The 5 no-nos of alphabet soup

When I was in nursing school, one of my professors made it very clear that, no matter what areas of nursing we decided to go into, we would all be nurses. She also made it clear that, regardless of how many nursing positions we accepted away from the bedside, we would still be nurses. For this reason, she said we should always list RN behind our names before any other credentials—to show that we are nurses before anything else and to reduce workplace incivility among colleagues—ADNs vs. BSNs vs. MSNs, etc.

Because of that professor’s instruction, I wrote my name and credentials that way for years, until that fateful day when a well-respected colleague told me I was doing it wrong. I let him know why I listed my credentials in the order I did, but he didn’t let up. Because I completely respected him and his viewpoint, I decided to do a little research and found he was right.

Even before I realized I was incorrectly listing the pomp-and-circumstance letters behind my name, I had a real issue with the massive dissension those letters create among nurses. Rather than become too irritated by the squabble, I decided to joke about it and refer to the collection of initialisms that follow nurses’ names as “alphabet soup.”

The more letters the better, right? Not necessarily.

Look at websites that list names and credentials of more than a handful of nurses, and you will often find the letters behind names listed in various orders. The nursing profession does not mandate the “proper” way to list credentials. As with many of other areas of nursing, there is no consensus. Observing the inconsistencies this has caused in the alphabet soup that follows some nurses’ names has given me many a hardy laugh. I have literally seen it all. Below are my nominations for the five biggest no-nos when listing nursing credentials.

No-no #1: Listing your RN license first

While the rationale for why RN should be listed first made complete sense to me, most “how to” guides will tell you that the alphabet soup has a certain order—and for good reason. List your highest degree first, followed by your license and, lastly, a credential identifying a specialty you have, if any, in nursing. The rationale is simple: List your honors in the order they are most secure. In other words, you list your degree first, because it is the least likely credential to be revoked or taken away.

The credential that identifies certification in a specialized area is listed last, because it has to be renewed regularly, and you may either lose the certification, decide to let it go, or become certified in another area. The certification credential is more fluid than the others; one year you may have it, the next year you may not. With regard to your license to practice nursing—your RN credential—that’s listed second, because it’s more stable than a certification, but not as stable as an academic degree.

No-no #2: Listing every degree you ever earned

It's completely unnecessary to list within a string of credentials every degree hanging on your wall. I have seen some nurses list an associate degree followed by a nonnursing bachelor degree, followed by a bachelor of science in nursing degree. Here’s the thing: Your highest degree is the only one that truly matters. While it’s nice to write your life story in alphabet soup, that’s what résumés and curricula vitae are for. Some people rationalize that if they had a nonnursing degree prior to obtaining a nursing degree, it should be noted. Well, my thought on that is simple: If you are working as a nurse, unless that other degree is higher than your nursing degree, it is not essential to list it behind your name. If people want to see your nonnursing degrees, they can look at your résumé.

No-no #3: Listing more than one nursing license

This is probably the no-no that bugs me most. If you are an advanced practice nurse (APRN), we know you are a registered nurse, so there is no need to list both your RN license and your APRN specialty. It is also not a good idea to list APRN as your license, because there is no APRN license in nursing; the license is based on your specialty. When looking at your credentials, people don’t want to know that you are an APRN; they want to know what type of APRN you are. APRN is an overarching category that encompasses various types of nursing licenses—certified nurse midwives (CNMs), certified nurse anesthetists (CRNAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs). Also, listing both APRN and your specific APRN license—as in “Your Name, APRN, CNM”—is not only redundant, it’s unnecessary for the aforementioned reasons.

No-no #4: Listing more than one specialty certification

You may want to list all your certifications in the form of alphabet soup, but why not leave something for people to learn about later? Really, you only need to list one certification. Which certification you choose to list is completely up to you. I tend to think that nurses should list their most honored certification, the one that requires the most work to maintain, or the one that is most prestigious to other nurses.

For instance, if I were a fellow of the American Academy of Nursing (FAAN), I would list that and not my inpatient obstetrics certification (RNC-OB) from The National Certification Corporation (NCC). Also, it is important to remember that some certifications can be combined with your license, while others cannot. For example, women’s health nurse practitioners who have been certified can list WHNP-BC, in place of WHNP, and still include another certification in their alphabet soup. However, nurses who are certified as advanced forensic nurses need to list both their licenses and AFN-BC.

Nurses should be careful to list only those certifications that are nationally or internationally accepted. For example, although most labor and delivery nurses are required to maintain fetal-monitoring certificates issued by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), this certification should not be included in our credentials. To help distinguish between certifications that are credentials and those that are not, answer the following questions. If you answer yes to each one, you have a certification that can be listed as a credential.

• Did you have to pay extra money to obtain the certification (not to take a class, but to submit an application and take the test)?
• Did you have to take a test similar to the NCLEX-RN to obtain this distinction?
• Do you have to earn more CEUs than other RNs to maintain the certification?
• Do you have to show proof of CEUs or retake the certification examination to maintain the certification?
• Does the certification come from a national or international credentialing organization?

If you are still unsure, look for the proper way to list the certification on the certifying organization’s website. If no instruction is provided for listing the certification with your other credentials, it’s probably not the type of certification that should be included in your alphabet soup.

No-no #5: Listing non-specialty certifications

Unfortunately, I have seen nurses who list advanced cardiac life support or other required patient-care certifications among their credentials. What’s worse, I have even seen BLS—yes, as in basic life support—listed as a credential. Clearly, nurses who do this do not understand that a credential is a degree or certification that’s above and beyond anything required to work with their patients.

If you aren’t sure whether or not you’re certified, you probably aren’t. Certifications require an application process that is completely separate from each state’s nursing-license application process, and there is a test that must be passed. Such certification tests are similar to the NCLEX-RN, but they are each given for very specialized areas. A number of certifications can be found on the American Nurses Credentialing Center, while other certifications developed specifically for women’s health nurses, pediatric nurses, and nurse educators are found at The National Certification Corporation and the National League for Nursing, respectively.

As nurses, we have fought long and hard to receive certain distinctions based on our education. I agree with nurses who believe it is important to let others know of our commitment to our profession and our commitment to meet and maintain the highest level of distinction in our areas of expertise. However, to do so, we don’t need a list of letters behind our names that is long as the alphabet itself. I’ll use myself as an example. here:I list my credentials as “MSN, RNC-OB, C-EFM.” This lets others know that I have a Master of Science in Nursing degree. I am a registered nurse, certified in inpatient obstetrics by the NCC and with additional certification in electronic fetal monitoring, also from the NCC (this in addition to my AWHONN advanced fetal monitoring certificate, which is not listed among my credentials).

I encourage RNs to give a great deal of thought to their alphabet soups and list only: 1) their highest earned academic degree (in other words, it shouldn’t be an honorary degree), 2) one nursing license (with certification, if appropriate), and 3) one nationally or internationally recognized specialty certification. Not only is this the proper way to cite your nursing credentials, it also keeps members of our profession from looking like egotistical credential fanatics who only maintain certifications so we can list them behind our names.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.