Henneman, Elizabeth A. PhD, RN, CCNS, FAAN; Cardin, Suzette DNSc, RN, FAAN
Elizabeth A. Henneman, PhD, RN, CCNS, FAAN, is associate professor, College of Nursing, University of Massachusetts, Amherst.
Suzette Cardin, DNSc, RN, FAAN, is assistant dean of student affairs and adjunct associate professor, UCLA School of Nursing, Los Angeles, California.
The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.
Address correspondence and reprint requests to: Elizabeth A. Henneman, PhD, RN, CCNS, FAAN, 226 Skinner Hall, University of Massachusetts, Amherst, MA 01060 (Henneman@nursing.umass.edu).
The purpose of this article is to urge all nurses to include both their first and last names when introducing themselves to patients, families, and health care colleagues. The current standard for professional nursing introductions for nurses providing direct patient care is at best unclear at worse nonexistent. It is probably most accurate to suggest that there is a commonly accepted standard, which includes the use of first names only. We contend that this practice represents a failure on the part of nursing leaders in both academic and practice settings to set a standard for professional nursing introductions.
Having spent the majority of our combined 70 years of nursing with one foot in practice (critical care) and the other in academia, we have learned a few things.
1. You can teach students anything you want in an academic setting, but it is a mistake to underestimate the impact of the organizational culture and standards of the organization where the nurse eventually practices.
2. Collaboration between academic and practice settings on issues of critical importance to both the nursing profession and patients is always the superior approach to achieving desired outcomes.
We are fairly certain that the majority of nurse administrators and educators reading this article would never dream of introducing themselves to a patient, family member, or physician colleague using only their first name. So the question is, why is it acceptable for nurses providing direct patient care to introduce themselves in this manner?
The issues surrounding nurses’ concerns regarding the use of first names only have been well articulated, ironically, by 2 nonnurses, Buresh and Gordon.1 The common rationales suggested by nurses for using their first names only fall under 2 themes:
1. First names are more personal and therefore make me more approachable.
2. If the patient/family knows my last name, my safety is compromised.
Ironically, these are very similar to the concerns that emerged prior to the introduction of 2 of the most significant practice changes in critical care that were adopted decades ago, namely, universal precautions and open visiting practices.
Nurses balked at the idea of wearing gloves when providing direct patient care. “It’s too impersonal,” “If they see me wearing gloves while I perform procedures, they’ll think I consider them dirty or think they have germs.” Well, indeed people do have germs, and we would be surprised at the patient or family member today who observed a nurse not wearing gloves who wasn’t concerned about the aptitude of the nurse as well as their own safety.
OPEN VISITING HOURS
When critical care units adopted family-centered care practices and implemented more flexible, open visiting hours, many nurses were concerned that their security was at risk. As early adopters of open visiting practices at a large academic medical center, we were surprised by the pushback from bedside nurses who, in addition to other concerns, believed more flexible visiting practices placed them at increased security risk. Experience later showed that security, although always a legitimate concern, was not a risk associated with flexible visiting. The key, we found, was engaging the staff in identifying valid security issues that could be addressed versus what needed to be done to meet the needs of patients and family members.
Benefits of professional introductions
INCREASED OPPORTUNITY FOR COLLABORATION
Once we accept and address the outmoded concerns associated with nursing introductions, our profession could potentially experience a “sea change” in how we are viewed by our health care colleagues and the public. The first, and perhaps most significant impact, would be with our health care colleagues, including physicians, pharmacists, and physical therapists. The lack of parity between roles, particularly between nurses and physicians, is established from the onset when the physician introduces herself as Dr Susan Moore, and the nurse introduces herself as Mary. Imagine being cared for in the emergency department by a physician who introduces herself as “Hi, I’m Lori. I’ll be the doctor taking care of you.” In our opinion, such an informal introduction does not instill confidence in the physician’s skills. Nurses have longed to established collaborative relationships with their physician colleagues but are falling short right from the start if they fail to introduce themselves in a professional manner.
There is a reason that the current Patient Safety Goals2 require 2 identifiers be used when caring for a patient. The chances of misidentifying a patient (or nurse) increase when only a single identifier is used. Of note is that these same Patient Safety Goals also include the need to improve staff communication around getting important tests results to the right person on time.
The following is a real-life example of how the use of first names only can create a dangerous situation related to an error in communication between a nurse and physician.
I (E.A.H., Beth) had an experience while working per diem in an intensive care unit where another nurse, also named Beth, worked full time and was well known by the attending and resident physicians. One afternoon, one of the surgical residents called the intensive care unit and gave me an order for a patient being cared for by the other “Beth” never suspecting there were 2 Beths working at the same time in the unit. Although I had answered the phone using both my first and last names, the resident admitted later he had not attended to that information because he did not know the other Beth’s last name. This scenario ended well but could have had serious negative consequences for both of the patients being cared for by the 2 Beths.
The time has come to reject the outmoded and invalid rationales supporting the use of first names only by professional nurses providing direct patient care. A proper, professional introduction will create the first impression that will set the stage for all subsequent interactions. We contend that respect for our nursing profession begins with respect for ourselves and starts with a professional introduction using both our first and last names.