Is the Florence Nightingale Pledge in Need of a Makeover?

By Christine Moffa, who was AJN clinical editor at the time it was written in 2010.

Authors and publishers frequently send nursing– and health care–related books to AJN in hopes we will review them. I love it, so keep on sending them. My latest read is Mystery at Marian Manor: The Adventures of Nora Brady, Student Nursea book for young adults. I guess you could call it a Cherry Ames for the new millennium.

At the beginning of the book is the Florence Nightingale Pledge, something I haven’t read since my graduation in 1995. I have to say it made me cringe. It’s almost as bad as when I visit my parents and see the nursing school graduation photo of me in that silly nursing cap I wore under protest. (If the men didn’t have to wear it, why did I?) If you’ve forgotten the pledge, here goes:

I solemnly pledge myself before God and 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 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.

While it’s hard to disagree with some elements of the pledge, certain parts prompted me to Google the phrase “Florence Nightingale pledge out of date.” I’m pleased to report that I am not alone in wondering about this. Donna Cardillo at NursePower! had a similar reaction this past December

[editor’s note: the blog post quoted below is no longer found at the url, so we cut it]:

I recently came across the Florence Nightingale pledge, the one I took 35 years ago when I graduated from a hospital-based diploma nursing program. When reading it on the eve of the year 2010, it occurs to me that it needs to be updated to better reflect where nursing practice is today.

Here’s my updated version: “I solemnly pledge myself before God and in the presence of this assembly, to live my life with integrity and to practice my profession faithfully. With dedication will I endeavor to uphold the ethical, scientific, and legal standards of my profession, and devote myself to the welfare of those committed to my care.”

In the spirit of evidence-based practice—questioning why we do things just because they’ve always been done that way—I wonder if it’s time for an overhaul of  the pledge. How would you revise it?

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2016-11-21T13:19:41+00:00 February 2nd, 2010|career, nursing history, nursing perspective, students|28 Comments

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  1. dayspringacres September 22, 2014 at 5:21 pm

    Reblogged this on Adventures in Learning New Skills and commented:
    I am in my last semester of my RN to BSN program, and have to research the Nightingale pledge and its relevance (or lack thereof) to modern times. As a family historian, I would argue to leave the pledge as it stands, understanding that it spoke of the times in which it was written, by pen in 1893. I also argue that it could use a little tweaking since the nurse of today operates as a member of a team in conjunction with physical therapy, pharmacy, the physician and even with the patient himself. Now, I must get to my paper and write something coherent for my instructor. This post, although written quite a few years earlier, was very timely for me.

  2. Tracey August 31, 2012 at 2:34 am

    If you don’t like it author a new pledge. This was Florence’s and cannot be changed.

  3. jm December 21, 2011 at 12:13 pm

    Thanks for reiterating that point. The original post doesn’t actually suggest that it was written by Nightingale. Seems more likely that her name was appended to it since she to some degree “symbolized” nursing and certain notions of single-minded devotion at a certain point.

  4. Jay Bulyah December 21, 2011 at 12:05 pm

    Please realize that this pledge was NOT written by Florence Nightengale. It was written in honor of her, well after her passing! The post by Liz Hickman/June 24, 2011 is correct.

  5. phyllis November 19, 2011 at 7:34 am

    If the pledge was updated , then it wouldn’t be the “Nightengale Pledge” would it?…It would be the “?????? Pledge”.

  6. rothlyn zahourek, phd, pmhcns-bc, ahn-bc November 6, 2011 at 2:20 pm

    I like this much better than the original – the original was appropriate for its time — but the times they have a changin!

  7. jm November 2, 2011 at 5:47 pm

    Great comments…and some new ways of looking at this as well. Maybe in having to determine what pledge really means something to you, you learn more about what nursing really is, or should be…some would say that idealism is misplaced, but it seems crucial to start with some kind of ideal, despite the complexity of real world situations.

  8. Alexander November 2, 2011 at 5:19 pm

    I think this pledge nicely sums up the spirit of the original, while making allowances for how the role of nurses has changed:

    With full knowledge of the responsibilities I am undertaking, I pledge to care for my patients with all of the knowledge, skills, and understanding that I possess, without regard to race, color, creed, politics, or social status.

    I will spare no effort to conserve meaningful life, to alleviate
    suffering, and to promote health.

    I will refrain from any action which might be harmful to the quality of life or health of those I care for.

    I will respect, at all times, the dignity and religious beliefs of patients under my care, and hold in professional confidence all the personal information entrusted to me.

    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.

  9. wendy gronbeck November 2, 2011 at 5:12 pm

    Florence Nightengale was the epitome of a visionary and agent of change. She would likely be horrified that nurses have not updated the pledge. It is no more appropriate today than the dress, racism, sexism, and medical treatments of her day would be. It can be greatly valued, but as a piece of history. Nurses should no more pledge their loyalty to physicians (even before their patients!) than physicians should pledge their loyalty to nurses. We both serve the patient, not one another, except as respectful colleagues and friends. I like the addition of scientific based practice (what better way to honor the woman who was so far ahead of her time?) and agree that a religious reference is not appropriate here because nurses are so diverse.

  10. Joyce August 29, 2011 at 1:04 am

    I graduated from a diploma based nursing school 50 years ago, St.M.M.H., class of 1961. When I first said the Florence Nightingale Pledge, chills went down my spine. It said everything that I felt at the time, and still do to this very day. I continue to work in the profession that I love with all of my heart and soul, although only two days a week now. I will be 71 years old in November, and have seen just about everything, good and bad, in the 50 years since graduation.
    Don’t change a word of the pledge. There is nothing harmful in those words. Remember, patients first and foremost. Do no harm. Live a life of service to others. Keep the pledge as is.

  11. […] Is the Florence Nightingale Pledge in Need of a Makeover? By former AJN clinical editor Christine Moffa, this post asked whether the ’Nightingale […]

  12. Liz Hickman June 24, 2011 at 8:19 am

    As a nursing student, I researched the Florence Nightingale Pledge. Before researching it, like many of you, I had assumed it was written by Florence Nightingale. However, it was authored by Lystra Eggert Gretter (1858 – 1951), a nurse and nurse educator whose accomplishments were extraordinary, in my opinion. Perhaps if you researched Mrs. Gretter and the pledge and understood all she has done for nursing, you would not change the pledge at all. Mrs. Gretter named the pledge in honor of Florence Nightingale and all she did for nursing. In honor of Mrs. Eggert and all she has done for nursing, we should not change it or update it. Each nursing school is free to create its own separate pledge to add to the history of nursing for future nursing students and graduates, if it so chooses. So, I say leave Mrs. Eggert’s pledge to stand on its own as a symbol of the history of nursing and a reminder of how far we have come and have yet to go.

  13. A.N. May 5, 2011 at 3:25 pm

    Blind followers of tradition: They are not Florence’s words! Nothing irks me more than people to cling to a tradition based on false assumptions.

    That aside, why should I be required to pledge something I do not believe in? As my mother used to say, “If all of your friends jumped off a bridge, would you do it, too?”

  14. kathleen dowis May 5, 2011 at 11:45 am

    Leave the pledge stand. Non-god believers, just don’t say the word “God”, simple. Why is it that todays society must always attempt to erase the past instead of learn from it? Forget the “politically correct” mindset, its caused more trouble than its worth. Would you change the pledge of allegiance and the articles of independence to make them “modern”? Of course not. Honor Florence for the visionary she was and see her words as they were meant. Its really quite simple. Basics. Good care, no harm, help and live decent. Who can argue with that?

  15. […] Is the Florence Nightingale Pledge in Need of a Makeover? « Off the Charts […]

  16. Amanda March 1, 2010 at 4:38 pm

    I think that the pledge could use updating. What strikes me as out of touch is the fact that we are Patient Advocates. That means standing up for that patient when things happen. Some of the time that means stading up to the physician as well. In looking at the different generations, in the beginning we were there to do the physician’s bidding. Now we are a profession that has critical thinking skills and such that allow us to be a true advocate. Just a thought.

  17. rorry zahourek. PhD, PMHCNS-BC, AHN-BC February 22, 2010 at 11:31 am

    I graduated from Skidmore College nursing program in 1965. Our director at the time was Agnes Gelinas who had been very active in the early days of the NLN. Our class decided the Florence Nightingale pledge really went against all we were learning. We wrote our own which I cannot now find. We took out purity and God and above all aiding the physician which we felt was against what we had learned that nurses had many independent functions and worked as part of an inter-disciplinary team not just in support of the physician. We called it the Agnes Gelinas Pledge for nursing. We were her final class.
    I did and still do value Florence Nightingale as a visionary and genius. That does not mean that we have to accept a pledge she wrote for a time that was very different from now and for a highly structured Victorian Society.

  18. rita wetzler February 17, 2010 at 9:47 pm

    Do not change it. It was written long ago, and the core values should still be in effect today.AMEN to the pledge.

  19. Leah February 17, 2010 at 1:05 am

    I completely agree about removing the “god” reference. I am a life-long atheist AND a very dedicated & committed professional nurse. God has nothing to do with “nursing” or the level of commitment or professionalism a nurse may/may not have. Any pledge should be equally applicable to all in the profession, regardless of beliefs, race, ethnicity etc. Having said all of this…do we not have our Code of Ethics?

    Also, as a professional nurse, it is not within my professional role or Scope of Practice to “assist” the physician. We’ve spend SO many years trying to get others NOT to view us in this way. My role is to collaborate with all other members of the health care team to provide the best, most comprehensive care possible to our patients/resident/clients. We all have to “assist” one another – let’s not single out one profession as needing “assistance”!

  20. Tracy L. Hawkins, MSN February 17, 2010 at 12:08 am

    I don’t think the pledge should be changed. Nursing is what it is beacause of Florence Nightingale. She was a visionary beyond her time. In fact, if you read her “Notes on Nursing”, you will find many of her ideas and suggestions are pertinent to nursing today. I think we spend too much time focusing on the political correctness of too many things. We should continue to honor her contributions to our profession by reciting the pledge the way it was written.

  21. Arlene Handler February 16, 2010 at 8:42 pm

    I think that the Nightingale pledge is still current. In fact, it even alludes to HIPPA! We should not harm, as it says in the physician’s pledge. We should not take drugs nor give incorrect medications. Although we like to think (and sometimes do) know “better” than the physician, we are still nurses who have to work together for the good of the patient!

  22. Lynn Baker February 16, 2010 at 3:19 pm

    I took this pledge 33 years ago and I would not change a thing. Florence Nightingale was a visionary. I think we should plegde to abstain from activities that could potentially cloud our judgement and cause harm to our patients. I also think we should do all that we can to maintain and elevate the standard of our profession. There is nothing old fashioned about aiding the physician, or a nurse practioner, or any other health care provider with whom we may work side by side.
    What is unfortunate, is that we no longer have time to practice real bedside nursing. My class of 1977 had a lesson in how to give back rubs. I am sure that is not even discussed these days. Budget cuts and profit margins have created staffing shortages, making it difficult for today’s nurse to spend time with patients and families.
    A lot of things have changed in nursing. I have learned more about technology than I ever dreamed I would. However, the practice of nursing people back to health still has its roots embedded in the pledge of Florence Nightingale. This pledge is in my office and I show it to every nursing student that I work with. It holds great meaning to me and makes me very proud that I chose this as my profession. It is a calling and we must all be dedicated to it.

  23. Elise Paquette February 16, 2010 at 12:55 pm

    I like Donna Cardillo’s effort at the rewrite. I think it encompasses the same values with modern language and is appropriate to the many different roles of nurses in this day and age.

  24. Tammy Casper February 10, 2010 at 11:52 am

    Yes, it is true that The Pledge is outdated but reflects the time frame of her life. I believe that as nurses, we all strive to provide nurturing nursing care to our patients in a manner that is respectful using evidence based care. It would be interesting for a nursing leader to create an “updated pledge” for this time frame and compare the content and wisdom for upcoming nurses to follow!

  25. Barbie RN, CCRN February 10, 2010 at 12:42 am

    It is impossible to rewrite the pledge. Florence Nightingale is dead. She lived far past the life expectancy of a woman during this era, probably because of her bold immune system from disease exposure. Stop trying to change history! It’s equivalent to trying to change the Declaration of Independence!

  26. Alicia Vignets-Cruz February 7, 2010 at 4:37 pm

    I do agree that the pledge is very outdated, but probably appropriate for those times. It definitely could use some updating, but it was very interesting to read and learn what the focus was on back then.

    Alicia Vignets-Cruz

  27. Mary February 5, 2010 at 4:11 pm

    I take offense to be required to pledge myself to God – what about the Atheists and Agnostics? If you don’t think they exist in nursing and medicine you are wrong. We did not recite this pledge at our pinning ceremony because we thought it outdated.

  28. jm February 2, 2010 at 7:12 pm

    Editor’s note: Here are some comments lifted from our Facebook page, where we posted a link to this post and got lots of comments (though sadly, none here yet, despite how many people our stats page show actually read the post!):

    –I would not change it. Sure some things have changed and evolved but striving toward purity of heart and being is not a bad thing!! It is like the Wesleyan pledge of going on toward perfection. When people question that, they are asked “what would you prefer to go on towards – imperfection?!”

    –I have wrestled with that purity statement for 40 years. It seemed sexist in the 70s and still seems to reflect a sexist attitude about women today. My class of 1972 declined to recite the pledge because of that “purity” statement.

    –I don’t think either author made a case for changing the pledge. Nothing wrong with the new pledge,I guess, but what in the old pledge is harmful?

    –Didn’t see Karen’s comment when I made mine, but I don’t interpret “purity” as having simply a sexual meaning. (When I look in my dictionary at “pure”, a sexual meaning is number six, almost at the end.

    –I like the pledge the way it was originally written. I disagree that it is sexist, although I can see how some would politicize the pledge and attempt to make it sexist. Purity does not only relate to sex. Purity in nursing can relate to honesty, integrity, withholding judgement when providing care, and becoming/practicing as a nurse for the right reasons.We could all learn a lot from Florence.

    –i don’t know how it could be sexist, taken in context of the time it was written, and who wrote it, geezz people, not EVERYTHING is sexist or racial or political

    –I don’t think that it needs to be redone, but it does not seem to describe the nurse of today. So much has changed in the role of the nurse and I think that it would be nice to see a pledge that reflects this.

    –How does it not describe the nurse of today?

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