US nurses warn of dangerous disrespect amid ‘doctor’ title row

California prosecution of nurse with doctoral degree held out as sign of academia’s wider failure to treat profession seriously

September 3, 2023
Nurses looking at chart
Source: iStock

The chief US nursing association is protesting against a California law that forbids the use of the term “doctor” by nurses with doctorates, calling it part of a dangerous failure in academia and beyond to respect advanced degrees in the patient care profession.

One nurse, Sarah Erny – who earned a doctorate of nursing practice at Vanderbilt University – accepted a court settlement requiring her to pay $19,750 (£15,700) after local prosecutors accused her of illegally implying that she was a medical doctor by publicly calling herself “Doctor Sarah Erny”.

The case reflects a longstanding and costly disrespect for the female-dominated nursing profession, said Jennifer Mensik Kennedy, an assistant professor of nursing at the Oregon Health and Science University who serves as president of the American Nurses Association.

That dangerous inequity is seen across higher education, Dr Mensik Kennedy said. The US has about 5 million nurses, but only about 2 per cent of them have doctorates, which are important qualifications for both improving nursing practices and training new nurses, she said.

And with nurses leaving the profession in large numbers after the stress of the Covid pandemic, the US by 2030 could be about 1 million short of the numbers it needs for an ageing population, according to published estimates. The shortfalls are the result of a variety of factors, including perceptions among both the general public and their own medical colleagues in academia that nurses occupy “a lower rung of the same ladder a physician is on”, Dr Mensik Kennedy said.

“And really, we’re on two different ladders”, performing different functions, Dr Mensik Kennedy said. Physicians study medications and surgical procedures, while the nursing profession “really looks at human condition and human responses, and how we can prevent things, how we can improve things”, she said.

Nurses with doctorates also teach most classes for US students training to become nurses, Dr Mensik Kennedy said. But low teaching salaries – nurses could face a pay cut of up to 50 per cent for taking a faculty job – are helping to drive the nation’s nursing shortages, she said. “There’s not a lot of incentive, outside of the love for the profession, that might make you want to go and be a faculty,” Dr Mensik Kennedy said.

The value of nurses as academic researchers, meanwhile, is celebrated across the profession in cases such as Barbara Braden, a long-time Creighton University faculty member who helped to devise the Braden scale, a widely used tool for assessing skin breakdown in elderly and bedridden patients.

Dr Braden, who died this summer, endures as a role model for advanced degrees in the profession, Dr Mensik Kennedy said. “Nursing needs to continue to get more PhDs to do more research that really looks at how do we improve patient care,” she said.

Such problems of respect and resources fuel shortages all along the production pipeline, in both facilities and instructors, said Pam Eddinger, president of Bunker Hill Community College in Massachusetts. “Right now, we are struggling on all fronts,” said Dr Eddinger, whose institution graduates about 70 registered nurses annually.

California prosecutors said they brought the case against Dr Erny because of a state law – one of the strictest in the nation – that sharply limits the use of the term “doctor” or “physician” to avoid confusing consumers.

While Dr Erny settled the government complaint against her, three other California nurses with nursing practice doctorates responded to her case by filing a lawsuit against state officials seeking to end such enforcement actions.

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Reader's comments (2)

This is not about disrespect but about not confusing patients. A PhD is not a medical degree and maybe the answer is that academic titles only be used in academic environments and not in hospitals.
To me, a 'doctor' is someone who holds a doctorate, not a medical practitioner... the US situation is slightly different as far more use is made of taught doctorates, so you get an MD for completing a medical degree, a JD for completing a law degree, a DVM for completing a degree in veterinary science and so on. Here in the UK, a medical degree is a bachelor's degree (MB BCh or variants), and it's interesting to note that at Aston, where academic dress is based on the level of degree not the discipline studied, the first medical school graduates wore the same bachelor's gown as all the rest! Calling a medical practitioner 'Doctor' is a courtesy title hereabouts, unless they have completed original research and presented it for a PhD.