FLAWS AND CRITICS OF NURSES’ PLEDGE by Omolola Adams
Lystra Gretter, formerly Miss Lystra Eggert, born in Ontario changed the face of nursing profession in the early 19th century. She changed nursing training from one year to two years and later three years while working at Ferrand Training School for Nurses Detroit, Michigan between 1889 – 1907. A major contribution of Lystra Gretter was working with a committee for the Ferrand Training School for Nurses in composing and editing the original version of the pledge in 1893. Later the pledge was named as Florence Nightingale Pledge since she’s been credited founder of modern nursing. The pledge was formulated after Hippocrates oath.
Below is the original version of Florence Nightingale Pledge.
Original “Florence Nightingale Pledge
I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practise my profession faithfully.
I shall abstain from whatever is deleterious and mischievous, and shall not take or knowingly administer any harmful drug.
I shall 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.
I shall be loyal to my work and devoted towards the welfare of those committed to my care 1.
This pledge has been tested over times and thus reviewed in 1935. All the ‘shall’ changed to ‘will’ hence give it a true state of pledge. I don’t want to bore you with the grammar of shall and will, in legal terms ‘shall’ is used as requirements and obligations while ‘will’ is used as willingness, predictions, natural behaviour and habitual occurrence2. Few lines were added to the pledge. Below is the 1935 Revised Version
Florence Nightingale
1935 revised version
I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practise 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 the practice of my calling.
With loyalty will I aid the physician in his work, and as a missioner of health, I will dedicate myself to devoted service for human welfare1.
Few lines in the above revised pledge had attracted several criticism. A lot of twentieth century researchers had frowned at the pledge which is believed to have not reveal the true professionalism of nursing profession. A lot of credits were given to those that wrote nursing pledge with view of attaining one of the criteria of professionalism, yet its flaws cannot be overlooked. After several deliberations and rigorous revisit of this version, considering some missing important elements and to test the time of reality, it was reviewed and established ‘Practical Nurse Pledge’ a modern version of Nightingale Pledge.
Below is the modern version of Nightingale Pledge.
Modern Version of the Nightingale Pledge
Before God and those assembled here, I solemnly pledge;
To adhere to the code of ethics of the nursing profession;
To co-operate faithfully with the other members of the nursing team and to carryout faithfully and to the best of my ability the instructions of the physician or the nurse who may be assigned to supervise my work;
I will not do anything evil or malicious and I will not knowingly give any harmful drug or assist in malpractice.
I will not reveal any confidential information that may come to my knowledge in the course of my work.
And I pledge myself to do all in my power to raise the standards and prestige of the practical nursing;
May my life be devoted to service and to the high ideals of the nursing profession1.
There have been several objections on Nightingale pledge with different critics on the subject. Schools, Colleges, Faculties and Organisations had adopted a pledge suiting its purpose. Even countries had a modified version of its Nightingale pledge thereby making it difficult to adopt a universal nursing pledge.
Critics ranging from religious view not depicting today’s nursing objectives including professionalism has not reflected with the latest version of Nightingale pledge. If we all agreed that nursing is a profession, establishing its metamorphosis from primitive to a full-fledged profession, then it’s imperative to adopt a universal and accepted nursing pledge.
I stumbled across different versions of nursing pledge in my quest for ‘most acceptable version’ with no one found. Guess what I discovered? There were series of different nurse’s pledge: The International Pledge for Nurses3, Nurses’ Pledge for Trained Nurses’ Association of India incorporated into Commonwealth Nurses’ Federation4. Nurses’ Pledge of Service adopted by Democratic Nursing Organisation of South Africa (DENOSA)5 and KZN Department of Health South Africa6. The Nurses’ Pledge adopted in Ghana7, Christian Nurses’ Oath8, Nursing Pledge Gifts on Zazzle and many more, just to mention but a few.
The third item of the pledge needs to be revisited. At different fora I’ve made it clear that nurses aren’t subservient to physicians, we are two parallel professionals that has its ethics and professional boundaries. Nurse’s pledge has not nothing to do with physicians, we work as a team and not obliged to perform all physician’s orders. Without a nurse (depending on the speciality) a physician cannot perform efficiently and maximally, hence nurses’ indigenous and homogenous practice isn’t under any physician liability. Gone are the days when nurses were considered ‘physician aide’ or ‘physician servant’ the story is no more in this twenty-first century.
A vey fascinating and widely commended Nightingale Pledge has been circulating on social media. The pledge has received a lot of attentions and accolades. In fact various organisations, schools and faculties had adopted the pledge as it’s found to meet current nursing professionalism and practical diversity. Lorita Renfro, a registered nurse, an instructor at Kaplan College San Diego, modified the modern version of Nightingale Pledge. Based on the comments on www.ajnoffthechats.com/one-instructors-updated-nightingale-pledge9 . The modified pledge had been consumed by many institutions and been preferred to other Nightingale pledge. Sasha Nelson reported May 2, 2018 that 23 new nurses from Colorado Northwestern Community College were honoured and adopted the modern version of Nightingale pledge modified by Lorita Renfro10. Below is the full version of Lorita Renfro Modified Version of Nightingale Pledge:
A Modern Nightingale Pledge By Registered Nurse Lorita Renfro
I pledge myself here, before my God and in the presence of this assembly, to practice my profession with integrity.
I will endeavor to maintain and elevate the standard of nursing, both as a science and as an art.
I wholeheartedly recognize the importance of high standards of care and of personal accountability.
I devote myself to the healing, protection, and welfare of those committed to my care.
I accept a duty to work for the improvement of health in the communities in which I live and work.
I will hold in confidence all personal matters committed to my keeping, and will respect the privacy of medical information.
I will act with compassion in ethical matters.
I will not knowingly administer or consume any harmful substance.
I commit to interdisciplinary collaboration and lifelong learning.
I fully acknowledge the seriousness of the responsibility that I accept in my calling, and the significance of this pledge that I take today10.
This pledge has thoroughly and immensely suited nursing profession, its merit are greatly acceptable making it a favourable pledge. Lorita has been able to capture minds of progressive nurses thus assuming to be credited as ‘Modern Nightingale Pledge’. I am calling on International Nursing Organisation to fine tune this pledge making it world acceptable Nightingale Pledge. I found a demerit on this pledge, the last verse of the pledge need to be fine tune ………..that I accept in my calling, and ………… if we all accept that nursing is an art and science, then nursing is not a calling. I don’t support the statement nursing is a calling, it’s a common word among nurses believing that it’s like a prophetic call. Historically, during the primitive stage of nursing, most missionaries’ are found to be nurse hereby incorporating nursing care with the missionary work. Below is a definition of nursing
Nursing is defined as science and art of life which is evidenced-based practice profession that is built upon a desired goal in attaining maximal health status of a client well or sick (Omolola 2014)11
Nursing is evidenced based and not a ‘calling’. There are educational attainment and clinical hours to be achieved before been a licensed or registered as a professional nurse, thus can’t be equate with a so-called ‘calling’. Some of us that attended a Christian faith-based training institutions, can attest that were strongly cultivated to believe nursing is a ‘calling’. I don’t want to bore you with this. I will detail this in my next write up; is nursing a calling or profession?
REFERENCE
1. https://en.wikipedia.org/wiki/Nightingale_Pledge
3. www.healio.com/nursing/…/the-international-pledge-for-nurses
4. www.tnaionline.org/news/NursePledge/9.html
5. www.denosa.org.za/DAdmin/upload/news/HUMANE_ETHOS_BROCHURE.pdf
6. www.kznhealth.gov.za/KZNCN/pledge.htm
7. https://nursingghana.com/nurses-pledge-midwives-prayer/
8. www.sanc.co.za/aboutpledge.html
9. www.ajnoffthecharts.com/one-instructors-updated-nightingale-pledge
11. www.adamshealthblog.com.ng/2015/01/nurse-practitioner-untapped-area-of.html
About the Author
OMOLOLA ADAMS is Public Health Strategist & Advocate, Independent Researcher and Health & Hospital Management Professional. He blogs at https://www.adamshealthblog.com.ng
