Credential Confusion: What is in Your Alphabet Soup? Protection Status
Blog Category: 
Alphabet Letters

by Diana L. Gallagher MS, RN, CWOCN, CFCN

Nature's seasons seamlessly transition from one to the next. This morning as I sit at my desk writing, autumn leaves in glorious colors are showering down forming a variegated carpet across my lawn. Just as changing landscapes celebrate nature's accomplishments, the credentials after our names celebrate our professional accomplishments.

Confusion about how to properly use and display medical credentials is a problem. It is commonly taught in educational programs, but it is still frequently debated. Read almost any journal and you will see disparity in how medical credentials are displayed. By using credentials correctly, we can take a stand to help educate everyone on their significance and importance.

I will admit that I do not consistently sign my full credentials every time I sign a chart. I do, however, understand the power that proper credentials can convey when used appropriately. I often write letters of medical necessity when I advocate for patients who need greater than the normal number of allowable ostomy supplies. Perhaps I write a very compelling letter, but perhaps my letters get the attention that they need (and my patient deserves) because I sign the letter with all of the appropriate medical credentials. The credentials should clearly convey that I have earned the appropriate education, passed my nursing boards, and have earned AND maintain national board certification in wound, ostomy, and continence nursing. My certifications should clearly convey that I am an expert within my fields of specialization.

How to Properly Use Your Medical Credentials

The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), has provided guidance on how to list credentials after our names. Their intent is to help nurses adopt the pattern of using and displaying their credentials properly. If everyone would conform, it would be help everyone understand the significance and value of credentials. This knowledge would be valuable to patients, families, colleagues, third party billers and government officials alike.

According to the ANCC, the preferred order that medical credentials should be listed in is as follows:

  • highest educational degree earned
  • licensure
  • state designations or requirements
  • national certifications
  • awards and honors
  • other recognitions

Once a Nurse, Always a Nurse

Confusion about what the credentials signify is a separate problem that is even more concerning. I had always believed in the simply adage, "Once a nurse...Always a nurse." The same values, quest for knowledge, caring, and compassion that leads to a career in nursing will remain as core values for most individuals. Nurses may change their specialty or the setting that they deliver care in but the caring should be a constant.

Until recently, I had never considered a point in time that I would not be able to call myself a nurse. I love what I do as a nurse and have no plan to retire to something less enjoyable. Early this fall, I volunteered for a senior health fair and had the opportunity to chat with the organizer of the affair. Her name tag captured my attention because instead of name and RN, it was name and RET. RN. She explained that in her home state, she was honored to be able to use the designation RET RN. She had opted not to maintain a license and because of that, she was no longer a RN. Here is a very tangible example of how the ANCC guidelines help clarify who an individual is. Simply by using medical credentials correctly she was able to convey that she had been a RN but was now retired and without a license has not been mandated to maintain continuing education.

By contrast, I had a similar conversation with a physician colleague. I suppose, in some ways, I am naive. I had not seriously considered what the designation, MD, represented. I thought I knew, but was mistaken. In reality, just like in nursing, it is simply the highest educational degree earned. It does not communicate licensure or specialty which would be additional designations.

I am proud to be a nurse and am proud of the education that I have earned so far. That education has provided the foundation for licensure, certification, and recertification. I embrace the ANCC's efforts to standardize how nursing displays its credentials. It clearly and succinctly celebrates the story of our careers and accomplishments. There are times that I am concerned that listing my credentials correctly may appear haughty. Correct use of credentials is not about bragging, but instead about honestly communicating our knowledge and skill levels. It is about conveying educational preparation, special knowledge, skills and lifelong learning. That knowledge benefits everyone and allows everyone to make informed choices.

About the Author
Diana Gallagher has over 30 years of nursing experience with a strong focus in wound, ostomy, continence, and foot care nursing. As one of the early leaders driving certification in foot care nursing, she embraces a holistic nursing model. A comprehensive, head to toe assessment is key in developing an individualized plan of care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.


I recently attended the STTI biennial convention in Indianapolis and I was SO surprised to see how few nurses seem to understand what you have succinctly explained in this post. One even had "RN, BSN, PhD" as a part of her credentials! Thank you for this (sadly) needed information.

A much needed clarification for clinicians suffering with ASF (alphabet soup fatigue :-) Thank you so much for this article Diana!


As a patient I want to know firstly if the person is housekeeping or medical staff, then I want the nametag to firstly indicate RN, LPN, MA, CNA, etc, think of patients.

Dear Diana, 3-30-14
I just want to say thank-you for writing me up in the nurse Magazine. It means a lot to me.
Shannon Hogan

I appreciate the information presented in your piece. I was taught the order as stated by you by a professor. I sometime tire of listing all my credentials especially since I have seen and worked with many healthcare professionals with no special certifications, but are the best at what they do at bedside. I have also seen the other end of the spectrum such as the MSN who could not do basic nursing skills. However, that being said it is important that we wave the credentials as a way of promoting our specialty. As the saying goes, "if you've got it, flaunt it!"

I asked the same question just prior to graduating with my doctorate in physical therapy. I already had a bachelors in physical therapy. The staff at Creighton ensured me that the appropriate way to list my credentials would be:
License or first degree
highest degree
other certifications
other honors
The first two seem to be the exact opposite from what you are stating. I wonder, is it the error of my instructors? or are the standards that different in each field? That would be unfortunate, leading to increased confusion.
I like the idea of leading with my license as it shows others first and foremost what I am. In fact, I often use just my license designation. That is the most important designation to the lay person. When communicating with medical or business associates, I tend toward the whole list to show my credibility

Katrin (aka Katrin Hurley Moffett, PT, DPT, CWS)

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