'I solemnly pledge myself before God and the presence of this assembly to pass my life in purity and to practice my profession faithfully …"

So begins the Florence Nightingale pledge, once spoken by nursing students across the country and still recited in some nursing school ceremonies today.

Last summer, a group of students at the California State University, Los Angeles Department of Nursing decided that the pledge, which is stitched on samplers and printed on nursing Web sites, could use some serious updating.

"What is purity?" asked Besty Blankfield, RN, who wrote the first draft of the students' new pledge, recited at a special pinning ceremony after graduation in the spring. "What does that mean in the year 2001? We could talk about that all day."

Blankfield and her fellow students are not the only ones grappling with the challenge to honor nursing's tradition while shedding harmful stereotypes. Many nursing schools around the country have either dropped or altered the pledge that has nursing students promising to "abstain from whatever is deleterious and mischievous" and to "aid the physician in his work."

At the same time, nursing students and faculty are expressing renewed interest in nursing history and in ceremonies such as lamp lighting, pinning and even capping-rituals that once solemnly marked a student's entry into the profession, said Geri Rosato, MS, RN. Rosato was president, founder and curator of the American Museum of Nursing in Glendale, Ariz., which she recently closed.

Actually, the Nightingale pledge has nothing to do with Nightingale herself. A committee headed by Lystra Gretter at the Farrand Training School for Nurses in Detroit (which eventually became the Harper School of Nursing) composed it in 1893, Rosato said.

According to Blankfield's research, the pledge was modeled on the Hippocratic oath. Blankfield also found mention of other schools changing the pledge. No one in her class objected to rewriting it.

"As a class, we were not happy with the Nightingale pledge," recalled fellow student Robert Valdez, who works at Los Angeles County Hospital. "It sort of connotes the Victorian era. It didn't constitute the area of nursing that we are in today and how it's constantly evolving."

Although Blankfield insists that the entire class wrote the pledge, her fellow students give her most of the credit. The new pledge is nearly twice as long as the original.

Because students came from different religious beliefs, it addresses a "God of all faiths," Blankfield said. Instead of faithfully aiding a male physician, students promise to work with other health care providers "in an atmosphere of mutual respect and consideration."

Purity is out. Serving as role models and working for social justice are in. "We've grown as a profession and we needed to say that," Blankfield said.

CSU Los Angeles students had used the original pledge in their pinning ceremonies at least since 1990, said Evelyn Calvillo, DNSc, RN, a professor at the CSU Los Angeles Department of Nursing.

Faculty members, though, had no objection to the changes proposed by Blankfield's class because the pinning ceremony is separate from the school's graduation and is planned and funded by the students, she said.

A lot of schools have stopped using the Nightingale pledge "because of the dated language," said Rebecca Rice, Ed.D., MPH, RN, deputy director of Colleagues in Caring, a national nursing education and workforce initiative, and a former nursing school dean. "Even when we said it in the mid-'60s, we had our fingers crossed behind our backs" for the purity part.

Other nursing schools reported variations of the pledge in their graduation, convocation and pinning ceremonies.

The University of Arizona College of Nursing in Tucson doesn't use any pledge, probably because there's no time for one, Pamela Reed, Ph.D., RN, FAAN, associate dean for academic affairs at the University of Arizona College of Nursing said. But if there were time, she isn't sure she'd want the original Nightingale pledge.

"It's not exactly appropriate for nursing in the 21st century," Reed said.

Rice said students she taught in Norfolk, Va., used a pledge taken from the Nursing Code of Ethics. Students at the University of Nebraska College of Nursing take the International Pledge for Nurses, based on the Nursing Code of Ethics, said Catherine Todero, Ph.D., RN, associate dean for the Omaha-based college of nursing.

"We felt the need to have a pledge and I remember thinking about the Florence Nightingale one, but I don't think I found it," Todero said. "It's a little old-fashioned."

About three years ago, faculty at the Arizona State University School of Nursing decided to hold a lamp-lighting ceremony for students who had completed two years of pre-nursing studies and were about to enter the second half of the program, Barbara Fargotstein, MN, RN, clinical associate professor at the school, said.

They wanted to honor tradition with the Nightingale pledge, but like the students at CSU Los Angeles, they were uncomfortable with some of the language. So they took out phrases they felt no longer applied to nursing, reducing it from nine lines to four.

"We felt that the idea was based solidly in our history," Fargotstein said, "but it could take us into the next century."

The Nightingale pledge traditionally was recited by students at diploma schools who passed probation, Rosato said.

The students received their nursing caps and the celebration was called a capping ceremony. Students at those schools in the early to mid-1900s often lived together and bonded, Rosato said, and their rituals reflected that connection.

"It became so symbolic," said Todero, who recalled some of the rituals. "There was a kind of thing where some people even knelt down and got a cap on their head."

As nursing schools became more academic and shifted to universities, those rituals disappeared, Rice said. Instead of uniforms, students wore academic regalia. Most schools still hand out pins at graduation, she said, but it's a small part of the ceremony.

Although some of the rituals now seem outdated, they had a purpose, Fargotstein said. They make the point that nursing is more than just a job, she said. "They prepare the families by letting them know that their loved ones are going to be doing something meaningful."

Rosato said many nursing students who visited her museum asked about candle-lighting ceremonies or where they could get a traditional nurse's cap for their photos. "What's old to us is new to them," she said.

She's glad to see their interest in tradition, but she also applauded the CSU Los Angeles students for updating the Nightingale pledge.

"We constantly evolve in health care," Rosato said. "Change is our way of life. We have the original pledge, which has historic value, but maybe it's more important to use the pledge rather than to hang it in a museum."