Pledges are common in many professions. They are solemn declarations to adhere to specific guidelines, terms of services and to some extent allegiance to specific people in authority or God. The nursing profession has had its share of the same. The Nightingale Pledge is the pledge use by nurse upon graduation. It is named after Florence Nightingale in honor of her contribution in the nursing profession. She is credited as the founder of modern nursing and also the actual initial idea of pledging. The pledge was created in 1893 by modifying the Hippocratic Oath by Lystra Gretter and a the Committee for the Farrand Training School of Nurses (Crathern and Alice Tarbell, 1953)
The original version of the pledge that was written by Lystra E. Gretter (1893), as recorded by Anna Caroline, Maxwell, and Pope (1910) by reads “I pledge solemnly before you all present and before God, to give my life in its fullness and to the practice of my profession faithfully, and that, I shall detach from all mischievous and deleterious. I shall not knowingly administer or take a drug that is harmful. I shall do my best to elevate and maintain professional standards and hold in confidence all personal matters committed to me and all family matters coming to my knowledge during my calling. I shall devote myself towards the welfare of those committed to my care and be loyal to them.” In 1935, it was amended to include the words “and as a missioner of health, I will dedicate myself to devoted service for human welfare” (Crathern and Alice Tarbell, 1953) in the end.
According to Basavanthappa, B. T. (January 1, 2003), it has since been developed a modern pledge for the nurses, it states, “Before all who are assembled here and God, It is my solemn pledge; To follow the code of ethics established for the nursing profession and co-operate faithfully with all the members of the nursing profession and adhere to the instructions of a physician or the nurse who may be assigned to supervise my work to the best of my knowledge. I shall not do anything malicious or evil, and I will not assist in malpractice or give any harmful drug knowingly. I will uphold confidentiality of any information that may come to my knowledge in the course of my practice. I pledge myself to raise the prestige and standards of the practical nursing by doing my best, and I do commit my life to devotion of service and the high ideals of the nursing profession.”
The pledge articulates the basic aspects that must be adhered to during the practice of nursing. The main function is to compel the nurses to retain and hold the professional guidelines during work. It also aims at creating allegiance to the superiors either the physician or the supervising nurses. Such hierarchy shall reduce the possible occurrence of conflict and confusion in the field of medicine. It ethically binds one not to disclose information on the patients or do any foreseeable harm to them. However, the declaration of no disclosure is not explicitly clear in the pledge. This is because, information found may be helpful to other nurses or physicians who may attend to the patient. This, however, is presumed not to be unethical but, it is not clear. At some point, the pledge is contradicting. Thus, the limit of disclosure should have been articulated better in the pledge. The information may be disclosed to family members taking care of the patient. It is thus necessary for confidential information to be disclosed at some point but, to the right people.
The question arises whether the nurses are under strict obligation to follow the physicians’ directions even when they are wrong? At what point does the nurse have the right to question the physician in case of realizing that he or she was participating in malpractice? yet the nurse was under oath to both adhere to the physicians instructions and not participate in malpractice? Such a contradiction may be limiting the applicability of the pledge especially while working with physicians who are under completely a different oath. It is thus difficult to adhere to some of the requirements of the oath. This creates a bigger dilemma, should the nurse take the Hippocratic pledge or not?
According to Amabelle Raymundo, March 1st, 2008, the pledge has been adopted by all the nurse training institutes and has already been integrated into the curriculum as part of the training; administered to mark the ultimate qualification. It has been voted as the only guarantee that a nurse commits so as to serve the patients or clients faithfully and fulfill their responsibilities. It is also argued that, licensed workers should make a pledge to assure the general public of the commitment to serve them and help the people in need without discrimination based on race, religion culture, economic prowess, sexuality, etc. The Nightingale pledge is the foundation of nurse’s personal goals and values (Fry and Veatch, 2005).
Those who support the oath also argue that, the oath helps in the understanding of the gravity of the problem and challenges at hand. The oath keeps the nurse focused and in full knowledge that, should they fail, there are consequences awaiting them. If one is not under oath, one may as well feel at liberty to do wrong or participate in malpractices for material gains. The oath also binds the nurse to be charged or sanctioned for any malpractice as well as be rewarded in the long run for good work (Erich H. Loewy, Jan 10th, 2007). The oath that is common to all nurse ensure that the roles as indicated are universal and interpreted to mean same thing. Should there be no oath, then could be different interpretations of the duties leading to confusion in the medical sectors. It is thus important to have this oath taken by all nurse in the world.
That notwithstanding, the oath has several ambiguities. This necessitates the need to upgrade it to fit the modern day nursing practices (Demrose, 2001). For example, there are contentions issues as to whom to owe allegiance to. Do nurses have to declare allegiance to the physicians’ directions or the supervising direction unquestionably even when they participate in malpractice? Certainly this cannot be the case. Therefore, the oath has to be amended to clearly define the allegiance and to whom the overall good is made.
Other opponents to the oath question Nightingales’ credibility to be honored with the pledge (McBurney &Filoromo, 1994). Although she is credited with the foundation of modern nursing, she had several flaws, some of which are fundamentally against universal human rights that seek no discrimination based on race, gender, sexuality, religion among others. For example, she denied Mary Seacole to work in her hospital due her mixed race during the Crimean war.
The wording of the pledge has also presented a lot of challenge. Some words can be misinterpreted or have a different meaning creating ambiguity, for example, the word purity has many meanings in different parts of the world. Pledging to God is one ambiguous part of the oath. There are many religions with different faiths and consequently hold different faith-based morals. In fact, there are a large number of pagans and atheist who belief in no god at all. Therefore, pledging to God is hence meaningless and non-binding in the perspective of Faith. There are also adherents to Satan. For example, there is a fully established church of Satan that belief in Satan. How do they pledge to God?
The oath is administered at the end of studies and not within the training of the nurses. There are students whose are morality can be questionable and are able to go through the nursing training since they are practically and technically very good. Shall these nurses hold the morals that they have never had during the training just because of an oath? Possibly no, therefore, the oath loses its meaning. The morals can be inculcated throughout the schooling so as to ensure that such students are dropped earliest possible or corrected.
References
Crathern, Alice Tarbell (1953). "For the Sick". In Detroit Courage Was the Fashion: The
Contribution of Women to the Development of Detroit from 1701 to 1951. Wayne University Press. pp. 80–81. Retrieved March 22, 2014.
Maxwell, Anna Caroline; Pope, Amy Elizabeth (1910). "The Florence Nightingale Pledge".
Practical Nursing: A Text-book for Nurses and a Handbook for All who Care for the Sick. G.P. Putnam's Sons. p. 17. Retrieved March 22, 2014.
Basavanthappa, B. T. (January 1, 2003). Nursing Administration. Jaypee Brothers. p. viii.
ISBN 8171796710. Retrieved March 22, 2014.
Fry, S. T. & Veatch, R. M. (2005). Case Studies In Nursing Ethics. Sudbury; Jones and Bartlett
Publishers, 66-68.
Amabelle Raymundo (March 1st , 2008.) The Nightingale Pledge: A Nurse's Promise? Retrieved
Erich H. Loewy (Jan 10th , 2007) Oaths for Physicians – Necessary Protection or Elaborate
Hoax? Retrieved on 22nd March, 2014, From http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925028/
McBurney, B.H., & Filoromo, T (1994). The Nightingale pledge: 100 years later. NurseManage,
2, 72-74.
Domrose, C. (2001). “A fresh tradition: Students, schools usher Nightingale pledge into a new
era of nursing”. NurseWeek, 123, 15-16.
