When I graduated with my BSN many years ago, I was filled with pride; pride for having completed a rigorous course of study and pride for having passed the most anxiety-producing exam I had ever taken – the NCLEX. I remember my professors saying that my
professional signature should always include my licensed title and degree; RN, BSN. RN – the holy grail of credentials for those who take the challenge of nursing education and dare to confront the NCLEX. They said all other denominations of nursing come after the RN. So, I became Lisa J. Sundean, RN, BSN and now I am Lisa J. Sundean, RN, MSN, MHA and soon-to-be Lisa J. Sundean, RN, PhD. Aside from my name, what is the constant in this lineage of credentialing ancestry? You got it – RN. Registered Nurse. Hello, I am Lisa and I am a Registered Nurse. In that you can trust according to annual public polls. RN is the only designation that allows me to practice as a nurse. No other credential allows me to practice legally except the RN license.
According to the American Nurses Credentialing Center (ANCC), the proper way to display licensure and credentials is by highest degree earned followed by licensure, state designations, awards/honors, and others (ANCC, 2013). So apparently, I need to tweak the order of my signature. I will consider it. But note, RN is still clearly in the signature. Some would argue that APRN can substitute for RN, but not according to ANCC. I’m not going to argue that point. I will leave that for the APRNs. What matters is that RN is displayed somewhere in the alphabet soup of acronyms.
Several years ago, I was volunteering for a local hospital fundraising organization. While recruiting sponsors for the flagship fundraising event as co-president of the organization, I was signing letters directed toward potential sponsors and donors. Of course, my signature was Lisa J. Sundean, RN, BSN (I didn’t have the MSN, MHA yet). The hired event planner took issue with my credentials saying it would be confusing for sponsors and donors. Naturally, I argued with him and I kept the signature intact. I argued that if people knew a nurse was asking for support they would feel more confident about giving. Revenue for that event increased by more than 100% over the prior year (yes, you read correctly!). Okay, maybe my signature was not the only reason, but nurses do have credibility. For sponsors and donors, knowing a nurse was leading the fundraising effort probably helped.
Not so many years ago, I was finishing my Master’s degree program. The capstone project had me combing through hospital websites and board directories looking for RNs serving on hospital boards. I’d heard of certain hospitals that had RNs on their boards but I was challenged to locate them in the board directories. I was perplexed that very few hospitals listed nurses on boards with their RN titles. The reasons for this are complicated, but in talking about it with a particular hospital CEO and RN, I was told that as nurses move up the career ladder to more senior level executive positions, they sometime drop the RN title because it can become an impediment to further career advancement. Pause. Think about that for a moment. The very licensing credentialing that allows nurses to practice, to deliver educated care to people in need, to advocate as educated and licensed professionals becomes an impediment to personal/professional development…(sigh).
Recently I have noticed that some nurses from academia and other work settings have retired the RN title in favor of using state designations and certifications. It may be obvious to those of us who are familiar with the constellation of initials that these people are, in fact, RNs with superlative credentials. However, the general population, who apparently trust nurses inherently, have no idea how to decode these initials. They wonder, “Is this person a nurse, a professional bill collector, a doctor of neuroscience, a professional health director, or a certified entrepreneur of noetic perspectives?” In all of the high level credentialing that nurses accumulate, the only letters that really stand out to the general population are RN – Registered Nurse.
At a time when nursing is entering its “golden age” as Donna Shalala declared so emphatically in 2010 at the release of the Institute of Medicine report, The Future of Nursing; Leading Change, Advancing Health (Robert Wood Johnson Foundation, 2015), some nurses choose to hide their licensing credential. At a time when we need nurse representation and participation at so many levels for healthcare transformation, some choose to stow the RN away. It is concerning that some feel the need to hide their professional identity to advance and have influence in leadership positions.
Now is the time to display the RN prominently along with other credentials. How else can we take credit for nurses’ roles in health, healthcare, and social justice? The public trusts us. Do we trust in the power of the RN? Let’s commit to leadership influence using the licensing credential that we worked so hard for; the licensing credential that we must hold to advance our nursing education, to provide bedside care, to be recognized as nurse leaders. The RN is not a license to hide. The RN credential is one to display proudly and be empowered by. If career advancement is at risk by our credentials, perhaps the alternative approach is to advocate for all that the RN stands for.
2016 is just days away. Now is nursing’s time. Be an RN. Happy New Year to all my colleagues.
References
American Nurses Credentialing Center. (2013). How to display your credentials. Retrieved from http://www.nursecredentialing.org/DisplayCredentials-Brochure.pdf
Robert Wood Johnson Foundation. (2015). Campaign for Action Five-Year Celebration Video. Retrieved from https://www.youtube.com/watch?v=SLM5zC7zmF4&feature=youtu.be
NurseManifest 
Thank you Lisa for so articulately and passionately stating the issue. Several years ago my employer adopted the order noted below in my first signature. RN is clearly there but buried in the alphabet soup. This rose to a new level of consciousness when, as a new board member, my name tag reads E Carol Polifroni, EdD as “only the first credential in anyone’s name is displayed.” I have asked for this to be corrected and will now change my business signature (second below) on all correspondence as I am proudly an RN and it colors and shapes everything I do.
E Carol Polifroni, EdD, CNE, NEA-BC, RN,ANEF
E Carol Polifroni, RN, CNE, NEA-BC, EdD, ANEF
>
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Thank you for your reply, Carol. Keeping RN front and center in your signature demonstrates the foundation of your perspectives and your practice. By the way, be sure to be counted for your board service on nursesonboardscoalition.org.
Kindly, Lisa
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Hi Lisa,
Thanks for you post. You raise the issue of title as a sociopolitical concern and I think you have something here worth exploring and talking about further.
It must have been shocking to learn that some RNs intentionally do not use their RN title for purposes of advancement. That intentional action is troubling and has ethical, moral and sociopolitical implications for those who feel they need to do this; and for the profession itself, if this is indeed more than an isolated action.
Perhaps they did not consider the implications of their action? Perhaps they did and wanted to circumvent the predominant belief system in “a MD at the top of the food chain” sort of perspective; which I find is still the strongly prevalent belief in my world.
I am labelled as a “mid-level; allied health” in my NP role; and even though state law says I am an independent practitioner (RN’s and experienced NPs in NYS have independent licensure) I am required, by my practice manager, to have all of my patients to also be seen by a MD or DO for “liability insurance purposes”. Some insurers still do not recognize NPs… that is beyond this discussion; but relevant from a food chain/ title-ment perspective.
From my personal/professional perspective; I dropped it because I eventually had too many letters after my name; and felt it was implied that I was a RN because one must be an RN to obtain an ANP license. I have however placed my RN after the ANP-BC at times when I purposefully wanted it there (i.e.: credentialing other RNs in a continuing education setting).
Best, Wendy DNS, ANP-BC, RN!
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Thank you for your reply, Wendy, RN! In many ways, this is about the food chain, the pecking order, the hierarchy of power. Without question, it is a sociopolitical concern. It is also historical when we interrogate the trajectory of nursing and hierarchies over time – which demonstrates the intersectional ways in which nurses have been marginalized. Given that, we now have a situation where nurses, very intelligent and highly educated people, feel they need to hide their professional identity in order to advance and influence healthcare away from bedside care. We can either embody the marginalized identity and expend our energy hiding the RN or we can stand tall and inform others of our capabilities as RNs, if not through communication then through demonstration. Our time will never come if we don’t take full advantage of the opportunity to leap!
Best, Lisa
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Lisa,
Thank you so much for your important post. I have thought about this very topic (and been concerned) many times over the past 22 years. I earned my RN before either of my nursing degrees (I had a BA in Bio before that) and I believe I am a registered nurse first, and then a master’s and doctorally-prepared nurse. So I have always displayed my RN first after my name. In fact, I have corrected people on several occasions when they have switched the order on me (and if you ever see it any other way in print, it’s a typo!).
I have often wondered why people would drop the RN. Many people do not know what the other letters stand for, or that they indicate a nursing degree, licensure, or certification. And I must admit that the thought of “superlative credentials” makes me sad, because, to me, nothing is of higher quality than an RN.
I would love to know the ANCC’s rationale for putting the degree first. You would never see “PhD, MD.” Putting RN first after my name is also consistent with how I introduce myself – to patients and professionals: I’m Jane; I am a nurse and certified diabetes educator.
I hope nurses everywhere will consider putting the RN back into their credentials. For the profession, and for a clearer message to the general public.
Jane K. Dickinson, RN, PhD, CDE
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Thank you for your reply, Jane. You bring up such a good point about the order of credentials. Physicians always begin their credentials with MD. When I began thinking about the issue of nurses dropping the RN, I went to ANCC to understand their position – but I did not ask the scientific question, “Why?” When I was a hospital board member, the minutes always came through with MD and PhD credentials – but never RN (I was the token on the board). I am still on a board committee as an external member, and I must continually remind them to include my credentials in the minutes. I don’t see this as a physician-nurse issue in this setting. It is the business perception of nurses that is the barrier – in addition to the perception of women in general (sorry guys, but nursing is still a female-dominated profession). I have created an alliance with another woman on the board who is eager for a 50/50 female/male board composition and supportive of nurses on boards. This is a critical alliance and one that can help bring light to the importance of the RN on the board in addition to equal gender composition.
Regards, Lisa
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Lisa,
Thank you for your informative and eloquent post. I have noticed a trend in new graduate nurses where they are proud to become an RN, but the mindset is to immediately advance to a higher degree. It is as if ‘RN’ is an stepping stone for millennials versus a career. Where I have always seen nursing as an honorable profession, the younger generation seems driven by titles. Each time I have my hospital nursing badge processed I am asked which credentials I would like printed. Every year I repeat the same thing to the badge department, “RN.” My co-workers also ask me why I don’t have my credentials listed. The answer is simple. I am Carrie Eaton, MSN-CNL, RNC-OB, soon to be PhD and CEDRN. When I work in the hospital my patients hope for a caring, compassionate and intelligent Registered Nurse at their bedside. RN is the title they recognize and trust. I am humbled every shift by my patients as they trust in my capacity to care for them. Nurses who enhance their badges with fancy initials confuse patients and undermine the power of the RN. Thank you, Lisa for sharing your thoughts and consistently working to empower nurses.
All My Very Best,
Carrie
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Hi Carrie;
Thank you for reading and responding. I have to admit, I am very much looking forward to wearing my PhD credential – we will have earned it! However, first and foremost, we are RNs. As Carol Polifroni commented above, it “colors and shapes everything I do.” I have no problem with RNs seeking advanced degrees – I encourage it at every level as long as we don’t lose sight of our RN roots, and we continue to let the RN credentials shine above others. See you soon, my friend.
~ Lisa
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I completely feel as you do Lisa…lets remember who we are and be proud of that. and I also put RN first…because I feel that I am a nurse first and foremost. So glad you are bringing this topic to light. Sue Hassmiller, RN, PhD, FAAN
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Hi Sue;
Thank you for your reply. As we talk about nurses’ contributions to a Culture of Health, it is imperative that we represent ourselves as nurses. Seems so obvious, but not so to all. Let’s keep reminding ourselves how important this is.
~ Lisa
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