When everybody knows your name

313RN, BSN, RN

This is something that I wrote 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 opinions 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 scrubs 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 to 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 with 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.

When everybody knows your name

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