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To the Editors:

Your editorial titled "Doctor of Nursing Practice—MRI or Total Body Scan?" (2005;14:278–281) was a thought-provoking, well-balanced essay on a very important topic. I would add another perspective that argues against the development of yet another nursing degree. I act as an expert witness on a variety of legal cases involving nurses and other healthcare professionals. Often, the key issue is scope of practice and a lack of understanding of who is responsible for which facets of patient care. It is alarming that the word "nurse" has become so generic and meaningless that patients can mistake a nursing assistant for a nurse practitioner. Even other healthcare professionals can lose sight of the responsibilities inherent to each level of "nurse." Often, it seems as though all women working in the healthcare setting who wear white uniforms or scrubs are referred to as "nurses" despite their true professional title (LPN, RN, NP, CNS, etc). These distinctions are not there to make us feel more important; they are there to identify responsibilities, define limitations, and protect the patient. The lack of distinction between roles can result in tragic consequences for patients. But the consequences also accrue to the individual nurses, physicians, and providers who must also endure the lawsuits when things go awry. To make the advanced practice continuum even more confusing with yet another degree would be ill-advised. I can’t tell you how many times patients—and other healthcare professionals!—look at the title on my name pin with pure puzzlement: How can I be a nurse (RN) and a doctor (PhD)?

We have done a poor job in making distinctions between nursing levels in the past. We might be better served by clarifying and explicitly naming the levels to ourselves, patients, and other healthcare providers before we engage in discussions about adding another title.

Mary Caldwell, RN, PhD
San Francisco, Calif

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