I was given a first-edition copy of Florence Nightingale’s book, Notes on Nursing, about a year-and-a-half ago. The book was in a glass case and slightly tattered from the looks of it. I was told I could do whatever I wanted with it – keep it, sell it, whatever.

I love old things. In fact, I have a copy of Elliott P. Joslin’s “Diabetic (sic) Manual for Doctor and Patient” that belonged to my great-great aunt and an old First Aid Handbook. But this one seemed different. I immediately felt it belonged in a place where nurses could enjoy it. I felt compelled to give it to my alma mater, University of Connecticut School of Nursing, because I know they have a collection of nursing artifacts and it would be well taken care of and displayed for nurses of generations to come.

This past Christmas I had the opportunity to hand off the cherished book to Thomas Long from the UCONN School of Nursing. He was actually excited that it wasn’t in perfect condition because that indicated that many hands had touched it and turned (and hopefully read) the pages. He asked how I came to own the book and where it had come from. Unfortunately I didn’t even know the story, so I couldn’t share it with him. I only knew that my friend’s mother had owned it.

Soon after I asked the friend who had given me the book and she told me the whole story:

My friend’s father’s sister was a Navy nurse during the 1940s. Soon after she was appointed the guardian of a boy who lost his parents. Later (I believe it was 1959) he purchased the Nightingale book for her (there is a letter with the book that shows the date and price of the purchase). This aunt lived with my friend’s parents the last several years of her life and when she died this book was found among her belongings. My friend’s mother kept it for the rest of her life.

If you are ever in Storrs, Connecticut, be sure to visit the School of Nursing at the University of Connecticut. There you will see the first-edition Notes on Nursing displayed as part of the Josephine Dolan Collection in the Widmer Wing of the Nursing Building. I look forward to seeing it there myself one day.

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

I recently returned from a conference in Spain about the economic value of nursing where I spoke about many promising international models of community nursing, including some that were not so new. What sparked the most conversation later was the final image of my presentation with the words of the Spanish feminist writer and activist Concepción Arenal: How many centuries will it take for reason to arrive at the conclusion on [social] justice that the heart instantly understands.

Surprisingly little has been written in English about this remarkable woman, whose work in social reform and the development of nursing was simultaneous with, and comparable to, that of Florence Nightingale. Born in 1820 (the same year as Nightingale), she was the first woman to attend a university in Spain (auditing law school classes dressed in men’s clothing). An early and influential advocate for women’s rights, she wrote extensively about issues affecting marginalized populations including those living in poverty and in jails.

I am just beginning to read Arenal’s original writings in Spanish, and am struck by the parallels between her writing and current conversations in nursing about social justice and cultural humility. For example, her manual for visiting (nursing) the poor begins with the philosophical questions: What is pain? (Ch. 1), What are we? (Ch. 2), and What is poverty? (Ch. 3)  Before moving on to the central chapters on the theory and practice of visiting (nursing) the poor and how to approach and handle different situations with humility, respect, and empathy, while empowering the poor to improve their condition and lives. The book ends with chapters on the importance of having respect for the pain [of the poor] (Ch. 14), and the spirit of the sick (Ch. 15).

Please join me in reading and reflecting (here in the comments on this NurseManifest blog) on the writings of Concepción Arenal. We hope to build connections with colleagues in Spanish speaking countries and bilingual academic settings around the world. Looking forward to learning more about your thoughts inspired by Arenal’s writings (comments welcome in English or Spanish).

Un cordial saludo,

Olga

P.S. Please also reach out if you are interested in working on a Spanish version of the NurseManifest Manifesto.

References and Further reading:

1. Josep Bernabeu Mestre – Encarna Gascón Pérez (Univ Alicante). Historia de la Enfermería de Salud Pública en España (1860-1977). [The History of Public Health Nursing in Spain] Capitulo 2. Full text pdf (162 pages)
2. Miguel de Cervantes Virtual Library Collection for Concepción Arenal, including her collected works in digital format http://www.cervantesvirtual.com/portales/concepcion_arenal/autora_biografia/

Direct links to a few of Arenal’s books that I’ll be reading and would love to discuss with others:

• El visitador del pobre [Manual for the visitor of the poor]
• El visitador del preso [Manual for the visitor of prisions]
• La educación de la mujer [The education of women]
• La cuestión social [The social question]