What virtues should shape nurse practitioner (NP) practice?

It is a question I have wrestled with for years. I suspect that NPs will answer it differently depending on their experiences, backgrounds, cultures, and moral commitments. Some may disagree with parts of the answer I eventually reached. That is okay. My purpose is not to provide a final oath for all NPs but to invite reflection on what kind of health care professionals we aspire to become.

My journey into nursing was quite personal.

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When my friend and I were nine years old, he died of relapsed lymphoma. He spoke of the compassion that nurses, physicians, and other health care professionals demonstrated as they cared for him. After he died, I realized that I wanted to honor God and my friend by identifying with one of the most trusted healing and caring professions—nursing. During my graduation ceremony, I swore to uphold the Nightingale Pledge. This solidified my identity as a nurse.

Years later, after practicing pediatric critical care as both a nurse and NP, I found myself returning to a question: What moral vision should guide my NP practice?

Physicians have long looked to the Hippocratic Oath. Nurses have the Nightingale Pledge. But NPs occupy a unique space. We remain grounded in nursing while also diagnosing, treating, prescribing, counseling, and promoting health. As I reflected on these responsibilities, I began to wonder whether there were virtues that deserved to be articulated from the perspective of NP practice itself.

At the same time, I recognized that our role is different than the professions that first developed many of the traditional health care oaths. NPs come from different backgrounds, traditions, faiths, and viewpoints. For that reason, I do not expect every NP to agree with every element of the vision I ultimately developed. Nevertheless, I believe the question remains worth asking.

My search for an answer led me to explore the history of nursing, the origins of the NP role, and the place of professional oaths in health care.

Brief History of Nursing and Nurse Practitioners

My journey started with reviewing the history of nursing. I learned that nursing emerged from caring for others in homes and communities before developing into a science and profession. Throughout this history, nurses cared for others through relationships, service, and concern for vulnerable persons.

I learned that Florence Nightingale and Isabel Robb helped shape nursing into a profession defined not merely by technical skill but also by character. Trustworthiness, confidentiality, and devotion to patient welfare became central and reflected the ideal nurse seen in the Nightingale Pledge.

Much later, in 1965, pediatric nurse Loretta Ford and pediatrician Henry Silver developed the NP role to expand access to care while preserving nursing’s holistic orientation. NPs inherited responsibilities from both nursing and medicine, yet our role never developed a unifying oath that explicitly connected our nursing roots with our expanded clinical responsibilities.

Articulating the Virtues that Shape NP Practice

As I continued reading, I became increasingly interested in the role of professional oaths.

Codes of ethics are essential. They provide guidance for professional conduct and accountability. But an oath serves a different purpose. An oath expresses the kind of professional a person aspires to become.

That distinction resonated with me. Beyond following professional rules, I wanted to articulate the virtues that I believed should shape my own NP practice. I wanted to remain firmly grounded in nursing while acknowledging the responsibilities that come with diagnosing illness, prescribing treatment, coordinating care, promoting health, and exercising clinical judgment.

My study led me to the idea of an internal morality of NP practice—by which I mean moral commitments that arise from the practice of being an NP itself. While others may identify different commitments, I found myself drawn to ideals such as healing, helping, service to the patient’s good, prevention of harm, respect for dignity, truthfulness, humility, shared decision-making, and mentorship.

A Nurse Practitioner’s Oath

The following significant portion of my proposed Nurse Practitioner’s Oath, published in the journal Ethics & Medicine, represents my attempt to express those commitments. In our increasingly technology- and efficiency-driven health care system, NPs must not lose sight of the healing and caring relationship at the center of care.

An oath reminds us that our NP role is ultimately about service to vulnerable human beings. I offer it not as the final word on NP identity, but as one NP’s effort to answer the question: What virtues should shape NP practice?

“I solemnly swear to God, my patients, and to the internal morality of nurse practitioner practice that I will aim only to heal and to help, not to harm, and when healing is not possible only to help. Out of respect for dignity, I will promote the health of patients in alignment with the natural functions of the human body and will not intend to end life with my practice…With this end, I will maintain trust with patients and other healthcare professionals and maintain veracity in our helping and healing relationship out of service to the patient’s good. I will educate my patients on their disease processes and provide education on how they can continue to live well to the best of their abilities. I will not take any drugs or therapeutics that affect the care of patients and will not prescribe nor administer treatments that will have no assistance to my patients. I will not take advantage of my patients physically, mentally, or monetarily but rather will intend to benefit the sick. I will not participate in practices for which I do not have expertise but rather utilize the expertise of those qualified. I will further my profession and seek to nurture and mentor those young in the profession. If I cannot or will not maintain this oath, then I will leave this noble practice to those who will uphold these aims intrinsic to the internal morality of nurse practitioner practice.”

Readers’ perspectives on this proposed pledge for NPs are welcome.

By Jesse Michael Kay, assistant professor of pediatrics, Division of Critical Care Medicine, at Baylor College of Medicine & intensive care nurse practitioner & group ethics consultant at Texas Children’s Hospital