One Instructor’s Updated Nightingale Pledge

Editor’s note: This post by Lorita Renfro, BSN, RN, proposes an updated version of the Nightingale Pledge. The author is a clinical nursing instructor in the ADN/VN programs at Kaplan College in San Diego and is currently working toward an MSN with an educational focus. Let Lorita know what you think. Would your version differ in any way?

Florence Nightingale in Crimean War, from Wikipedia Commons

As the science of nursing evolves, one aspect of nursing remains the same: the art. We see it when we are inspired to do the best for our patients, develop higher standards, and provide care from our hearts. This inspiration is the basis of all good nursing practice.

The science of nursing is seen in the interventions that provide comfort and protect our patients from harm. In the past, this protection often meant cleaning floors and carrying bed pans. My father believed until the day he died that what I did was to “help the doctors” heal the patients.

This may still be true at times, but the science of nursing is now also represented by innovation, intuition, strength, and the responsibility of being a team member who collaborates in the delivery of care. Nursing processes have been worked and reworked to harness our independent, evidence-based contributions to patients’ healing and their adjustment to illness as well as the alleviation of their pain and suffering.

When our students have completed rigorous programs of study, we welcome them to the profession. We celebrate with the lighting of the lamp and the recitation of the Nightingale Pledge. I love the lighting of the lamps; candles evoke inspiration whenever they are lit. But the inspiration felt by new nurses on the day of graduation could be more appropriately expressed with an updated Nightingale Pledge that better represents the evolution of nursing. 

Tradition helps to inspire, but it can also hold us back. Today’s students are different in so many ways from the student who represented nursing in 1893 when the first Nightingale Pledge was written. With many second-career and second-degree students who are older, and greater numbers of men in nursing, we need to recognize that the identity of nursing has changed. Old stereotypes are finally falling as nursing is increasingly respected as an equal profession.

If our bottom line is to inspire, we are not going to be able to do it for today’s students with the words of the 1893 pledge. 

To me, the following more modern Nightingale Pledge both honors the original pledge and gives substance to a vision that represents the present, and future, of nursing. 

A Modern Nightingale Pledge

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 today.

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Rachel November 21, 2014 at 10:30 am

    Lorita, I absolutely LOVE this!!! I was one of Lorita’s clinical students years ago (she still remembers me as the student who came up with “logs floating on rapids” as a way to remember that Humalog and Novolog are rapid-acting insulins), and this inspiring representation of modern nursing reminds me so much of how she taught. She truly is one who practices what she preaches!
    Miss you, Lorita!
    – Rachel

  2. dayspringacres September 22, 2014 at 5:32 pm

    Reblogged this on Adventures in Learning New Skills and commented:
    I found the post written a few years ago questioning whether the Nightingale pledge should be revised. And, lo and behold! here it is. I really like this version, it is better than any I could come up with myself.

  3. Lorita Renfro August 30, 2012 at 5:55 pm

    Thanks so much, Rosemarie. I didn’t even consider that mentioning God would evoke such a debate. I was hoping that the nursing issues that I mention in the pledge would become the topic, as nursing has changed so much in the over one hundred years since the original pledge was written. I was trying to re-focus the emphasis of nursing, but instead, the God issue got stuck. L

  4. Rosemarie Arredondo Kidd August 15, 2012 at 7:57 pm


    Your post is inspiring and thought provoking to me. I can see from the other posts that your pledge has also been quite moving to others. I like your pledge, jsut the way it is. I commend you on your faith, keep the faith!

    I am a new Doctoral student, going for my DHA(Doctorate in Health Administration), the blog post has been inspriring to me in my journey, I will be keeping a copy of it in my doctoral journal to look back on it. Keep up the good work.


  5. Brent Thompson PhD RN August 14, 2012 at 11:57 am

    It perplexes me how many people need to believe there is a need for a reason for events despite all evidence that there is no reason. The randomness and chaos of life means that is all the more important that we love and take care of each other as much as we can. Ethics and morality have been around longer than any of the popular religions so it does not even provide that rationale for belief. Concepts like souls, afterlife, and heaven are understandable since thinking about our own mortality is rough. But I found that when I let those things go I got more pleasure from life and more energy to do good.

    I have worked many years in pediatric oncology. Seeing children die and prayers not answered only confirmed my observation that bad stuff happens and that it does not have to be for any reason. Belief in a deity seems only to make such situations worse in my experience. Thinking that some deity has decided my child should die seems more cruel than the more likely reality that our biology has flaws. In fact, not believing makes my work as a nurse easier as the idea I was working against a god’s plan would be frustrating.

    I think a lot more people think like me but are afraid to say it out loud (as illustrated in one of the comments in this thread). The cultural and social pressures to believe in “higher powers” are intense. The fear of ostracization is so strong I know many atheists who are afraid to say it out loud. I decided that if we are free to believe in any deity we choose then I choose not to believe in any of them. I can say there is no god out loud as many times as want without fear of being struck down. Scaring me with boogeyman stories of eternal torment doesn’t work either. I have no respect for a god that issues eternal punishment for a finite thought crime.

    Many theists have decided that nontheists must be angry at god, but I speak to a lot of nontheists and not found that to be true. I can’t be angry at your god any more than a theist is angry at leprechauns. I have also found that many theists feel that just questioning the existence of their god is attack. Nontheists are not attacking you they are just asking for evidence, just as most of us do for any expressed idea. If you tell me there is a monster in the closet, but you have no evidence of the monster, is it an personal attack if I don’t believe you?

    As for our school, we have done the pledge but left out the god part. We don’t do it every year as we leave much of the planning to the students. If students want prayers or clergy we ask them to organize that outside the official graduation event.

    As I have said before I like your pledge because it incorporates all the values of nursing I believe are important for our profession. I would just leave out the phrase “before my God and in the presence of this assembly” since that only applies to one subset of theists in the class. I get the feeling, Lorita, that it pains you to leave it out but please be assured that it is more inclusive to leave it out, and I promise you will not be struck down…well, most likely not be struck down 🙂 .

  6. Lorita Renfro August 13, 2012 at 11:30 pm

    Hi Brent. I am enthralled by your perspective. I have to also say that I am perplexed by it too. I don’t think of any religion as important in my life, but I don’t think I would feel complete if I didn’t have some faith that there is some control over the chaos and randomness of the world, including my own destiny. I am wondering, after reading your last post…does you school use any pledge for its graduates? Lorita

  7. Brent Thompson August 6, 2012 at 1:14 pm

    There is common ground on Lorita’s proposed pledge with theists, agnostics, and atheists. All nurses can agree on the values it espouses. The only difference is in perceived need to evoke a god in such a pledge. Obviously some are for it, against it, or just don’t care.

    As a nursing instructor who has attended many graduation ceremonies let me add another rationale for leaving out references to higher powers:
    I teach a taxpayer-suppported school. My graduates are monotheists, polytheists, agnostics, and atheists. Pledges are usually led by faculty or administrators. In my case those are taxpayer-funded employees who have to abide by First Amendment separations as confirmed by numerous court cases.

    Lorita’s pledge may be appropriate at a religiously-based nursing school but not at a publicly-funded school.

    The First Amendment says “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech”. My call for neutrality at a publicly-funded school is not a suppression of your beliefs over mine but rather a respect for the Constitutional call not to establish a government-endorsed religion.

  8. jm August 6, 2012 at 11:31 am

    There are strong feelings all round of late on this topic. We appreciate the relative civility and respect for other perspectives people have shown in their comments.

    I’m aware that many atheists have become newly emboldened to attack religious beliefs as a kind of root of all evil in our culture. Some do it with a more open mind than others. Some do it without any real knowledge of the beliefs, practices, and related value systems that they are attacking.

    And I’ve also seen a lot of defensiveness from those who do believe, or who merely acknowledge the possibility of belief, and who feel that some people are going out of their way to attack their beliefs for no good reason. But there have also been some really meaningful exchanges taking place in some quarters that explore the ways religion has done harm and also been a force for great good at other times.

    So thanks for weighing in, and as always let’s stick to the ideas in our comments, rather than making assumptions about each other. In that we show what’s best in being human, whatever its origins may be.

    Jacob Molyneux, blog editor

  9. Dj August 6, 2012 at 11:17 am

    I believe it is appropriate to mention God in the Nightingale Pledge. If you are atheist, then deal with it, let it go (if you can) and move on to the bigger picture. The majority of people believe in some sort of Higher Power than themselves… The Great Mystery, if you will. If you are angry at the notion of God, that is another issue altogether… and I suggest you find a way to take care of your resentments. I am sure you would be much happier and healthier if it weren’t such a thorn in your side!

  10. Brent Thompson August 5, 2012 at 3:38 pm

    If you’re having trouble understanding how to live without a higher power there are several books that may help: Letter to a Christian Nation by Sam Harris, The God Delusion by Richard Dawkins, and God is Not Great by Christopher Hitchens. I suggest reading them in that order if you are theist.

  11. Lorita Renfro August 3, 2012 at 8:20 pm

    Hi Brent. I especially liked your bald comment – that says it all. I can see your point, and you have made me more aware of the almost “insult” it is to an atheist to invoke God. I guess I don’t completely understand not having a higher power to turn to, but hooray for you if you don’t. And thanks for widening my vision. Lorita

  12. Karen Kearsley August 2, 2012 at 12:15 pm

    I wrote my own version several years ago as part of an article. I had to look back to see if I did or did not include God in the pledge. As it turns out I did. Besides that, I put the research and evidenced based first and end with strengthening each other with support and sharing knowledge. My full article can be found here:

    Before God and in the presence of this assembly we promise:

    To practice the art and science of nursing, toward increasing patients’ physical and emotional health, based on evidence and current nursing research.

    To acknowledge the privilege to hold their lives in our care, and practice nursing, in partnership with our patients.

    To acknowledge the privilege to comfort our dying patients, into death, with dignity.

    To hold those entrusted to our care with respect, affirm their innate worth and hold their privacies in confidence.

    To advocate for the health and needs of our patients, respecting their cultural and religious beliefs.

    To act as leaders in promoting health throughout our communities.

    To hold in esteem nursing educators, researchers, scholars and experts who have guided our path, and are welcoming us into the profession.

    To help strengthen fellow nurses and advance the aims of our nursing profession.

    To share our knowledge with, encourage, and welcome future nurses.

    Karen Kearsley
    Student Nurse Advocate

  13. Brent Thompson August 1, 2012 at 10:43 pm

    I am sorry but adding a god or higher power does nothing for me. There is no need to endorse supernatural beliefs in a pledge to ensure performance at a high ethical and moral level.

    There are many atheist nurses. It is not a religion any more than being bald is another hair color.

    Since we atheists don’t see any need to fear a god in order to act ethically there is no need for nurses to make pledges to any such gods.

    Nurses have beliefs in many different (and often conflicting) gods, saviors, and prophets, as well as no beliefs in any of these. Therefore it is more exclusionary to invoke any god in such a pledge.

    In fact, Lorita, you are an atheist too. I bet you don’t believe in all the other gods. I just don’t believe in one more than you. Let’s leave gods out of the earthly art and science of nursing.

  14. Maria August 1, 2012 at 9:15 am

    Lorita, I really like your pledge. God has nothing to do with religion; one can belive in God or in a “Higher Power” (however they want to say it) without being a member of some church or religion. Thanks for sharing Lorita.

  15. jm July 31, 2012 at 4:52 pm

    Nicely said, Lorita!-Jacob

  16. Lorita Renfro July 31, 2012 at 4:48 pm

    Yes, Anonymous, I do believe that any religion should be reflected in the pledge, whether it be belief in a deity, or the choice to believe that everything happens by chance and natural selection (to me, that is still a “religion”, just as the ancient Egyptians believed in a religion of the stars). That is why I changed it to “my God”, to allow for other beliefs. I tried to keep the seriousness of spirit of the pledge intact, and for, I think, most people, that is invoked with the mention of a spiritual deity, (“my God”). Thanks so much for your thought-provoking comment. Lorita

  17. jm July 31, 2012 at 2:30 pm

    We appreciate you sharing your thoughts on this. There are no doubt many perspectives on this aspect of the pledge, and it would be a terrible shame if anyone held it against you that you didn’t want to invoke their particular god, God, or gods.

  18. ~Afraid to sign my name because I love my career and have felt the judgement of "religious" co-workers before~ July 31, 2012 at 2:17 pm

    I’m liking this pledge! Thank you for a thoughtful article.

    One question though, when can we get the “God” out of the pledge? I understand belief has plenty to do with some nurses perception of their own source of compassion, and I can respect that. But please let’s not pretend belief is, or should be, the credit of any atheist’s compassion. We all really can be loving and caring people because we chose to be, which can as easily as not be a choice made far from any belief in a deity. I am proud to be a sharing, productive and skilled nurse, praised for my enthusiastic and compassionate care.

    Pray and praise, but please don’t imply that every new nurse must surely be on your path.

    ~ Anonymous, because I still love my career and have felt the judgement of too many “religious” co-workers before~

Comments are moderated before approval, but always welcome.

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