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International Nurses Day is celebrated each year on May 12, Florence Nightingale's birthday.

The "lady with the lamp" who selflessly ministered to the sick remains the enduring symbol of nursing.

But is that an appropriate image for the modern nurse, or is it time to say "Goodnight, Florence," and retire Ms. Nightingale as the icon for the largest health-care profession, as was suggested by a British nursing union?

If not the lamp alit, what is the appropriate contemporary symbol of nursing? And what of the legacy of the founder of modern nursing?

First and foremost, it should be said that Ms. Nightingale gets short shrift and, in that sense, she is Everynurse.

She was much more than the cartoonish Victorian iron maiden who, with nun-like devotion, left a life of privilege to pursue her "calling," tending to British soldiers during the Crimean War.

Ms. Nightingale's most celebrated achievement, however, was not hers alone. Her floor-scrubbing and laundering is credited for the drop in the death rate at a British barracks hospital to 2 per cent from 40 per cent.

In reality, that dramatic turnabout did not come about when nurses arrived, but only after the sewers at the barracks were cleaned out.

Regardless, Ms. Nightingale was a crusader and reformer. While she didn't shovel out the sewers herself, she nonetheless revolutionized battlefield medicine. She greatly advanced public health and hygiene, made nursing a respectable profession, did pioneering work on the link between poverty and health, campaigned for the rights of prostitutes and property rights for women, and made groundbreaking use of health statistics.

Modern nurses have a similarly diverse range of interests and achievements. They toil not only in hospitals and nursing homes, but on inner-city streets, battlefields in Afghanistan, refugee camps in Sudan, and in schools, public health units, northern nursing stations and myriad other locales.

When Ms. Nightingale began nursing in 1851, as the superintendent of the Institution for Gentlewomen in London, hospitals were squalid places with horrid working conditions. Nursing was a lowly, menial task.

In relative terms, today's health-care institutions are not much better, and the work environment of nurses continues to be disgracefully bad. Nurses' pay is not paltry, but it is not commensurate with the skills and training required, and nursing is one of the few professions where the hiring of people on a casual, rather than permanent, basis is rampant.

(None of which is coincidental to the fact that 96 per cent of nurses are women.)

Nurses, paradoxically, are among Canada's sickest workers. They have epidemic rates of back injury, troubling levels of depression, astronomical rates of sick days. Early retirement due to burnout is becoming the norm.

As in Victorian times, the most persistent challenge for most nurses - the greatest impediment to caring for their patients - is pathogens, the bacteria, viruses and other bugs that stalk the halls.

So, if Ms. Nightingale were a nursing leader today, whatever would she do?

Without a doubt, she would promote professionalism and education. Thanks to her wealthy background, she was able to get a "man's education."

She recognized that nursing required more than soft hands and a warm heart (as the condescending saying goes). Rather, good care has a scientific basis.

A modern-day Florence Nightingale would, no doubt, embrace politically unpopular causes such as safe injection sites, decriminalization of prostitution, provision of affordable housing, the raising of the minimum wage and so on, because all have clear public health benefits.

She would rail against the nursing shortage - which is expected to hit 113,000 in Canada by the year 2011 - decry excessive workloads and the fact that nurses continue to be relegated to second-class status among health professionals.

Reborn, Ms. Nightingale would push for the expansion of practice guidelines, for a greater role for nurse practitioners, and for nurses as leaders of interdisciplinary health-care teams.

A leader of her ilk would, as she did 1½centuries ago, recognize the primordial importance of cleanliness and good hygiene in hospitals. She would be appalled by the rate of medical errors, and the routine spread of pathogens.

The 21st-Century incarnation of Florence Nightingale would also use all the tools at her disposal to fight the problem, including good research and new technology like personal digital assistants to track patient health records.

Today's nurse is not the romanticized docile, obedient lady with the lamp.

Today's nurse is the educated, headstrong, professional woman with a PDA. (And probably a backache, too.)

That is the legacy of Florence Nightingale, and the image that should be celebrated on International Nurses Day.

And, in that vein, the leaders of our health-care sector - hospital administrators, policy makers and politicians alike - should be marking May 12 with concrete proposals for improving the working conditions of nurses, not merely cake, balloons and feel-good speeches.

apicard@globeandmail.com