1. Fagin, Claire PhD, RN, FAAN
  2. Lynaugh, Joan E. PhD, MSN, FAAN

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Over the past few years the question of renaming our profession has resurfaced. At meetings of nurse practitioners (NPs), the usefulness of being identified as a "nurse" has been questioned-NPs often say that they don't want to be thought of as just nurses. The name nurse, it seems, is one fraught with associations, not all of which are positive. "Nurse" has many meanings, including to nourish and to care for, conjuring images of the wet nurse and the baby carer. The negative images associated with the word nurse have included sexual ones perpetuated in the media. Having been around so long, one might expect nurses to exhibit a certain measure of confidence about our personal and collective identity. But some believe that false notions associated with the name distract attention from nurses' knowledge and skill.


Any group that promises to serve the larger society must be sure of its collective identity and be able to project that identity in a convincing way. When a teacher, lawyer, or physician enters a room, the client has already decided that "this person has the skills I need." The teacher (or lawyer or doctor) feels no need to say "I am not your sexual desires writ large," "I am not a dummy," or "I am not a hand-maiden"-they don't have to prove their expertise at the beginning of every encounter.


Nurses raise a hue and cry whenever a group or individual tries to rename them or specialists within the field. Early on, some nurses were extremely opposed to the introduction of the title nurse practitioner, arguing correctly that all nurses are practitioners. This opposition was eventually quelled by our recognition that the title conveyed something distinctive to the public; further, the word nurse was not dropped from the designation. The current discussion seems to suggest that some nurses are too well prepared to be called nurses.


Name concerns from the elite are not unheard of. In the mid-19th century, an upper-class woman seeking admission to a London training school would be admitted as a "lady nurse." Her maid might also be admitted to the same training school; she would be called a "nurse." The work opportunities for the lady nurse and the nurse were quite different: the lady nurse became a superintendent and the nurse worked in private duty. After a generation or so, these distinctions of title and restrictions on work opportunities began to be seen as invidious and inconsistent with the mores of nursing.


In the United States, social class distinctions were never as clear as in Europe but were very important nonetheless. Distrust and lack of understanding across the broad social range represented within nursing was a problem at the beginning and it's a problem now. Nursing reflects American society-2.5 million nurses embody most if not all of the social, economic, and intellectual categories that exist within this country. It isn't surprising that the fact of disparate educational routes vexes the nursing body politic.


Since 1963, billions of federal dollars spent on educating nurses under the Nurse Training Act contributed to the preservation of our several educational channels-designating any particular nurse education program as the one route to the profession proved politically impossible. But if we look at the substantial changes in the scope of our practice, in the quality of our education, and in the development of new knowledge, we can see huge advances on all three fronts in just two generations. And now verifiable research proves what nurses have always believed to be true: the quality of nursing care affects patient mortality and correlates with higher levels of nursing education and experience. Nurses who obtain higher levels of education can only serve to strengthen the profession.

FIGURE. Fagin... - Click to enlarge in new windowFIGURE. Fagin
FIGURE. Lynaugh... - Click to enlarge in new windowFIGURE. Lynaugh

So why are we talking about abandoning our trusted name? Why would we want to divide our forces? Americans trust the nurses they know-the ones who take care of them in hospitals, at home, and in EDs. Americans appreciate nurses. Why can't nurses-all nurses-do the same?