contributions  to the advancement of the nursing profession  minimized, undocumented and, finally, forgotten. 

For decades, historians have argued that nursing has been historically, structured by gender, segregated by race, and, at least for those with some financial resources, determined by class.

The Victorian ideals of “true womanhood”, including perceptions of dignity, purity, morality and virtue, served as the tenets, on which nursing, as a profession, was established — symbolised by white caps and pristine white smocks. People, who did not meet these “ideals”, were prevented from practicing nursing.

The mainstream culture held the belief that Black women did not possess these ideals of “true womanhood” and, in turn, were prevented from pursuing nursing as a career. Many of these unconscious biases and stereotypes about nursing are still believed today, with evidence showing that the exclusion of Black folks and anti-Black practices persist in nursing.

Additionally, Canada’s lingering history of racism and segregation has contributed to residual anti-Black racism that remains present in Canadian nursing. In many nursing discourses, a critical topic that repeatedly rises to the surface, is racism. Seldom, if ever, is there a recognition, or discussion, of the ways in which nursing perspectives sustain the structures of racism.

Also, rarely discussed in history is Nightingale’s racism and her political role in the genocide of Indigenous people under British rule. Despite being armed with the knowledge of the death and destruction left in its wake, she believed Indigenous lives were a small price to pay for the expansion of the British Empire, and that imposition of the British culture was necessary. Anything else, “would be simply preserving their barbarism for the sake of preserving their lives.”

By her own accounts, Nightingale considered Indigenous peoples to be inferior, and the British state to be a “civilizing” force. The previous quote is taken from a report, commissioned by the Colonial Office of the British government and published in 1863, titled Nightingale’s Sanitary Statistics of Native Colonial Schools and Hospitals.

In the report, she concluded that the high death rates of Indigenous people in colonial schools and hospitals reflected the haste of British authorities to assimilate them. She felt assimilation should be more gradual, in order to minimize the death toll, but had no issue with the death toll itself: “Every society, which has been formed, has had to sacrifice large proportions of its earlier generation to the new conditions of life arising out of the mere fact of change.”  

Also in the report, Nightingale defended the deaths of Indigenous children in the Canadian precursors to residential schools: “There is nothing in the school education, as described in the returns, sufficient to account for the special prevalence of tubercular diseases in these schools. The causes must probably be looked for in the close foul atmosphere of the native dwelling.”

Her comments on the Canadian situation were indicative of her larger position: that the deaths of Indigenous people was due to habits of Indigenous people themselves, and that British rule catalyzed a process of “decay” already in motion. These are some of the many racist statements made by Florence Nightingale.

Today, thanks to digitization efforts, the writings are now accessible, making it easy to access sources that reveal her racism. From 1861-1868, Florence was advisor to George Grey, the Governor of New Zealand. However, due to her role in advising the governor during a brutal era of repression against Māori anti-colonial uprisings, the New Zealand Nurses’ Organization (NZNO) decided not to celebrate her birthday in 2020.

The World Health Organization declared the year of Nightingale’s 200th birthday to be the International Year of the Nurse and the Midwife. For the nurses of the NZNO, however, “Raising her as the beacon for nursing globally, causes trauma and re-ignites the history and pain of colonization.” They called her legacy “dangerous”.

Mary Agnes Snively (1847-1933) was a Canadian-born nursing educator and pioneer, who led the struggle for recognition of nursing as a legitimate science-based profession, rather than a domestic pursuit.

Known as “The Mother of Nurses of Canada”, she founded the Canadian National Association of Trained Nurses in 1908 and served as its president during its formative years. The organization was the voice of registered nurses, with member societies in every province by 1924, when it became the Canadian Nurses Association.

Snively further advanced the profession by transforming the Toronto General Hospital School of Nursing into a model of education and patient care in Canada. Intending to attract middle-class women into the nursing profession, Snively convinced the hospital to build a residence for student nurses. The new residence was completed in 1887 and included a library, dining rooms and sitting rooms. 

As a result, well-educated women were beginning to show an interest in attending, and, by 1894, the Toronto General Hospital Training School for Nurses became the largest in the country.

The first nursing training facility opened in 1874 in Ontario, and the first baccalaureate nursing program started in 1919 at the University of British Columbia.

Bernice Redmon, the firstBlack nurse to practice in public health, was born in Toronto, Ontario, but was not allowed to become a nurse there, or anywhere in Canada. Black students were not allowed to enroll in Canadian nursing programs until the late 1940s, so Redmon had to leave the country to get her education at St. Philip Hospital Medical College in Virginia, USA.   

Ruth Bailey and Gwennyth Barton were the first Black nurses to earn a nursing diploma in Canada, from the Grace Maternity School of Nursing in Halifax, graduating in 1948 — almost three-quarters of a century after the first school opened.

American schools began allowing Black folks into nursing in the 1870s, while Canada continued to restrict admissions to Blacks until the 1940s, granting admission only after pressure from community groups and organizations.

Permit me to issue a caveat that the intended goal of this article is not to expunge Florence Nightingale from our history books, but instead, propound that her history is more carefully studied, so that she is better known, and what her legacy means for nursing. There is absolutely no loss in relegating “ the lady with the lamp” to her rightful place in history, instead, we gain critical insight, growth, and a richer understanding of what nursing is. 

Notwithstanding the clarity of Nightingale’s writings, nursing academia often uses the writings on public health and education to champion her as a defender of human rights, an expert in peacekeeping, and credits her with coming up with the social determinants of health. Her body of work, despite scholarly critical perspective, remains largely unchallenged within the nursing profession. Throughout the Diaspora numerous nursing schools, awards, hospital wings and more are named after her.

The disparities have been recognized, and acknowledgement made, of some of the disadvantages experienced by people of color, yet there is a lingering and permeating failure to recognize that White privilege remains as powerful a dynamic as it ever was. 

In actuality, the languages of diversity and multiculturalism maintain and bolster this dynamic. On closer examination, these viewpoints in nursing treat cultures of color as “other” — interesting curiosities. Culture is regarded as characteristics of any practices that are not White. 

It should be noted that, in nursing books and discussions, there are rare, if any, discussions of White dietary habits, rituals, family relationships, religious practices. The “White” experience is typically seen as diverse and individualized as the norm against which other practices are judged or compared.

In 1971, the International Council of Nurses (ICN) declared International Nursing Day as May 12, in honor of Nightingale’s birthday. The weight of Nightingale seems to smother nursing capacity as a profession, to celebrate other historical nursing leaders, especially Black and Indigenous women.

Edith Monture was the first Indigenous nurse in Canada and a pioneer in maternal and Indigenous health. The historical figures we choose to venerate say a lot about who we are.

The continued veneration of Nightingale tells a story of racism and exclusion within nursing. We cannot claim to teach nursing advocacy and leadership, when our model for these concepts was a Victorian zealot.

Despite the persistence of anti-Blackness in society, nursing education and health care, Black nurses continue to provide care. Now, more than ever, their contributions should be actively recognized and immortalized in the annals of Canadian history. This would be a significant step towards adopting anti-racist frameworks in Canadian nursing education and practice. 

Yvonne Sam, R.N., R.M.N., S.C.M., M.Ed., B.Sc.N., Dip. Adult Ed., a retired Head Nurse and Secondary School Teacher, is the Chair of the Rights and Freedom Committee at the Black Community Resource Centre. A regular columnist for over two decades with the Montreal Community Contact, her insightful and incursive articles on topics ranging from politics, human rights and immigration, to education and parenting have also appeared in the Huffington Post, Montreal Gazette, XPressbogg and Guyanese OnLine. She is also the recipient of the Governor General of Canada Caring Canadian Citizen Award.