Abstract
As nurses seek to advance their educational preparation to prepare them for the practice realities of today, many have sought advanced degrees and earned additional credentials. The Journal of School Nursing publishes articles written by school nurses and other health professionals, as well as those authored by writers and researchers from education and related fields. Many of the authors have a string of letters after their names, indicating their educational preparation and other credentials. Many times, these credentials are a mystery, even to me the editor. I have been known to e-mail authors to find out the meaning of the credentials behind their names. In the December 2002 issue, the Journal acknowledged the reviewers who give their time in critiquing manuscripts submitted for publication. In going through this list, I noticed many credentials unfamiliar to me. Again, I e-mailed a number of the reviewers, requesting them to tell me the meaning of those letters—which affectionately have become known as “alphabet soup.” The purpose of this editorial is to help readers decipher the cornucopia of letters floating around in the proverbial alphabet soup.
The degrees granted for basic education in nursing are familiar to most nurses, such as ADN (Associate Degree in Nursing) granted to associate degree nurses after their 2-year program. For those graduating from baccalaureate programs in nursing, the BSN (Bachelor of Science in Nursing) is the most frequently granted degree. However, many nurses return to school to receive a bachelor’s degree in areas other than nursing; therefore, one may see other degrees, such as a BA (Bachelor of Arts) or a BS (Bachelor of Science). I graduated from a baccalaureate program in nursing that granted a BS in nursing, not a BSN, and people have been trying to correct this on my curriculum vitae for years, not realizing the diversity of degrees offered to nurses.
The degrees offered at the master’s level are even more diverse, with MSN (Master’s of Science in Nursing) being the most common. However, there are schools that grant MN (Master’s in Nursing), MS (Master of Science), and MA (Master of Arts). A number of nurses also have received master’s degrees in related areas and have an MEd (Master of Education), MPH (Master’s in Public Health), MBA (Master of Business Administration), or an MA or MS degree from a wide range of programs such as psychology, sociology, microbiology, education, or health administration. Therefore, it becomes more difficult to know just what those degrees mean because, although the letters may be familiar, they do not give any indication of what the degree was granted in and hence the area of expertise of the nurse. In addition, even an MSN does not show the area of specialization—which could range from child health nursing to gerontological nursing or from nursing administration to informatics.
Nurses who have earned their doctorate in nursing also present the same dilemma because many institutions grant different degrees depending on the policies of the university and the nature and purpose of the doctoral programs. The DNS and DNSc (Doctorate in Nursing Science) are offered by schools where the emphasis is on preparation for leadership in clinical practice, whereas the PhD (Doctor of Philosophy) is offered by programs where preparation to become a researcher is a major objective. However, as programs have evolved, it seems that there is considerable overlap of purposes in programs offering both the DNS and PhD degrees. Many nurses also earn doctorates in related areas for a variety of reasons. Sometimes the program selected is the one that is geographically or financially accessible. Other times, the nurse may find that his or her interests or career goals are more aligned with another area of study. Before doctoral programs in nursing became available to nurses in the late 1980s and the 1990s, many nurses received their degrees in education, psychology, anthropology, and administration, as well as in other related areas. Today doctoral study in nursing is more widely available, and many nurses are able to tailor their programs to their career goals. For many school nurses, this may include a focus on child health, public health, administration, or research in school health. There are many options available that are relevant to school nurses because of the wide scope of school nursing practice. However, the DSN or PhD degree does not reveal anything about the specialization of the persons having those credentials behind their name. I recently contacted a reviewer to inquire about her credential, MPA, which she informed me was a Master of Public Administration, a degree designed to prepare individuals for high-level public administrator jobs in local, state, or national government—sounds pertinent for school nurse administrators. She further informed me that she had just completed her DPA, a doctorate in public administration, a program attractive to nurses who work for state government agencies.
To complicate the matter, the rise in nurse practitioner and other certification programs, usually at the master’s degree level, has added a plethora of letters to the mix in our pot of alphabet soup. Most familiar are PNP (Pediatric Nurse Practitioner), FNP (Family Nurse Practitioner), GNP (Gerontological Nurse Practitioner, and CNM (Certified Nurse-Midwife). These certificates are granted after a specific practitioner program, often part of a master’s degree program in nursing. In addition, a host of certifications are available today to nurses who have had clinical experience in a specialized area of practice, have specialized education, and pass a certification exam. The American Nurses Credentialing Center (ANCC) certifies nurses in 40 specialized areas. Since 1991, they have certified more than 151,000 nurses (ANCC, 2002). Today nurses can become certified through the ANCC or other specialty organizations in diabetes education, oncology, ostomy care, mental health nursing, nursing informatics, and occupational health nursing, as well as many other specialties.
Many states not only provide licensure as an RN (registered nurse), indicating that the nurse has a minimal level of knowledge to practice safely, but they also offer ARNP (Advanced Registered Nurse Practitioner) licensure to nurses who have passed certification exams in specialty area, indicating a high level of expertise (NASN, 2002). Board certification (BC) is awarded by the Board on Certification for Baccalaureate Nursing Practice and the Board on Certification for Advanced Nursing Practice of ANCC, whereas Certification (C) is awarded by the Committee on Certification for Diploma and Associate Degree Nursing Practice and the Committee on Modular Certification (ANCC, 2002). The ANCC Web site gives information on the many certifications offered by this organization and an explanation of the credentials. For example, Martha Dewey Bergren, the Information Technology Section Editor of the Journal, recently became board certified in nursing informatics, adding BC to her list of credentials. Unfortunately, ARNP, C, and BC do not communicate what the certification signifies.
School nurses can become nationally certified by meeting the criteria for certification and passing the certification exam of the National Board for Certification of School Nurses (NBCSN). In October 1999, the designation C.S.N. (Certified School Nurse) was changed to NCSN (National Certified School Nurse) (Gregory & Marcontel, 2000). This change was made for a number of reasons, including the need to eliminate the confusion between individual state and national certification (for a detailed description of the certification requirements for each state, see Constante, 2002). The NBCSN exam is available to experienced school nurses with a baccalaureate degree. This certification shows distinction and a mark of excellence for experienced school nurses. Gregory and Marcontel (1999, 2000) describe the history of school nurse certification, the examination process, and the advantages of certification.
Nurses who have had a distinguished career in nursing and have made outstanding contributions to a specific area of nursing may be elected as a Fellow of the American Academy of Nursing, adding FAAN to their credentials. This is one of the highest honors that can be bestowed on a nurse, signifying outstanding service to the profession. In October, Judy Robinson, the Executive Director of the National Association of School Nurses (NASN) was inducted as a Fellow in the American Academy of Nursing, recognizing her contributions to school nursing. In addition, NASN selects outstanding members to become Fellows in NASN (FNASN), recognizing their leadership and contributions to the specialty of school nursing. You will note that a number of members of the Editorial Advisory Board and reviewers of The Journal of School Nursing have achieved this distinction. You will also see FASHA (Fellow of the American School Health Association) listed.
As you can see, there are many degrees, certifications, and honors attained by school nurses and others who write for The Journal of School Nursing. Listing their credentials gives readers some idea of the background and expertise of the authors. However, the wide variety of credentials often leaves readers bewildered by what all the letters that make up this alphabet soup signify. As nurses continue to seek avenues to advance their knowledge and skills, they will no doubt add to the mix in this soup pot. The fifth edition of the Publication Manual of the American Psychological Association (APA, 2001) states that only the place where the study was conducted should be listed in the author note, omitting degrees and other credentials. However, The Journal of School Nursing publishes a wide variety of articles, not only research studies. Therefore, we will continue to list author degrees and credentials to assist our readers in learning more about the backgrounds of those who contribute to the journal.
The Journal publishes the RN status of authors first, then the highest degree earned. For example, I have a BS in nursing, an MA in nursing of children, and a PhD in educational psychology, but only RN and PhD are listed as my credentials as an author. When authors have additional certifications, such as ARNP or CPNP (Certified Pediatric Nurse Practitioner), those are listed next, and authors who hold national certification, such as NCSN, have those credentials listed next. We do not list state certification because these vary from state to state and are more likely a condition of employment. Finally, authors who have distinguished themselves as Fellows of the American Academy of Nursing or NASN have those credentials listed last—FAAN or FNASN.
Our readers are curious about the qualifications of the authors who communicate their knowledge and experiences through the Journal. The letters our authors bring to the alphabet soup illustrate the wide variety of advanced preparation sought by school nurses as they face numerous challenges in the school setting, as well as the wide range of educational opportunities available to school nurses today.