The public often wonders if nurses must take an oath, similar to traditions in medicine. There is no universally mandated, legally binding oath for all practicing nurses. However, professional ethics and traditions hold a central place in the field, guiding the nurse’s commitment to patient well-being and the integrity of the profession.
Are Oaths Required for Nurses?
No federal or state licensing board mandates the signing or reciting of a specific professional oath for a nurse to receive their license. Licensure requires academic completion, passing the National Council Licensure Examination (NCLEX), and fulfilling good moral character requirements set by the state board of nursing. Some state applications require a statement made under oath regarding the truthfulness of the application, but this is an affidavit of fact, not a professional commitment to ethical standards of care.
Reciting a pledge is generally a ceremonial tradition undertaken by a nursing school, not a legal prerequisite for licensure. This practice is entirely institution-dependent, meaning some schools include it in their graduation rituals while others do not. The voluntary nature of the pledge means its recitation is not legally binding for a nurse to begin or continue professional practice.
The Role of the Nightingale Pledge
The most well-known ceremonial vow is the Nightingale Pledge, created in 1893 by a committee led by Lystra Gretter. Named in honor of Florence Nightingale, this pledge was designed as a modified version of the Hippocratic Oath to provide a formal ethical commitment for new nurses.
The original pledge outlined foundational principles such as practicing the profession faithfully, abstaining from anything deleterious or mischievous, and maintaining the standard of the profession. It also included a commitment to confidentiality, vowing to “hold in confidence all personal matters” coming to the nurse’s knowledge. A 1935 revision expanded the nurse’s scope to include becoming a “missioner of health,” broadening the focus from bedside care to public health and human welfare.
Many nursing schools worldwide adopt this pledge for graduation ceremonies. Some institutions have updated the language to reflect the modern nurse’s independent role, often omitting the original phrase about loyalty to physicians. Despite these revisions, the pledge functions as a statement of ethical principles and a professional guide for dedication to service.
Binding Ethical and Legal Obligations
While ceremonial pledges are optional, nurses are professionally and legally bound by rigorous standards of practice and ethical codes. These mandatory obligations are enforced by state boards of nursing and national organizations like the American Nurses Association (ANA). These entities set the enforceable parameters for competent and ethical patient care.
The ANA’s Code of Ethics for Nurses with Interpretive Statements provides the authoritative framework for ethical practice across all nursing roles. This document is structured around nine provisions that detail the nurse’s duties and commitments, including practicing with compassion and respect for every person’s inherent dignity and worth.
A nurse’s primary commitment is to the patient, requiring them to promote, advocate for, and protect the patient’s rights, health, and safety. The code addresses accountability for practice, responsibility to maintain competence, and the duty to preserve integrity and character.
It also mandates that nurses work to establish and maintain an ethical work environment conducive to quality healthcare. State nurse practice acts often incorporate aspects of the ANA Code of Ethics, making adherence to these principles an enforceable legal requirement of licensure. Violations of these professional standards can lead to disciplinary action, including the suspension or revocation of a nurse’s license.
The Significance of the Pinning Ceremony
The context in which the Nightingale Pledge is often recited is the Pinning Ceremony, a tradition that serves as a symbolic rite of passage for graduating student nurses. This event is typically held separately from the academic commencement ceremony, making it a more intimate occasion focused specifically on the nursing profession.
The tradition of the nursing pin traces its history back to the 12th century, but the modern practice is linked to Florence Nightingale, who awarded a medal of excellence to her brightest graduates. The ceremony marks the transition from the identity of a student nurse to that of a professional nurse, symbolizing the completion of educational requirements and entry into the global community of practitioners.
Nursing Pledges Versus the Hippocratic Oath
Public interest in a nursing oath often stems from the well-known Hippocratic Oath associated with medical doctors. While both historical traditions emphasize ethical practice, the Hippocratic Oath has a longer, more centralized history in medicine, dating back to ancient Greece. However, even the Hippocratic Oath is not legally required and exists in many modern, revised versions.
Nursing pledges, such as the Nightingale Pledge, were created later and are more diverse, with different institutions adopting or modifying them to suit their values. Ultimately, professional conduct for both physicians and nurses is governed not by an oath but by enforceable codes of ethics and standards of practice. Nurses are guided by ethical principles tailored to their profession, reflecting core values such as beneficence, nonmaleficence, and patient autonomy.