In the previous issue of Advanced Emergency Nursing Journal, the inappropriateness of the terms “mid-level provider” and “physician extender” was discussed (Hoyt, 2012). Prior to that, we explored the difference between the terms “evidence-based practice,” “standard of care,” and “best practice” (Proehl & Hoyt, 2012). Some readers probably think, So what, it's just semantics. So what? Do semantics matter? Some minor points may not be worth quibbling about, but the fact remains that words are powerful and can create or reinforce an inaccurate image or misunderstanding. As editors we are very sensitive to the subtle nuances of language that can lead to misunderstanding. As advanced practice nurses, it is incumbent upon us to set a good example and help educate others. One of the ways we can promote the dissemination of accurate information is by using accurate and precise language. Here are a few more terms that deserve consideration.
First, the name “emergency room” or “ER.” Does anyone still have one room where all emergency patients are seen? Perhaps, in a clinic setting this is true, but hospital-based emergency care is invariably carried out in a multiroom department. On the hospital's organizational chart, emergency care certainly deserves departmental status. Judy Kelleher famously made this point when she and Anita Dorr merged their two organizations, the Emergency Department Nurses Association and the Emergency Room Nurses Association; the resulting organization was named the Emergency Department Nurses Association. The name was changed in 1985 to the Emergency Nurses Association in recognition of the fact that emergency nurses do not just practice in emergency departments (EDs). To be inclusive of all nurses who practice our specialty, the words matter.
What is our specialty? If you said “emergency medicine,” do you have a medical license? You are not a physician, you are a nurse. Therefore, your specialty is emergency nursing or emergency care. What do you do if someone calls you “doctor” (and you are not a doctorally prepared nurse)? If you don't correct them, you are misleading the patient and that is unethical. You may also be promoting the stereotype that only physicians, not nurses, are highly intelligent. Many of you have undoubtedly been told by well-meaning physicians and others that you are so smart you should have gone to medical school. To this we respond, “Thank you. I'm sure you meant that as a compliment. But don't you think that the nurse, who spends the most time at the bedside, who makes life-saving decisions and performs complex interventions, and who advocates for patients and helps to protect them from harm, should be smart?” Of course, nurses need to be smart; patients' lives depend on them. You should be proud to be a nurse and ready to gently correct and educate your patients and the public.
The term “medicine” is often used as a synonym for “health care.” While the distinction between the two terms may seem picky, inappropriate use of the term “medicine” may also serve to obscure the contribution of nursing and other disciplines to health care. For example, consider the term “medical records.” What about the nurses' notes and the notes from physical therapy, respiratory therapy, nutrition services, so forth? Why not call it the patient record or the health care record? A glaring example is the Institute of Medicine (IOM), which recently produced a ground-breaking document, The Future of Nursing: Leading Change, Advancing Health. This report fully recognizes the value of nursing. In fact, two of the major recommendations in the report are that nurses be (1) allowed to practice to the full scope of their education and training and (2) full partners in redesigning health care (IOM, 2010). The IOM report has been applauded by nurses and nursing organizations across the country. It is ironic, but not surprising, that the report came from the Institute of Medicine but was not well received by all medical groups because some perceive this as a threat to their status as “captain of the ship.” That the report is from the Institute of Medicine may reinforce the idea that nursing is subservient to medicine on a grand scale. We have previously suggested that the IOM be renamed the Institute of Health Care in recognition of the fact that medicine is a component of health care; it is not all of health care (Proehl & Hoyt, 2011). Tilting at windmills? Perhaps, perhaps not.
—Jean A. Proehl, RN, MN, CEN, CPEN, FAEN
Emergency Clinical Nurse Specialist
Proehl PRN, LLC
—K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP
Emergency Nurse Practitioner
St. Mary Medical Center
Long Beach, CA
Hoyt K. S. (2012). Why the terms “mid-level provider” and “physician extender” are inappropriate. Advanced Emergency Nursing Journal, 34, 93–94.
Proehl J. A., Hoyt K. S. (2011). The future of nursing. Advanced Emergency Nursing Journal, 33, 1–3.
Proehl J. A., Hoyt K. S. (2012). Evidence versus standard versus best practice: Show us the data. Advanced Emergency Nursing Journal, 34, 1–2.