The Nightingale Pledge dates back to 1893. It was formulated by a committee headed by Mrs. Lystra E. Gretter for use during the graduation of nurses from medical schools (Temple, 2012). The pledge was given the name of the founder of the nursing profession in honor of her role in developing the profession. This pledge is a source of controversy today because of the implications of some of its statements. This paper explores the place of the Nightingale Pledge in contemporary nursing, and examines both sides of the debate surrounding the structure and purpose of the pledge.
Historical Role, Function, and Purpose of the Nightingale Pledge
When Florence Nightingale decided to become a nurse, her goal was not to establish a new trade. Rather, she was driven by compassion for wounded soldiers. Her goal was to find ways of making their lives more bearable during recovery (Yeboah, 2009). Her commitment and desire to nurse the weak and the dying led to the establishment of the modern nursing profession. Therefore, when a committee headed by Lystra E. Gretter sat to develop the Nightingale Pledge, they were attempting to immortalize the memory of Florence Nightingale, and all the values she espoused as a nurse (Temple, 2012).
The function and purpose of the pledge was twofold. First, it was meant to encourage newly qualified nurses to make a lifelong commitment to the practice of nursing. Nursing is often referred to as a calling (McEwen & Wills, 2011). This comes from the immense physical and emotional burden that nurses carry daily. It is impossible to carry this burden successfully without wholehearted commitment to the profession. Therefore, the Nightingale Pledge serves as a reminder to graduating nurses that nursing is not an ordinary profession, but a vocation. Whole-hearted commitment to nursing is necessary for effectiveness.
Secondly, the pledge was supposed to encourage professionalism in the practice of nursing (McEwen & Wills, 2011). It identified the broad issues that nurses deal with on a daily basis, and prescribed a professional approach to these issues. In this sense, the Nightingale Pledge binds all nurses to the professional execution of their duties. The general standards of professionalism may vary from one jurisdiction to another. However, the gist of the pledge is that all nurses must handle their work in conformity to professional standards.
Ethical Benefits of the pledge
The Nightingale Pledge has several ethical benefits. First, it secures the confidentiality of the information that patients give during the process of treatment (McEwen & Wills, 2011). The fact that nurses take a pledge that requires them to keep in confidence all information they came across gives patients the assurance needed to cooperate with the nurses. Patients can open up to nurses with the reasonable expectation that the nurses will handle all issues in confidence.
The second ethical benefit of the pledge is that it ensures that all nurses make a commitment to do no harm in the course of their work (Temple, 2012). Specifically, nurses agree not to administer any medicine that can harm a patient. This means that patients can relax with the full knowledge that any medicines administered by nurses are solely safe to use.
The third ethical benefit that accrues from the Nightingale Pledge is that is commits the nurses to take personal responsibility for the care of patients under them. The use of the term “purity” in the pledge is a source of contention because of its ambiguity (McEwen & Wills, 2011, p. 22). However, it is clear that it refers to a sense of personal commitment to the profession revolving around moral clarity in the exercise of the duties of a nurse. This is the highest level of commitment to any office.
The fourth ethical advantage of the pledge is that it places the responsibility of keeping private information about a patient’s family confidential. In a broader sense, it means that a nurse is not only responsible for caring for the patient, but also handling some of the needs of the family members of the patient. In this sense, a nurse is ethically obliged to cater for the needs of patients in a wholesome manner. Such an approach enhances recovery.
Limitations of the Pledge
The pledge has some notable limitations. First, the pledge assumes that all nurses have some sort of religious affiliation or appreciation. While the freedom of religion is a right for all nurses, it is not a requirement for a person to be religious in order to become a nurse. In light of the increasing respect for the personal freedoms, pledging allegiance before God can cause some nurses discomfort if they have no spiritual appreciation of a deity. In this regard, the pledge may sound hollow to such nurses.
The second limitation of the pledge is that nurses take the pledge before an “assembly” (McEwen & Wills, 2011, p. 22). The assembly refers to the congregation at the graduation ceremony. The problem with this is that no accountability arises from being part of the gathering. In fact, after graduation, all the nurses disperse to various places to find opportunities to practice, and they may never meet again to review their allegiance to the pledge. In addition, no mechanism exists to facilitate the follow up of individual nurses based on the pledge taken during the graduation ceremony.
The third weakness of this pledge is that it gives physicians a blanket commitment from the nurses. In practical terms, nurses practicing today are professionals in their own right. They are not subordinates to physicians in a similar manner to the time when the pledge was originally crafted. More so, the pledge seems to take away the freedom of conscience from the nurses because it binds them to “aid the physician in his work” with loyalty (McEwen & Wills, 2011, p. 22). Nurses are bound to do everything a physician demands from them.
Justifications for the Pledge
Proponents of the Nightingale Pledge have proposed a number of justifications for the continued use of the pledge. These justifications include the following. First, the Nightingale Pledge codifies the ethos of the nursing profession. The basic tenets that underpin the nursing profession find expression in the pledge. In other words, the pledge is similar to the apostle’s creed in relation to the Christian faith, or to the Ten Commandments in the context of Judaism. The pledge embodies the spirit of the nursing profession. It talks about commitment to the profession, professionalism, and the rules governing patient care.
The second justification for the continued use of the pledge is that it creates a sense of universality among nurses (Yeboah, 2009). The fact that almost all nurses take the pledge makes it possible for nurses to have a universal worldview in relation to their profession. The calling of any nurse is to humanity in general. This pledge affirms this outlook.
The third justification for the pledge is that it establishes personal accountability in the practice of nursing (McEwen & Wills, 2011). It is true that nurses all over the world are only allowed to practice if they are licensed. The level of accountability emanating from licensing procedures arises from the enforcement of accepted rules and procedures in a specific jurisdiction. The Nightingale Pledge on the other hand makes accountability a personal matter. It puts the burden of regulation on the individual nurse. Therefore, nurses who take this pledge do not need external regulations to carry out his work.
The pledge also creates a sense of collective responsibility among nurses in regards to patient care and professional conduct. All the nurses know that their colleagues took the Nightingale Pledge. This empowers nurses demand professionalism from their colleagues. This is very important in high-pressure situations such as when dealing with emergencies. It is important for all nurses know the level of commitment to expect from each other. In addition, nurses know the expectations of other nurses. This serves to make the practice of nursing smoother.
The last justification for the pledge is that it gives patients a predictable environment. The fact that nurses take the Nightingale Pledge makes it possible for the patients to open up to the nurses. This improves the quality of care that the patient receives.
Arguments against the Pledge
The pledge is also the cause of serious concerns in some quarters. The main arguments against it are as follows. First, the wording of the pledge seems to suggest that everyone taking a nursing course must have religious convictions. This expectation is difficult to sustain in contemporary society. The trend in many professions is to separate the provision of professional services from the practice of faith. In this sense, the pledge is offensive to nursing graduates who have no religious convictions, and offers no assurance to similar patients.
The second flaw in the pledge is that it is not enforceable. This also applies to many pledges taken by professionals in other fields. Pledges that have no basis in law are difficult to enforce. The only way that the pledge is enforced is when its tenets form part of the code of conduct of nurses in a certain jurisdiction. In this sense, the codes of conduct are more effective than the famed pledge.
The third main issue with the pledge is that it puts nurses at the mercy of physicians. The wording of the pledge makes it sound as if a nurse cannot question anything that comes from a physician. This means that the pledge robs nurses of their freedom of conscience when dealing with orders from physicians. This situation is unacceptable in the context of professional practice. Nurses are fully-fledged professionals and their relationship with physicians should not be one-sided (Temple, 2012).
The fourth problem with the pledge is that is establishes a hierarchy in the provision of health care. The hierarchy places physicians above nurses. Modern nursing practice is a very skilled profession compared to the time when the pledge was developed. Services offered by nurses are specialized. These services are not subordinate to the services offered by physicians. In the hospital environment today, it is safer to view the role that physicians and nurses play as complimentary. In addition, nurses work with many other health professionals apart from physicians in the present day healthcare setting. The pledge is outdated on these two fronts. It fails to recognize that times have changed. It refers to an era that is more than a century old.
Conclusion
In conclusion, the Nightingale Pledge is old. It is no longer as effective as it once was. Its continued use robs the nursing profession of the opportunity to stand out as one of the arms of patient care. While it plays some very important roles in the development of the nursing profession, there is need to update it to take into account the changes that have taken place in the last century.
References
McEwen, M., & Wills, E. (2011). Theoretical Basis for Nursing. Philadelphia, PA: MPS Limited.
Temple, J. (2012). Becoming a Registered Nurse: Making the Transition to Practice. Thousand Oaks, CA: Sage Publications.
Yeboah, C. A. (2009). Relocating to a Nursing Home: The Significance of Cultural Diversity. Victoria: Australian Catholic Unversity Research Services.