Nurses promise to protect your safety, respect your dignity, keep your information private, and act as your advocate when you cannot speak for yourself. These commitments are formalized through ethical codes, legal standards, and licensing requirements that hold nurses accountable at every level of care. While the specific language has evolved since the profession’s earliest days, the core promises have remained remarkably consistent for over a century.
The Original Nursing Pledge
The earliest formal promise in nursing dates to 1893, when the Nightingale Pledge was created as a professional oath for graduating nurses. It reads:
I solemnly pledge myself before God and in the 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 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 endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.
Three promises in this pledge still form the backbone of modern nursing ethics: do no harm, keep patient information confidential, and devote yourself to the welfare of the people in your care. The pledge’s language about loyalty to physicians has been updated in modern codes to reflect a more collaborative, team-based model of healthcare.
The Modern Ethical Code
Today, the American Nurses Association’s Code of Ethics lays out the profession’s core promises in a series of provisions. The first three are the most patient-facing and define what every nurse owes to the people they care for.
- Compassion and respect for dignity. Nurses commit to honoring the inherent worth and unique attributes of every person, regardless of background, condition, or circumstance. This applies to all communication and all aspects of care.
- Primary commitment to the patient. Whether the patient is an individual, a family, or a community, the nurse’s first loyalty belongs to them. Not to the hospital, not to the physician, not to the insurance company.
- Advocacy for rights, health, and safety. Nurses promise to actively promote and protect patients’ rights. This includes respecting autonomy (a patient’s right to make their own decisions based on their own values), practicing beneficence (promoting good outcomes), and upholding non-maleficence (avoiding harm).
Internationally, the framework looks similar. The International Council of Nurses organizes its code around four pillars: the nurse’s relationship to patients, to their own practice, to the profession, and to global health.
Acting as Your Advocate
One of the most meaningful promises a nurse makes is to serve as your advocate, and this plays out in very concrete ways. Research published in Nursing Open found that registered nurses describe patient advocacy through several specific behaviors.
Nurses protect patients from harm, including harm caused by the actions or inactions of other healthcare workers. If a treatment plan doesn’t seem right, or if a colleague’s approach could put you at risk, a nurse is expected to intervene. They also serve as your voice. When critical decisions are being made and you’re unable to participate fully, whether because of sedation, confusion, fear, or simply not knowing what questions to ask, the nurse speaks on your behalf to ensure your needs and concerns are communicated to the rest of the care team.
Advocacy also means going beyond the minimum. Nurses described it as “going out of your way to help patients get or achieve the best care they are supposed to have.” In some cases, nurses reported pooling their own money to help patients cover bills so they could be discharged. And perhaps most importantly, advocacy includes empowering you to speak for yourself through education about your condition, what to expect, and why certain decisions are being recommended.
Keeping Your Information Private
Confidentiality is one of the oldest and most legally enforceable promises in nursing. Under federal privacy law (HIPAA), a nurse cannot use or share your health information except in specific, limited circumstances. These include situations directly related to your treatment, payment, or healthcare operations, and cases involving public safety.
The law also requires a “minimum necessary” standard. Even when sharing your information is permitted, nurses and other providers must limit what they share to only the amount needed for the task at hand. They can’t casually discuss your full medical history with someone who only needs to know your medication list.
Violations carry real consequences. Knowingly obtaining or disclosing your identifiable health information can result in criminal penalties up to $50,000 and a year in prison. If the violation involves false pretenses, penalties climb to $100,000 and five years. If someone misuses your information for personal gain or to cause harm, the maximum reaches $250,000 and ten years.
Ensuring Safe Medication Use
The promise to “not knowingly administer any harmful drug” from the original Nightingale Pledge has evolved into one of the most structured safety systems in healthcare. Every nursing student learns the “five rights” of medication administration: right patient, right drug, right dose, right route, and right time. These aren’t suggestions. They are a systematic checklist that nurses follow with every single medication they give.
This means verifying your identity before giving you anything, confirming the medication matches what was prescribed, checking that the dose and concentration are correct, ensuring the method of delivery (oral, injection, IV) is appropriate, and administering it at the intended time. Errors in any of these areas are among the most common causes of preventable harm in healthcare, which is why the verification process is built into every step.
Making Sure You Understand Your Care
Nurses promise to ensure that you actually understand what’s happening to you. While physicians are responsible for explaining procedures and obtaining formal consent, nurses play a critical role in verifying that you truly comprehend what you’ve agreed to. Research from Padua Hospital found that nurses serve to ensure patient comprehension, address anxiety, facilitate the documentation of consent, and identify the right person to make decisions when a patient cannot.
This goes beyond handing you a clipboard. It means checking that the information was presented in a way that made sense to you, answering follow-up questions, and advocating for a process of shared decision-making that respects your autonomy and self-determination.
Respecting Your Culture and Values
Modern nursing standards include a promise to honor your cultural background, beliefs, and personal values in the care you receive. This means not assuming, but asking. Nurses are expected to inquire about your background, religious practices, cultural traditions, and preferences for family involvement. If you’ve tried herbal remedies or follow cultural health practices, a nurse should ask about those and factor them into your care plan rather than dismissing them.
This commitment extends to co-constructing a treatment plan with you rather than dictating one. Your language, socioeconomic situation, gender identity, age, and physical ability all shape what effective care looks like, and nurses promise to be responsive to those realities rather than applying a one-size-fits-all approach.
The Legal Promise of Competence
Beyond ethics, nurses make a legal promise through their professional license. Each state defines a scope of practice through its nurse practice act, which describes the services a nurse is deemed competent to perform. Practicing outside that scope, or failing to meet the standard of care within it, creates legal liability.
If a patient is harmed, four elements must be established to prove malpractice: that a nurse-patient relationship existed (duty), that the standard of care was not met (breach), that the breach caused the injury (causation), and that actual harm resulted (damages). This legal framework ensures that the promises nurses make are not just aspirational. They are enforceable, with real accountability when they are broken.