Evaluation etiquette

A topic I have wanted to address for some time is teacher and speaker evaluations. I kept toying with the idea, but never acted upon it. Now is as good a time as any. I’m sure this post will resonate with educators and conference presenters, as well as other speakers.

As a nurse leader, I have had the opportunity to review many conference evaluations, including my own. As a teaching apprentice, I have become used to receiving quarterly student evaluations. Although most are positive and some are fairly constructive, there are always several that are downright mean. I’m not sure why members of the most trusted profession in the United States feel the need to anonymously bully their peers or superiors, but I see this as a trend.

Andrey Popov/iStock/Thinkstock

Two evaluations of presentations by me stick out like sore thumbs. The first came from an attendee of a major annual nursing conference. In presenting national legislation that supports teen pregnancy prevention programs, I spoke of a new law in California that prevents insurance companies from sending explanation-of-benefits (EOB) information to anyone other than the receiver of health care services. I observed that this was a great move for reducing teen pregnancy, because minors and young adults on parental insurance who consult a health care provider no longer have to be afraid their parents will be notified. In evaluating my presentation, one person wrote that he (or she) couldn’t wait until my 16-year-old daughter came home pregnant. I was devastated when I read this! How does advocating for reproductive health autonomy lead someone to wish such an unfortunate circumstance on my future children? Why would someone write something like that?

In another instance, a student wrote that I should be kept away from students because I made him (or her) sick. Again, what would cause someone to write something like this, especially since, in this case, I didn’t interact with the class enough to make anyone dislike me that much. What could I have possibly done that this graduate student was repulsed by my very presence? Not only was this comment hurtful, it made me wonder what kind of people we are preparing to care for those who are vulnerable?

I have seen or heard other inappropriate comments, including references to the presenter’s or instructor’s hairstyle, nail polish, and accent. Yes, someone actually commented on another person’s mispronunciation of a word! I still can’t believe some people are so petty.

If you’ve read enough of my other posts, you know I like to provide lists of action items to assist readers. Well, at this point, I thought it might be nice to remind you of a few important elements of properly written evaluations. Here goes.

Be constructive, not just critical.

If your comments won’t help the speaker become a better educator or presenter, keep them to yourself. Everyone who gives a presentation wants to do a good job, and most of us are open to constructive comments. Critical comments—especially those that refer to dress, style of hair, or pronunciation—are not only unwarranted, they are just plain mean.

Say about others what you would have them say about you.

We have all heard this advice in one form or another. Before commenting, stop and think, “How would I feel if someone were saying this about me?” Apart from the truly constructive comments I advocate above, if what you are preparing to write isn’t a comment you would want to receive, don’t write it. We are always representing our family, our employers, and the nursing profession. We should never act without considering those we represent. How would your employer feel if someone wrote about you what you have written about others? Keep these thoughts in mind the next time you fill out an evaluation.

Don’t write anonymously what you wouldn’t say directly.

Some people hide behind anonymity. It happens with social media, and it happens on evaluations. Just because your identity is concealed is not a good reason to write cruel remarks about someone. Maintain integrity even when commenting anonymously. After all, almost all evaluations—especially electronic ones—can be traced back to the author. Although many companies involved in processing evaluations won’t go to the lengths necessary to identify commenters, it can be done. So, when completing an evaluation, do so as if you are signing your name at the bottom of the page.

Put yourself in his or her shoes.

When completing evaluations, we should consider what it feels like to be evaluated. Giving a presentation requires a great deal of effort. Lecturing is no easy task. In addition to the preparation and travel time involved, a certain level of vulnerability comes with speaking in front of an audience. Imagine what that feels like. Then imagine, after giving your best effort, the horror of reading a comment that is completely devastating. Think of the embarrassment of knowing that what has been written about you is available for all of the organization’s top-level administrators to read. Imagine the confidence that needs to be rebuilt before you would be able to give another presentation, one that may very well be scheduled for the next week or even the next day. If we played these images in our minds prior to completing conference or classroom evaluations, we would be more kind with our comments.

It’s not about you.

This tip is not for evaluators, but those being evaluated. Unfortunately, the powerful impact of negative evaluations may discourage educators and other presenters from reading evaluations altogether. While I encourage my students and those who attend my conference presentations to complete their evaluations, I know many nursing colleagues who refuse to read them. After reading the negative comments that come with each set of evaluations, it’s easy to become disheartened. Even if there are only one or two nasty comments in a hundred, the mean, hurtful and negative comments are the ones that tend to stick with us. They are the ones we remember, the ones we dwell on. Still, try not to internalize them. They aren’t about you. Mean and inappropriate comments say more about the person who wrote them than they ever say about the person about whom they were written.

Wrapping it up

Evaluations are a necessary component of program assessment. It’s important that those involved in program development and members of curriculum committees receive meaningful feedback. Asking workshop attendees and students to provide that feedback is necessary to refine programs for better outcomes, but negative, unconstructive, and inappropriate comments are not helpful. Rather, they reveal the immaturity of certain attendees and students and, are not useful in making accurate assessments.

I hope I never see another nasty comment about a presentation or lecture I have given, but I know this is a big wish. More than anything, I want nursing students and fellow nurses to be compassionate with each other. I want us to be kind to one another. I’m not asking that we sugarcoat bad presentation styles or ineffective teaching, but we should be considerate in what we say. This isn’t too much to ask.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Grade inflation. (I'm against it.)

I love education—always have, always will. I love being a student. Learning new information, writing papers (yes, I actually enjoy writing papers), discussing with classmates interesting topics—I love it all.

In recent years, I have discovered my love of education from the perspective of an educator. I enjoy creating exams, suggesting curricula changes, and mentoring students. (I tend to have more of a love-hate relationship with grading papers, but that is neither here nor there.)

I get it!
Working as a teaching assistant is interesting, because I am neither the student nor the faculty member of record. I get to see things from both sides. I am closer in age to most of the students than the faculty members are, and, in all of my TA experiences except one, the faculty members are further removed from nursing school than I am. That said, I understand student anxieties and frustrations. “Honestly,” I tell them, “I get it!”

koya79/iStock/Thinkstock

What I don’t “get” is the overwhelming desire to achieve perfect grades. As an MSN-prepared nurse educator, I appreciate an exam that yields beautifully shaped, bell-curve scores. I understand that not everyone can or should receive a top score. I recognize that, on the NCLEX, more than one answer may be correct but candidates are examined on their ability to choose the best answers. I realize that the drive to have a perfect GPA should never supersede one’s drive to acquire excellent nursing skills.

I will admit that, as a nursing student, I loved it when an instructor granted extra points to compensate for a poorly written exam question. I even had one professor who gave an extra point to anyone who discovered a grammatical error on exams she gave. Free points were an unexpected surprise. However, as an educator, I do not agree with this practice. I think students should receive only the grades they earn. Call me Nurse Educator Hatchet, but I am not a fan of grade inflation, and I have no plans of contributing to it.

Once, after being questioned about the legitimacy of a grade I gave, I sent the following email to a student: I understand, trust me. I once cried in a professor’s office after receiving an A- instead of an A on a paper. I get it. I have also been a nurse for nine years, so I understand the insignificance of grades in “the real world.” Your worth as a nurse will not be rooted in your GPA. To be frank, your worth as a student isn’t, either. You are so much more than the grades on your transcript. Striving for excellence is always the best way to go. As a PhD student, however, I’ve learned that the pursuit of perfection can actually cause more harm than good. You all did a wonderful job in class. You received a well-deserved grade in a fast-paced course with material that is very different from what you are used to. Please don’t be too hard on yourself.

The bigger picture
I sincerely hope this student took my words to heart. We are not the sum total of our GPAs! We cannot allow ourselves to get so caught up in getting the best grades that we miss the bigger picture of getting the best education. As students, we don’t pay tuition with the expectation of buying a stellar GPA. We pay tuition with the expectation of being well-prepared to take the NCLEX or an advanced practice licensing exam.

I have witnessed, via social media, the disrespect of students unhappy with their grades. They say things about their instructors that I’m sure they wouldn’t say to these men and women in person. It seems that they think life is over if they don’t earn an A on every assignment or exam. I remind my students that I have never been asked to show my transcripts during a job interview. No one cared whether I received an A or a C in pathophysiology or pharmacology. In the real world, nurses are judged on their ability to provide appropriate care and to do it with a smile. On the hospital unit, grades are a nonfactor.

It's not just students
Students aren’t the only ones obsessed about grades. Some educators also obsess over whether they are perceived as a friendly, likeable instructor or a hard-grading one. Obsess as we may, we are not here to be our students’ friends. It is unethical to give exams after we have already given the answers to them, or to reward students with grades that don’t match their academic or clinical performance. We need to be supportive of one another and ensure that students actually learn the material we are required to teach. We are not in a profession where we can afford to allow students to enter the workforce unprepared.

I implore educators to take a good look in the mirror. Are we helping students by giving away unearned points? Should we continue to send nursing graduates into the workforce with an unrealistic assessment of their abilities by padding their grades? Are we doing the next generation of nurses any real favors when, to quiet the voices of students disappointed with grades they have earned, we change those grades? Are we giving outstanding students in our classes an opportunity to accurately represent themselves when we inflate grades of students who should be receiving median grades? No, no, no, and no!

I believe the answer to the current obsession with grades is to move from a letter-grading system to a pass-fail system. If grades were given in the same manner as NCLEX scores, students would not have to worry about their GPAs. I honestly believe such a shift in grading would do wonders for the morale of nursing students. Until a shift to a pass-fail grading system occurs—or if it never does—nurse educators must work to ensure students are given the grades they earn, while doing their best not to break the students’ spirits in the process. We need to build up nursing students, while helping them understand that their grades do not reflect their future careers as nurses.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Nurses are not second-rate physicians!

I am a nurse who absolutely adores my profession. I have no idea what I would be doing if I weren’t a nurse. There was no question in my mind which major I would declare when I began filling out my college application. I only applied to one school, and I chose one major—nursing. Each time I returned to school, it was to obtain another nursing degree. At one point, I entertained the thought of pursuing an EdD, but it was because I wanted to be the best possible nurse educator. No matter where I work once I obtain my PhD, I am a nurse first. I will always be a nurse. My passion for the nursing profession fuels my disdain for the idea that nurses are second-rate physicians.

People sometimes make the most asinine assumptions about why nurses go into nursing. I have heard it all. We weren’t intelligent enough to go to medical school. We didn’t want the liability that comes with being a practicing physician. We didn’t like science enough to become a premed major. Medical school is too expensive, and we didn’t want to spend a lifetime paying back the loans. I can’t speak for all nurses, but I take offense to these assumptions. I, for one, did not choose to become a nurse because life’s circumstances prohibited me from becoming a physician.

Nursing is not a steppingstone to a medical degree. In fact, the two disciplines are quite different from one another. Nursing is one discipline, medicine another. Physicians do not supervise nurses, nor is it required that physicians vet nurses. Nursing is a profession, not a trade. We have our own theories, schools within universities, professional organizations, and state boards. Physicians do not teach nurses, and they do not regulate our practice. A physician has never hired me and, unless I choose to work in a private practice, never will. Unbeknownst to the general public (or maybe just unbeknownst to me until I went to nursing school), nurses write their own assessments, diagnoses, and care plans. Nurses work with physicians, and, in most circumstances, not for them.

I know of a few nurses who decided to become physicians. There is nothing wrong with this, but it is not the norm. And I know very few nurses who went into the profession desiring to become a physician, but not doing so because of lack of intelligence or money. I have had a few physicians encourage me to go to medical school, but why on earth would I want to do that? I didn’t become a nurse to test the waters of the health care industry; I became a nurse because I wanted to be a nurse.

As a huge fan of the television show “The Waltons”—yes, my favorite TV show is one that went off the air before I was born—it upset me to no end that the writers decided to make Mary Ellen Walton a physician when she was already a nurse. Why was nursing not good enough to stick with? Did the character have to become a physician to gain status? What subliminal messages were the writers trying to send the show’s viewers?

I didn’t learn that Mary Ellen had decided to become a physician until I was already an RN. As a child, I saw Mary Ellen attend and graduate from nursing school, and I saw nothing wrong with that. To confirm her love of health care and her ability to act as an autonomous, intelligent, and caring health care provider, was it really necessary to change the character’s profession? Of course not! Nurses are all these things and more.

No matter how many times nurses are compared to physicians, I am not swayed to leave the profession I so dearly love. If I want to work as a primary care provider, I can do this as a nurse practitioner. If I want to work as part of an anesthesia team, I can do this as a nurse anesthetist. If I want to deliver babies, I can do this as a nurse midwife. Nurses can even become certified to work as first assists in operating rooms.

The profession of nursing offers so many possibilities. The ability of a nurse to move seamlessly from one specialty to another is unmatched. Nursing is a rewarding profession. Nursing is a well-trusted profession. Nursing is a profession in high demand. There are many things nursing is. A second-class profession behind the medical profession it is not.

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

Those who can’t ... teach?

While an undergraduate nursing student, I was introduced to the saying, “Those who can, do; those who can’t, teach.” One of my nursing professors said it’s a statement often used to negatively compare nurse educators to nurses involved in direct patient care. At that point in my education, I didn’t really think much about it. After all, I had no plans to become a nurse educator.

A year later, however, after completing my second year as a nursing student, my plans changed. I did decide to become a nurse educator, and went on to obtain a master’s degree in nursing education. However, despite having an education degree, I never actually worked as a paid educator … until now.

As a doctoral student, I am required to work as a teacher’s assistant, and I have quickly learned that studying teaching and learning theories, teaching methodologies and philosophies, and even learning the science behind creating an effective examination, is much different than actually putting this knowledge into practice in the classroom.

I began working with my assigned teaching mentor the summer before my first year in the program. She allowed me to have some input into the creation of the syllabus. I helped create the grading rubric for the students’ papers, and I was allowed to suggest references they could use when writing those papers. As a part of my teaching-apprentice class assignment, I was also required to teach the students one lesson. Although we were only required to teach for about 30 minutes or so, I taught the entire two-hour lesson that day. Preparation for that one lesson took weeks. I had never been responsible for an entire lecture and, although I enjoy speaking in front of audiences, there are so many things to consider when presenting information to impressionable freshmen and first-year transfer students.

If working on the syllabus and my one lesson plan wasn’t time-consuming enough, I had to help grade papers and quizzes, a much more in-depth process than I anticipated. Educators must take into consideration the reasons students miss certain quiz questions or interpret an essay question in a way the instructor had not intended. Grading papers was something I had never done before, and I struggled with it somewhat. Fortunately, the instructor I worked with was really good about sitting down with me to help me understand what is most important when assigning grade points to various aspects of student papers. She helped me frame my comments in ways that promoted critical thinking and didn’t make the students feel that I was chastising them for their writing. My experience with this instructor was so valuable that I decided to work with her again, this time as a paid teaching assistant.

My responsibilities as a paid TA are much greater than they were as a teaching apprentice. To be honest, I thought I was taking somewhat of the easy way out. I thought, “Hey, the syllabus and quizzes have already been created. What more is there to do?” I quickly learned that the answer to that question is, “A lot!” Good nurse educators update their syllabi and lectures annually. This year, in fact, we assigned an additional textbook, rearranged the order of the topics covered in class, and created a different format requirement for papers. We even changed up the rubrics a little, and we’re in discussion about increasing the amount and type of technology used during lectures. I’ve learned that teaching a particular class one time doesn’t mean you don’t have to prepare when the time comes to teach it again.

To those people who believe the old saw that “Those who can’t … teach,” I encourage you to forgo commenting on something you know nothing about. As someone who has worked on “the floor” for many years, I can honestly say that, for me, working in practice is much easier than working in education. No offense to anyone who works in a practice setting, but when you go home, you don’t usually take your work with you. You don’t mull over lesson plans for weeks (or possibly months) before giving a lecture. You don’t wonder how the information was received during those lectures. You aren’t concerned about the reason a certain student hasn’t shown up in class for two weeks. You don’t keep up on the latest literature so you can incorporate some of it into next year’s syllabus. You don’t clear your night or weekend schedule so you can sit at home and grade tons of papers multiple times each term. You don’t counsel students who are having issues adjusting to college life. You don’t go home at night wondering if you said the right thing during office hours. You don’t; you just don’t!

Now, this isn’t to compare the relative importance of practice and education, because they should not be compared. Both areas need dedicated nurses who are committed to the work involved. Now that I have worked in both settings, I can honestly say that teaching is the most difficult, yet rewarding, job I have ever taken on.

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

Stay-at-home mom, with a PhD

Now that I’m coming to the end of my first year as a doctoral student, I’m beginning to wonder what type of position I want to take on once I complete my degree. My dream job is to work as a researcher in teen-pregnancy prevention. I love teaching, so I’d like to do that, possibly on the side. If I could create my own position, I’d work full time as a researcher for a government agency or other non-profit organization and part time as a women’s health nursing instructor. But here’s the catch. I don’t want to work full time right away; I’d much rather spend the first few years after graduation starting a family.

I make no secret about the fact that my desire has always been to be a stay-at-home mother while my children are small. I want to have the opportunity to raise them without interference from a child-development or day-care center, at least until they are ready for preschool. When I make these types of statements aloud, I see the furrowed eyebrows of my colleagues. I used to get offended, but now I think it’s pretty funny. I don’t know why people assume that, just because I am in a doctoral program and want to establish a career in research, I also want to be a full-time career woman. The reality is this: If I am in any position to be a stay-at-home mom, I will be at home with a PhD.

Women have made important strides in employment over the past 50 years. I can appreciate all the struggles they had to go through so that I have the opportunities I have today to climb the corporate ladder. I am keenly aware of present-day gender imbalances in male-dominated career fields, so I understand the difficulties other women go through. I don’t have to deal with too many gender differences as a nurse, I’m thankful to say. (I will admit that I recently became aware that male nurses may come in at a higher salary and move up the ranks quicker than female nurses, but that may be because of their desire to show they are as capable of being good nurses as women. Who knows?) But my appreciation of past and present struggles of women who work outside the home is not enough of a reason for me to give up my own dream of being a stay-at-home mom.

One of the great things about nursing, especially for a person like me, is the flexibility the nursing profession offers. Even as a full-time staff nurse, I could work two to three days per week (12-hour shifts, of course). To be a full-time employee, yet stay at home four or five days per week is a pretty good deal, if you ask me. There’s also the option to work from home. As one of my classmates stated, “If you have a computer, you’ll be fine.” There are lots of nursing jobs that allow nurses to work from home. I can teach online, for example. There, I get the best of both worlds—I can continue to gain experience in my career and still be a stay-at-home mother.

If I had to give my honest opinion, I’d say earning a PhD opens—not closes—the door to stay-at-home motherhood. Nurses with doctoral degrees have many more career options than nurses who practice at the bedside. It is also my opinion that women should not feel pressured to work full time outside of their homes just because gender inequalities are less today than in times past. Women should feel free to work outside the home, stay at home to care for their children or otherwise work at home as they please.

A mother who chooses to stay at home the first few years of her child(ren)’s life/lives is no less committed to her career than a mother who chooses to return to her place of employment following her six-week postpartum visit. As members of a profession that is comprised mostly of women, we shouldn’t judge one another for wanting to take time away from our careers to tend to our families, nor should those of us who do make that choice impose our beliefs of familial importance on those who choose to sidestep traditional maternal roles to be full-time career women. To each her own.

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

Work hard, play harder

Nurses work very hard. We do a great job of caring for others, but tend to cut corners when it comes to caring for ourselves. We work long hours, in sometimes not-so-great conditions, and we rarely take the time needed to rejuvenate. We do our best to please our doctors, our patients and upper management. But why don’t we take time to please ourselves? We have to learn that it’s OK to take out “me time,” and we have to make a conscious effort to protect that time. If we are no good to ourselves, how can we possibly be any good to others?

I have spent the vast majority of my nursing career caring for the needs of others while putting myself and my needs on the back burner. Last year, when I finished my master’s degree, I promised myself I would celebrate this accomplishment. I realized how long I worked toward the degree and how much time and energy I sacrificed to get through the program. I worked full time while in my MSN program, and I often picked up extra shifts to help the unit. I didn’t take out as much time as I should have for myself during the 2 1/2 years it took to finish the program. But once I walked across the graduation stage, I planned to party hard!

About two weeks after graduation, I went on a short vacation to Cabo San Lucas with my friends. We had a wonderful time hanging on the beach, eating at various restaurants, riding jet skis and parasailing.

Tiffany and friends

Sometimes, you need a break!

About six weeks after our trip to Mexico, my friends and I traveled to Jamaica. This was the first time I had ever flown over the Atlantic Ocean. I had never been on an island before (unless you count Alameda, a small island in Northern California). It was exciting and refreshing. It was nice to stay at an all-inclusive resort for the first time. It felt good to be away from the stresses of work life. I love what I do, and I am definitely living my dream of working in women’s health, but sometimes you need a break. Jamaica was just the break I needed.

After having such an amazing time in Cabo and Jamaica last year, I planned a cruise to the Western Caribbean for 2011. The trip was planned long before I sent my application to UCLA, but once I was notified that I had been accepted into the PhD program, the trip became my official “last hoorah” before going back to school. I had a blast! My friends and I were able to leave the care of our home and work lives on the dock in Miami as we set sail to four beautiful foreign countries.

At Altun Ha in Belize

As nurses, we must value and appreciate any time we have to ourselves. We spend hours upon hours each week pouring out ourselves into others. We have to take the time to fill ourselves back up. We must learn to say no, when the requests will take away from our time. Yes, we love our jobs, we love our patients, and we desire to lend a helping hand to our co-workers, but if we don’t ensure we are taken care of, who else will?

So, use your vacation time to take vacations and your life-balance time to balance your life. We need a healthy balance between work and home life. We need to learn that it’s OK to take pride in time spent away from work. I’ll be the first to admit that it takes a bit of effort to take time away from caring for others to care for your self. But, I have finally learned to stop revolving my life around work and start revolving work around my life. I work hard, and I am making a commitment to play even harder.

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

Doctor nurse

I have taken hold of a few interesting ideas regarding the term “doctor” since beginning my PhD studies. These ideas stem from my experiences with friends and family and also from my increased knowledge of terminal degrees and the basis upon which they are conferred.

As more and more of my family and friends began to refer to me by the nickname “Dr. Montgomery,” I noticed that others seemed to assume I had made the choice to go to medical school. Now, I have never told anyone that I have a goal of becoming a medical doctor (because I love being a nurse and would never choose to go into medicine), but that is the general assumption. The more this type of awkward situation occurred, the more I began to question the reason for the misunderstanding.

It has been my experience that, outside of an academic setting, a person introduced as “Doctor X” is assumed to be a medical doctor. Why is this so? The terms “doctor” and “physician” are not synonymous, but apparently to the general public they are. If we look at the first definition for the terms “doctor” and “physician” in Webster’s Dictionary, they are as follows:

• Doctor—(a) an eminent theologian declared a sound expounder of doctrine by the Roman Catholic Church, (b) a learned or authoritative teacher, (c) a person who has earned one of the highest academic degrees conferred by the university, (d) a person awarded an honorary doctorate by a college or university.
• Physician—a person skilled in the art of healing; specifically: one educated, clinically experienced, and licensed to practice medicine as usually distinguished from surgery.

Looking at the above definitions, it is clear that a doctor and a physician are not one and the same. So again, why is it a general assumption that all doctors are physicians? The truth of the matter is this: All physicians may be doctors, but not all doctors are physicians. Doctors come in many shapes and sizes, and they may have earned one of many degrees: Doctor of Philosophy (PhD), Doctor of Nursing Science (DNSc), Doctor of Education (EdD), Doctor of Pharmacy (PharmD), Doctor of Psychology (PsychD), Doctor of Dentistry (DDS), Doctor of Music (DM) or Doctor of Medicine (MD).

Recently, I read a New York Times article titled “Calling the nurse ‘doctor,’ a title physicians oppose.” This article reveals physicians’ concerns that patients will become confused if nurses with doctoral degrees begin to identify themselves with the title “doctor.” According to the writer, physicians in the State of New York have even gone to the state legislature to enact a law that forbids nurses to use the term “doctor,” regardless of the type of doctoral degree they have earned. This to me is ludicrous.

I believe that a nurse who greets her patients by saying, “Hello, my name is Dr. Tiffany, and I am your nurse practitioner,” is not causing any confusion. If a short discussion regarding the nurse’s level of education ensues, this type of introduction may actually make the patient more comfortable. Nurses who have attained doctoral degrees, but remain practitioners at the bedside, should be proud of their accomplishments. By all means, if you have earned a doctoral degree, introduce yourself with the appropriate title!

Physicians do not own the rights to the title “doctor.” Anyone with a doctoral degree, whether a practice degree (i.e., MD or DDS) or a terminal degree (i.e., PhD), has the authority to use the title “doctor.” Nurses with doctoral degrees have long been referred to by their professional title in the academic setting. It is obvious that the recent introduction of the nursing practice degree (Doctor of Nursing Practice, or DNP) and its attainment by nurses who wish to remain in direct patient care has ruffled a few feathers. For this reason, it is the responsibility of every nurse to help patients understand the difference between a doctor and a physician.

When people ask if I’m in school to become a doctor, I let them know that, once I earn my PhD, I will be a doctor, but not a physician. I am quick to inform my friends and family that I am a nurse and will always be a nurse. Nursing, for me, is not a steppingstone to medical school; nor am I abandoning the profession in pursuit of a doctoral degree. The reason nurses become doctors is to become better researchers, teacher, and clinicians. Those of us pursuing PhDs in nursing want to understand the philosophical underpinnings and framework of the nursing profession and add to the state of nursing science. We have no intention of practicing medicine or posing as physicians. We desire to be learned and authoritative teachers of nursing. We desire to be doctor nurses.

Reference:

Harris, G. (2011, October 1). Calling the nurse ‘doctor,’ a title physicians oppose. The New York Times. Retrieved from http://www.nytimes.com/2011/10/02/health/policy/02docs.html?_r=1&pagewanted=all/

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

I'm going to Disneyland!

After working as a labor and delivery nurse for 2 1/2 years, I decided it was time to head back to school. It wasn’t a hard decision to make; after all, I’d spent the better part of 18 years in an academic environment, and the 2 1/2 years I spent working full time made me long to be back inside a classroom. So, I went to back to school, complaining about how long it was going to take to finish. There were many days of seemingly relentless stress and nights when I burned the candle the whole night through but, before I knew it, I was lining up to walk across the graduation stage. They called my name—“Master of Science in Nursing … Tiffany Monique Montgomery,” I shook the hand of the college president and walked off the stage. Now what?

Before the start of my last year of the MSN program, I began to throw around the idea of going back to school one last time for my PhD. The thought of obtaining a PhD was somewhat of a fairy tale but, once graduation was over, it became an idea that was very real. I began to think about my high school ROP* instructor, who told me that each level of my educational process would be a little easier than the level before.

When I was an anxious high school senior preparing for graduation and not knowing what life as a college student would hold, she told me my high school diploma was the most taxing diploma I would ever earn. At the time, I thought she was nuts, but now, as I looked back, I understood what she meant. Each time I graduated and decided to return to school, I was studying something I wanted to study—something I was interested in, something I got excited about, something that made me want more knowledge. She was right; each diploma was a little easier to obtain than the one before, not because the coursework required less effort, but because my hunger for knowledge was a little stronger. After reflecting on the words of my ROP instructor, I decided I would allow my education to take me as far as I could go. I was going to earn my PhD!

I began the application process the same day I attended the PhD program orientation at the University of California, Los Angeles (UCLA). When I walked into the orientation, UCLA was one of two universities I was considering to pursue my PhD. By the time I left, I had decided it was the only program I would apply to and, if I did not get in on my first try, I would continue applying until the university accepted me. That evening, I created my profile on UCLA’s online application website. I completed as much of the form as I could and began piecing my statement of purpose together. Little did I know at that time, I would be logging on to the site multiple times each week, and my statement of purpose would be revised almost every other day.

I learned during the program orientation that, after applying to the PhD program, meeting with current professors to discuss potential research areas is a good place to start, so I scheduled meetings with two nursing professors. Before those meetings, I thought I wanted to study nursing education, but they inspired me to study an area of nursing that I loved and not simply list an interesting research question in my statement of purpose.

It didn’t take long to acknowledge the area of labor and delivery I loved most—working with teenage patients. Don’t get me wrong, I don’t like the fact they are pregnant, but caring for a pregnant teen brings out a sense of compassion and motherly protectiveness that I never felt when caring for adult women. I realized my desire, more than anything else, is to prevent teenage girls from having to face the harsh realities of motherhood. This is when my research focus changed from issues in the labor and delivery triage unit to teen-pregnancy prevention.

I wrote and rewrote, edited and revised my statement of purpose more times than I can count. Fifty revisions is probably on the conservative side. I changed the order of some paragraphs and completely deleted others. The part of writing the statement that I found most difficult was discussing my personal achievements. I understood that, because the PhD program does not include an interview as part of the application process, I had to “sell myself” on paper. But no one has a more difficult time than me when it comes to boasting of my accomplishments. While I enjoy keeping my friends and family abreast of my latest professional endeavors, I am not one to brag. I reviewed an early version of my statement of purpose with one nursing professor who told me I needed to do a better job of marketing myself. So, I went back to the drawing board and, as difficult as it was, I boasted of some of the wonderful successes I have experienced.

After working on my application for about two months, I finally pressed the Submit button. All of the transcripts had been mailed and letters of recommendation requested. Now, all I had to do was to wait … and wait … and wait. Waiting was, by far, the most challenging part of the entire application process. Once, during the waiting period, my mother asked me, “What are you going to do when you get in?” I remembered the old commercials from my childhood featuring Super Bowl champions, and I replied, “I’m going to Disneyland!”

Waiting to hear back from the school seemed to take forever, but that fateful day finally came. When I learned that I had been accepted to the program, I was overjoyed. I can’t quite put into words the way I felt. My dreams were coming true. Not long after word of my acceptance came, I was informed that I had also been awarded a fellowship. This was news I could not prepare for; for about a week, I felt like I was in a dream. Every time I told someone my good news, I smiled uncontrollably and wanted to pinch myself to make sure I wasn’t dreaming. I’m still in shock and in awe that I am entering a nursing PhD program in a few short months, and my tuition is already paid for.

When I was a high school senior, you couldn’t have paid me to believe I would someday be accepted into a PhD program. Me? No, not me! I’m the young woman from a broken home in Long Beach, California, who almost didn’t go to college because my mother couldn’t afford it. I wasn’t poised to become a nurse researcher then, but here I am, 11 years after my high school graduation, remembering the wise words of my high school ROP instructor and looking forward to all of the struggles and triumphs this PhD program will bring.

Disneyland, here I come!

*Regional Occupational Program (ROP) is a career-training program for high school students.

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