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DNP Answers

When the Nurse Wants to be Called Doctor

Published July 23, 2014 8:38 AM by Keischa Cash

Getting my DNP was challenging, but, unfortunately, my employer was not as supportive as I had hoped of my hard-earned achievement. When I received my doctorate I intended to introduce myself as Dr. Cash to patients and wanted staff to address me as such, as well. I found out this would be harder than I thought.

The organization I work for is highly physician-centered. Yes, they still reference NPs and PAs as midlevel providers and physician extenders. I despise these terms. I was told I could not address myself as Dr. Cash because I, in fact, was not a doctor. I promptly challenged this pointing out that I was not a physician, but I was a doctor. I thought it absurd to only allow physicians to call themselves doctor. The clinic clearly employed other non-physician doctorate-prepared professionals. What were they calling themselves? Were they okay with this? Had anyone ever challenged this before? I would be the first.

I was told by a higher up in the company that the clinic had never allowed and would never allow other non-physician providers to use the title doctor and in his words (not mine) said, "let's face it, PhD's are not real doctors!"

I about choked, thinking, Could he really be serious?

Did he even know the difference between a DNP and a PhD? I am not even sure he knew what a DNP was. Certainly didn't sound like it! Clearly this was a teaching moment. So began my quest to be ‘allowed' to call myself doctor and bring awareness to the DNP title with my current employer.

I was asked to write a letter to the board of directors and our credentialing committee as to why I should be allowed to introduce myself as "doctor." How absurd I thought, but I did it.

It took them six weeks to respond and it came in the form of a letter from the medical director (whom I still have NEVER met). Initially, they were not going to allow me the privilege, but realized it was not within their right to deny me. They also said they would not address me as Dr. Cash - only as Keischa Cash, DNP - in all clinic correspondence, publications, newsletters, emails, marketing materials and website mentions. I still don't know how I feel about this.

I challenge all DNPs to go for what you want. Fight for what you believe in. Because we (DNPs) are still so young in our existence, we MUST challenge the status quo. We are knowledgeable, highly educated and have a lot to offer employers that are willing to see beyond traditional nursing roles and titles.

Lastly, let me be clear, this is not about titles. It's about putting NPs and the profession I love in the forefront. This is about all of the DNPs that will follow me.

My quest to change existing paradigms has only just begun. Wish me luck.

27 comments

An MD is a doctor. A DO is a doctor. A nurse, of any kind, is not.

As a patient, I would be angered by the misrepresentation involved in a nurse (with whatever letters after their name) introducing themselves as "Doctor". It's wrong, it's silly, and it's deliberately confusing to the patient and their advocates.

It's also insulting to the physicians who have actually earned the title.

By all means, get further education and be proud of your work. But don't pretend to be something you're not.

j November 6, 2014 9:23 PM

Oh, and I also wanted to point out that not all DNPs get their degrees online. The DNP curriculum From the school I graduated from  is very much hands- on and very minimal online work. now the DNP programs also involve coursework  in healthcare administration and policy etc as well, which may be partially online, but the clinical components are similar to or the same as any medical school rotation. Sheesh people make it seem like you got it from a cereal box. Sounds like some of you need to educate yourselves more about the education and preparation of your peers instead of acting so condescending.

Katie October 14, 2014 12:21 AM

I would like to point out that yes, the medical school curriculum is much more intense education than nursing school at the bachelors level. That being said, nurses who go on to be NPs have at least an additional 2 years on top of their nursing background. Dnps have 4 years after their nursing education.. The exact number of years of medical school. They (NPs)  also complete the same advanced patho and pharm and health assessment as medical students. They also have clinical rotations, as med students do. The overall learning experience is not identical, but closer than you think. One of the major differences between NP school and MD school are how soon the students initiate patient care. For Nps it's Immediate. NPs hands down will trump Most MDs with bedside care experience (because they were and always will be nurses) which by the way is why many patients value us as primary care providers. I'm by no means taking a shot at med students or MDs- I love the ones I collab with. But my care is not inferior to that of an MD. And if I obtain my DNP, you betcha I'm going to use my title Doctor. I respectfully call all of my colleagues doctor who have earned a doctoral degree- including pharmacists, physical therapists, dentists, psychologists... You name it. That's the way it should be. This argument that it's  "confusing" is just a bunch of Balogna. We all utilize each others' expertise- the interdisciplinary community needs to start reflecting THAT.

Katie , Family medicine - RN, FNP-BC October 13, 2014 11:58 PM

As one who has a basic nursing degree and then went to medical school, I can assure you that the training is MUCH different.  As a nurse, one is trained to provide care and help the patient, as a physician one is trained to understand the pathophysiology of disease and plan for its treatment.  This is not something taught in an on-line DNP program, nor in the classroom setting; it is learned at the bedside of the patient.  In the appropriate setting, referring to yourself as Dr. X, a nurse practitioner (or PA) shouldn't be objectionable, but to say Dr. X, without the requisite modifier, makes an assumption, in the mind of a patient, that you are a physician.  You are not, anymore than a PhD, DPT, dentist, chiropractor, podiatrist, lawyer, etc. would be considered a physician.  Sorry, it just isn't the case.  This doesn't minimize the hard work you put into achieving your doctorate, only seeks to comment on how it is seen.

Pat McGroin September 28, 2014 1:31 PM

Thanks for all your great comments. Just wanted to spark a conversation.  I spent ten minutes writing a response then deleted it. Doctor, Nurse, I don't care call me what you want. No matter how you feel about it...I am both. Just don't insult my intellect and hard work.

Dr. Ca$h

Keischa Cash August 20, 2014 12:43 AM

I always enjoy it when someone believes passionately in something. I have  a PhD and I am a nurse. My degree is in Human Development and I have had an Integrative Health practice for over 20 years. I have been told NOT to call myself Dr. by psychologists, MD's and nurses. What I call myself does not matter it is what I do and I have found that my patients get exceedingly great results and for this I have had both good and not so good (jealous) attention from competing (in their eyes) practitioners. I say claim your name - and go out and do good work. There are SO MANY hurting people that we can all be guarunteed to be busy. Cynthia Howard RN, CNC, PhD

Cynthia Howard August 6, 2014 5:11 PM

I always enjoy it when someone believes passionately in something. I have  a PhD and I am a nurse. My degree is in Human Development and I have had an Integrative Health practice for over 20 years. I have been told NOT to call myself Dr. by psychologists, MD's and nurses. What I call myself does not matter it is what I do and I have found that my patients get exceedingly great results and for this I have had both good and not so good (jealous) attention from competing (in their eyes) practitioners. I say claim your name - and go out and do good work. There are SO MANY hurting people that we can all be guarunteed to be busy. Cynthia Howard RN, CNC, PhD

Cynthia Howard August 6, 2014 4:55 PM

It seems to me that the dispute is centered around a word or title. The problem is that the academic community awards this title to those the have completed a terminal degree in their discipline. Physicians have adopted this title and seem to believe that it only belongs to them. The title belongs with the degree. It is not specific to a certain discipline. Many disciplines maintain this title. However; re-teaching the whole country is the problem. I see both sides of this issue. If I spent 4 years of nursing school, then 2 years in Master's program, then 2 years in a doctoral degree, I would definately feel like I have earned the degree and should be addressed by the title that comes along with it. The hard part is changing peoples view of who they are seeing.

Wade, FNP August 5, 2014 10:02 AM
Hohenwald TN

Actually, I did have to take general, organic, and biochemistry as a pre-nursing requirement, Sean, PA-C. But what does undergrad nursing have to do with the DNP? Anyone who earns a doctorate in ANY field earns the right to use the title of "doctor". This includes pharmacists, physical therapists, professors, dentists, vets, etc. A DNP practicing alongside an MD needs only to clarify how the title was obtained so as to avoid title confusion for the patient.

Kerri, ANP-BC August 2, 2014 3:34 PM
GA

How sad it is that some of us are so hung up on titles. l totally agree with Andrea from Mobile, AL. In the end it's not about the title, but about pt centered care, and what each profession in COLLABORATION bring to the field in order to give our pts the best care. We need to stop being so hung up on titles and start focusing on making our messed up healthcare system better so that EVERYONE can receive care.

Joy August 2, 2014 9:44 AM

I am sorry but pre-nursing is not as difficult as pre-med.  

I don't believe you need to take organic chem, bio-chem and physics to get into nursing school.

Sean, MPAS, RPA-C August 1, 2014 11:45 PM

Who cares how long the growing season is as long as the fruit is mature..... get over your title phobias physicians and worry about doing the best  job you can do and listening to your patients... the number one complaint I hear in the clinic every day is " My doctor doesn't listen and just wants to tell me what to do all the time". The end of physician-centered care is coming .... patient centered care is here, and all of you better worry about that not you precious titles. Other professions get it , people get it, .... grow up.

 Someone who has earned a doctorate can be called Dr. ( Dentists, podiatrists, optometrists, chiropractors nurses etc. etc. ) I agree the name tag should give more information so people know you are not a physician, and then I think it's just a respectful term people use when in a therapeutic relationship...in the end we should just worry about good care , please? Insecurities on both sides need to pass away. Nurses don't want to be surgeons etc , but do want some damn respect from you guys some day. Geeeze.

Bob D August 1, 2014 6:35 PM

We have more things to worry about than who is called Doctors!  As a Certified Pediatric Nurse Practitioner, I am appalled about the person who said my pre-Nursing courses were a joke and can not be held to the same standard as a physician.  Obviously this person did not go to my college.  Pre-Nursing was a rigourous as Pre-Med. Nursing was as rigorous as Medicine.  Long hours studying, long night burning the candle with a big pot of coffee.  That being said...can we move on....and take care of our patients.  As time goes on, our positions become more challenging and there will be fewer providers.  Call and truce and realize what we all bring to the table.  Look at what unites us, not divides us.  It is not about the titles we wear....but about our patients and the care they receive.  Without patients...you might as well write you doctoral credentials in the sand!

Andrea Roberts, Pediatrics - CPNP August 1, 2014 10:49 AM
Mobile AL

<<I can't believe that a Nurse who received FNP and DPN title by online methods with little or no clinical residency,  now wants me to call him/her "Doctor".    Complete 4 years pre med,  4 years in the principles and practice of medicine and 3-5 years residency and I will call you Doctor.    A online course and a thesis on nursing practice doesn't prepare you in any way to practice medicine (under the guise of advanced nursing) independently. Just my opinion.>>

OK, Mr. Shelby, you are entitled to your opinion.  We are entitled to our opinion.

You are a physician assistant.  I have many friends who are PAs.  Most of them are fully cognizant of what we NPs bring to the table.  Most of them fully recognize that we are stellar providers...whether or not we have a doctoral degree.

Where do you come off spouting about PHYSICIAN degree requirements in your commentary about the DNP degree?  This is a degree ON TOP OF our Masters-prepared requirements...I might add, the equivalent of what most PA programs require.  

Get off your high horse, my friend.  Play nicely in the sandbox.

Kim Spering, Emmaus Internal Medicine Assoc August 1, 2014 12:06 AM
Macungie PA

Historically PhDs and MDs used the title doctor. PhDs discover new knowledge and contribute their original evidence to science. This is a difficult and challenging task. MDs and DNPs use the evidence PhDs have discovered. DNPs, DOTs, DPTs are clinical degrees and they use evidence in their practice. A PhD Nurse Scientist with multiple years of scientific investigation to produce original research and a DNP are not educated in the same way. I understand why physicians and scientists do not consider the clinical DNP, DPT or DOT in the same category.

Sheree Loftus, PhD

Sheree Loftus, Gerontology - Nurse Scientist, Beth Israel Neurology July 31, 2014 10:46 PM
New York NY

I have held a PhD in clinical endocrinology for over 20 yrs, obtained from the University of Wisconsin, Madison.  My experience includes nearly 6 years in cancer research prior to becoming a PA.  Now, after 20 yrs in the profession I have recently been reported to our state board for using the title Dr., even though our marquee and my lab coat show PA-C.    I'm not sure who it was, physician or mid-level who made the complaint to the board.  I feel I hold as much right, if not more, to use the title than a DNP.  I am not saying they do not have the right, just that I have as much right as they do.  The controversy will continue no matter what and even with Missouri approving the title of Assistant Physician to those docs who can't find a match is raising some eyebrows.  I simply believe there are a lot of insecure physicians out there who need to reconsider our positions vs. theirs.

Max, , PA-C, PhD clinic July 31, 2014 10:18 PM
Henderson NV

I've been a PA for 30+ years; married to a physician; father to both a PA and NP. In a medical encounter the patient must be fully aware whether they are seeing a physician or a mid-level provider. I have no problem with an NP or PA (yes there is a Doctorate of Physician Assistant Studies degree) introducing themselves as "Dr. ...." As long as it is followed by "I am a nurse practitioner " or "I am a physician assistant" and it is plainly spelled out in full on their jacket.  Anything less is misleading and borders on malpractice.

Thomas Carrino, MPAS,PA-C July 31, 2014 9:57 PM
Greenville TN

I can't believe that a Nurse who received FNP and DPN title by online methods with little or no clinical residency,  now wants me to call him/her "Doctor".    Complete 4 years pre med,  4 years in the principles and practice of medicine and 3-5 years residency and I will call you Doctor.    A online course and a thesis on nursing practice doesn't prepare you in any way to practice medicine (under the guise of advanced nursing) independently. Just my opinion.

William Shelby, PA-C July 31, 2014 9:17 PM
Rotan TX

I am a practicing PA that works in a clinic with NPs and Physicians.

I also agree that allowing DNPs to be called and calling themselves "doctor" in a clinic setting is very confusing and should be avoided.  I am not saying they cannot be capable healthcare providers.  However, in a clinic setting doctors are and likely always will be thought to be physicians.  To allow patients to believe a DNP is a physician is misleading and frankly I believe disrespectful to physicians.  You can't tell me that as a DNP you would take the time or even think you will have the time to explain in detail the difference to patients.  Even if you did, many would still not understand.  In a clinical setting where patients are being seen and provided with medical care, a doctor is a physician.  Period.  I believe it should stay that way.  Physicians education a residency is very rigorous and beyond anything a NP has to do to achieve a DNP.  I don't kid myself to believe my training as a PA was as in depth or rigorous as a physician's and a PA's training is far more similar to a physician's than is a NP's training, doctorate or otherwise.  Let us not forget, the PA profession was created by a physician.  We (PAs) were not met to compete with physicians and many NPs I have met and spoken to over the years feel that they are in direct competition with physicians.

Sean, MPAS, RPA-C July 31, 2014 8:00 PM

Also a DNP is not a PhD.  They are two different degrees. Also the PAs do not have a doctorate degree established yet so unsure of why PAs are even mentioned here.

Heather Riddle, Peds - CPNP-DNP July 31, 2014 6:32 PM
Tampa FL

Congratulations DR. Cash!!! You deserve it!!  All your hard work and dedication in school and your career shows your love for the field.  Not only do Nurses practice nursing, they run circle around doctors in every aspect in the medical community.  DO, MD, PA each in their own category.  Why are some of the respondents grouping them together?  Each one has a different educational path as NPs have their own educational path and philosophy of medicine. The one thing in common is that all practice medicine. Each do it in their own way and it is up to the patient to decide which approach they feel comfortable.  Everyone keep doing what your doing and use your "DR" if you EARNED it.  I know I am proud to be a Doctor of Nursing Practice.

Heather Riddle, Pediatrics - CPNP-DNP July 31, 2014 6:29 PM
Tampa FL

I think that anyone who earns the title "doctor" should be able to use the term but I do think that it should be clarified so as not to confuse patients.  The NP who earned the title of "doctor" should be able to be called Dr. but she/he should also explain to patients that "I am Dr. Cash, nurse practitioner".  This would eliminate the confusion but also allow NP Cash to use the title that she earned.  I do think our medical community is changing and NP's and PA's are earning more rights/priviledges so we all have to keep up with the times.

Sandy McCoy, Family Practice/Bariatrics - RN,MSN, FNP-BC, Northstar Surgery Center July 31, 2014 5:36 PM
Dallas TX

Ok Dr. Nurse. Do you believe that your education matches that of an MD or a DO, heck even a PA? Seriously even your watered down prerequisites for nursing school are a joke compared to the extremely difficult and applied studies for MD, DO, and PA schools (based on medical models). But you believe that you earned the right to be referred to as Dr., perhaps... just not in a clinical setting where the term Dr refers to an MD or a DO. This is "your" NEED to be recognized, and it trumps what MDs and DOs have truly earned. You are NOT the same as an MD or DO, you should not be referred to as such. Or maybe you should be referred to as Dr. Nurse and MDs and DOs should only be referred to as physicians, that way the separation would, and should, maintain. But eventually you would probably want to be referred to as physician nurse... or something.

J July 31, 2014 5:35 PM

In response to the posters here that argue it's too confusing for Dr. Cash to use her title. Are you often confused that your "Dr." Chiropractor or your "Dr." dentist or your "Dr." podiatrist are your family M.D.?... Keep using your earned title Dr. Cash, and keep educating.

K July 30, 2014 4:36 PM

Interesting how this is not a problem for academic PHDs. Many professors are commonly call "doctor" on a daily basis without even batting an eye. A doctorate earned is a doctor in that particular area of study and should be recognized as such. As DNPs, nurse practitioners are not trying to represent themselves as medical doctors, but rather as doctors or experts in the field of nursing care. The skill set to each distinctive profession has and never will be the same. Nursing is a specialty of care that is and always has been unique in and of its self, and one that most MDs know little if anything about. Obtaining a DNP degree is taking that nursing knowledge and expanding to a new level that only benefits the healthcare system and patients in the end, and there should be recognition of the achievement. I think the unspoken truth is the threat MDs feel by the newly expanded role, as it overlaps there knowledge base, yet they have done nothing to expand their nursing knowledge. (Could you ever see an MD providing bedside nursing care) If they could only see that we are not doing this to replace or confuse anyone, but rather to fill a gap in our healthcare system and provide more wholistic patient centered care. That frees up and allows MD to do what they do best, and DNPs do what they do best. The end result is a win for patients if they can learn to be more accepting and work together. Maybe  physicians should start introducing themselves as doctors of medical practice, just to clarify and also eliminate potential confusion for patients, and let them decide.

Michele, MSN FNP-BC July 25, 2014 2:15 PM
Green Bay WI

Lawyers have argued this for a long time.  Lawyers hold "doctorates" (Juris Doctor), and many in the profession believe that since they have attained that level of academia they should be referred to as "Dr." as well.  I think it's a silly argument.  I agree with the comment above that referring to an NP as doctor due to the advanced degree would cause unnecessary confusion.  MD is a doctor.  Period.

s nelson July 24, 2014 5:48 PM
Kill Devil Hills NC

The term "doctor" has many uses in society but, in the context of the healthcare setting, the vast majority of laypeople understand it to be synonymous with "physician." DNPs, like other holders of advanced degrees, have earned the title in an academic sense. But I think most would admit that it carries heavy implication, and a high potential for confusion, in the clinical realm. I wonder why such a proud profession would invite that kind of confusion about their identity.

Harrison Reed July 24, 2014 12:25 PM

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