November 18th, 2015

The Name Game

Elizabeth Donahue, RN, MSN, NP-C

Elizabeth Donahue, RN, MSN, NP-C, practices adult primary care medicine in Boston, MA.

Nice to meet you, my name is Elizabeth… I think. My mother, a woman who was referred to by her middle name for her entire life because her own grandmother had such a distaste for her actual name, insisted that her daughters would always be known by only their given names. Yet as far back as my memory goes, I have been “Lizzie” to my family, “Liz” to my friends, and countless other variations throughout the years, depending on my mood. I even tried “Beth” out for a limited run lasting just the academic year in second grade (it didn’t feel right; I dropped it in June). So much for the no-nickname rule, Mom.

I guess given our family nomenclature history, it’s not surprising that I continue to have an identity crisis in my professional career. At least once per week I am conferred an honorary degree without any formal ceremony; I receive a consult letter or request from another facility or provider addressed to Doctor Donahue. Voila, a doctor — no further education, experience, or student loan debt required! And with a bit less frequency (thankfully for my ego), a patient occasionally refuses my care because I am “just a nurse” or “not a real doctor.” I remember one patient fondly from my first practice who insisted on referring to me at each and every visit as Nurse Practitioner Donahue — very accurate, though a mouthful to be sure. The vast majority of my patients simply address me as Elizabeth — fulfilling my mother’s first wish for me, one she could not manage to execute herself.

name tagsThe confusion of my patients seems a symptom of a larger problem: My colleagues, employers, and an entire healthcare system have struggled to “name” me. The In Practice blog was created to engage the growing number of NPs and PAs who have joined the provider workforce but who are not physicians. Yet the educational and healthcare systems that train and employ us have grappled with what to call us, creating a hodgepodge of references — most of which, in my estimation, fall flat. We have been collectively called non-physician providers and advanced practice clinicians — both accurate though leaving something lacking. Less enticing is the title mid-level provider, which to me suggests that the care itself or the person providing it is less than ideal, only mediocre, not high-quality. My least favorite of these names is physician extender. So many of my colleagues provide care in emergency situations, are the first providers a new patient sees, or work collaboratively with physicians in roles that do not overlap.

Thinking of all of the available choices and their meanings, my real question is, do we need another name? I would challenge my colleagues in healthcare and academia to strip it down and keep it simple. And then it can be simple for patients as well. What names can we use and apply to all? Can we adapt our vernacular to utilize simple, all-encompassing names and discard the “nicknames” that force us into more specialized categories? We are all providers. We are all practitioners. We are all clinicians. We are all members of a patient’s team. We are here for the same purpose.

As Shakespeare wrote in Romeo and Juliet: “What’s in a name? That which we call a rose by any other name would still smell as sweet.” We should stop playing the name game and apply this famous playwright’s supposition to our practice; a clinician by any name has the same goal — to provide high-quality, patient-centered care. And this should be our focus.

P.S. Hi Dad, I included that Shakespeare quote for you, in case you were feeling left out by my mention of Mom. Thanks for sharing your love of literature with me — can you believe I’m a “writer” now?

20 Responses to “The Name Game”

  1. Faith Towers says:

    That was a fascinating article Nurse Practitioner Donahue!

  2. Scott Cuyjet says:

    I very much concur.

    Your fellow NP blogger,

    Scott

  3. Kristen Vicino says:

    Thank you for the thoughtful post. Looking forward to hearing more from NPs and PAs, who are such an important part of our healthcare system!

  4. Linda Mann says:

    Hi,

    Happy to see this blog. I became an Internal Medicine Nurse Practitioner, with Family Practice experience, in 1975! This was through an excellent program at Kaiser-Permanente Fontana, and Los Angeles, CA. At that time using the title of Physician Extender was raised by someone (certainly not the RNPs) and one of my RNP friends said it made her feel like Hamburger Helper! I agree…how many physicians would appreciate being called Nurse Extenders?

    L. Mann, RNP Retired

    • Loretta Sernekos says:

      Had to laugh at the Hamburger Helper reference! That is exactly what I have been saying for years, “I am NOT medical Hamburger Helper”. The term “physician extender” so irritates me that I immediately close the window when I see the term in an advertised job description. I find it disrespectful. I can live with all the other terms currently in use. But “nurse practitioner” is fine with me.

    • Elizabeth Donahue, RN, MSN, NP-C says:

      Linda, thanks for your feedback and for your years in service to your patients. I think you understand my premise – which is that our individual professional titles are perfectly descriptive and appropriate (Nurse Practitioner, Physician Assistant, Physician, Certified Nurse Anesthetist, Midwife, etc.). But if we are going to move toward naming this collective group, we should use a name that applies to, and represents the contributions of, all the members of that group.

  5. Rory O'Driscoll says:

    Hi Lizzy, Rory here. Nice to see that you have Irish blood anyway. I’m a GP (in Kerry), otherwise known as Family doctor, Family Physician, Primary Care Physician…
    I like GP best. My patients commonly referred to me as Dr Rory, Rory, or at times other less flattering terms. My patients also sometimes refer to my GP wife as “Nurse”!
    I suggest you not worry about it but I like “Nurse practitioner” the best. It describes your role reasonably accurately I think.
    Call in if you ever in Kenmare Co. Kerry. We have a brilliant Primary Care Team here

    • Elizabeth Donahue, RN, MSN, NP-C says:

      Hi Rory – thanks for reading from so far away. I am always happy to be called a Nurse Practitioner – proud of the experience and education it took me to get here and also of what I can contribute to patient care. But if we’re going to use something else, I’d rather a simple, accurate term that doesn’t diminish my work or confuse my patients. Would love to visit you in Ireland someday – I’ll bring my 100% Irish (now American really) blood with me!

  6. Mustafa says:

    The day will come when PCP will stand for primary care provider and not primary care physician. The subtitle MD, NP, PA will be a detail. it’s just a matter of time until the public gets used to the terminology. Well done Lizzy.

    • Elizabeth Donahue, RN, MSN, NP-C says:

      Mustafa (Mustie) – it is a gift to work each day alongside a physician colleague who believes that we are equals despite our differences in training. Thank you for your support and for taking the time to read.

  7. Loretta Sernekos says:

    I think “Nurse Practitioner Donahue” is fine. It indicates you have a separate role from a physician, but one that is worthy of a title and respect. I can live with most of the things we are called — provider, clinician, etc. “Mid-level” does not excite me and “physician extender” irritates me. I am trying to let these things go a little bit as I get older. 🙂

    I have a PhD and my patients often call me “Doctor”. The first time they do that, I tell them I am not a physician, but an advanced practice nurse with a PhD. They sometimes continue to call me “Doctor”, but then it is their choice. Of course, explaining what a “nurse practitioner” is and how that differs from a “nurse” is something I am often asked about. Maybe that is a blog post for another day.

    Most of my patients call me “Loretta” and that is actually the way I prefer it. I am happy they feel comfortable enough with me to address me by my first name.

  8. Diane Pope says:

    Like your article. Got my advanced nursing degrees in the ’80s, retired from nursing years ago and had to laugh that the world STILL doesn’t know what to call us. I’m now a hypnotherapist certified by the International Medical and Dental Hypnosis Association after attending lengthy traing.
    You ought to hear what they call me now, weired, crazy, nuts, etc. I just laugh and use my nursing and hypnosis traing to help clients have their best possible lives. That doesn’t mean titles don’t count when finding a place at policymaking table and financial reimbursements. Keep up the good work.

  9. Elizabeth Smith says:

    Hi Liz,

    I too am an “Elizabeth” and that’s what most of my adult primary patients call me. There are a few that call me NP Smith, and to most of my spanish speaking patients I am “la doctora”. They all know I’m an NP but there isn’t a good descriptor in Spanish either. We’re pretty much all NPs out here in CA, there isn’t much use of the other titles.

    As far as do we need another name: ultimately yes, but I think that will come hand in hand when we all have our own practice statues NOT based on advanced practice nursing. I certainly do use a lot of my nursing background in caring for my patients, but to suggest that I’m practicing advance nursing and not medicine does not appropriately describe what I do. I think that’s the biggest issue is what “they” call us…..!

  10. Dr.V> says:

    Like “Doctor” = Dr, and single woman or not goes to Ms, how about Np Donahue (pronounced in parallel to the way Ms is pronounced)?

  11. john collins says:

    Why all the concern about titles? We are all providers, brings everyone to the same levels, no difference between physicians, NPs, PAs, EMTs, pharmacists, MAs, etc.

    Providers.

  12. John Donahue says:

    Thought provoking. I am enjoying the discourse you have stimulated among your peers in the health care community. Well written. Personally, I prefer to call you Lizzie. It embodies your witty, intelligent and compassionate outlook on life. Love, Dad (or Daddy, as your sister prefers to call me).

  13. Courtney says:

    Well done Lizzy 😉 I am so very proud of you.

NP/PA Bloggers

NP/PA Bloggers

Elizabeth Donahue, RN, MSN, NP‑C
Alexandra Godfrey, BSc PT, MS PA‑C
Emily F. Moore, RN, MSN, CPNP‑PC, CCRN

Advanced practice clinicians treating patients in a variety of settings and specialties

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