The Hippocratic oath revision: A concept whose time has come

The nurses’ Hippocratic oath dates to 1893 when Lystra Gretter and a committee for the Farrand Training School for Nurses in Detroit, Michigan, created the Nightingale Pledge. In 1935, Gretter revised it to include the various domains of nursing, including public health, holding nurses to an oath as key players and missioners of health. This oath (or pledge, as some may call it) is often taken at the end of one's training before beginning practice as an ethical statement for nurses to be committed to preserving the health of humankind and working with physicians to provide patient care. It’s known globally in the nursing profession and is widely used as an organ for professional ethical accountability and code of conduct for nurses. While the needs and safety of patients and working with the physicians are strongly emphasized in the oath, there is no commitment from nurses to their own health and well-being. 

Nurses and midwives—who make up the biggest percentage of the healthcare workforce—face hardship prioritizing their health and well-being. From my perspective in Uganda, as in many low-income countries, the majority of nurses have no health insurance; face professional hazards; and experience job burnout, depression, and stress mainly due to the high burden of the patient-to-healthcare-worker ratio. Furthermore, there are very few counseling and rehabilitation centers to help healthcare workers cope and receive psychological support in the workplace. And where it is available, it’s not used effectively by nurses or midwives. 

As we strive to achieve universal health coverage, prioritizing the well-being of nurses and midwives is key to ensuring that we do not lose the people critical to driving this agenda forward. What if we revised the Nightingale Pledge again, to ensure nurses make it a promise to maintain their well-being as they serve the needs of their population? This would enable nurses' and midwives' health and well-being to become a priority right from the policy level. All employers would treat this as key and develop systems to support this in the workplace. Maybe most importantly, it would be a constant reminder among all nurses to prioritize their health as they serve. 

Various nursing organizations, such as the World Health Organization (WHO), International Council of Nurses (ICN), and International Confederation of Midwives (ICM), governments, and professional and regulatory bodies can work together to create a global dialogue and agenda that can lead to a declaration in this domain. This can have constructs that address aspects of well-being in line with the employer and nurses themselves, as it’s a two-way street. 

A sentence added to the oath like, “I will prioritize my health and well-being as I serve the population” is only fair, since nurses themselves are human beings saving others but yet again need to prioritize their health. Long term, this will create an intrinsic commitment by the nursing health workforce to their well-being and dully supported by the various stakeholders.