One of the first questions I am asked by attorneys as an expert witness is, “what do all those letters behind your name mean?” Nursing is a unique profession with its own designations and regulations, and credentialing is an essential part of the nursing practice. The order of specific designations after a nursing expert’s name can provide information on education and experience, thus establishing his or her credibility as an expert.
The four basic categories of nursing credentials are:
- Educational degrees
Educational degrees are earned at a college or university. These degrees cannot be changed or taken away.
Undergraduate programs for nursing include:
- Licensed Practical Nurse (LPN), a one-year training program that focuses on basic nursing skills.
- Associate Degree in Nursing (ADN), a two-year program that prepares students for the Registered Nurse (RN) licensing exam, but does not include management, leadership or graduate study.
- Diploma nurse, a 3-year, clinically-focused training program that has been phased out in most of the US. Graduates would also go on to take the licensing exam in order to become a Registered Nurse.
- Bachelor of Science in Nursing (BSN), a 4-year degree program offered at universities. This is the desired standard entry level into practice for Registered Nurses.
For graduate education, nurses typically earn a Master’s of Science in Nursing (MSN), which requires two additional years of study after the BSN. An MSN is required to teach in most states in the US. Nurses with an MSN usually have an emphasis such as administration, education, or clinical practice as an advanced practice registered nurse (APRN).
APRNs are expert clinicians. The four main APRN roles are nurse anesthetist, nurse midwife, clinical nurse specialist (CNS), and nurse practitioner (NP).
Lastly, the two major doctoral degrees earned by nurses today are the PhD (Doctor of Philosophy in Nursing), which is the universally accepted and recognized terminal research degree. Nurses can also earn a Doctor of Nursing Practice (DNP), the clinical practice doctorate.
Licensure is required to legally practice as a nurse. To become licensed, a nurse must graduate from an accredited program and pass the state licensing exam. Nursing practice is governed by individual states, but your expert may be licensed to practice in more than one state. For APRNs, some states require a second license to practice
Most attorneys prefer their expert witness to be an RN versus an LPN.
Certification is a prominent means for nurses to demonstrate expertise and mastery in a specialty area. There are dozens of certifications available in many specialty areas. The American Nurses Credentialing Center is one of the major bodies that offers certification, and certification in any specialty area (such as orthopedics, rehabilitation, critical care, pediatrics, wound/ostomy etc.) generally requires a specific number of years of experience in that field.
Some certifications require a certain level of education, or proof of completing a particular curriculum. All initial certifications mandate that the nurse pass a certification exam, and most renew either by exam or portfolio every 4-5 years, alongside a practice requirement.
Fellowships in nursing are similar to those in medicine. Being granted fellow status in any organization requires that the nurse meet rigorous criteria. Fellowships are thus considered an honor and a sign of prestige.
To become a Fellow in an organization, the nurse must have demonstrated outstanding service, commitment, and expertise in a specific area. One of the most coveted fellowships is Fellow of the American Academy of Nursing (FAAN). Only about 1% of nurses in the US are part of this elite group that represents the most distinguished leaders in the nursing profession.
The best acceptable order for credentials listing in nursing can help attorneys decipher the meaning of the many designations behind an expert’s name. The highest degree is listed first (with lesser degrees not listed), followed by the professional license, certifications in the order received, and then fellowships. Consider what you can learn about this nurse expert by her credentials:
Sally Smith, PhD, DNP, RN, CCRN, AGCNS-BC, AGACNP-BC, FAHA
We can see that Sally Smith has two doctorates and has thus has achieved the highest level of education both in research and practice. Dr. Smith may also hold an MSN and BSN; only her highest degree is listed. The attorney should obtain her current CV for more complete information.
She has a CCRN, meaning she is certified as a critical care nurse. We can also see that Dr. Smith is Board Certified (BC) as both an adult/gerontology clinical nurse specialist and an adult/gerontology acute care nurse practitioner. Lastly, Dr. Smith is a Fellow of the American Heart Association.
By looking at Sally’s credentials, we can be confident that she is highly educated. Her PhD means she is a researcher so she knows the current standards of care, and her DNP tells us that she understands evidence-based practice in her area of expertise. She is an expert in acute care, critical care, has worked with adults and older adults in acute care settings at an advanced practice level and most likely has prescriptive authority (can write prescriptions for medications). As a nurse practitioner, she would diagnose and treat uncomplicated conditions in her area of expertise. In the clinical nurse specialist role, Dr. Smith is board certified to function in teaching, organizational systems management, and patient care. She has some expertise related to heart disease and/or stroke because of her Fellow status with the American Heart Association. Sally would be highly qualified to provide an expert opinion on a variety of cases in acute care nursing in a hospital setting.
When choosing your best legal nurse consultant, it is important to recognize and examine the credentials of your expert. Do not hesitate to ask the meaning of the various designations, as these will assist you in finding the best fit for your case.