Nursing, as a modern profession, can trace its foundation to Florence Nightingale. This revolutionary figure started the first nurses’ training school at St. Thomas’s Hospital in London in the late nineteenth century. Due to her efforts, people who were interested in nursing could, for the first time in history, receive formal training in this subject.
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As a result of Nightingale’s contribution, the professional nursing field emerged, and its impact on the health care sector has continued to be pronounced over the decades. According to the World Health Organization, nurses are today an integral part of the health delivery system. Due to her status as the founder of modern nursing, Florence Nightingale had an important pledged named after her.
This “Nightingale Pledge” was written in the late nineteenth century, and thousands of graduating nurses recite it in the different nursing schools all over the world. However, the pledge does not have the unanimous support of all the stakeholders in nursing education. Some people feel that this pledge is not relevant in modern times, and as a result, there is a debate over whether to pledge or not to pledge. This paper will give a history of the Nightingale Pledge and highlight some of the arguments made for and against the pledge.
Historical Role, Function, and Purpose
The Nightingale Pledge is an oath that is widely regarded as the original nursing code of ethics. The pledge was not written by Florence Nightingale but by Lystra Gretter, together with a committee of nursing instructors at the Farrand Nurses training school. The pledge was named after Nightingale since it was supposed to represent her view on nursing. The composers of the pledge structured it after the Hippocratic Oath that physicians take. The pledge provided graduating nurses with something they could recite as a rite of passage before becoming nursing professionals.
An important function of the pledge was to elevate the nursing profession to the same level as other practices. As a new field, professional nursing needed to establish traditions similar to older fields such as medicine. In the late 19th century, it was common practice for students of a profession to be sworn in before they could become practicing professionals. Butts and Rich (2005) reveal that the Nightingale Pledge was first administered in 1893, and it helped to establish nursing as an art and a science.
From the onset, the Nightingale Pledge fulfilled some important purposes in nursing. To begin with, it served as the original nursing code of ethics in the newly formed nursing field. Kenner and Finkelman (2010) document that by the late 19th century, the issue of formal ethics in nursing was being discussed seriously.
The pledge was the first attempt at coming up with a formal code of ethics for nurses. Nightingale had put forward some ideal views regarding nursing, and the oath was meant to articulate them formally. The pledge composed by Lystra Gretter integrated the ideals embodied by Nightingale and clearly articulated some of the professional obligations of the nurse.
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Ethical Benefits of the Pledge
From the moment it was first administered in 1893, the Nightingale Pledge presented a number of ethical benefits. To begin with, it was the first formal code of ethics available to nurses. Through this pledge, some of the ethical standards that nurses needed to abide by were clearly stated. Finkelman (2014) reveals that the Nightingale Pledge consists of a number of ethical principles that nurses should live up to.
For example, the pledge asserts that the nurse will be committed to promoting the health of the patient and avoiding any action that might bring harm to the patient. The nurse who has taken the pledge will, therefore, endeavor to promote the wellbeing of the patient. In addition to this, the pledge touches on the issue of confidentiality by the nurse. Nurses often deal with sensitive issues, and it is critical for them to exercise confidentiality. The pledge underlines the commitment of the nurse to live up to this important ethical standard.
Limitations of the Pledge
However, the Nightingale pledge sufferers from some major limitations. The most significant one is with regard to the role of nurses. At the time when the pledge was written, almost all nurses were women, and their primary role as nurses was to serve the doctor. Bosek and Savage (2007) state that from the pledge, the nurse’s dependence on the physician is very noticeable. The pledge is, therefore, inadequate since it places nurses as nothing but mere assistants to physicians.
Another limitation of the pledge is that it does not allow the nurse to act autonomously. Instead, she/he is expected to demonstrate constant obedience to the doctor. In modern nursing, nurses are expected to exercise significant autonomy in their work. They possess the skills and knowledge that allow them to provide some services to the patient without the intervention of the doctor.
Finally, the pledge’s emphasis on the nurse’s loyalty to the doctor can be detrimental to the patient. A nurse who is obligated to show loyalty to the doctor cannot engage in advocacy for the patient’s rights in instances where such advocacy conflicts with the personal interests of the doctor.
Arguments for the Pledge
An argument made in support of the pledge is that it acts as a rite of passage, symbolizing the new nurse’s assumption of full professional responsibilities at the completion of her training. In many nursing schools, the pledge is made by the graduating student before her peers, tutors, and parents.
It marks the end of the training and the beginning of the individual’s life as a professional. Kenner and Finkelman (2010) note that after this pledge, the nursing student begins to view himself/herself as a legitimate nursing professional who can provide service to the community. Another argument in favor of the pledge is that it acts as a conscious assertion by novice nurses that they are continuing a tradition.
This tradition entails upholding a system of values that are articulated in the pledge as well as providing service to humanity. By making the pledge, graduating nurses get the feeling that they are becoming part of this tradition of nursing began by Florence Nightingale. Sioban and Rafferty (2012) declare that the pledge asserts the importance of the noble obligation of nursing, and invokes Nightingale’s monumental stature as a way of lifting nursing into the realm of higher service.
By doing this, it distances the profession from the routine service work that nurses are in practice expected to undertake. Finally, supporters of the pledge assert that it increases the nurse’s awareness of the societal impact of his/her actions. The nurse is reminded that his/her actions are a healthcare professional has major consequences on the health and well-being of the patient. The nurse is, therefore, exhorted to be diligent through this pledge.
Arguments against the Pledge
A major argument against the pledge is that it reduces the role of the nurse to nothing more than a complacent assistant to the doctor. One line in the pledge reads, “With loyalty will I endeavor to aid the physician in his work” (Bosek & Savage, 2007, p. 46). Such a statement clearly shows how the nurse was placed lowly in the medical industry hierarchy at the time of the writing of the pledge.
Feminists have expressed concern over the assertion that the nurse should endeavor to aid the physician in his work since this perpetuates the culture of male dominance in society. In a society where gender equality is desirable, a pledge that reduces the position of women is undesirable. The loyalty to doctors articulated in the pledge is not relevant in modern nursing. Finkelman (2014) asserts that there has been a shift in nursing responsibility from the physician to the patient.
Modern nurses have a primary responsibility to the patient, and their first duty is to the patient. The pledge is therefore deemed outdated in modern nursing. Finally, opponents argue that in a society that allows religious freedom for all, it is immoral to force people to make a pledge under God. People worship different gods, while others are atheists. Obligating such people to make the pledge under God is not ethical.
Florence Nightingale is arguably the most prominent figure in nursing. The Nightingale Pledge, which was named in her honor, has continued to be an important rite-of-passage for graduating nurses since it was first administered in 1893. This paper has discussed how the pledge has come under fire due to some of the statements it contains. In its original form, the pledge highlights the values and duties of the professional nurse, and this has some ethical benefits.
However, the pledge reduces the contribution of the nurse and also infringes on the religious freedoms of individuals. For these reasons, some people are advocating for nursing students not to take the pledge. However, this paper has demonstrated that the pledge has some significant advantages. It should, therefore, be revised to address the identified limitations and ensure that nurses continued to benefit from the positive aspects of the Nightingale pledge.
Bosek, M., & Savage, T. (2007). The Ethical Component of Nursing Education: Integrating Ethics Into Clinical Experience. London: Lippincott Williams & Wilkins.
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Butts, J.B., & Rich, K. (2005). Nursing Ethics: Across the Curriculum and Into Practice. NY: Jones & Bartlett Learning.
Finkelman, A. (2014). Professional Nursing Concepts. NY: Jones & Bartlett Publishers.
Kenner, C., & Finkelman, A. (2010). Professional Nursing Concepts: Competencies for Quality Leadership. NY: Jones & Bartlett Publishers.
Sioban, N., & Rafferty, A. (2012). Notes on Nightingale: The Influence and Legacy of a Nursing Icon. Ithaca, NY: Cornell University Press.