Later career
In the Crimea on 29 November 1855, the Nightingale Fund was established for the training of nurses during a public meeting to recognise Nightingale for her work in the war. There was an outpouring of generous donations. Sidney Herbert served as honorary secretary of the fund and the Duke of Cambridge was chairman. In her 1856 letters she described spas in the Ottoman Empire, detailing the health conditions, physical descriptions, dietary information, and other vital details of patients whom she directed there. She noted that the treatment there was significantly less expensive than in Switzerland.
Nightingale had £45,000 (equivalent to £4,730,725 in 2025) at her disposal from the Nightingale Fund to set up the first nursing school, the Nightingale Training School, at St Thomas' Hospital on 9 July 1860. The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary. Now called the Florence Nightingale Faculty of Nursing and Midwifery, the school is part of King's College London. In 1866 she said the Royal Buckinghamshire Hospital in Aylesbury near her sister's home Claydon House would be "the most beautiful hospital in England", and in 1868 called it "an excellent model to follow".
Nightingale wrote Notes on Nursing (1859). The book served as the cornerstone of the curriculum at the Nightingale School and other nursing schools, though it was written specifically for the education of those nursing at home. Nightingale wrote:"Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognised as the knowledge which every one ought to have – distinct from medical knowledge, which only a profession can have".Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale spent the rest of her life promoting and organising the nursing profession. In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote: "The book was the first of its kind ever to be written. It appeared at a time when the simple rules of health were only beginning to be known, when its topics were of vital importance not only for the well-being and recovery of patients, when hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing".As Mark Bostridge has demonstrated, one of Nightingale's signal achievements was the introduction of trained nurses into the workhouse system in Britain from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff. In the first half of the 19th century, nurses were usually former servants or widows who found no other job and therefore were forced to earn their living by this work. Charles Dickens caricatured the standard of care in his 1843–1844 published novel Martin Chuzzlewit in the figure of Sarah Gamp as being incompetent, negligent, alcoholic and corrupt. According to Caroline Worthington, director of the Florence Nightingale Museum:"When she [Nightingale] started out there was no such thing as nursing. The Dickens character Sarah Gamp, who was more interested in drinking gin than looking after her patients, was only a mild exaggeration. Hospitals were places of last resort where the floors were laid with straw to soak up the blood. Florence transformed nursing when she got back [from Crimea]. She had access to people in high places and she used it to get things done. Florence was stubborn, opinionated, and forthright but she had to be those things in order to achieve all that she did."
Though Nightingale is sometimes said to have denied the theory of infection for her entire life, a 2008 biography disagrees, saying that she was simply opposed to a precursor of germ theory known as contagionism. This theory held that diseases could only be transmitted by touch. Before the experiments of the mid-1860s by Pasteur and Lister, hardly anyone took germ theory seriously; even afterwards, many medical practitioners were unconvinced. Bostridge points out that in the early 1880s Nightingale wrote an article for a textbook in which she advocated strict precautions designed, she said, to kill germs. Nightingale's work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice on organising field medicine. Her ideas inspired the volunteer body of the United States Sanitary Commission.
Nightingale advocated autonomous nursing leadership, and that her new style of matrons had full control and discipline over their nursing staff. The infamous "Guy's Hospital dispute" in 1879–1880 between matron Margaret Burt and hospital medical staff highlighted how doctors sometimes felt that their authority was being challenged by these new style Nightingale matrons. This was not an isolated episode and other matrons experienced similar issues, such as Eva Luckes.
In the 1870s, Nightingale mentored Linda Richards, "America's first trained nurse", and enabled her to return to the United States with adequate training and knowledge to establish high-quality nursing schools. Richards went on to become a nursing pioneer in the US and Japan. In 1873, Elizabeth Christophers Hobson co-founded the Bellevue Training School for Nurses in New York, setting the trend for nursing training practices in the US according to the Nightingale plan.
By 1882, several Nightingale nurses had become matrons at several leading hospitals, including, in London (St Mary's Hospital, Westminster Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables at Putney) and throughout Britain (Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary and Liverpool Royal Infirmary), as well as at Sydney Hospital in New South Wales, Australia.
In 1883, Nightingale became the first recipient of the Royal Red Cross. In 1904, she was appointed a Lady of Grace of the Order of St John (LGStJ). In 1907, she became the first woman to be awarded the Order of Merit. In the following year she was given the Honorary Freedom of the City of London.
From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. Her birthday is now celebrated as International May 12th Awareness Day for chronic immunological and neurological diseases as Nightingale may have suffered from myalgic encephalomyelitis/chronic fatigue syndrome. A recent biography, however, cites chronic brucellosis and associated spondylitis as the cause, attributable to an attack of remitting "Crimean fever" she experienced in May 1855 shortly after arriving in Crimea from Scutari that may have represented the acute form of the disease. By 1870, she regained capacity to walk and her spinal pain resolved, while the depression, headaches and insomnia dissipated in the early 1880s. Despite her symptoms, she remained phenomenally productive in social reform. During her bedridden years, she also did pioneering work in the field of hospital planning, and her work propagated quickly across Britain and the world. From home, she was able to select and purchase flannel via mail order, a then-new method of retail conceived by Welsh entrepreneur Pryce Pryce-Jones, who would use Nightingale's name as a customer in his advertising. Nightingale's output slowed down considerably in her last decade. She wrote very little during that period due to blindness and declining mental abilities, though she still retained an interest in current affairs.
