The use and abuse of credentials: More is not better…

Many of us have been plagued by seeing signatures at the bottom of emails or business cards that appear more like ‘alphabet soup’ (https://online.alvernia.edu/program-resources/nursing-credentials/; accessed 3 January 2020) than something that is truly informative and/or understandable. There is a plethora of credentials that nurses might earn over the course of their careers. These include degrees (e.g., BScN, MScN, PhD), licensure (e.g., Registered Nurse (RN)), certifications/specializations (e.g., Certified Research Associate (CRA), Acute Care Nurse Practitioner (ACNP)), and fellowships (e.g., Fellow of the Royal College of Nursing, Fellow of the American Academy of Nursing, Fellow of the Canadian Academy of Health Sciences). Worse yet, it is becoming commonplace, particularly in the United States but also increasingly in other countries, to see the use by some authors of ‘PhD Candidate’ or ‘PhD (C)’ after their name. Though achieving the status of candidate (as is done in some countries) is admirable, placing the ‘credential’ after one's names looks clumsy and, in the case of the latter example, signifies copyright! More importantly, it seems to mislead, as often all we may note is the PhD. Surely people who use such terms are strictly postgraduate students. Normally the undergraduate nursing degree is of greatest interest as that is the entry to becoming a Registered Nurse. Attaining licensure is the entry to practice in the nursing discipline. Thereafter, nurses may earn graduate degrees in a variety of disciplines. While there are several, usually clinical, certifications available depending on the country of origin, nurse.org (https://nurse.org/articles/nursing-certifications-credentials-list/; accessed 3 January 2020), an American website, identifies 183 potential nursing certifications. (Canada currently has 22 (https://www.cna-aiic.ca/en/certification; accessed 3 January 2020)). Finally, nurses who have excelled in their clinical or academic careers may be awarded fellowships to certain societies or organizations. Certainly, identifying oneself as a credible authority or as one who has recognized expertise should be rather simple. Yet, it is not. Why individuals choose to make this exercise so complex is indeed puzzling. We are particularly troubled by the use of PhD (C). It smacks of indicating that they have attained or are on their way to attaining a PhD which, whilst the candidate might attain; they also might not! It also indicates a sense of insecurity on one hand and arrogance on the other. It is akin to putting FRCN (A) – FRCN (Applied for) or, as an extreme example, Nobel Laureate (D) – Nobel Prize (Dreaming of!). Following a recent exchange on Twitter prompted by one of us (RW) who asked what people thought about the use of the ‘C’ for candidate after PhD, there was an overwhelming response against this practice. However, there were some who defended it, and these were all, it transpired, people who may fall into the fictitious category of PhD (C). Two reasons appeared in favour of the ‘C’ and these were people who were ‘proud to be undertaking’ such a big thing as a PhD and others who indicated that in their institutions—after a particular process was undergone in the PhD journey—that they were then officially considered to be PhD candidates. One person was shocked that anyone would think that they were trying to mislead. We do not subscribe to either of these as being legitimate reasons for the use of the letters ‘PhD’, however qualified by a ‘C’, after anyone's name until the degree is earned and we advocate that it ceases. Being proud of undertaking a PhD is a worthy sentiment. However, we can be proud of taking part in a marathon and feel pretty pleased with ourselves in the course of the race. But, unless we complete the course, we have not completed the marathon and if we never complete such a course, we can never consider ourselves or describe ourselves, honestly, as a marathon runner. As for the official status of being a PhD candidate, while we do not doubt the veracity of this claim, we do take issue with using it in the form of a post-nominal and we do, most definitely, consider that inappropriate even if there is no attempt to mislead. Here, we make a plea for simplicity (and perhaps for humility) rather than complexity (and perhaps displaying self-importance) and hence ‘understand-ability’ for the reader whether they are practitioners, academics, or the public. The question then becomes: When and how does one identify that they have earned degrees, certifications/specializations, and/or fellowships in a clear, concise, and appropriate manner? In the UK, customary practice is to use the following order of post-nominals: Orders and Decorations conferred by the Crown or Government (i.e., CBE); university degrees (where more than one, listed in the order of the faculty from which they were earned—first degrees should be omitted if a higher degree is shown in the same faculty/university; professional registrations (i.e., RN, RM); fellowships or memberships of learned societies, academies or professional institutions (i.e., FRCN). So, an example would be: Sam Smith, CBE, BNurs, PhD, FRCN. Certificates are usually not shown but Diplomas may be. We make a final plea for keeping: (a) the listing of credentials simple, and (b) in the context for which the credentialing is listed. We appeal to our nurse colleagues to keep the ‘alphabet soup’ to a minimum by using only the credentials that are most salient and understandable by the audience. Absolutely include the licensure credential. However, it is not necessary to list all the degrees that one has obtained. List only the terminal degree, unless there is another degree of particular relevance (e.g., if the degrees are in different subjects, such as an MBA, MA, MPhil, MSc). Thereafter, particular certifications/specializations and fellowships should be identified judiciously.

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