What's in a Name? A lot!

For years I have been a broken record about nurses not using their last names when delivering patient care, dealing with physicians, etc. I have written lots on this topic starting with an article in the American Journal of Nursing entitled, What’s in a Name? that I co-wrote with a nursing educator Elizabeth Grady. In a book I co-wrote with fellow journalist and non-nurse Bernice Buresh, From Silence to Voice: What Nurses Know and Must Communicate to the Public, we consider this topic in depth. I remain impressed and depressed by how committed nurses are to maintaining their anonymity when dealing with patients.

Just how devoted they are to this practice was recently conveyed to me when I talked with a Canadian nursing union leader about efforts throughout Canada that nurses are undertaking to reaffirm their identity as a registered nurse. In many provinces including Newfoundland and Labrador, Nova Scotia and others RNs are very deliberately telling patients that they are RNs and even changing their come as you are uniforms to a standard uniform that is reserved for RNs exclusively (say in Newfoundland and Labrador) or in other provinces for nurses and licensed practical nurses.

While I unequivocally support nurses efforts to give their professional credentials to their patients what I find almost unbelievable – is their commitment to hiding their identity from their patients. The very same nurses who are donning new uniforms and introducing themselves by highlighting that they are registered nurses refuse to tell their patients their last names and sometimes even go as far as to tape over their last names when they are included on their hospital issued IDs. And this is apparently allowed or at least tolerated, (enabled really) by hospital nursing leadership as well as by professional leaders.

It is 2015, nursing is supposed to have come a long way baby. Older nurses tell me with great pride that they no longer get up and give their seats to a physician when he – or now she –comes into the room. Female nurses – as they did in the fifties and sixties – no longer hold the door open for a male physician. Yet these same nurses who now boast about their new found pride in their work and the increasing recognition of the importance of their profession have actually regressed when it comes to naming practices. At least before the 80’s, they had last names, which they used and told their patients and which physicians referred to – as in Mrs. Smith or Nurse Smith. Today, physicians no longer demand their chairs, their door opening or their more clear symbols of deference. They don’t need to, nurses are demeaning themselves by rendering themselves children among grown-ups all of whom have last names along with their titles, while nurses cling to being the kids or the servants whom Dr. Smith is allowed to refer to as Sally or Joanie or Jim, while Sally, Joanie or Jim, not only calls Dr.Smith Dr. Smith but actually refuses to let patients know that they are full fledged professionals who actually have identities, as in Sally Jones, Joan Patel, or Jim Johnson.

Nurses insist that they will not, cannot, and must not share their last names with their patients because these patients – the ones for whom nurses claim to serve as the only real advocates in the health care system – will attack them, stalk them, and in all sorts of ways endanger them. Almost all nurses I meet with echo these arguments but they are particularly adamant when they work in ERs or psych. This in spite of the fact that physicians – who work with the same patients – use their last names as well as first names.

What this means is that nurses – at least those in North America – have constituted themselves as a singularly endangered professional species who ask for and are granted a kind of professional endangered species status that we would not accord to any other group of professionals. Teachers, for example, work with children who might be quite threatening or might have threatening parents but everybody knows their first and last name. Police officers not only display their last names but badge numbers and the majority of the time they are the ones who are endangered (except of course when they endanger).

For a more detailed discussion of this issue please check out From Silence to Voice: What Nurses Know and Must Communicate to the Public, the chapter on Presenting Yourself as a Nurse. Why is this still an issue? If nurses feel endangered, they should go to the NIOSH website and consider real ways to deal with any violence there is in their workplace. Hospital administrators or nursing leaders who want nurses to act in a more professional manner might also consider why they are assenting to – or at least acquiescing to – this practice. If nurses are so afraid of their patients, something is very wrong. We know that perception is reality. If nurses perceive themselves to be in danger then something should be done about it that does not violate professional standards and even regulations. You are not licensed to be an RN as Joanie. You are licensed under a first and last name. Plus hospital bills of patient rights stipulate clearly that patients have a right to know who is taking care of them and that does not mean that you, as a nurse, have a right to maintain anonymity in the workplace. Finally, let’s consider who is really at risk in the healthcare workplace. Is it nurses or is it patients. Up to 440,000 nurses are not killed in hospitals every year. Up to 1.5 million nurses are not seriously injured every year. These are the statistics on patient harm not harm to nurses.  To really be a patient advocate – which means you stand up and defend patients – you have to be willing to take the risk – a totally minimal risk in fact – to name yourself. Try it, see if it makes your more endangered. I suspect you will actually be safer. Think about it, who is easier to attack – Joanie, or Nurse Smith?