Alphabet Soup: Why So Many Letters After Nurses' Names?

From The Floor

Alphabet Soup: Why So Many Letters After Nurses' Names?

Let's go back to the basics of just listing the licence credential and highest degree.

By Genevieve M. Clavreul, RN, PhD
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It snuck into our profession so clandestinely that hardly anyone noticed what was happening. One day there appeared after many a nurse’s name, a deluge of letters, many with little or no meaning without using the Taber Medical Encyclopedia to decipher them. Today, nurses seem to be drowning themselves in what I have come to call Alphabet Soup.

Look around; you can hardly pick up a nursing journal or even a nurse’s business card without seeing a slew of barely decipherable initials attached. In preparing to write this article, I found the following, with only proper names changed.

B. Goode Nurse, RN, APRN, BC, CWOCN, Ph.D., FAAN
Buck Smith, RGN, BSC (HONS), MSC, DIPN, DN
Marc Supernurse, RN, BC, APRN, BC, CRNI, MS
Betty Jo Doe, RN, Ph.D., CAN, CHE, CPHQ
Jack Daniel, RN, EdD, CCRN, CCNS, CCRC

I often wonder why some nurses think that it takes a string of letters to give them self worth and respect. Ask yourself when was the last time you saw doctors or attorneys with so many initials after their names—and I bet you’ll say hardly ever or never. In nursing, however, I have noticed that this has become an increasing trend. More and more nurses seem to be putting as many initials after their names as they can.

For example, how many of you reading this column know that CCCN can stand for Certified Continence Care Nurse? Or that CDONA/LTC stands for Certified Director of Nursing Administration in Long-Term Care? That CRNO stands for Certified Registered Nurse in Ophthalmology? Or, finally, that IBCLC stands for International Board Certified Lactation Consultant?

It Came About Due to Specialization

Back when I got my Registered Nurse license (before they invented the light bulb or telephone), we basically had two types of nurses: the Licensed Vocational/Licensed Practical Nurse and, of course, the Registered Nurse. Most nurses at that time were also more likely to be generalists, working on whichever floor had a need. Over time, just as with doctors, we saw a move toward more specialization in our practice and this was not necessarily a bad thing. However, somewhere along the line we also saw the evolution of nursing certification as some kind of indicator of nursing competency—which I would argue, it most certainly is not.

To be sure, one could argue that an RN with specific and extensive training in NICU is a better choice to work with neonatal patients, or even pediatric intensive care patients, than let’s say an RN with specific and extensive training in Med/Surg. Yet, does a RN with 30 years of experience working exclusively in NICU need a special certification to prove that she knows her “stuff?” I think not.

What critical change has occurred in our nursing psyche that has caused so many nurses today to appear to have an almost compulsive need to validate their worth by placing all their licenses, degrees, and certifications after their names? Could it be the ongoing argument as to whether the entry into the nursing profession should be the Bachelor-prepared nurse, relegating the Diploma-trained and Associate-prepared nurses to some sort of second-class status, or “no-nurse land?”

You can see by the initials behind my name that I subscribe to what is a minimalist style. I chose not to acknowledge all my various degrees and certifications because, after achieving my doctorate in hospital management, it didn’t matter that I also had a bachelor in psychology/sociology, a masters in public administration, and a masters in education. These additional degrees, though helpful in developing the skills that I use as both a nurse and as a consultant, are not needed as proof of my expertise. Therefore, I do not need to “advertise” them on my business card. Of course, I list all my earned degrees, all the states that I am licensed in, organizational memberships, etc., on my curriculum vitae, which I give to interested parties.

What Do Our Patients Think?

I think that when it comes down to it, our patients only care that we have RN after our names and that we demonstrate that we know how to do our jobs. Ask that frantic mother and father pacing in the waiting room whether it is important to know that their child’s nurse has five additional initials after his name. I can assure you all they care to know is if he is a good nurse.

As nurses, we are taught with a more or less universal curriculum, which is why a nurse educated and licensed in South Dakota should be able to apply for a license by endorsement so he/she can practice in New York State.

Much of the problem with Alphabet Soup comes through the attaining of additional certificates. Though many certification programs can help hone a nurse’s skill and knowledge, one has to ask: are these programs all that different from some of the continuing education units that we must fulfill every two years? Have some of these certification programs become nothing more than moneymaking efforts for organizations that administer them?

Organizations promoting and demanding that nurses achieve these certifications rarely provide quantitative proof that there is an impact on patient care. Nor do they always follow up on the retention of skills in the workplace. Therefore, do the initials attained through the certificate programs merit being added to a nurse’s name?

Licence Credential and Highest Degree

Some initials should always follow your name on your business card and correspondence. You should always display RN, even if you have a BSN, since having graduated with a BSN doesn’t make you an RN. Passing the state board or NCLEX does. Of course, there can also be a discussion as to what order one puts degrees and credentials.

There are two schools of thought on this subject. The first, and the one I subscribe to, is that you place your license credential nearest your name, followed by your earned degrees in ascending order. The reasoning is that the license that allows you to practice your chosen profession should get highest priority. The second school of thought, which seems to be most popular today, is to put the highest earned degree by your last name, followed by the license credential and then the other degrees. Whatever your decision, please be sensible.

Geneviève M. Clavreul, RN, PhD, is a healthcare management consultant and a former Director of Nursing.

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