NURSE PRACTITIONERS IN MEDICINE



Yesterday I went to my mental health center for a renewal of my meds. My old “doctor” was a Nurse Practitioner with a Masters in Psychiatry. He was personable, down to earth, and highly knowledgeable about medications and people, and I felt that I could tell him anything. We weren’t doing therapy, per se, but he would ask me questions about how I was doing, smile and show real pleasure at good things that had happened to me and he was warm and non-judgmental toward me at all times. I always looked forward to seeing him, because he acted toward me with friendliness and did not expect me to kowtow to him.

He has retired as of a month ago, so they have given me a new doctor, who is a Psychiatrist with an MD, and ever so conscious of it. I made the mistake of being openly friendly with him, and conversationally asking him what country he comes from. He didn’t answer and stiffened physically, a clear sign of offense. I do frequently ask people where they are from because I am very interested in names, faces and parts of the world. It’s my way of traveling the world, since I can’t afford world travel. I certainly do NOT feel anyone is inferior to me, and I welcome “outsiders” rather than seeking to exclude them. Most people I ask that question do take it as friendly interest, and it serves as an “ice breaker.” Not so with him.

I also made the mistake of warmly mentioning “Dr.” Fricke, whom I have known for a long time is an NP. He said in a frigid way, “I am a Psychiatrist.” I reactively said, “Oh, a Psychiatrist! Great!” He then spoke of Mr. Fricke as “Mr.” Fricke with a heavy emphasis on the “Mr.,” and the fact that he is NOT a psychiatrist. I let that pass. He prescribed my meds. Finally I asked him whether he is from the Philippines, explaining that he has a Spanish name, but an Asian face, and that I had known several others from the Philippines. He retorted, “You’re a very intelligent person!” I wasn’t trying to prove that I’m an intelligent person, but to establish a human connection with him. I don’t want to deal with him as my doctor.

Between his heavy emphasis on his medical degree, his scornful mention of Fricke and his general distancing behavior and coldness, I plan to call the mental health center and ask to be put with another individual, and another Nurse Practitioner if possible. I recognize Alcalde as a highly “conservative” personality of the exact type that I dislike and distrust. They’re all about status ranking, especially theirs. That really isn’t helpful in a psychotherapy setting. It may be the old Freudian model, but it doesn’t work for me. My prior therapists have not been Psychiatrists, though one had a PhD in Psychology, but I was able to form trusting relationships with them and they guided me through the process of thinking my reactions and past experiences out. That’s what therapists should do. I can only relate to people who respond warmly in that kind of relationship. While it’s true that I perhaps shouldn’t respond to such interpersonal distancing as dislike, I do tend to do that. I also don’t form relationships with people who are socially or personally conceited.

See the very interesting and informative blog below.




http://www.maverickhealth.com/blog/entry/it-is-a-mistake-to-call-a-nurse-practitiioner-a-nurse/

It Is a Mistake to Call a Nurse Practitioner a Nurse


I do not like it when people call me a Nurse. I liked it when I was a Nurse, but for more than 17 years now I’ve been a Nurse Practitioner. The two titles are NOT interchangeable and the duties and responsibilities are NOT the same.

As a Nurse Practitioner I’m often asked “What should I call you?” Doctors are addressed as “Doctor”, but if your doctor is a Nurse Practitioner, how should you address that person?

Call Me Carla, Just Don’t Call Me Late to Dinner

My patients are often not sure what to call me. When they ask me, I say “just call me Carla”. That’s my name. When patients call me Ms. Mills, it makes me feel like some stiff and formal version of myself - and that is not who I am as a health care provider. On the other hand, if you are my dry cleaner and just lost my best pair of black slacks, you will find Ms. Mills works a lot better for you.

Names Matter

Names matter. Don’t you dislike it when someone calls you by the wrong name? I think most of us do. Names call things what they are. A maple is a tree, but every tree is not a maple. A terrier is a dog, but every dog is not a terrier. A Nurse Practitioner is a Nurse, but every Nurse is not a Nurse Practitioner.

Types of Nurses and Their Correct Titles

I don’t know why my profession has chosen such confusing language to name the different types of nursing professionals but it’s no wonder you are confused about who does what.

Even among advanced practice nurses like Nurse Practitioners, there are other types of nurses who also have advanced clinical training. Those include Nurse Midwives, Nurse Anesthetists, and Clinical Specialists.

My purpose in writing this post is to help you get nurses’ names strainght. I will describe the three types of licensed professional nurses. I am also including CNAs, who are NOT nurses, but are healthcare workers that assist nurses. When you use the words “Nurse” or “Nurse Practitioner” I want you to know what you are talking about.

Correct Names of Nursing Professionals

Nurse Practitioner (NP) is a licensed registered nurse with advanced academic and clinical training at the master’s or doctoral level. NPs provide both medical and nursing care under their own license. NPs are licensed to give orders, prescribe medications, and direct medical care of patients. Depending on state law, NPs practice either independently or in collaboration with physicians. NP areas of specialization and certification include Family, Adult, Pediatric, Gerontologic, Women’s Health, Psychiatric, School and Occupational Health, Emergency, Neonatal, and Acute Care. NP education is shorter than physician education, and continuing education for certified NPs is 150 hours every five years and recertification is every five years. Click here for more about NP practice. Correct name: Nurse Practitioner or NP.

Registered Nurse (RN) is a licensed health professional who is a graduate nurse who has passed an examination for registration. Education required is an Associate’s or a Bachelor’s degree but may be a Master’s or Doctorate degree. RNs provide nursing care, administer medications, provide health counseling and teaching, and supervise less skilled personnel. The RN must have an order to administer any medications or give any treatments. RNs are NOT licensed to give orders, prescribe medications, or direct the medical care of patients. It is this difference in scope of practice between a NP and RN that makes calling a Nurse Practitioner a Nurse incorrect. Correct name: Nurse or RN.

Licensed Practical Nurse (LPN) is a licensed health professional who works under the supervision of an RN, NP, PA, MD, or DO; education required is a high school diploma and completion of a formal training program at a vocational school or community college that includes supervised clinical instruction. LPNs must also successfully complete a licensing examination. LPNs can perform many basic nursing functions including administering medications. Their scope of practice varies from state to state. Correct name: Nurse or LPN.

Certified Nurse Assistants (CNA): are NOT nurses. They are healthcare workers, unlicensed but certified, and are known by many names including CNA, Nurse Aides, Orderlies, Patient Care Technicians, and Home Health Aides. They are an important part of the healthcare team and provide direct, hands-on care to patients in a wide variety of settings. They give personal care such as bathing and feeding and other duties and work under the supervision of an LPN or RN. Education depends on the state, and requirements for certification vary anywhere from two weeks of training followed by a test to several months of clinical and classroom training. Correct name: CNA or Nurse’s Aide.

3 Ways to Support Nurses

NPs, RNs and LPNs work together with the collective goal of providing you the best care possible. You can return the favor by doing the following:
•When you are treated by a Nurse Practitioner, say you saw a Nurse Practitioner and not a Nurse.
•When you talk about nurses who have cared for you, identify them by their correct titles.
•When you hear someone jumbling up our roles and titles - correct them.

We already love you, learning about our profession and understanding our titles are the best ways to love us back!

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.


COMMENTS


#1 | On October 12, 2009, happy said:

Erm hang on one second.

A nurse practitioner IS a nurse. A nurse with extra qualifications in some aspects of practice, but a NURSE nonetheless. Why are you ashamed of your profession?


#2 | On October 13, 2009, Carla said:

Dear Happy,

A nurse practitioner is a nurse - absolutely! But it is a mistake to call a nurse practitioner a nurse for two reasons - 1) It is confusing and 2) nurses and nurse practitioners have different scopes of practice.

Nurses (either LPNs or RNs) are skilled health care professionals that administer and follow the orders of doctors, physician assistants and nurse practitoners.

Nurse practitioners function in roles traditionally associated with doctors. Nurse practitioners write orders and direct care - nurses do not.

EXAMPLE: If a patient reports that he or she saw “a nurse” no medical work up is implied. If the patient says he or she saw a nurse practitioner, it will be understood the patient has had a medical evaluation and probably diagnostic studies as well.

Ashamed to be a nurse - blarny! I am PROUD to be a nurse!! When I worked as an RN calling me a nurse was correct. But it is a mistake to call a nurse practitioner a nurse - and it is confusing to other providers and to patients. Let’s call each other by our proper titles. Nurse practitioners are absolutely nurses - but not all nurses are nurse practitioners.

Carla Mills



#3 | On February 06, 2010, Dawn said:

My husband received his doctorate in nursing (ND) from CWRU twenty-four years ago, as well as an MSN from Case. He’s been a university professor for the past 22 years and has always been call doctor by his students. Five years ago, he acquired his post-doctoral certificate as a family nurse practitioner and became a certified FNP. When he started collaborating with a local physician (part-time in addition to his full-time work as a professor), the physician’s staff, NOT the physician, insisted that the patients be told to call him by his first name and not call him doctor. They said they were concerned about misrepresentation, etc. During the first few years some of the same staff members made derogatory remarks about his educational credentials, and were always quick to “correct” patients who called him doctor. None of these staff members even had a four-year college degree, yet my husband has a full 11 years of higher education under his belt—BS, MSN, MBA, NP Cert., & ND. The whole situation would have been comical if it hadn’t been so absurd. My husband was very patient with them. Since that time all of the negative members of the original staff have left the practice. And my husband has proven himself as an outstanding practitioner with an excellent reputation as a diagnostician. A percentage of the previously-established patients in the practice even prefer to be seen by him on a regular basis rather than be seen by the physician. He has also brought many patients to the practice and has established his own new-patient population. Many of these patients are associated in some way with the university at which he teaches and these patients prefer to call him doctor. The current staff, however, discourages this by referring to him by his first name in front of the patients, even going so far as to tell patients, “We call him ....... so that patients won’t be confused and think he’s a doctor.“ —But if there’s anyone who knows he’s an ND and not an MD/DO, it’s these patients from the university community. I think it’s unfortunate, because he has more than earned the right to be called doctor, can’t accurately be called mister; and having patients call him by his first name is inappropriate because it doesn’t afford him the respect he is due for all of his hard work, knowledge, credentials, and responsibility he takes on in seeing, diagnosing, treating, and prescribing for his patients. (A very popular local chiropractor, who does not have prescribing rights, is always referred to by the title doctor by the same patient population.) I strongly believe all of the patients should call my husband doctor, and that this would appropriately increase the level of confidence and trust they have in him.


#4 | On February 06, 2010, Carla Mills said:

Dawn,

Thank you very much for your thoughtful comment which highlights many of the difficult issues related to NPs and our titling. I revisit this question again in my upcoming column in the Jan-Feb 2010 issue of NP World News. I’d also be very interested in hearing from your husband himself.

I do not know how best to resolve this issue. A professor on a college or university campus with the title of Dr. is a clearly understood position. A NP using the title Dr. in a medical setting (at least at this point in time) is confusing. It’s not a matter of it not being earned or deserved – it’s just confusing.

I agree ND (nurse doctor) is a better title than NP (nurse practitioner) because it more clearly defines the role. For my part, I’ve been a clinician for over 25 years and am often called “doctor” but I correct people 100% of the time when they do it. Even if I had a doctorate degree in addition to my masters’ plus 25 years of clinical experience, I do not want to be called a “doctor” because I’m not one and am more proud of being a NP.

It also doesn’t bother me being on a first name basis with my patients. It is an expression of our partnership and that is what I want to achieve therapeutically. But that’s just me, clearly DNPs and PhDs cherish their degrees and many want to use the title “Dr.”. What title serves patients and NPs best? That’s what we have to come to some agreement about as a profession.

I suspect the subject will continue to provoke a lot of debate and bleed a lot of time and energy from NP practice - energy that I think could be used in better ways. That is the thing that frustrates me about the whole issue.

Thanks again for sharing your thoughts.

Carla



#5 | On March 29, 2010, Heather MacLeod, ARNP-BC said:


I am a psychiatric NP working in community mental health. This problem of what to call me comes up daily. Most of my patients, when I tell them I’m not a doctor but a nurse practitioner, still call me “doctor,“ and often to show that they heard me delineate the two, they will call me “doctor Heather.“ It’s interesting.

My current medical director calls me by my first name, regardless that I have asked him to refer to me as NP with my last name. For obvious reasons, I am leaving that job, and am considering at my new employment, making clear that I want my patients to call me NP with my last name.

The reason for this is that it cuts through the confusion, and in dealing with patients, especially forensic patients, the NP title denotes respect. Calling me by my first name has become too jocular and when I am having to tell a benzo-seeking patient “no,“ the first name basis becomes a hindrance.


#6 | On April 03, 2010, Carla said:

Hi Heather,

You highlight well here how titling and respect and authority all go together and affect how effective providers can be with patients.

Thanks for commenting.

Carla Mills


#7 | On September 13, 2010, Helen Harris said:

What name should I call a Nurse Practitioner, who prescribed my 49 year old brother-in-law Lisinopril, which severe allergic reactions caused difficulty breathing, swelling of hands, mouth, face, lips, tongue & entire body; renal failure, blood pressure dropped, vomiting, sudden unusual weight gain of 32 pounds, and angioedema that killed him after consuming only two pills over a two day period?


#8 | On September 13, 2010, Carla Mills said:

“Nurse Practitioner” - just as you would call any physician who prescribed exactly same medication (one, by the way, that is commonly used safely and effectively by millions of patients who have high blood pressure and/or diabetes) - “Doctor”.

I hope, though, that the very first thing you did was call an ambulance. What you describe is a life-threatening medical emergency that required IMMEDIATE emergency intensive care. It may not have been possible for the prescriber to predict his reaction. Delay in seeking emergency care in a case like this can result in the tragic outcome you describe.

I am sorry for your loss.


#9 | On March 09, 2011, Lori,DC said:

I appreciate this discussion: most of it has been very educational and eloquently stated. I came looking for an asnwer as to how to address a letter to a nurse practioner. I will use the title NP Smith, and hope that I don’t get off to the wrong start. I think people resist using NP ahead of a name because it doesn’t flow, or it just sounds strange. But, as with anything, the more we hear it, the more we will get used to it!

I agree with most of what is said regarding establishing boundaries and professional qualification via one’s title. I think in general, regardless of what one calls a healthcare provider (or anyone for that matter), their respect or lack thereof comes through in their comments and actions. Also, I find that the respect patients have for a provider is not because of their credentials, but because of their skill and the manner in which they treat their patients.

I also wanted to say that I found the tone of some of the comments above to be less than respectful, especially in regards to the post by Dawn stating that the local chiropractor was called doctor, and they don’t have the right to prescribe. Chiropractors don’t prescribe because our method of treating the body is using physical, not chemical, treatments. Our scope of practice does not include prescribing by choice and design, not because we are not worthy. Chiropractors take all the same A&P, pathology, and diagnosis courses as at med school. The difference is in our chosen method of treatment. The degree is a doctoral degree, and so the proper title is Doctor. Also, in many states, we may function as a primary care physician, coordinating and directing a patient’s care. We do have the right to order laboratory and imaging studies.

Sorry for the lecture, but in this forum focused on giving proper respect via a title, I felt compelled to educate those who may not know about my profession (which is the purpose of the letter I must now write to NP Smith).

Thank you for helping me!
Lori


#10 | On March 09, 2011, Carla said:

Hi Lori,

I think you really hit the nail on the head with this comment:

“I think in general, regardless of what one calls a healthcare provider (or anyone for that matter), their respect or lack thereof comes through in their comments and actions. Also, I find that the respect patients have for a provider is not because of their credentials, but because of their skill and the manner in which they treat their patients.“

Thanks for visiting.

Carla Mills