Introduction
Extant literature demonstrates that the first generally accepted code of ethics for nursing in the United States was written in 1893 by Lystra Gretter and named the Nightingale Pledge to embody the highest ideals of nursing as demonstrated by the founder of modern nursing Florence Nightingale (Fowler, 2010). The pledge, which was a nursing adaptation of the Hippocratic Oath, was solemnly recited at graduation or “Pinning” ceremonies across the United States of America and beyond, even long after the American Nursing Association (ANA) adopted its first official code of ethics in 1950 (Sellman, 1997). The present paper attempts to discuss and explain the Nightingale Pledge, including its historical role, function, and purpose, and also its ethical benefits and limitations.
The Nightingale Pledge, Historical Role, Function & Purpose
The Nightingale pledge has undergone various modifications ever since it was originally written over 100 years ago to reflect various shifts in the nursing profession. In its original form, however, the pledge read as follows:
I solemnly pledge myself before God in the presence of this assembly: To pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my knowledge in the practice of my profession. With loyalty will I endeavor to aid the physician in his work and devote me to the welfare of those committed to my care (Gretter, 1910 cited in Fowler, 2010 p. xiii).
Various thematic scenarios can be synthesized from the above pledge to demonstrate the historical role, function, and purpose of the Nightingale Pledge in its original form and context. In the historical role, it can be argued that the Nightingale Pledge is the foundation of modern professional nursing ethics because it was the first piece of ethical standards aimed at informing and influencing the nursing practice (Bliss-Holtz, 2002). By reciting the pledge during graduation ceremonies, nurses were bound by Nightingale’s sphere of influence to develop and demonstrate certain exemplary habits of behavior (Miracle, 2009). Consequently, the pledge served as a representation of the nurses’ professionalism and promise to abide by certain ethical rules and behavior in their entire nursing profession (Veatch, 2000).
The Nightingale Pledge has a multiplicity of functions arising from the discussed historical role. It can be argued that the current edition of ANA’s code of ethics, which is essentially a guide for undertaking nursing responsibilities in a manner consistent with quality in nursing care and the ethical responsibilities of the practice (Andrist, 2006), is firmly grounded on the Nightingale’s Pledge of 1893 (Bliss-Holtz, 2002). Although the traditional recitation of the pledge has lost some of its prominence and implications over the years, the current Code of Ethics for Nurses borrows heavily from the original pledge by calling on nurses to promote, advocate for, and endeavor to safeguard the health, safety, and rights of the patient (American Nurses Association, 2001). In Nightingale’s pledge, this tenet can be found in its call for nurses to practice their profession faithfully and abstain from whatever deleterious and mischievous activities can endanger the life of a patient (Fowler, 2010, p. xiii). In this context, it can be argued that the Nightingale Pledge serves as a critical foundation for the modern-day code of ethics for nurses.
Additionally, the Nightingale Pledge not only functions as a sacred bond between nurses and patients in the provision of care, but it reminds them of their cardinal responsibilities to the patients (Miracle, 2009). This way, nurses are bound by the pledge to only do what is in the best interest of patients and to undertake their responsibilities ethically, not to mention that they are also bound to keep in confidence all information regarding their patients. In this context, it can be argued that the Nightingale Pledge has over the years functioned to assist nurses to establish a relationship of trust with patients in the process of care (Sellman, 1997). Consequently, it should be noted that the practice of nursing cannot be effective if nurses are not bound to hold in confidence all personal matters of patients that come to their knowledge during the practice of their profession.
Although the Nightingale Pledge was not written by Florence Nightingale herself, it functions as an explication of the virtues so dearly held by Florence and without which there would be no foundation for the nursing profession. More specifically, it functions to exemplify the virtues of soberness, caring, honesty, obedience, truthfulness, loyalty and trustworthiness, and desire to do something to help the needy (Sellman, 1997). To date, these virtues function as the foundation for nursing education and practice. In this regard, it can be argued that the Nightingale’s Pledge functions as a symbol of an individual’s professionalism and a promise before mankind that he or she would be bound by the ethical rules and virtues as espoused by Florence Nightingale (Miracle, 2009).
Flowing from the above, it is of fundamental importance for all licensed workers to commit themselves to a pledge, with the view to assuring the general public that they are indeed committed and dedicated to serving and to assisting those who are suffering (Sellman, 1997), and to uphold the rules and regulations governing their profession as they continue interacting with other members of the society (Miracle, 2009). Nursing, as is the case with other professions, needs to be grounded on a pledge because it is a profession that uniquely depends on a nurse’s values and virtues to guide the establishment of a trusting relationship between the professional and her patient. Consequently, the overriding purpose of the Nightingale Pledge is to serve as the foundation that not only guides but also informs a nurse’s values and virtues in the practice of the nursing profession (Bliss-Holtz, 2002).
Ethical Benefits & Limitations of the Nightingale’s Pledge
To date, a multiplicity of arguments has been advanced for and against the relevancy of the Nightingale’s Pledge in contemporary times. Advocates of Nightingale’s pledge maintain that it is still relevant in modern-day nursing due to its ethical obligations for nurses to demonstrate (1) faithfulness to the profession, (2) compassion and care to patients by not administering harmful drugs, (3) confidentiality in all personal matters regarding the patient, and (4) devotion to all those committed to the nurse’s care (Veatch, 2000). These ethical standards, in my view, are still applicable in the nursing profession today, not to mention that they exemplify the values and virtues without which it would be impractical to practice the nursing profession.
Additionally, academics and practitioners have suggested that the Nightingale’s Pledge serves as the foundation on which the current code of ethics as espoused by ANA is premised (Andrist, 2006). For instance, the Nightingale’s Pledge required graduating nurses to “…hold in confidence all personal matters committed to [their] keeping, and all family affairs coming to [they’re] knowledge in the practice of [they’re] profession” (Fowler, 2010 p. xiii). As per the 2001 ANA’s code of ethics for nurses, confidentiality is depicted to be at the core of nursing professionals establishing trusting relationships not only with patients but also with their families and other nurses (Sellman, 1997). Consequently, it can be argued that many of the ethical standards depicted by the 1893’s nursing adaptation of the Hippocratic Oath are still very much in use today.
However, several arguments have been advanced to critique Nightingale’s Pledge, in large part due to the ambiguities of the words contained in the pledge. For instance, there exist ethical implications in requiring graduating nurses to pledge to God while it is a well-known fact that some individuals do not subscribe to any religious doctrine (Miracle, 2009). Extant literature demonstrates Florence Nightingale as a deeply religious character; however, it is ethically wrong to assume that all nursing professionals subscribe to the same supernatural deity and therefore must pledge their allegiance to God (Veatch, 2000).
Critics have also questioned the ambiguous nature of the word “purity” in the pledge, with some suggesting that the word “clarity” would have been more appropriate as nurses need to clarify every thought to prioritize the needs of the patient and do whatever is in their power to deal with the suffering and anguish of the patient (Bliss-Holtz, 2002). The word “purity”, it is argued, can be interpreted in many ways, hence pledging to lose a sense of direction and context (Veatch, 2000).
Lastly, the pledge continues to receive widespread condemnation due to the phrase “…with loyalty will I endeavor to aid the physician in his work” (Fowler, 2010 p. xiii). Although these words encapsulate the essence of traditional nursing ethics whereby the physician was perceived as the captain of the healthcare team and nurses were socialized to be loyal foot-soldiers, critics argue that such a predisposition has no place in the contemporary nursing profession as nursing has matured to be an autonomous discipline (Andrist, 2006) and that nurses should demonstrate commitment and loyalty to the patients but not to the physician (Veatch, 2000). The critics further argue that the requirement for nurses to demonstrate implicit, unquestioning obedience to the physician as required by the Nightingale school of thought cannot be applicable in the contemporary nursing environment as it should be the obligation of nurses to ensure that patients receive competent and ethical care even if this means questioning some of the decisions made by doctors (Holliday & Parker, 1997). Nurses, in my view, must be allowed to make independently responsible and accountable decisions for nursing to be viewed as a fully-fledged profession.
Conclusion
The present paper has comprehensively discussed and explained Nightingale’s Pledge, including its historical role, function, and purpose, and also its ethical benefits and limitations. The overriding concern of the pledge, as portrayed in the discussion, has always been to serve as the foundation that not only guides but also informs a nurse’s values and virtues in the practice of the nursing profession. It can therefore be concluded that Nightingale’s Pledge is still at the core of the nursing profession as most of the ethical standards it sought to explicate are still in use today. However, some of its tenets need to be repealed or modified if graduating nurses are to continue using the pledge.
References
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