What the Nightingale Pledge Means to Today’s Nurses

Have you heard of nursing schools including a Florence Nightingale Pledge at graduation? Though it’s less commonly used today, it actually doesn’t originate from Nightingale, but from a nursing school in the U.S.

However, the wording and message of the pledge has become more and more outdated for today’s nurses, and Nightingale has become an increasingly controversial figure. We’ll explore the meaning of the pledge and key considerations for the modern nursing practice.

What Is the Nightingale Pledge?

Florence Nightingale is considered by many to be the mother of modern nursing. Her nursing theories pioneered foundational practices like standards of care and nursing education. In 1893, Lystra Gretter, at the Farrand Training School in Detroit, wrote a nursing pledge and named it in Nightingale’s honor. This sworn mission statement became a ritual performed by many graduating nurses during the 20th century, and updated versions are still used in some schools today.

This pledge was modeled after the Hippocratic Oath. And although neither statements are sworn contracts or legally binding agreements, physicians who swear the Hippocratic Oath are agreeing to embody a code of principles. Nurses do the same when they swear the Nightingale Pledge, meaning that this oath is more of a tradition for nurses than a binding agreement meant to protect patients. Like the lamp of learning and the caduceus, the pledge is a symbol for nursing.

The Florence Nightingale Pledge: Original Version

Here’s the original pledge of Florence Nightingale, written in 1893 by Lystra Gretter:

“I solemnly pledge myself before God and 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 or mischievous, and will not take or knowingly administer any harmful drug.

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 all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.”

Some parts of this pledge remain true for modern nursing, such as the commitment to avoid drug harm, elevate care standards, and respect patient confidentiality. Still, many others don’t. These specific areas of the original pledge go against the values and ethics of modern nursing:

• Purity and faithfulness. The emphasis on living a life of “purity” may be viewed as subjective and tied to moral judgments that vary across cultures and belief systems. In a diverse and inclusive workforce, language implying a specific moral standard can be seen as exclusionary and judgmental.
• Deleterious or mischievous actions. This language is vague and open to interpretation. What is perceived as harmful or mischievous can vary based on individual values and perspectives.
• Physician-centric language. The pledge expresses loyalty to “aid the physician in his work” reinforces a historically hierarchical relationship between nurses and physicians. In a modern and collaborative healthcare environment, it’s crucial to emphasize teamwork and mutual respect among healthcare professionals.
• Gendered language. During Nightingale’s time, and when the pledge was written, only women were nurses. The pledge uses gendered language, assuming a nurse’s loyalty to a male physician. In contemporary nursing — and as more men join the profession — it’s essential to promote gender-neutral language to be inclusive of all healthcare professionals.

The Modern Nightingale Pledge

In response to a changing world, and a changing model for nursing, some schools have updated the pledge. Here’s one version of an updated pinning ceremony pledge, from Kent State University:

“With full knowledge of the responsibilities that I am undertaking, I solemnly pledge myself to the service of humanity and will endeavor to practice my profession with consciousness and dignity. I will maintain by all the means in my power to honor the noble traditions of my profession.

The total health of my patients will be my first concern. I will hold in confidence all personal matters coming to my knowledge. I will not permit considerations of religion, nationality, race or social standing to intervene between my duty and my patient. I will endeavor to keep my professional knowledge and skills at the highest level and give my support and cooperation to all members of the healthcare team.

With full awareness of my qualifications and limitations, I will do my utmost to maximize the potential of the nursing profession and to uphold and advance its standards. I will maintain the utmost respect for humanity. I make these promises solemnly, freely, and upon my honor.”

Is The Nightingale Pledge Relevant Today?

The answer to this question depends who you ask, but many nurses would likely say no. While pinning ceremonies are still common among nursing schools, sworn oaths like the pledge aren’t. As nursing has grown from being a vocation to a respected profession, the language around a nurse’s commitment has changed. For example, words like “loyalty” are not as common in the profession today.

As critical as nurses are for the health of a population, nursing is a job. Nurses are professionals, and while some nurses may describe their work as a calling, many do not. The commitment and sacrifice that the pledge requires don’t align with the modern ideals of being a professional nurse, like taking care of oneself and taking time away from work.

While oaths may be less common, nursing ethics are just as essential as ever — although they’ve shifted significantly since Nightingale. Examples include:

• Patient autonomy. Medicine has shifted from a paternalistic model, where healthcare decisions were made by physicians without patient input. In modern medicine, there’s an emphasis on respecting and promoting patient autonomy, involving patients in their care decisions, and ensuring informed consent.
• Nurse autonomy. In Nightingale’s time, nurses assisted physicians. Today, nurses are independent clinicians who practice with autonomy in conjunction with the entire healthcare team.
• Inclusivity and cultural competence. Nightingale’s nursing paradigm didn’t include people of color or people with diverse beliefs. She came from a Christian belief system, which lacked flexibility for others, and she didn’t believe men could be nurses. Inclusivity, mutual respect, and non-judgement are essential in modern nursing practice.

While the original pledge may have grown stale as nursing has evolved, it can help modern nurses reflect on the ways that the profession has changed over the years. It wasn’t too long ago that many nurses were nuns working in monasteries or expected to blindly follow a doctor’s orders. Today, nursing is the most trusted profession. And while the modern nursing workforce still has a long way to go, it is more diverse, inclusive, and accomplished than ever before.

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