The Nightingale Pledge was written in 1893 by a committee chaired by Lystra Eggert Gretter (American Nurses Association, 2013).The committee was from a nursing school, Farrrand Training School in Detroit. It is modeled from the Hippocratic Oath which is an oath usually taken by physicians who promise to practice medicine truthfully. The Nightingale oath was later revised by Mrs. Lystra Gretter in 1935. The Nightingale pledge has been revised severally by people to ensure it reflects the changing role of the nurse and the changing position of the nurse in the current health team.
The purpose of the Nightingale pledge was to describe the ideal nurse so that all the Nurses endeavor to reach that point. The pledge defines the values of nurses. It is used to determine the professional conduct among nurses: how nurses should conduct themselves. It is also used as guiding principle to judge disciplinary cases and to give credit to nurses who show exemplary action. The pledge is used to ensure that nurses work to the best interest of the patient and therefore it reassures the public of the role of the nurse and the commitment of the nurse to this role (American Nurses association, 2013). It can be referred to in cases of moral dilemmas in the nursing profession: it will provide a basis for the decision making.
Limitations of the pledge were many and that is the reason many changes have been made. The original pledge written in 1893 included the nurse’s personal life; it required the nurse to live a life that is pure. This may have been ideal at the time because most nurses had religious backgrounds and purity was important. This was revised as subsequent oaths do not contain the quote. The second limitation was the fact that that it was a promise to loyally help the doctor in his work. This interferes with a nurses’ work as commitment should be to the person receiving the service. Many suits limited the nurse even when the nurse was aware that the physician was on the wrong, they had a moral dilemma whether to testify against them as their pledge requires them to be loyal to physicians (Schafer, 2007).
The clause about aiding the physician was understood like loyalty without questioning. A landmark case in the nursing profession, a nurse Lorenza Somera was convicted for manslaughter because she did not question the doctor’s orders (Schafer, 2007). The doctor ordered that the nurse administer cocaine to a tonsillectomy patient, instead of procaine. The patient lost his life because of the mistake. The doctor and the nurse were both accused of manslaughter. The nurse was convicted but the doctor who gave the order was acquitted, this led to a change in how people viewed nursing in relation to just taking orders or advocating for what is right. The nurse was later pardoned (Schafer, 2007).
People who propose that nurses should take the pledge argue that the pledge is an indication of professionalism. It gives a worldwide concept on the role of the nurse and the commitment of the nurse to that role. It gives a basis by which the nurse should conduct himself or herself. They argue that the growth of the nursing profession is dependent on the nurse’s individual values. The pledge gives a basis for the values (Raymundo, 2008).
Controversies are also based on the wording of the pledge. Some people think that the wording should be revised to reflect the modern nurse. They claim that some of the words used in the initial pledge are ambiguous. There are nurses who also feel that there should not be a change of wording, they argue that the wording should be maintained as it is. The reason they give is that keeping the original form shows the loyalty of nurses to their profession and also to their clients (Raymundo, 2008).
The pledge is also made to God. The nursing profession initially had a Christian basis because of its founders who had a Christian background. The modern times has seen a lot of changes with other religions such as Muslims, Hindus, Buddhists and Atheists joining the profession. This brings about a conflict as the pledge is made to God and it’s because of the superiority of God in the Christian religion that gives the pledge its importance. Making a nurse pledge before God yet he or she does not belief in God befits the meaning and the importance of the pledge. People who argue against this require that it should be modified to accommodate all religions (Miracle, 2009).
Those who oppose the pledge also argue that the fact that it is referred to as the Nightingale pledge is not ideal. They argue that Nightingale did not deserve the honor as she showed biased in her nursing practice. Nightingale refused a mixed race British nurse to work in her hospital. The Nightingale oath should be something that reflects the universal nurse as the pledge should be used worldwide among all nurses. This show by Nightingale shows some kind of bias and not the universal nature of the nursing profession.
The oath has important aspects that apply to the profession of nursing today. The aspect of patient confidentiality comes out clearly in the Nightingale pledge. This issue is important in the profession of nursing. Most nursing associations recognize its importance and it is listed in the ethical issues of nursing. The issue of confidentiality is important in ensuring patient disclosure which is important in giving adequate care to the patient.
The other aspect that is listed in the oath and is still important today is the issue of working with physicians. The way it is put out may not be ideal but it is important to note that most patients require multidisciplinary approach to management. All health care professionals, nurses, doctors, pharmacists, dentists and laboratory technicians should work together for the overall benefit of the patient. The pledge also mentions that nurses should participate in the growth of the profession. This is important in the modern nursing as many nurses are required to conduct researches to improve the profession.
People who have made the pledge before argue that it plays an important part in reminding them of their achievement and their role. The fact that one has graduated may not be enough to remind them of their role as a nurse. The memories of making the pledge play an important role in guiding the decisions made by the individual and even the kind of care administered to the patients.
The difference in the view of the pledge has led many people to abandon the pledge or others to modify the pledge to suit their idea of the role of a nurse. A case in point is the California State University which has modified their pledge to accommodate other religions by mentioning ‘God of all faiths’ and not just ‘God’. They have also modified the close about loyalty to physicians by indicating that nurses pledge to work with all other healthcare professionals under conditions of mutual respect and consideration (Miracle, 2009)
It is important that nurses assure the public of their work. Nurses should also have something that binds them together and it should form a basis from which the profession is built. The pledge should be recited in a similar way across the world so that despite the place its meaning and the interpretation is the same. This calls for revising of the pledge to solve the differences identified but at the same time the originality of the text should be maintained (Gill & Gillian, 2005).
In summary, the pledge has both positives and negatives effects in the medical field but despite this, its importance in history and at the moment cannot be overlooked. It is therefore necessary that the controversies be resolved as they may affect the integrity of the nurse and the profession as a whole. Nurses across the world should have values that bind them together. A pledge that can be used across the world may play a major role in the move from being a nursing student to a qualified nurse. The ceremonial graduation may not be enough to remind the nurse of their role in society.
In addition to the summary, the formulated pledge will provide a basis upon which the character of the nurse is judged. It will ensure that the international nurse of the year can be selected with the same standards across the world.
References
American Nurses Association (2013) Florence Nightingale Pledge. Web.
Gill, C., & Gillian C. (2005). Nightingale in Scutari: Her Legacy Reexamined. Clinical Infectious Diseases, 40(12), 1799–1805.
Miracle, A. (2009). A closing word: National Nurses Week and the Nightingale Pledge. Dimensions of Critical Care Nursing, 28(3), 145-146.
Raymundo, A. (2008). The Nightingale Pledge: A Nurse’s Promise? Web.
Schafer, A. (2007). Nurses New Role Patient’s Advocate in William I. Arch of Experience. Toronto: Holt, Rinehart and Winston.