Serious Side: Wannabes Use All the Letters

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Letters (Blocks)All nurses pay a heavy price for our education standards. As a group, we show a striking bias against education: how often do I hear just how many other factors matter to a nurse more than her education? It’s understandable that folks with Associates Degrees feel defensive towards increasing numbers of new grads with Bachelors. Still, when we express pride in our pee-holding more often than our training, it reflects poorly on us all, and we all pay heavily for it.

Albeit for some admirable reasons like inclusiveness, we’ve positioned ourselves solidly in last place for education in health care, dead last. While others consider Master’s or even Doctorate requirements, we demand an Associates. Among nurses, it remains inflammatory to even suggest that a Bachelors matters. When nurses comment on education, it’s most often to disparage or belittle it, or describe all the countless factors that matter more than education to make a “good nurse.” I can think of no other profession that values education less. Why do most of us take classes? One reason: no other choice.

Although there are many valid ways to look at it, such low expectations greatly contribute to all of nurses’ woes. Our standards hold us all back, and prevent us from improving our lot. How? In America, education remains a leading road to power and prestige. Physicians, lawyers, executives: their professional power hinges on their education. The lower the bar a group sets for education, the less power it has, the less influence and prestige, the less ability to protect itself in our ruthlessly competitive society. Powerlessness invites exploitation and abuse. Until nurses show rather more enthusiasm and savvy about power, we doom ourselves to consequences like inadequate staffing, and abusive, unsafe work conditions. Our patients, too, suffer for it. To the extent we accept powerlessness and its consequences, our patients suffer for our inability to offer optimal care. We see it all across America every day, steadily worsening. Every choice has consequences.

Lose power, and you soon lose in countless other ways. Ask physicians: business types have outmaneuvered them and seized much of their power. It shows in their incomes and work conditions. It’s why they spend more and more unpaid time listening to elevator music on the phone, waiting to beg for approval for their decisions, again. From whom? From those in power, of course. Their patients suffer, too, for lack of time with them. Education isn’t everything when it comes to power, as today’s docs illustrate, but it matters a lot. It’s noble, perhaps, to ignore power, but you suffer for it, as do your patients. Power matters. Education matters.

Nurses today are the most trusted profession in America, year after year… and trust by itself offers very little power, as reflected in our work conditions. Most of our complaints stem, indirectly, from our powerlessness, as does our inability to remedy our complaints. Powerless people get treated poorly in our society, and their conditions improve only once they’ve seized the power necessary from others who never give it up willingly. Were women granted the right to vote? Only in a children’s book. Read your history, folks: women fought long and hard. The men in power ruthlessly suppressed them, and some heroic women withstood the suppression and seized that right. Those men didn’t grant women anything; they surrendered to women once they saw no other choice.  Should it be that way? Does it matter? Life IS that way and it will not change in the foreseeable future. We can improve our lot and seize the right to better serve our patients, or we can wait for it to happen somehow, which it will, perhaps… at some point in the future, once someone finally does something about it. Which choice sounds more professional to you, more responsible? Would you hope for the best and wait for a patient to get better on their own, or would you take action to make it so? Like it not, folks, our profession is our patient. Our society, too, is our patient. Responsible versus negligent apply in both cases, for each of us.

As for the puffed-up credentials so many nurses display, they amplify my take on power. All these letters beg for respect, prestige, and power: they offer very little of it in practice. To most audiences outside of academics (how much wordly power do you find there? They don’t call it an ‘ivory tower’ for nothing), too many letters actually suggest a lack of power or prestige. They can also signal insecurity, and the desperation to make a splash. Powerful, prestigious, influential people need no such letters, nor do they offer many: MD, JD, MBA. They know what works. In the humble life I choose, I enjoy far more power than I might, and thus far more freedom. I’ve studied power a bit, and learned ways to gather a bit. That’s why I get so much done for my patients, easier and more often than so many peers. Power is what gets things done. Even physics teachers know: “Power is related to how fast a job is done.”

When I was a new nurse, I signed my name “Greg Mercer, RN.” When I became a Nurse Practitioner, people told me to use all kinds of wild letter combinations. I learned to use exactly two: “NP.” These days, I go with three: “MSN.”

It helps. Think about it.


  1. education is power, the power to get paid a decent wage and the power to be taken seriously. An inflation of what it takes to get the right kind of education means that few can enter those hallowed halls and fewer still get a bit of paper to tell them who they are. You’re not just talking about nursing. Those that keep referring back to that bit of paper need to keep reading from the same script. I’m better than you.

    Liked by 1 person

    1. I agree that in our society, education is a major source of power. For various reasons, nurses have decided to help each other NOT take full advantage of it, and to help each other feel as comfortable as possible when they hold themselves back, instead of pushing each other forward. It’s gentler that way, but I doubt any group has ever advanced on such a path; it’s bound to get left behind by other, more ambitious groups that makke different choices. These social changes happen so slowly, though, that most people ignore them entirely.

      If nurses in the past has the same priorities we do today, there would be no nursing colleges. Nurse would remain the lowly doctor assistants they once were. Once you make great strides, it’s natural and sad to start to coast and lose momentum.

      The time is coming when some nurses may need to consider a split based on education. As it stands, we’re appraching a point akin to that if physicians had Associates-level members: a title so broad and variable as to have no meaning.

      As I see it, when people have little power, they tend to come up with all kinds of symbols: pretend prestige. Without real power in this world, a groups ends up poor and ill-treated. A group like nurses could easily gather power far more effectivdely and benefil nurses and patients. Why? We go so far out of our way to limit our power, and make such poor use of what little we have, that the room for improvement is breathtaking and easily within our reach. The central concept here?



    1. So much potential! I’d feel rather resentful it took my Muse so long to grant me this one, except I’m far too amused, thankful and happy for any resent or regret right now. Maybe later… Maybe not 😉 Thanks for your enthusiasm and ideas!

      Keep Playing!
      – Greg

      Liked by 1 person

  2. great Idea! Sometimes I think the ones who keep getting higher degree’s need to put A.S.S. after their name , you cant go to school that long and be up on any area of bedside nursing.
    it used to be everyone was AA nurse, then they decided they needed BSN, then msn, then phd, so you can take classes like , statistics, wow , knowledge in medicine and bookkeeping. crazy stuff. The most educated are those who work the bedside, year after year and dont want to be a pencil pusher.
    PHD piled higher and deeper
    Have you noticed those in the Nurses association are pretty much into initials behind their name? Who are they impressing, ?

    Liked by 1 person

    1. I’m all for education, although quality is far more important than quantity. No profession benefits from an anti-education bias. They just don’t.

      As for puffed-up credentials, they show our insecurity and limited status as a profession. Folks with real power and prestige need and use few letters: MD, JD, MBA, etc. They don’t need to, and not doing so signals confidence.

      When you pile on too many letters, its doesn’t necessarily add repect, prestige, or power. Instead, it oftens signals lack of confidence and desperation for respect, prestige, or power. In many circles, it elicits far more of the latter than the former. It holds you back more than it moves your forward.

      It’s interesting. I often use unpublished drafts to save ideas. I have many drafts stored right now. Every once in a while, though, I hit “publish” instead of “save draft” – in my defense these buttons lie right next to each other. Usually I fix it, but in this case I was in my car and didn’t have time to pull over. So I left it. Such a response to just a title over just a few hours!

      Soon I’ll actually write the post, although I think I’ll let it simmer a bit this way…

      Liked by 1 person

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