The Nightingale Pledge: Past, Present and Possible Future
The Nightingale Pledge: Past, Present and Possible Future
Florence Nightingale is the most famous nurse in the history of the nursing profession. It perhaps was inevitable that a Nurse’s Pledge, written in 1893 by a Detriot committee of the Farrand Training School for Nurses (Calhoun; 1993), would be named the Nightingale Pledge:
“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.” (Calhoun; 1993.)
Florence Nightingale was all about change. It seems ironic that her name would be given to the unchanged tradition of making graduating nurses take the Nightingale Pledge (more or less) since 1893. Is the Nightingale Pledge relevant for the twenty-first century nurse? Yes, it is relevant, but in a roundabout way.
Why Have a Pledge at All?
In 2014, the nursing profession is generally respected. In Florence Nightingale’s day, nurses were generally low-class cleaning women without the intelligence or the sobriety to help in the wellness of a patient. Nurses in Victorian times were expected to mop floors, stoke fires and that was about it. In those days, nurses did not perform basic doctoring skills such as stitching wounds, diagnosing illnesses or suggesting changes in medication. Since nurses only did hard and dirty work that no self-respecting lady would condescend to do, only lower class, uneducated women would take such jobs. (Cooper and Brent; 1981.) Nurses often had only alcohol in order to help them get through the long shifts and their usual aches and pains. The average Victorian was horrified to accept medical help from a nurse because it was the doctor’s job. Letting a nurse clean your wounds, prescribe medicine or perform surgery was akin to letting a janitor do so.
Florence Nightingale stared the change to make nursing a respectable and helpful profession. She faced an uphill battle. Even when Nightingale became a national hero after the events of the Crimean War (1853 – 1856), doctors and hospital administrators were loath to recognize the value of trained nurses. Having nurses take a pledge was meant to help the public see that nurses took their profession just as seriously as doctors. Since doctors took the Hippocratic Oath upon graduating, it followed that nurses should recite something similar upon their graduation. The pledge let the public know what to expect from a professional nurse – that she stay sober, to keep the patient’s needs uppermost in her mind and to help assist any doctor’s care.
The Pledge showed the paternalistic public that nurses could be professional, of good character and have the ability to be discreet. The phrase “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” certainly anticipates modern-day privacy laws. If a nurse swears in public that she can keep a secret, then patients could feel easier about letting nurses treat them and their loved ones.
Present Changes
Times and attitudes have changed greatly since 1893. Different states and universities tinker with the Nightingale Pledge to reflect these changes. For example, the Pledge mentions God. This was the respectable thing to do in Victorian America and Europe. However, many nurses today no longer believe in God or just one God. To counter the protests of modern nursing students, schools like the University of California changed the Pledge to “God of all faiths” (Miracle; 2009.)
Another issue that modern nursing students sometimes wince at is the phrase “With loyalty will I endeavor to aid the physician in his work” which suggests that nurses are always subservient to their omnipotent physicians. Unfortunately, physicians are far from omnipotent. In many cases, physicians may not be available to assist patients, leaving nurses or other medical professionals to help suffering patients. In Victorian times, patients were treated by one doctor. In 2014, healthcare is considered a team effort of specialists, including nurses. To reflect this change, the University of California changed the Pledge to read that nursing graduates swear to “work with members of all healthcare disciplines in an atmosphere of mutual respect and consideration” (Miracle; 2009.)
Another big problem with the Nightingale Pledge is how vaguely it is worded. In today’s litigious society, both nurse and patient need to know what the nurse is responsible for. The American Nurses Association (ANA) addressed this vagueness with the nine provisions of their Code of Ethics. The Code originated in 1926 and was revised in 1960 (Viens; 1960.) The ANA will revise the Code in the future, should the need arise.
Another problem is the phrase “living a life in purity.” What exactly does that mean? Back in Victorian times, it meant that that the nurse was not only chaste, but kept far away from any sort of scandal or controversial behavior. This is not expected of women of today and so many nursing students wonder why they have to state what they obviously will not follow because they cannot foresee their future. This also bothers “reformed” nursing students such as recovering addicts or even homosexual students who would have given proper Victorians heart attacks. It is also difficult to define just what “purity” means in the twenty-first century. “Purity” is a vague word that means different things to different people (Miracle; 2009.) Each nursing student must determine what his or her own “purity” is.
Possible Future
Despite the problems with the Nightingale Pledge, whether it is left on its own or whether an altered version is used, it looks like the Nightingale Pledge is here to stay. The pledge is as much for patients as it is for nurses. Humans admire tradition. It helps offer a source of stability in the tsunami of change that life repeatedly throws both patients and nurses. Some find comfort in keeping at least some traditions, even in the ever-progressive world of healthcare. Since reciting the Pledge takes a minimum of effort and resources, it looks as if it will be one tradition that will stay far into the future.
Is it ethical to make nurses who do not believe in God or who have other problems with the Pledge be made to recite the Pledge? Yes. During the course of any nurse’s career, he or she will face numerous situations that will challenge that individual’s moral system. For example, all nurses will face the day when they meet a patient that has a “Do not resuscitate” order. Is the nurse who ignores this order working in the best interest of the patient? Nurses will also met patients that cannot afford treatments, diagnostic tests or procedures that can greatly better their lives. Withholding these from the patient because of money issues is a severe moral problem that all American nurses face sooner or later. Nurses also must withhold information as to a patient’s current condition to non-relatives. How about if a dear friend of a person without living relatives comes to a hospital trying to find out how the patient is doing? Is it more ethical to follow orders in this situation?
Reciting the Nightingale Pledge when the individual nursing student has issues with the wording helps to prepare nurses for the much more complicated moral issues to come in his or her career. It also reminds the nursing student that professional nurses have to be team players. This requires tact, people skills and constant compromises. Reciting the Pledge even when the student has issues with it is just one of those tactful compromises.
The Nightingale Pledge was not written in stone. As seen from schools like the University of California, minor details in the Pledge can be easily changed without impacting the spirit of the Pledge, which is to care for patients in the best way available. If a nursing school insists on a particular wording of the Pledge for all of their graduating students, then the student should take it unhesitatingly. Now more than ever it is more important to get good nurses in the American healthcare system rather than to quibble about semantics or political correctness.
References
Calhoun, J. (1993). The Nightingale Pledge: a commitment that survives the passage of time. Nursing & health care: official publication of the National League for Nursing, 14(3), 130-136.
Cooper, C. G., & Brent, N. J. (1981). Nursing Profession and the Right to Separate Representation, The. Chi.-Kent L. Rev., 58, 1053.
Miracle, V. A. (2009). National Nurses Week and the Nightingale Pledge. Dimensions of Critical Care Nursing, 28(3), 145-146.
Viens, D. C. (1988). A history of nursing's code of ethics. Nursing outlook, 37(1), 45-49.
