The First-Name/Last-Name Conundrum

We have a new physician at work. He is new, new, meaning just out of residency as well as new to our department. I introduced myself when I saw him because one of my peeves is people going all around treating patients where I work and I never know who they are. It just seems unprofessional. I said, “Hi, I’m Megen. I’m one of the full-time night nurses.” He said, “Hi, I’m Mike [name changed to protect the innocent]. Looking forward to working with you.”

Then I was stuck. He clearly had attended the “be nice to the nurses” class they have in medical schools now, but I happened to know that the medical director has a policy, which he either does not know about or disagrees with, insisting that nurses be addressed by their first names and the physicians by “Dr. Lastname.” I learned of it secondhand by hearing a former new physician told about it, and the reason given was that it makes patients more comfortable to hear this form of respect given. My (unasked) question was, “And they should not respect nurses for what reason?” The whole thing irritated me, and I could find no good solution. I don’t want to be called “Nurse Duffy,” so that equivalent was a nonstarter.

I do feel that patients appreciate knowing who is who when even the housekeepers wear scrubs, so using “Dr. Lastname” makes sense to me for that reason—similarly, for that reason, when I introduce myself to a new patient, I say, “My name is Megen, and I’ll be your registered nurse while you’re here.” This clearly defines my role in these days when people from CNAs to NPs call themselves “nurses,” and the “I’ll be taking care of you today” I hear so often does not cut the mustard. Everyone in the department will be taking care of the patient. She needs to know my role.

But all of that is provider-patient interaction. The departmental policy (policy!) of “nurses go by first names and physicians go by title and last name” applies also to provider-provider interaction and is offensive to me. I went to school too, and I might even know a thing or two. In my current department, everyone largely gets around this by using all last names, like the military, and many of us even have nicknames. However, at my last job, no nurse dared call a physician anything other than “Dr. Lastname.” I know from my friends who are physicians that many feel uncomfortable with this forced formality, but no one has a good solution. Perhaps “Dr. Lastname” at the bedside and then according to mutual agreement elsewhere?

That idea makes the most sense to me. The bedside is where physicians and nurses need to establish their roles, not only to with patient but with the patient. I was brought up right and still ask patients, “What would you like me to call you?” even though 98% say, “Oh, Dorothy is fine” or whatever it says on the band. But some like “Mrs. Jones” or “Bubba” or a middle name. We all negotiate what to call each other in a little linguistic healthcare dance with every patient contact. My question is, why can we not do this amongst ourselves? I do it already with new employees. “I’m Megen, but please call me Duffy because we have four Megans in this department.” I’ve told the person how to address me. How hard is that? The new physician could have said, “I’m Mike. Please feel free to call me Mike outside patient rooms but Dr. Somethingelse during patient contact.” Problem solved.

About Megen Duffy

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Megen Duffy, RN, BA, BSN, CEN, is a practicing nurse, blogger, and contributing editor for the American Journal of Nursing. Megen has practiced in a variety of settings from emergency rooms to prisons.