As we prepare to celebrate National Nurses Week, I remember one of my students asking about its history. This led to a class discussion on the history of nursing as well as the history of National Nurses Week, the current state of nursing, and the future of our profession in the midst of a nursing shortage, rising healthcare costs, access to healthcare problems, and insurance issues among other things.
National Nurses Week is celebrated May 6 to 12 and was established by the American Nurses Association in 1990 as an extension of National Nurses Day (May 6). This official celebration of nurses and the profession of nursing started in 1954 as a week in October to mark the 100th anniversary of Florence Nightingale's work with patients during the Crimean War. After many attempts by several nursing groups, a joint resolution to celebrate National Nurses Day was made by the US Congress in 1982. This day is May 6. Then with the support of many groups, the day of celebration became week to include May 12, the birthday of Florence Nightingale.1 This class then wanted to discuss the Nightingale Pledge.
I clearly remember reciting this pledge when I graduated from nursing school. I will not tell you when, but suffice it occurred a few decades ago. I remember being slightly misty-eyed and beaming with pride in finally accomplishing the dreams of becoming a nurse since I was 6 years old.
The Nightingale Pledge is as follows2:
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 and 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 this practice of my profession.
With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.2(p391)
Interestingly, the pledge was not written by Florence Nightingale. The pledge was actually written by a committee at the Farrand Training School for Nurses in Detroit, Michigan, in 1893. The committee was chaired by Lystra Gretter3 and was based on the Hippocratic Oath. The pledge was meant to describe the opinions of what nurses did at the time and to shape the image of nurses.4
Many aspects of the pledge are still applicable today. For example, nurses have long recognized the need for confidentiality even before legislation was mandated. The need for privacy and confidentiality is included in the Code for Nurses published by the Ethics Committee of the American Nurses Association. This code also promoted the ethical conduct of nurses and their role as a patient advocate to protect the rights of patients. Today, this is mandated by the Health Insurance Portability and Accountability Act.5
Although there is some controversy about the use of the Nightingale Pledge from schools of nursing and nurses, many aspects of it are still applicable today such as the example above. Many schools have either abandoned its use completely or modified it to better describe the role of the professional nurse in today's healthcare settings. There are many who still advocate aspects of the pledge for today's nurses.3-6 The profession of nursing is constantly evolving, and nurses must adapt to these changes to survive, particularly in this area of nursing shortage and decreasing healthcare dollars.
Some schools, such as the California State University in Los Angeles, California, have revised the pledge.3 For example, the phrase, "I solemnly pledge myself before God,"3(p1) has been changed to "God of all faiths"3(p3) to reflect the various religious backgrounds of nurses. Another change concerning the relationship between nurses and physicians has been revised to "work with members of all healthcare disciplines in an atmosphere of mutual respect and consideration."3(p3)
Others have also recognized the need to adapt the pledge because many of the words may have different or ambiguous definitions today.4,6 For example, the original pledge included living a life of purity. This may mean different things to different people. Some may see purity as chastity, whereas others see it as meaning worthy of trust and genuineness.4
I believe that although some changes may be justified, many of the tenets of the Nightingale Pledge are still pertinent today. The phrase, "will hold in confidence,"2(p391) is mandated by the Health Insurance Portability and Accountability Act as described in the article by Erickson and Miller5 in 2005. The phrase, "I will not take or knowingly administer any harmful drug,"2(p391) is still a vital component of nursing care. Also, "I will do all in my power to maintain and elevate the standard of my profession"2(p391) is still valid today.
The phrase, "with loyalty will I endeavor to aid the physician,"2(p391) is interpreted by some to show a subservient role of the nurse.3,4 However, as nurses, don't we aid the physician as well as other healthcare providers to aid our patients and their families? I agree with McBurney and Filoromo,4 who stated, "It is the freedom to act and exert control over one's own area of expertise."4(p74) This reaffirms the nurse's autonomy.
Whether a school of nursing chooses to use the Nightingale Pledge as it is written or adapted or not to use it at all is actually a discussion made by the nursing leaders at that school. However, as we approach and prepare to celebrate National Nurses Week, I ask that each of us remember why we became a nurse and reflect on the importance of the work of Florence Nightingale as well as the tenets presented in the pledge as it was written in 1893. Thank you for all you do as nurses. Please remember to show your colleagues the appreciation they deserve as well. In fact, plan to celebrate nurses all year long.
Vickie A. Miracle, EdD, RN, CCRN, CCNS, CCRC
Editor, DCCN and Lecturer
School of Nursing