The Future of the Nightingale Pledge

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May 2nd, 2012

By , BSN, RN

Today, one of RNCentral’s Twitter followers asked us a great question, “Do nurses take an oath similar to the Hippocratic one that doctors take?”

The simple, short, answer is “yes.” But, if you read this blog regularly you know simple and short isn’t really my style. I find the backstory and its relevance to nursing today so much more interesting than a simple “yes or no.” So, here goes.

The Hippocratic Oath is for doctors only; nurses do not take it when they finish nursing school. Nurses may take a similar oath known as the Nightingale Pledge, depending on the policy of their nursing school.

History

Originally, when a doctors took the Hippocratic Oath, named for Hippocrates, a physician of classical Greece, they swore by Apollo to treat his medical mentor as a father and to freely share his knowledge with students at no charge. He also swore to act for the benefit of the sick, to keep his patients' confidences and to not practice surgery, euthanasia, or abortion (surgery was considered a separate job from being a physician). The new doctor asked for fame and honor if he lived up to the oath and infamy and shame if he failed.
The oath was framed by Hippocrates in the fifth century before Christ (B.C.).

Twenty-first century medical schools use a variety of modified oaths with different tenets: The oath no longer calls for doctors to teach for free or to abstain for surgery, only a minority of modern oaths include bans on abortion and euthanasia, and very few invoke a deity.

The nursing oath, by comparison, is fairly new to the practice. The Nightingale Pledge was composed by Lystra Gretter, an instructor of nursing at Harper Hospital in Detroit, Michigan, and was first used by its graduating class in the spring of 1893. It is an adaptation of the Hippocratic Oath.

I solemnly pledge myself before God and in 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 all 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 myself to the welfare of those committed to my care.

The pledge was named after Florence Nightingale, the founder of modern nursing, as a token of esteem. It is sometimes ascribed wrongly to Miss Nightingale's authorship. At the time it was written, the pledge reflected the nurse’s commitment to moral and ethical values and principles in the practice of nursing, by late 19th century standards.

The pledge is often recited at graduation and pinning ceremonies for nurses. It is also often included in programs honoring nurses during Nurses Week (May 6-12 each year) or on Nurses Day (May 6 each year). May 12 is the anniversary of the birth date of Florence Nightingale.

Criticism

There is no question that the language that was suitable in 1893 is outdated for contemporary nursing practice. However, today, we often recite a pledge that is a modification made to make it more palatable to modern audiences. More contemporary versions of the Nightingale Pledge have been proposed and composed which include changes such as:

  • Elimination of the reference to God.
  • Elimination of the reference to purity.
  • Adding in references to social justice
  • Substituting phrases such as “collaborate with the health care team” for the original “aid the physician” terminology.

A few years back, Donna Cardillo, RN, MA, nursing guru and frequent contributor to the Dr.Oz show, wrote her own blog about whether the Florence Nightingale Pledge was out of date. She even offered up her own, succinct, modern version.

I solemnly pledge myself before God and in the presence of this assembly, to live my life with integrity and to practice my profession faithfully. With dedication will I endeavor to uphold the ethical, scientific, and legal standards of my profession, and devote myself to the welfare of those committed to my care.

She received a quite a few responses supporting a newer, modernized version of the pledge. And it’s not just here in the U.S. that a more contemporary version of the pledge is a topic for consideration and conversation. Our colleagues north of the border, in Canada, have thoughts on this as well. Here is a lovely version of the Nightingale Pledge, written by Beverly Hansen OMalley, Registered Nurse:

As I enter the nursing profession I pledge to:

Use all the knowledge, skills, and understanding that I possess when providing professional nursing care.

Deliver nursing care non-judgmentally and to all those who require it, to the best of my ability.

Refrain from any action which might be harmful to the quality of life or health of those I care for.

Treat each client with respect.

Hold in professional confidence all the personal information entrusted to me.

Keep my professional knowledge and skills at the highest level give my support and cooperation to all members of the health care team.

contribute to the advancement of the nursing profession.

Maintain my nursing practice in accordance with the professional nursing standards required for my profession.

Other Criticism

Other critics have raised questions as to whether there's any point at all to the Nightingale Pledge or the Hippocratic Oath. Some doctors say the Hippocratic Oath ignores the complex realities and decisions involved in modern medicine. Some healthcare professionals say that while the classic oaths were seen as solemn covenants, today they are meaningless rituals with no influence on doctors' or nurses' behavior.


I really hope that last part isn’t true.

Despite modern criticisms of the pledge as portraying the nurse as subservient to the physician, it continues to provide a framework for clarifying values and principals for the delivery of healthcare and for promoting nursing standards. I, for one, know that when I said the pledge at my nursing school graduation, I didn’t take all the words at face value but I was proud to become part of a profession that places value on its history and on its original endeavors while it continues to grow and meet the future head on.

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