Introduction
Nurses are important professionals in the health care system. They outline the point of contact between a patient and the system. Similarly, they identify problems, assess health situations, and offer solutions for health issues that may, or may not, need a doctor’s intervention (Haigh, 2013). Because of their critical role in the health sector, and the sensitive nature of their work, nurses often have to take an oath to affirm their commitment to their work (Haigh, 2013).
This is an old practice in the nursing profession, which applies today. Indeed, since many people believe that the profession is very important to human existence, they demand a lot of dedication and commitment from the stakeholders. Therefore, nurses have to assure people of their commitment to help them when they need their services (Finkelman and Kenner, 2010).
Throughout the world, nurses have used the Nightingale pledge to affirm their commitment to the practice (Haigh, 2013). However, this is an old pledge, and many people are pessimistic about its relevance to modern nursing practices. For example, some experts say some of its clauses and concepts are ambiguous and irrelevant to modern nursing (Finkelman and Kenner, 2010).
Others believe that the pledge is still relevant to the profession because the same issues that affected nurses, in the early 1900s, also affect them today (Finkelman and Kenner, 2010). The latter group believes that the nursing profession needs to keep the original components of the pledge because they symbolize a nurse’s commitment to the practice (Finkelman and Kenner, 2010).
The above controversy has created new problems for people who want to change the pledge to suit the modern nursing context, but still keep its originality. This issue has created two new problems for professional nurses. First, nurses need to assure the public that they are still committed to their practice by associating with the original words of the Nightingale pledge.
Secondly, they need to assure the public that they can meet modern nursing challenges by subscribing to a new set of ethical rules, which address modern nursing challenges. It is crucial to solve this issue to avoid integrity issues because the failure to do so may significantly affect the reputation of nurses. Based on this need, this paper investigates whether nurses should continue using the Nightingale pledge, or not. To do so, this paper explores different issues about the pledge, including its historical relevance, ethical limitations, functions, and ethical benefits.
Historical Relevance of the Pledge
Lystra Gretter developed the Nightingale pledge to commemorate the work of Florence Nightingale. She introduced the pledge as a tool for nurses to reaffirm their commitment to the profession (Finkelman and Kenner, 2010). Based on this need, new graduates in the practice often recite it as a modified version of the “Hippocratic Oath.” By doing so, nurses affirm their commitment to ethical practice. Similarly, as shown in this report, reciting the oath is akin to adhering to ethical values. Relative to this assertion, Selanders and Crane (2012) say the pledge has symbolically cemented the commitment by nurses to do their duties diligently.
Function and Purpose of the Pledge
Florence said,
“Good nurses are often distressed because they cannot impress the doctor with the real danger of their patients and provoked because the patient will look either, so much better, or so much worse, than they are when the doctor is there” (Haigh, 2013, p. 2).
Observers believe that this distress is justifiable, but it comes from a point of weakness where nurses do not have the power to explain their views to the doctors. The Nightingale pledge gives them this power. For example, Florence empowered the nurses by discussing their registration and examination requirements. In detail, she opposed nurse registration because she saw it as a technical intervention, as opposed to the moral development of the practice (Haigh, 2013).
Through the same concern, she believed that many doctors would have undue influence over nurses by controlling medical training facilities (Haigh, 2013). Based on these concerns, Florence believed that the law should empower nurses. Partly, this is the reason she introduced a code of conduct for nurses.
Unlike the registration of nurses, Florence did not oppose nursing examinations. However, she had some reservations about it because she said it was a tool for the upper classes to dominate over lower classes (Haigh, 2013). Similarly, the inability of such exams to measure character and morality concerned her. Based on this concern, Florence believed that nursing experts were better examiners. Moreover, since examinations failed to judge character and morality, the Nightingale pledge sought to do so.
Arguments in Favor
The Nightingale pledge, although shrouded in controversy, is relevant to modern nursing practices because it created a focus on patients’ requirements. For example, it introduced important welfare issues, such as the need for nurses to ensure their patients are clean and rested (Selanders and Crane, 2012). The pledge also created the link between clinical requirements and access to education. This link suffices through Florence’s assessment of nursing examination and registration requirements.
Overall, it is difficult to deny the commitment that the Nightingale pledge introduced to the practice. The New York Times also shares these sentiments and says, “Perhaps the greatest good that has resulted from her noble life is the creation of a force which has led thousands of women to devote themselves to systematic care of the sick and wounded” (Haigh, 2013, p. 21). Since patients’ welfare is still relevant today, as it was in the past, proponents say nurses should continue using the Nightingale pledge.
Arguments Against
Some people criticize the Nightingale pledge for the beliefs of its main sponsor, Florence Nightingale (Selanders and Crane, 2012). For example, they say the pledge is impractical to modern medicine because modern medicine would not exist without registering nurses, yet Florence did not understand this need in the first place (Haigh, 2013).
Similarly, in a modern world that strives to bridge social and economic divisions, they say the theory focuses too much on social divisions to align with modern societal practices. Another criticism, which they based on Florence’s character, was her “bullish” behaviors. She often opposed doctors who tried to overstep their mandate. In fact, people who have investigated this issue, in detail, say, her views of other health workers have created divisions between nurses and doctors (Haigh, 2013).
This quality prompted many of them to argue that Florence’s “bullish” tendencies live through the Nightingale pledge because it “bullies” and “manipulates” nurses to agree with her principles, regardless of their personal beliefs. Partly, they associate this issue with hostilities and power struggles between nurses and doctors (a divide that has taken several decades to end) (Haigh, 2013).
Ethical Benefits and Limitations of the Pledge
Understanding the ethical boundaries of any profession is a difficult process. This is why many professional bodies introduce ethical codes of conduct to guide the behaviors of their members. Before Florence came into the nursing profession, there was no ethical code of conduct to guide health workers. However, after nurses adopted the Nightingale pledge, the practice got an ethical framework. This section of the report explores the benefits and limitations of this pledge.
Benefits
As shown in this paper, the Nightingale pledge is an ethics statement. In this regard, it has an important ethical benefit. Particularly, it reaffirms a nurse’s commitment to refrain from participating in unprofessional activities (deleterious or mischievous activities) (Dahnke, 2013). Using the same impetus, the pledge creates a strong zeal to offer quality health services.
Based on this ethical commitment, some scholars have revised the pledge to portray the nursing role as a pivotal aspect of human welfare advancement (Dahnke, 2013). For example, in 1935, Gretter (a nursing scholar) used the ethical foundation of the Nightingale pledge to expand the role of nurses to make them “missionaries” of health (Shelly and Miller, 2009).
Limitations
The greatest limitation of the Nightingale pledge is human fallibility (Dahnke, 2013). This ethical limitation does not only characterize the nursing practice, but other professions as well. Indeed, nurses are human beings and human beings are prone to making errors. Therefore, although they want to work diligently, they are still bound to make some technical and moral misjudgments. Particularly, this is true because an excerpt in the Nightingale pledge requires nurses to support physicians, always.
This clause is contentious because it implies that all nurses should support physicians even when they make mistakes. The same ethical dilemma exists through a different clause in the pledge, which requires nurses to pledge to God. The belief in God embodies religious beliefs and such beliefs vary across different societies. Therefore, there is an unclear line between religion and practice (Shelly and Miller, 2009).
Lastly, environmental factors, such as changes in technology and organizational structures, also limit the Nightingale pledge. To affirm this assertion, Dahnke (2013) says no ethical code of conduct could predict the nature of ethical challenges that environmental factors in the 21st century could bring to the practice.
Summary
This paper shows that although the Nightingale pledge is useful to modern nursing, it has some ethical limitations. These limitations stem from ambiguous phrases in the pledge. For example, this paper highlights the pledge to God as an ethical dilemma for nurses. Similarly, the pledge to help physicians in their work highlights the same dilemma.
However, broadly, the pledge has brought many positive contributions to the nursing practice. For example, this paper shows how it brought a structural change in the practice – focus on patients. Although it also contributed to other developments in the profession as well, its commitment to patients’ welfare touches the core of the nursing practice.
Therefore, changing the contents of the Nightingale pledge to appeal to new and modern challenges of the nursing profession is not feasible, in the short-term, because it may lead to different interpretations of nursing roles, thereby causing a lot of confusion in the field. Therefore, nurses should pledge their loyalty to it, at least in the short-term.
References
Dahnke, M. (2013). The Role of the American Nurses Association Code in Ethical Decision Making.
Finkelman, A., & Kenner, C. (2010). Professional Nursing Concepts: Competencies for Quality Leadership. New York, NY: Jones & Bartlett Publishers.
Haigh, C. (2013). Nightingale’s Relevance to Nursing Education.
Selanders, L., & Crane, P. (2012). The Voice of Florence Nightingale on Advocacy. The Online Journal of Issues in Nursing, 17(1), 1-10.
Shelly, J., & Miller, A. (2009). Values in Conflict: Christian Nursing in a Changing Profession. New York, NY: InterVarsity Press.