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Playing the Credentials Game

Saturday April 1, 2006
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Many RNs wonder how to use the academic and certification credentials they have worked hard to earn. Others complain we have added too much "alphabet soup" after our names and are confusing the public. This "Campbell's approach" can be confusing for health care providers, the public, and even nurses themselves. Here, we'll shed some light on credentials and answer some of the more commonly asked questions, such as -
Where do I put them in reference to my name?
In which order do they go?
Do I have to use them?
Do the certification credentials come before or after my degree?
What if I have more than one certification?
Do I need to indicate my specialty area if my certification credential does not indicate this? For example, if the credential is APRN, BC and I am an FNP, do I need to put both?
Credentials - what are they?
There are six basic types of credentials you may possess that can be used after your name -
Degree (e.g., BS, MS, JD, PhD, EdD). These credentials are awarded based on the completion of a particular educational program. The choice of whether to use all your degrees is personal. If the degrees are in different professions, one might use the highest one in each, such as "Mary Smith, EdD, MPH, BSN." You may even begin to see the initials CAS (certificate of advanced study) or PMC (post-master's certificate) included with the degrees. This is particularly true for nurse practitioners and clinical nurse specialists who are broadening their scope of practice.
Licensure (e.g., RN, LPN). These credentials are awarded based on the completion of a specified educational program and the successful passing of a national licensure exam.
State designation or requirement. These credentials are similar to licensure, but they are usually beyond basic licensure and designate authority and recognition to practice at a more advanced level in that state. These credentials, such as APN, APRN, ARNP, CRNP, NP, CNS, and CS, are authorized by a particular state based on meeting certain criteria, which may include the completion of advanced education, specific course work, or certain types of experience.
This type of designation may not be acceptable to another state because each state has its own authority to govern nursing practice. This is one of the reasons nurse practitioners and clinical specialists have difficulty moving from one state to another while keeping the same level of prescriptive authority and autonomy.
Some states have also protected the titles they use in their regulations or statutes, which means you cannot use the credential in that state unless authorized to do so by the board or commission that governs nursing practice. To do so would be violating the law in that state. (There are still nurse practitioners who have been practicing for years who were educated in certificate programs that didn't require a master's in nursing.)
National certification. These credentials are awarded by a nationally recognized, usually accredited, certifying body, such as RN, C; RN, BC; or APRN, BC, from the American Nurses Credentialing Center, or NP-C from the American Academy of Nurse Practitioners Certifying Board. These credentials are usually linked to the profession, job role, or licensure. Certifications like the CAE (certified association executive from the American Society of Association Executives' certifying body) would also be included here as a professional credential.
Awards or honors. Two examples of this type are FAAN (Fellow of the American Academy of Nursing) and FCCM (Fellow of Critical Care Medicine). These awards are given to individuals who are selected for their outstanding service or accomplishments in a particular area.
Other certifications. These can include a variety of things like ELS (editor for the life sciences) or even certification for computer skills. These credentials may or may not be associated with the profession or license, but they do indicate additional skill sets a person has acquired through education or testing.
What do you have to use?
The only credentials that a nurse is required to use on legal documents, such as progress notes and prescriptions, are those that the state has authorized the nurse to use and says must be used when practicing in that state.
The majority of states require national certification to practice as an advanced practice nurse, and some require a nurse to use the national certification credential awarded. The licensure credential, RN, is usually standard and may or may not be required in addition to the advanced practice credential giving additional authority. For instance, your required format might be "Mary Smith, RN, APN," or just "Mary Smith, APN." If you are writing for publication, you will need to check with the journal or publisher as to the required guidelines they will want you to use (at Nursing Spectrum, we always put nursing licensure first).
Multiple credentials
For individuals who have multiple credentials, the order in which to place them is always a question. Through informal research, I have found the general rule of thumb to be, "Follow your name with the credential that can least be taken away from you, in descending order, with awards or fellowships last."
For example, Mary Smith, PhD, RN, CPNP. The degree, once awarded, can least be taken away. The license does have the potential to be revoked for a variety of reasons, and the certification, if not renewed or if you lose your professional license, can also be taken away. If multiple certifications are earned, the most recently earned one is usually placed last. An example of an associate's degree, certified critical care, and med/surg nurse with a new case manager certification might look like, "Sally Jones, AD, RN,C, CCRN, CCM." This individual may or may not choose to use the AD for associate's degree after her name.
What next?
There are many degrees out there, and with lifelong learning a necessity, the number of degrees a person acquires will continue to rise. More than 90 different nursing certification credentials exist, and many people carry more than one. Plus, an innumerable number of certifications are available in other areas that can enhance your nursing background. However, it is an individual choice (except as mandated by the state in which you practice) as to what and how many of your other credentials you use and where and when you use them.
Patients have a right to know who is talking to them and caring for them. Educating the public about what your credentials mean is your responsibility. If you're applying for a particular job or giving an important presentation and the degrees and additional credentials will provide additional emphasis on your background and skills, by all means use them. You worked hard to get them, so use them to pay off for you.
Mary C. Smolenski, FNP, NP-C, EdD, is the director of certification services at the American Nurses Credentialing Center. She has 30 years of health care experience in a variety of positions, including consulting, education, military flight nursing, and primary care as a family nurse practitioner.