Ms. Nightingale's resolve to alleviate suffering was heightened by a meeting with American reformers, Samuel and Julia Howe. He advocated free medical care for the blind ill or elderly and had instituted such a program in New York. Florence Nightingale told the Howes of her desire to become a nurse.
Soon after the Howe's visit, Ms. Nightingale was allowed to care for the sick family members, which taught her a lot about what nursing is and what it is not. Until that time she may have concurred with the general consesus that any caring and sympathetic woman would make a good nurse. After nursing her family back to health, she knew that knowledge and skill were needed to provide nursing care. In Notes on Nursing she wrote:
" I believe.... that the very elements of nursing are all but unknown."