Say Hello to Dr. Nurse

Altra, BSN, RN · Apr 17, 2008

Even still, I think the whole concept of addressing someone solely by their last name makes the experience a bit dehumanizing in the long run. Nurses are supposed to be, according to our 8,000 pages of nursing theory at least, more in touch with the patient's psychological needs. Taking up such a formal mode of address strips away at the relationship.

I was with you, up until this last bit.

I thoroughly disagree that the use of surnames damages the nurse/patient relationship.

hypocaffeinemia, BSN, RN · Apr 17, 2008

I was with you, up until this last bit.
I thoroughly disagree that the use of surnames damages the nurse/patient relationship.

It certainly makes the relationship more formal. I don't think it's too big of a stretch to extrapolate that for better or for worse this increase in formality affects the relationship.

elkpark · Apr 17, 2008

I plan to pursue DNP at some point in the future after I finish my RN, but I think you'd have to be obtuse to introduce yourself to a patient as "Dr. ..." and not expect them to be given the wrong impression.
"Hi!, I'm Doctor Methylene! I'm not a medical doctor but the scope of my doctorate allows me to practice medicine!" would go over swimmingly, I'd bet.

Well, one of the things wrong with that statement is that the scope of your doctorate (DNP) does not prepare or allow you to practice medicine; it allows you to practice advanced practice nursing ...

Also, I very much disagree with your comments about the use of last names. I would argue that nursing's reluctance to use last names contributes significantly to our lower status and power within the healthcare milieu. There are a number of other, older discussions on this site about that issue.

hypocaffeinemia, BSN, RN · Apr 17, 2008

Well, one of the things wrong with that statement is that the scope of your doctorate (DNP) does not prepare or allow you to practice medicine; it allows you to practice advanced practice nursing ...

This is semantics. "A rose by any other name" sort of stuff. NPs make medical diagnoses (in addition to nursing diagnoses) and order medical treatments (in addition to carrying out nursing interventions), do they not?

Nevertheless, your objection only highlights the absurdity:

"Hi!, I'm Doctor Methylene! I'm not a medical doctor but the scope of my doctorate allows me to practice advanced practicing nursing, which isn't medicine but allows me to diagnose and treat your medical conditions!"

Also, I very much disagree with your comments about the use of last names. I would argue that nursing's reluctance to use last names contributes significantly to our lower status and power within the healthcare milieu. There are a number of other, older discussions on this site about that issue.

I agree with you- even argued as much in a recent thread about name badges- that failure to use our last name lowers our status. I disagree that having patients address us by our salutation and surname is the proper solution. Physicians/Dentists and professors are perhaps the only professions (do I get bonus points for alliteration?) that utilize such an awkwardly formal greeting. I don't address my lawyer as "Esquire Richards", for example.

Perhaps something along the lines of "Hi, I'm Methylene Blue (last name), your nurse (or nurse practitioner as the case may be)". I think patients would be much more hesistant to contact us if they had to ask for "Mr. Blue" instead of "Methylene.

Our credentials are on our name badges and we can explain them to the patient if they're curious.

Now outside direct patient care, "Doctor" would be an appropriate title.

elkpark · Apr 17, 2008

This is semantics. "A rose by any other name" sort of stuff. NPs make medical diagnoses (in addition to nursing diagnoses) and order medical treatments (in addition to carrying out nursing interventions), do they not?

I suggest you call up your state medical and nursing licensing boards and ask them whether you're practicing medicine or nursing.

hypocaffeinemia, BSN, RN · Apr 17, 2008

I suggest you call up your state medical and nursing licensing boards and ask them whether you're practicing medicine or nursing.

This doesn't address my point. They're labels with deep political connotations, but this doesn't make them functionally all that different when you get right down to it. Anyways, this is a digression from my reductio ad absurdum scenario regarding patient role confusion that I fixed in my last post.

Altra, BSN, RN · Apr 17, 2008

It certainly makes the relationship more formal. I don't think it's too big of a stretch to extrapolate that for better or for worse this increase in formality affects the relationship.

I agree with you- even argued as much in a recent thread about name badges- that failure to use our last name lowers our status. I disagree that having patients address us by our salutation and surname is the proper solution. Physicians/Dentists and professors are perhaps the only professions (do I get bonus points for alliteration?) that utilize such an awkwardly formal greeting. I don't address my lawyer as "Esquire Richards", for example.
...
Perhaps something along the lines of "Hi, I'm Methylene Blue (last name), your nurse (or nurse practitioner as the case may be)". I think patients would be much more hesistant to contact us if they had to ask for "Mr. Blue" instead of "Methylene.

Can you explain how you believe that "formality" damages the nurse/patient relationship, or why patients might be more hesitant to hit the call button for Nurse Blue than Methylene?

Can any nurses who have been practicing for many years corroborate this? Did patients request the assistance of a nurse less frequently back in the days when Nurse X was the conventional address, rather than today's typical practice of using first names?

And how would you explain the "informality" practiced by most of the physicians with whom I work, who introduce themselves to patients as FirstName LastName, not Dr. LastName?

hypocaffeinemia, BSN, RN · Apr 17, 2008

Can you explain how you believe that "formality" damages the nurse/patient relationship, or why patients might be more hesitant to hit the call button for Nurse Blue than Methylene?

To preface, this argument of mine is simply conjecture. I think the formality of being addressed by surname creates a coldly formal relationship that would intimidate or isolate patients. I feel they'd be essentially hesitant to disturb "Nurse Blue" than "Methylene, their nurse". They might not be as open regarding their thoughts and feelings initially, either. I think this would be overcome as the relationship progresses, but I think our initial relationships would be adversely affected.

And how would you explain the "informality" practiced by most of the physicians with whom I work, who introduce themselves to patients as FirstName LastName, not Dr. LastName?

I think the "FirstName Lastname" approach is the professional way of addressing ourselves (as RNs and as NP/DNPs).

Altra, BSN, RN · Apr 17, 2008

To preface, this argument of mine is simply conjecture. I think the formality of being addressed by surname creates a coldly formal relationship that would intimidate or isolate patients. I feel they'd be essentially hesitant to disturb "Nurse Blue" than "Methylene, their nurse". They might not be as open regarding their thoughts and feelings initially, either. I think this would be overcome as the relationship progresses, but I think our initial relationships would be adversely affected.

One person's "cold formality" is another person's "respectful address."

Just curious ... how do you greet patients the first time you meet them, particularly patients who are older than you? Do you use their first name immediately without being invited to do so? If not, are you "intimidated" or "isolated" if they do not invite you to use their first names?

Miss Mab · Apr 17, 2008

Came across this today (a tad late):
http://blogs.wsj.com/health/2008/04/02/say-hello-to-dr-nurse/?mod=WSJBlog
It's interesting to see the innovations health care is trying to make to quench the pending shortage. What are your thoughts?

I think RN applications for PA school are gonna go way up....

hypocaffeinemia, BSN, RN · Apr 17, 2008

One person's "cold formality" is another person's "respectful address."
Just curious ... how do you greet patients the first time you meet them, particularly patients who are older than you? Do you use their first name immediately without being invited to do so? If not, are you "intimidated" or "isolated" if they do not invite you to use their first names?

I use "Mr. or Mrs.", but the "intimidated" comment is irrelevant since I'm not the one who is sick as hell lying in an uncomfortable bed in a foreign place exposed (literally) to complete strangers who are responsible for managing my recovery and/or keeping me alive.

Apples and Oranges.

TiredMD · Apr 17, 2008

This is semantics. "A rose by any other name" sort of stuff. NPs make medical diagnoses (in addition to nursing diagnoses) and order medical treatments (in addition to carrying out nursing interventions), do they not?

Most of your points are very well-taken, but here I think you're just wrong. Medical education occurs along a medical model, while NP education proceeds along the nursing model. These are two substantially different philosophies (which is why we have both PAs and NPs). My wife can tell me when I have the flu and give me ibuprofen, but that doesn't mean she is practicing medicine.

And from a more practical standpoint, if you are telling patients that you are able to practice medicine by virtue of your NP certification, you probably will not keep your license very long. Neither physicians nor RNs take very kindly to NPs who claim to practice medicine, and I suspect you would find yourself explaining yourself before a disciplinary committee.