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Florence Nightingale: To Pledge or Not to Pledge

Introduction

Florence Nightingale is regarded as the founder of the modern nursing profession. This pioneer started the first training school in the late nineteenth century where nurses could receive professional training. Her efforts led to the emergence of professional nurses, who are major players in the health care industry. Owing to her significant contribution to the nursing field, Ms. Nightingale had a pledge named in her honor. This is the “Nightingale Pledge”, which is recited by thousands of graduating nurses each year. Over the recent decades, there has been some controversy over the appropriateness of this pledge. Many nursing schools and nurses feel that some of the aspects of the pledge are not compatible with modern nursing practices. The question of whether or not to pledge is therefore becoming more common. This paper will set out to discuss the Nightingale Pledge and the various arguments advanced in favor or against the pledge.

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The Nightingale Pledge

The Florence Nightingale Pledge is an oath that nursing graduates recite before becoming fully-fledged members of the nursing profession. This Pledge was written in 1893 by a committee of nursing instructors at the Farrand Training School for Nurses in Detroit. The pledge was composed in the early years of professional nursing. Bliss-Holtz (2002) observes that at that time, the practice of “swearing-in” those who were becoming members of a profession was very common. The nursing profession, therefore, needed to come up with an oath that its members could recite before becoming professionals. The pledge composed for the nurses was a modified version of the “Hippocratic Oath” that physicians had been taking.

The pledge was composed to fulfill some important functions in the new profession. When Nightingale entered nursing, there was no formal code of conduct for practitioners in this field. The duties of the nurse were also not well articulated and they varied from hospital to hospital. As an individual, Nightingale embodied and advocated for high value and ethical standards in the profession. The pledge represented the earliest attempt to bring together and formalize the traditionally accepted values and duties of nursing (Dahnke, 2009). The pledge also formalized some of the obligations of the nurse which included clarity of thought and the demonstration of high levels of professional conduct.

Ethical Benefits

A number of ethical benefits are attributed to the Nightingale Pledge. It formalizes some of the ethical standards that nurses have to live up to. Peterson and Potter (2004) observe that a number of ethical ideals are articulated in the pledge. The nurse who takes the pledge is therefore making a decision to live by some ethical values during his/her professional life. The pledge establishes the commitment of the nurse to avoid bringing harm to the patients under his/her care. A nurse who has taken the pledge will be committed to taking the most productive action for the good of the patient. He/she will abstain from deleterious actions that will be detrimental to the health of the patient. The pledge also emphasizes the high level of confidentiality in professional nursing. Peterson and Potter (2004) reveal that nurses deal with matters of a sensitive nature. For the nurse to be effective, the patient must have some trust that his/her confidential information will remain private.

Limitations

The pledge was guided by the commonly accepted ideas of the time, which were not favorable for nurses. At that point in time, the nursing staff was almost entirely made up of women while most physicians were men. The doctors were regarded as the leaders in the healthcare setting while the nurse was a mere assistant. Mylott (2008) observes that the hierarchical structure in the health care system placed the nurse at the bottom of the chart. The pledge therefore overlooks the important role played by the nurse and his/her autonomy in healthcare provision. A major limitation of the pledge is that it does not consider the new role of nurses in the health care industry. The pledge places emphasis on the nurse’s obedience to the physician. This implies unquestioning obedience to the decisions of the doctor when dealing with a patient. However nurses today exercise greater autonomy and they are strong advocates for the health and wellbeing of patients (Mylott (2008). The loyalty to the physician may greatly hamper efforts by the nurse to advocate for the patient’s rights. If a doctor is guilty of misconduct, the nurse following the “with loyalty will I endeavor to aid the physician in his work” will be hesitant to act as a whistle blower.

Arguments in favor of the Pledge

Supporters of the pledge declare that it serves as a symbolic admission into the nursing profession. When a graduate student pledges herself before witnesses, he/she is engaged in a rite of passage that marks his/her entry into the nursing profession. From then on, the individual is recognized as a nurse and can serve the community as a professional. Bliss-Holtz (2002) observes that after the pledge, the individual takes on the being of a professional and his/her outlook on life is changed. Another argument made in favor of the pledge is that it serves to promote the adoption of ethical and moral behavior of nursing graduates as they join the workforce. The wordings of the pledge indicate an emphasis on ethical and moral conduct when working in the real-world setting. As they recite the pledge, the nurses are reminded of the professional code of conduct that they should adopt. Advocates of the pledge declare that it raises awareness on the social implications of the nurse’s work. The work carried out by nurses in the healthcare setting has major effects on the health outcomes of patients. The particular manner in which these professionals engage in their tasks determines if the health outcomes will be positive or not. The pledge makes it clear that the nurse’s conduct will have social implications. This heightening of awareness might contribute to greater diligence by the nurse as he/she engages in his/her everyday work.

Arguments Against

Opponents of the pledge declare that it belittles the contributions of the nurse in the healthcare industry. The pledge places emphasis on the nurse’s obedience to the physician. A contentious phrase from the pledge is “with loyalty will I endeavor to aid the physician in his work” (Bliss-Holtz, 2002, p.3). This statement suggests that the nurse’s role is little more than that of a servant to the physician. Historically, the nursing staff has been comprised of women while most physicians have been men. Feminists have therefore expressed concern over the pledge as it perpetuates the culture of male dominance, which has characterized the hospital settings for many decades. In addition to this, opponents state that the pledge does not acknowledge the shift in nursing responsibility that has occurred over the past 4 decades. At the time the pledge was written, the nurse’s primary responsibility was to the physician. However, this trend changed as nurses were required to focus more on the patients (Mylott, 2008). The Nightingale pledge is therefore obsolete as it to emphasize on the direct and implicit duty that nurses have to their patients today. Finally, Opponents of the pledge declare that forcing the nurse to make a pledge under God is unethical. The country allows people to belong to different religions or even belong to none. This personal right to practice or not practice religion is protected by the constitution. The Nightingale Pledge obligates the nurse to solemnly pledge himself/herself before God.

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Conclusion

For over a century, the Nightingale Pledge has been an important rite-of-passage for nurses. However, this pledge has come under attack over the past few decades with some people calling for it to be updated. This paper set out to explain the historical role of this pledge and offer arguments for and against the pledge. It began by acknowledging the significance of Florence Nightingale in the nursing profession. The paper observed that the pledge was named in her honor due to the contribution she made to modern nursing. The pledge was the first attempt at formally codifying the values and duties of a professional nurse. It resulted in some ethical benefits including increased commitment to professional conduct by nurses and a promotion of the public’s trust in nurses. However, the pledge is limited in that it belittles the nurse’s contribution and does not consider the autonomy that nurses have in decision making. The paper then presented some of the arguments for and against the pledge. While both advocates and opponents of the pledge have strong positions, the limitations of the pledge are significant and they need to be addressed. Nurses and other players in the healthcare industry should therefore advocate for the Nightingale Pledge to be abridge to address the limitations identified by its opponents.

References

Bliss-Holtz, J. (2002). Nightingale Revisited. Issues in Comprehensive Pediatric Nursing 25(3), 1-4.

Dahnke, M. (2009). The Role of the American Nurses Association Code in Ethical Decision making. Holistic Nursing Practice, 23(2), 112-119

Mylott, L. (2008). The ethical dimension of the nurse’s role in practice. J Hosp Palliat Nurs, 7(2), 113–118.

Peterson, M., & Potter, R.L. (2004). A proposal for a code of ethics for nurse practitioners. J Am Acad Nurse Pract, 16(3), 116–124.

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