The focus for this article is the approach taken by the famous British nurse and public health reformer Florence Nightingale (1820–1910) to responsibility for care, with particular reference to healthcare as practised in the home. It begins by examining Nightingale’s involvement as a young woman in ‘Lady Bountiful’ style upper-class charitable health visiting in the period before 1850. It goes on to consider the district nursing model designed by Nightingale and William Rathbone in the 1860s as an attempt to adapt this localised model of charitable care to the demands of industrial Victorian cities. The final section broadens the lens to examine Nightingale’s views on religious vocations in care work and the state’s expanding role in regulating the nursing profession. Nightingale’s ideal vision of care combined multiple elements: attachment to a local community, a sense of religious vocation, and the scalability and fundraising of national or governmental organizations.