Florence Nightingale...To pledge or Not to Pledge?
The Nightingale Pledge is an adaptation of the Hippocratic Oath for nurses. Most of nursing school graduates have to take this pledge. The aim of this paper is to analyze historic role of the Nightingale Pledge, as well as its functions and purposes, ethical benefits and limitations. There will also be a research of arguments for and against the oath.
According to the text of the Nightingale Pledge, nurses promise to live their lives and do their job in an honest way. They also pledge not to commit any deleterious actions, such as taking harmful drugs or giving them deliberately. Besides, nurses say that they will try to increase the standard of their profession and keep all personal matters and family affairs in secret. They also promise to help physician in his work and devote themselves to caring about others (Miracle, 2009).
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The Nightingale Pledge was created in 1893. It was written by a committee at the Farrand Training School for Nurses, which is located in Detroit, Michigan. Despite the reference to Florence Nightingale, the name of the pledges author was Lystra Gretter. She chaired the committee of School at that time. In fact, the Pledge was based on the Hippocratic Oath. Nevertheless, it has played a significant historical role. The pledge was written in order to demonstrate nurses responsibilities back then and create the image of nurses (Miracle, 2009). Therefore, its major historic role is that it helped the society to understand what the profession of nurse presupposes. Moreover, it had influence of shaping modern requirements for nursing, particularly the Ethics Committee of the American Nurses Association included the needs for confidentiality and privacy in its Code for Nurses. The following code also encouraged nurses to play the role of advocate in their relations with patients and protect their rights. Nowadays, this norm is included in the Health Insurance Portability and Accountability Act (Miracle, 2009).
Functions and Purpose
The initial function of the Nightingale Pledge was demonstrating the founding principles of nursing to society. The purpose of this was adding certain value to nursing practice, as well as creating a definite image to it. In particular, the Nightingale Pledge depicted the necessary characteristics of the nurse of that time. After reading the Pledge, people understood that nurses were required to demonstrate faithfulness, godliness, purity, loyalty and readiness to aid the physician. Other important characteristics were humility, modesty and obedience (Grainger, 2011). Apart from that, the Nightingale Pledge is the tool for conveying the motivational message to all nurses that take it. Thus, nurses get a clear understating of commitments that they should make, such as respecting themselves, their patients, colleagues and their chosen profession. The Nightingale Pledge also serves to underline the need for privacy, advocacy and confidentiality in nursing practice (Grainger, 2011). Despite the evolving of the profession and changing social norms, the Nightingale Pledge still executes its function of a creator of correct image of the nurse. Furthermore, this function has become even more important due to developing the media and its influence on the image of nursing. Sometimes, they do not describe the real situation within the nursing practice. This disrupts the morale of nurses, as well as affects the opinion of patients (Grainger, 2011). For example, nurses might forget about their commitments before patients and colleagues. Early or later, this negative information may lead to reducing trust to healthcare specialists from the side of patients. As a result, the quality of health care services will be reduced but reminding nurses about their oath might improve the situation.
Ethical Benefits and Limitations
Ethical benefits include pledging graduates of nursing schools to follow major moral values in their work, which are important for creating good relationships between nurses, patients and other healthcare specialists. Good relationships are impossible without respect for self and others and without following confidentiality. Another important aspect for building good relationships is demonstrating empathy. All these are clearly defined in the Pledge, so healthcare organizations get specialists that know what to expect in their profession. People that do not share the above-described values do not pass the selection. There are nurses who do not treat taking the Nightingale Pledge seriously and see it as formality. However, for many nurses, the word pledge sounds as something sacred, which could not be violated.
Despite many benefits, there are also arguments against the Pledge, particularly, specialists stress that it has several limitations. This has led to modifying some of its parts or lines. For instance, graduates of California State University did not agree to pledge to God because it addresses mainly to Christians but not to representatives of all the religious groups. Such limitation could be explained by the fact that in the nineteenth century, religious diversity was not significant. However, today times have changed and the Pledge needs to evolve too. Therefore, graduates of California State University used the phrase of all faiths instead of God. The change was introduced in the spring of 2001 (McBurney & Filoromo, 1994). Apart from that, there were feminists concerns because of the phrase to aid the physician in his work. This phrase violated the rights of women due to making them serve a physician. This is why the line was replaced by the promise to work together with other healthcare administrators in an atmosphere of mutual respect and consideration (Miracle, 2009). In fact, this change is very similar to previous modifications of the phrase about God because it also demonstrates how social norms have evolved. Earlier, the role of woman was more submissive and her human rights were more limited. Therefore, both changes just reflect the modern society, which has become less conservative. Moreover, it refers not only to religious variety and expanding human rights but also to values. For example, graduates of the California State University also insisted on removing the word purity. Instead, they wished to insert social justice (McBurney & Filoromo, 1994). Overall, the removal of these limitations has made the Pledge more inclusive to all healthcare specialists
In addition, some new aspects could be included in the pledge because the original version does not possess all the demands that are important for modern society. For example, nurses should pledge to be lifelong learners, which could be done through engaging in reflective practice and using various possibilities for constant professional development. This would allow nurses to expand their knowledge, that is necessary for increasing their control and influence on their areas of expertise. Besides, there should be a commitment to support and develop the profession itself and to provide their services in the way that would be good for patients by acting as their own advocate. However, this should be done in cooperation with other healthcare specialists (Grainger, 2011).
Despite the fact that nurses do have personal lives outside of healthcare facilities, society members have expectations of the things that nurses should do and should not do, both at work and at home. In this context, the Nightingale Pledge insists on living a life of purity, which sounds limited today. Instead, the modern version of the pledge could address to the nurses as a person that is worth of trust. Finally, the Nightingale Pledge lacks a description of unique role of nurses in patients life. Therefore, there should be some lines that reflect this aspect, as well as a prompt to advance the nurse-patient relationship and attempt to make each patients day in hospital a little bit better (Grainger, 2011).
Arguments for and Against the Pledge
The Nightingale Pledge has both advantages and disadvantages. On one hand, it has been an effective tool for publicizing what nurses perform and paying attention to the profession, which allowed creating certain image of nursing. In addition, doctors also have to take a pledge, so it looks quite reasonable that nurses also pledge to follow the moral values and norms. This makes their cooperation with doctors more efficient. The pledge also provides the high level of professionalism among nurses. On the other hand, as it has already been discussed, the pledge has some limitations due to its significant age. Nursing in the nineteenth and twenty-first centuries cannot be the same due to different moral values and social norms, so requirements for nurses are also dissimilar. For example, feminists now conceive proving aid to physician, as some kind of humiliation. However, the Pledge could be adapted to the modern world and applied for increasing todays morale (Grainger, 2011).
In conclusion, the Nightingale Pledge is an adaption of the Hippocratic Oath for nurses. The importance of its historical role is in its attempt to demonstrate the responsibilities of nurses in health care process. For people of the nineteenth century, it was also a representation of profession of nurses because they did not have a clear image of nursing at that time. For nurses, the Pledge was also important because it explained them how they are obliged to behave and what moral values possess and develop. Later, the pledge has been modified. For example, some of its lines were replaced by more modern ones, which is a natural process because a nursing practice is characterized by constant evolving. Nevertheless, the Nightingale Pledge has saved its original functions and purposes. It still possesses ethical benefits. For example, the pledge works as a lift for morality of modern society. It is also efficient for building trust between nurses, patients and other healthcare specialists because the pledge demands from nurses to demonstrate such important qualities as humility, modesty and obedience. Therefore, if to evaluate the number of arguments for and against the Pledge, supportive points win. This means that the Nightingale Pledge should be further taken by graduates of nursing schools but with some changes. For example, the commitment to life-long learning could be added because it allows increasing the quality of nursing practice.