When everybody knows your name
This is something that I wrotte for a class while I was in Nursing School. I came across it again and decided to post it and see what the reaction would be. Fire away, all responses or opionons will be welcomed, none will be taken personally.
American culture has become less and less formal in recent years. In most businesses employees are on a first name basis with everyone else, right up to the CEO. Business casual is the new dress code in many places, and in some sectors blue jeans and t-shirts are the norm. The President of the United States has revised White House dress codes, no longer requiring suit jackets be worn at all times. Polo shirts and khakis can even be found on tellers and loan officers in many banks, which have traditionally been the most staid and sober of institutions. In hospitals nurses have abandoned the traditional starched whites in favor of a mix of and logo shirts. It's worth noting here that physicians have yet to discard their long white coats.
In many places nurse have not only abandoned their uniforms, they've given up their last names. Most seem to have done it gladly, accepting the new American informality with scarcely a thought. They introduce themselves by their first name, and in some cases take steps to conceal their surnames. Concealing last names or credentials is an issue being addressed by Nursing's governing bodies in various states with a variety of results; but still patients call for nurses using first names and physicians and other staff generally use a nurse's first name while in a patients room and no one thinks anything of it. Nurses accept and appear encourage this practice generally.
A physician was asked by the author how she refers to nurses when in front of a patient, and was told that if the nurse is in the room she usually uses a first name. Were she to encounter a nurse who insisted on being address by his or her title and last name in when in front of a patient she would consider that nurse somewhat cold, snooty and pretentious. Conversely, she expects to be referred to as "Doctor". She feels that patients want their physicians, even the female ones, to take a paternal role, essentially telling patients what they must do, allowing patients to abdicate their decision making rights completely. Nursing, she noted is more maternal and intimate, and the use of a first name makes establishing a relationship easier. The physician suggested that using a nurse's first name makes patients more comfortable.
Some of her points regarding a nurse's relationship to a patient feel true. She pointed out that most of us would address our attorney by their first name, yet they seem to retain their status. But in court, the judge addresses those attorneys with the Mr. or Ms. honorific, followed by their last name. Attorneys of course address the judge by title or honorific, and fail to do so at their own peril. Formality and at least the outward appearance of respect are expected. It would seem that the analogy in this case fails to hold up.
Opposite this, an example that comes to mind is a server in a restaurant. It's not uncommon to be seated at a table and have a waiter or waitress arrive with a name tag that reads "Jennifer C". Jennifer C then introduces herself by saying something like "Hi, I'm Jenny, I'll be your server tonight. Can I get you something to drink?" Substitute server for nurse and you have a scene that plays out in hospitals all around the country every day. If nurses are unable to separate themselves from the staff at the local Denny's how can we expect the general public to know the difference between the 23 year old college senior refilling their water glass and the 23 year old baccalaureate prepared ICU nurse adding yet another line to the seven already running while carefully managing fluid and electrolyte balance at their loved-one's bedside?
The use of last names sometimes brings out strong emotions when nurses are asked opinions on the issue. Most seem to cite the need for security, talking about patients and families who may make threats or become obsessed with the nurse to the point of harassment and stalking. Here again this seems to be less of a concern for physicians, even those who happen to be young and female. Perhaps there is a difference in maturity level between a 20 year old with an ADN (associate degree) and a 26 year old first year resident. Age, experience, education and the almost Olympian authority bestowed by the letters MD may provide a degree of protection that the young nurse does not enjoy. However, while planning this paper, nurses who did cite security always had anecdotes that involved a friend of a friend. None claimed to have been stalked, threatened or attacked personally. Google searches were performed on keywords "nurse attacked", "nurse threatened" and "nurse stalked" and the first 100 returns were checked. When combined with attacked or threatened, it appeared that it was more often the nurse who was attacking or threatening someone. In the cases where a nurse was attacked, the fact that the victim was a nurse appeared to be coincidental unless the attack occurred in a patient care setting. Stalking does seem to be a more significant issue, but still most of the evidence reviewed was anecdotal with only a few exceptions.
I once read an article which suggested using nurse's first names while at the same time insisting on titles for physician's subtlety demeans and devalues the nurse and his or her role in the eyes of the patient, the physician, and within the profession of nursing itself. The authors argued that using our last names and credentials will help nurses win and retain the position of respect that they have earned.
The arguments for allowing informality seem fairly weak overall, and nurses need to start recognizing it. In giving up our surnames along with the titles we have earned we give up or fail to gain respect from our patients, their physicians, and most importantly, from ourselves. In concealing our names and credentials we deny our identities and imply that a patient hasn't the right to know the name of his or her caregiver. None of these things are acceptable. Nurses will stop being treated as second class citizens as soon as we stop behaving like second class citizens.
Mar 19, '10My first thought (and keep in mind I still have 7 more weeks of nursing school, or a year, if I don't pass critical care) is that the nurse often provides such intensely intimate care -- both physically and psychologically, that a first-name basis is only appropriate. I might be off base, but that is what I think. And I know that in both my personal life and at the hospital for clinicals, when I encounter the doc who introduces him/herself by his/her first name, I get the feeling that there is a doctor who cares and is there for the patient. JMHO and .
(I do think nurses are often disrespected, but for whatever reason I am not sure it has to do with how they're addressed professionally).Mar 19, '10Interesting point of view.
Not gonna give my last name if a staff nurse.
However: I would give first and last name if...
1. I had my own practice and received direct/insurance payment from my patients
2. If I was partner in a practice and had my own patient population to build and maintain... take with me if I should choose to leave that practice
Why is this situation different? Because I can control the relationship with my patients - can fire them if they are trouble and I can benefit from a continued profitable relationship from good patients.
MD's? I don't care what they do with their names. I worked for one and automatically just called him Doc. Some other docs I know hate that, and want me to call them by their first names. They are all different.Mar 19, '10the writting is just the rantings of another delusional nurse (nursing student when it was written), thinking being a nurse is more than it is.
1. the typical nursing job is a blue collar job. being a doc, lawyer and judge are white collar jobs.
2. a typical nurse (diploma, adn, bsn) does not compare to a doc in education or professional responsibility.
3. a typical nurse does not compare to a lawyer in education or professional responsibility.
4. the typical nurse and doc relationship is nothing like the attorney and judge relationship, both are typically lawyers.
most people call me "nurse" and if they're going to call me anything else, i prefer my first name.Mar 19, '10After being sexually harassed twice in one month, despite attempts to rectify indiscretions, I refuse to show my last name. Also in the realm of Facebook, people who cling to the care they received, can sometimes reappear as friend requests.
I believe respect is earned by being competent, confident and assertive in my care, while using my first name leaves me open to a more intimate relationship with my patients.
However I am an ADN and was a waitress for seven years, so after reading this paper I am lent to believe I may just exist naturally on a lower plane of society...
In addition, historically nurses have been viewed as either saintly servers of God, or Nurse Ratchets with metal bedpans. (I am purposely excluding the sexual connotations of the field) We work in a field that requires us to walk into a room, gain immediate trust, and delve ourselves into a vulnerable and confidential part of our patients life.
How many times have you walked into a room, immediately after a doctor has left and asked "Did you ask the doc that question we talked about?" and they look at you and sheepishly shake their head. I do not want to be on a different level as my patient, I want to be a comfort to them, and a resource.Last edit by Tait on Mar 19, '10Mar 19, '10I agree with most of what's been posted in the replies above (not so much to the *delusional* thought, though). I think using first names helps build a rapport of ease and trust with our patients. It also used to be the norm to call patients "Mr. Smith" and "Mrs. Jones," and I don't care to go back to that, either. I think it's your demeanor that commands respect, not how you're addressed (and if everyone is addressed the same, by either first name or as "Nurse So-and-So," the how becomes irrelevant anyway, since it's all the same from one to another....your demeanor still comes back in to play).
As far as "Doctor X" goes, at least "Dr." is an actual prefix...you don't put "Nurse Doe" when addressing envelopes, do you?
I don't work with any doctors that I call by their first names (I don't know that I'd be comfortable doing so, anyway, and that's just MY preference), but if/when I do encounter doctors that introduce themselves by just their first name, the only impression that I get is that they don't take themselves or their title too seriously. Which makes me respect them more.Mar 19, '10Quote from cherrybreezeIs this not the norm? I've always called my patients "Mr. Lastname" or "Ms. Lastname." Even if I were corrected by the patient with their first name, I doubt I would be able to get out of my habit enough to remember and use the first name when I next gave care to that patient. I've also noticed the vast majority of my hospital's nurses and doctors referring to the patients similarly with title and last name when in the room with the patient.It also used to be the norm to call patients "Mr. Smith" and "Mrs. Jones," and I don't care to go back to that, either.
At the nurses' station or dictation room or med room, though, when discussing care or passing along a call light request, we almost always refer to the patients as just "Lastname" or even the dehumanizing "Rm. #"
I'm very curious for some other opinions on this. Is it a regional thing? Or is my facility just as out-of-touch with modernity as Cherrybreeze's comment could be construed to suggest?Mar 19, '10There are some patients who I call by their first name. Some who I call by Mrs/Mr *Last name*. There are a couple of patients who we call by their nicknames.
As for me I prefer if patients call me by my first name. Just the sounding of Nurse *Last name* makes me think of Nurse Ratched lolMar 19, '10In Wisconsin we called out patients by their first name, here in Georgia it is last names only...unless they have been with us for a long, long time.
TaitMar 19, '10I think its purely a matter of personal preference...a lot of the docs that I work with, especially the younger ones (by that I mean under 40), introduce themselves by Doctor First Last Name, rather than just Doctor Last Name...and many of the patients continue to refer to them as Doctor First Name...especially if their last name is long or difficult to say, and none of the doctors that I've ever worked with are offended by that. Because the Nurse/Doctor relationships are very close on our unit, we are all on a first name basis, so even the nurses in front of the patients often refer to the doctors by Dr. First name...again never been a problem. At our hospital, our ER staff (both doctors and nurses) does not have their last names printed on their badges for safety reasons--there are way too many weirdos out there, and regardless of whether or not I've been stalked or attacked in the past, I'm certainly not going to open myself up to that possibility for the future by asking my patient to use my last name. Most of my friends and family don't understand the hierarchy of nursing education (diploma nursing, Assoc, BSN, MSN, LPN--but we are all still nurses) so I certainly wouldn't expect my patients to understand, nor do I have the time to explain it to them...all that they need to know is that the state says that I am licensed to do my job, and what my FIRST name is in case something happens before I get back into their room.Mar 19, '10Quote from TaitIt might be regional, I am in Wisconsin. We call patients by their first name at work, but I've also only been called by my first name when I'm a patient, such as in the doctor's office. When they call people back from the waiting room, it's by first name. Same for dentist's office.In Wisconsin we called out patients by their first name, here in Georgia it is last names only...unless they have been with us for a long, long time.
TaitMar 19, '10One more thought, in terms of calling nurses by first name rather than "Nurse Breeze," is that IMO it's easier for the patients to remember. Some of the first names can be hard enough, and with some of the last names of the nurses on the unit, patients would end up just calling everybody plain old "nurse."
I had a patient this week (young gal, too, 27?) who, even though my name was on the white board, kept addressing me as "Nurse," as in, on my way out of her room, "oh nurse? Can I have some more juice?" She did this multiple times.
I hate being called "Nurse."
Speaking of whiteboards, if we went with last names, what would we write up there? We put both the RN and the LPN/CNA's names. Would we write "Nurse Breeze, RN" rather than "Cherry RN"? Would we put that for the RN, but a first name for the LPN or CNA?
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