Introduction
The practice of taking an oath before undertaking an activity or holding a given position is a common tradition among various professions and society in the world. An oath binds an individual to a given activity in accordance with a given set of conditions, rules, and regulations. For instance, when Barrack Obama was being sworn into office as the president of the United States of America, he took an oath of office where he swore to serve and protect the people of his nation. Consequently, there are professions where an individual is expected to take an oath before he/she starts practicing. Most graduates are expected to undertake the Nightingale pledge prior to commencing their nursing practice.
This pledge contains principles and ethics that govern this practice (Domrose, 2001). This pledge was written in honor of Florence Nightingale who is credited as being the founder of modern nursing. It is through her efforts, directions, and works that the practice of nursing, as we now know it, developed from. According to Domrose (2001), the Nightingale pledge is also considered as a modification of the Hippocratic Oath that was historically taken by a professional in the field of medicine to ensure that they will conduct their roles and duties with utmost honesty. Given these considerations, this paper will critically analyze the Nightingale pledge, explain its historical roles, functions, and purpose, and finally focus on the ethical benefits and limitations that are associated with the pledge.
The Nightingale Pledge, Historical Development, and Ethical Considerations
Graduates who have completed an LPN or RN course usually take the Nightingale pledge before they start practicing the profession. This pledge was written by Lystra Gretter and named after Florence Nightingale who developed the currently accepted practices in nursing. Gratter was an instructor at Harper Hospital in Detroit. Due to the fact that her career was influenced by Mrs. Nightingale, Gretter decided to name this pledge after her (Fry and Veatch, 2005). The graduating class of 1893 of the Harper Hospital is the first group of nursing graduates to use this pledge.
This oath is a modification of the Hippocratic Oath that was historically taken by physicians. The aim of the Hippocratic Oath was to bind all physicians and other practitioners in the field of medicine to practice their profession in accordance with the traditionally accepted morals (Fry and Veatch, 2005). This oath is believed to have been written by Hippocrates but modified over time to conform to the changing needs of the medical profession as well as the society. The oath was also adopted by different societies hence it was rewritten to ensure that it is applicable in these localities. It is thus evident that both of these oaths have specifically been designed to ensure that medical practitioners practice their profession in accordance with specific ethics and codes.
An oath is usually considered as a pact between God and the people. Therefore, this pledge included the word ‘God’ to make it a sacred oath between nurses and the people who are to benefit from the services of nurses. Moreover, Nightingale was a religious woman who professed in the Anglican faith. From the strong faith that she had, she believed that God had specifically given her the knowledge and wisdom that she had to practice nursing in a bid to save the lives of people. Therefore, while writing the pledge, Gretter believed that having a reference to God would ensure that the nursing practice ultimately honors the beliefs that Nightingale had while developing the profession.
Currently, this pledge is still used by various nursing schools across the globe. However, these schools have made various modifications to different segments of the pledge to conform to the changing nursing needs as well as the advocated practices in these schools. To some extent, there are nursing schools that have completely done away with the pledge. According to McBurney and Filoromo (1994), purists and traditionalists are offended by the shifts that nursing practitioners have been taking over time that has slowly made the pledge to lose its meaning. In the 21st century, for instance, very few graduating classes take this oath, a move has been attributed to the growing liberalism in nursing (McBurney and Filoromo, 1994).
There have been several changes in the pledge since it was first used in 1893. As it has been asserted, these changes vary from one institute to another. However, it has emerged that these institutions modify segments of this pledge not because they want to eliminate it but because some of the lines do not apply to their current practices (Fry and Veatch, 2005). This clearly shows the dynamic nature of the world and the impact that has on the nursing profession to address the changing needs of society.
In 2001, the California State University omitted the word ‘God’ from the pledge and introduced a new phrase ‘of all faiths’ to ensure that graduates who come from different religions, cultures, and backgrounds are equally included in the pledge. Modern societies comprise of individuals who profess different religions hence bringing about the need of modifying the pledge to advocate for this change. Consequently, to advocate for the growing liberalism in the nursing profession, this institution (California State University) eliminated the reference to purity that the pledge has and instead referenced it to social justice. Given the manner in which these changes are being made, it is thus evident that the pledge is being modified to become applicable in the modern world.
Despite these changes, there are other segments of the pledge that are still applicable in the modern world. All through the development of the nursing profession, it has been considered an ethical practice for nurses to maintain the confidentiality of their patients (Fry and Veatch, 2005). The Nightingale pledge advocated for maintaining the privacy and confidentiality of patients. This ethical consideration is contained in the line below:
“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 family affairs coming to my knowledge in the practice of my calling.” (Fry and Veatch, 2005).
The pledge has also been used to devote nurses to their work. According to the nursing codes, it is a matter of principle that a nurse conducts his/her duties with the utmost care and faith. This is because nursing is a sensitive practice especially in sustaining the health of the patients.
The pledge asserts that “doing all in my power to maintain and elevate the standard of the profession (Fry and Veatch, 2005).” However, there have been instances where nurses have failed to adhere to this phrase and dire consequences have followed. For instance, a nurse was found guilty of negligence in Canada after concentrating on filling a crossword puzzle in the course of a normal operation that greatly affected the recovery and health of the patient after the procedure. After being found guilty, the patient was awarded a compensation of $1 million. The pledge is thus used to avoid such acts that diminish the credibility of the nursing profession especially due to negligence.
From a critical point of view, it is evident that this pledge has two main purposes in supporting the profession of nursing. The first purpose of this pledge is ensuring that nurses are informed of their roles in the course of practicing their profession. Therefore, the pledge acts as a reminder of the promise that they had made to ‘God’ and the people that they plan to serve. The second role of the pledge is to advocate nurses to adhere to the ethics and codes of the nursing profession as they perform their duties in delivering healthcare to society. This ensures that the act in a manner that is morally and legally accepted.
Conclusion
Modern practices in nursing were developed by Florence Nightingale during the 19th century. The Nightingale pledge was developed to honor her efforts and to ensure that nurses act in a manner that is morally and ethically accepted. Up to the present moment, there are specific segments of this pledge that are still accepted in sustaining the role of nurses. For instance, matters of confidentiality have always been considered as critical in the nursing profession since its inception. However, there have been changes in the pledge such as the elimination of the word ‘God’ to ensure that nurses from all religions, cultures, and background are bound by the oath. Thus, the main aim of this oath is to ensure that nursing is practiced following ethical and moral standards.
References
Domrose, C. (2001). A Fresh Tradition: Students, Schools Usher Nightingale Pledge into a New Era of Nursing. Nurse Week, 123(1), 15-16. Web.
Fry, S. and Veatch, R. (2005). Case Studies in Nursing Ethics. JSTOR, 14(2), 34-45. Web.
McBurney, B. and Filoromo, T. (1994). The Nightingale Pledge: 100 Years Later. Nurse Manage, 2(1), 72-74. Web.