Florence Nightingale is regarded as the initiator, pioneer, and legend of the nursing field and she laid the basis for the conception of the Nightingale Pledge in 1893. Mrs. Lystra E. Gretter facilitated the creation of the pledge, which is similar to the Hippocratic Oath in association with the Farrand Training School for Nurses. The pledge focuses on the ethical issues and principles that must be adopted by all nurses in their line of the profession (Nelson & Rafferty, 2010).
Over the years since the creation of the pledge, various changes have been made to it in a bid to enhance the responsibility of nurses to ensure that they value the well-being of patients under their care. In this light, a recitation of the pledge is a requirement for nurses during their graduation after the completion of their nursing programs, especially from the US nursing institutions. This paper explores the pledge’s historical background, the functions and purposes that it seeks to fulfill, and its ethical elements and limitations.
Historical Background of the Nightingale Pledge
The tradition of oath-taking after the completion of a training program in a particular field to instill the rules and principles has been practiced for a long time. The Nightingale Pledge seeks to foster responsibility among nurses through ethical and principle aspects that must be observed strictly for the profession to enhance its efficiency in serving humanity. The pledge strives to shape the perceptions of the nurses and guides their course of action. Initially, there was the Oath of Hippocrates, which also sought to provide rules and principles in the medical field, but some practitioners did not abide by its expectations (DeNisco & Barker, 2013). As a result, there was a need for a new pledge that would address the issues of ethics and principles required to be observed in the nursing practice.
The creator of the Nightingale Pledge, Lystra Gretter, was a staunch Christian, who observed religious values keenly. She is credited for presiding over a committee that facilitated the creation of the pledge in 1893. The oath was primarily focused on the ethics and principles that were perceived as essential for the nursing profession. A revision of the pledge was done in 1935 to include an oath that viewed a nurse as a “missioner of health” seeking to improve “human welfare” as a move towards widening the scope of the nurses’ roles (Creasia & Friberg, 2010).
Before the 1970s, the recitation of the pledge was done at graduations or “pinning” occasions in the US. However, in the recent past, the pledge has not been functional in many educational nursing institutions (Creasia & Friberg, 2010). Additionally, alterations to the pledge have been witnessed since it tends to promote the nurses’ loyalty to physicians. For example, the California State University Los Angeles Department of Nursing had been administering the pledge in its ‘pinning’ ceremonies until 2001 when criticisms of some of its phrases emerged.
Functions and Purpose of the Loyalty Pledge
The Nightingale Pledge seeks to facilitate various functions in the field of nursing. The functions and purpose of the pledge are depicted in the pledge that reads as follows
I solemnly pledge myself before God and the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote me to the welfare of those committed to my care (Nelson & Rafferty, 2010, p. 73).
Therefore, the pledge seeks to instill good morals in the nursing practice by upholding the quality of faithfulness. The pledge also purposes to curtail the cases of wrongful drug administration that result in detrimental outcomes among patients. The function of the pledge aims at fostering professionalism among nursing practitioners by emphasizing the separation of personal family matters with nursing operations in a bid to facilitate the nurses’ concentration in their line of duty.
The pledge also intends to improve the relationships between physicians and nurses. On this issue, the pledge advocates the nurses’ loyalty to the physicians. Additionally, the Nightingale Pledge seeks to promote the well-being of patients by advocating for the nurses’ devotion in their line of work (Nelson & Rafferty, 2010).
Analyzing the elements of the Nightingale Pledge depicts the functions that it plays in the nursing profession. In this light, the pledge seeks to highlight the aspects of ethics, professionalism, the relationship between nurses and physicians, and the focus on the wellbeing of the patients under the care of nurses. Those supporting the pledge base their arguments on these benefits.
Nurses are perceived as ethical individuals who strive to make decisions that guide moral actions in their field. The Nightingale Pledge fosters ethical behavior among nurses, which implies that the stakeholders would benefit collectively. The client’s safety is enhanced by the presence of an environment that upholds the safety of patients. This aspect implies that nurses would strive to administer drugs that are appropriate for a particular condition without errors that may deteriorate the current conditions of patients (Butts & Rich, 2015). Therefore, the pledge enhances the implementation of a safe nursing environment that focuses on the patients’ well-being.
The pledge facilitates the delineation and the establishment of professional limits with clients seeking nursing services (Butts & Rich, 2015). In this regard, nurses strive to curtail any behavior that would cause emotional, verbal, or physical abuse to the clients. The pledge also tends to bar nurses from sexual engagements that would be regarded as unethical by the clients, authorities, and the public.
The pledge encourages the practice of privacy during the diagnosis and treatment of the complications affecting clients. Therefore, the confidentiality of the patients’ information is upheld and it is only made accessible to the relevant parties when necessary. As a result, mutual respect between the nurses and patients is achieved, thus leading to improved relationships that promote the client’s well-being (DeNisco & Barker, 2013).
The dignity and individuality of the clients in the nursing sector are enabled through the nurses’ adherence to the Nightingale Pledge. The application of the pledge implies that clients must be approached with respect and courtesy in a way that portrays equal treatment irrespective of their health conditions (Creasia & Friberg, 2010). The nurses’ devotion to the welfare of the individuals under their care means that approaching clients with respect, courtesy, and understanding values their dignity.
The Nightingale Pledge has some limitations that tend to indicate its inefficiency in the nursing field. In this regard, various aspects of the pledge have welcomed criticisms from different stakeholders including nursing schools that administer the pledge during graduation ceremonies. The pledge seems to focus on a single religious group, for instance, this line, “Í solemnly pledge me before God”, focuses on Christians (Miracle, 2009, p. 83). The phrase needs to be altered since nurses are from different religious backgrounds. Besides, some groups oppose this pledge due to the feminist nuances in the line “…aid the physician in his work.” (Miracle, 2009, p. 83).
Initially, the pledge directed nurses to live a pure life. However, people perceive and interpret the issue of living in purity differently. Some nurses may interpret purity to mean celibacy while others may perceive it as trustiness or legitimacy. Therefore, different interpretations may confuse nursing practice (Butts & Rich, 2015).
The nurses’ autonomy tends to be curtailed by the requirement that nurses must be loyal to the physicians in agreement with the Nightingale Pledge (Miracle, 2009). The loyalty aspect shows that nurses play a subservient role in the provision of their services, and thus they are expected to be submissive to the physicians. The nursing profession helps not only the physicians and other medical practitioners but also the patients and their family members. Therefore, nurses are expected to act freely and take control of their field of expertise.
The creation of the Nightingale Pledge as spearheaded by Mrs. Lystra E. Gretter has played a significant role in the promotion of ethical behavior in the nursing profession. Issues of privacy, confidentiality, respect, faithfulness, and professionalism have been addressed by the pledge, which underscores its significance. However, some parties in the nursing industry have opted to adapt, alter, or drop the pledge considering its strengths or limitations. The shortcomings of the pledge are portrayed in the religious, purity, and loyalty aspects resulting in controversies that demand various alterations to the pledge.
Butts, B., & Rich, L. (2015). Nursing Ethics: Across the Curriculum and Into Practice. Burlington, MA: Jones & Bartlett Learning.
Creasia, S., & Friberg, E. (2010). Conceptual Foundations: The Bridge to Professional Nursing Practice. Maryland, MO: Mosby.
DeNisco, M., & Barker, A. (2013). Advanced Practice Nursing: Evolving Roles for the Transformation of the Profession. Burlington, MA: Jones & Bartlett Publishers.
Miracle, V. (2009). National Nurses Week and the Nightingale Pledge. Dimensions of Critical Care Nursing, 28(3), 145-146.
Nelson, S., & Rafferty, A. (2010). Notes on Nightingale: The Influence and Legacy of a Nursing Icon. Ithaca, NY: ILR Press.