Nametags and safety: Really?

Anecdotes are powerful. Some even take on the status of urban legends. I even have an anecdote that absolutely feeds into what I would call a nursing urban legend: putting your last name on your nametag puts your personal safety at risk! Forgive me, but despite a personal experience with this, I don’t believe it. What’s more, even if I did believe it, I still think it is inappropriate to leave your last name off your nametag in most nursing practice environments (maybe in all nursing practice environments actually, but I could maybe be convinced if the evidence was compelling).

First, my anecdote:

Many years ago I was working a night shift in our intensive care with an intubated, ventilated young man who had attempted suicide. Through most of my shift, he was unconscious. He began to lighten and make eye contact with me around 0200. By 0300 he was able to follow commands and was aware of his surroundings, and by around 0400 we were extubating him.  I truly doubt he could even see my nametag, but if he did, it only had my first name on it, as per policy in our institution. I nursed him comprehensively and with the same caring manner I always bring to my nursing care.  As this was my last of 3 night shifts, I went off shift at 0700 and really didn’t give this young gentleman another thought. I was off for several days, teaching at the university in my other job as a nursing instructor. Two or three days after the shift, I received a call from the Director of Nursing at the hospital to come to a meeting with the heads of Psychiatry and of Security—it was about this young man, and they felt that my security was at risk.  Yikes.

Somehow, through that single encounter, this disturbed young man had decided that “I was the one for him”, and that if he couldn’t have me, no one else could either. So, he had to kill me. This is what I learned at the meeting with these concerned folks. They told me that on the day following my shift with him, the patient had asked the unit clerk the name of the nurse who had cared for him the previous night, and she told him. So, he knew my name, and he had a plan to kill me—not going to lie, it scared the heck out of me. With some forethought, a few precautions and most importantly—continued therapy for this young man, I was fine, and he went on to be fine too. Bottom line though: if he wanted to find out who I was, he could. Nametag details notwithstanding.  

 It really forced me to think about this issue of being identifiable. Was the unit clerk wrong in providing my name? Absolutely not. He had a perfect right to know my name; what if he had wished to lodge a complaint with my professional association about my care? A professional providing service to the public cannot wear the cloak of anonymity—this completely contravenes one of the pillars of professionalism: accountability for service provided. What it means is that I must be identifiable to ALL my patients, even the disturbed ones. Further, not only is it inappropriate to obscure our identity, it’s impossible. If we think that just having a first name on our nametags makes us non-identifiable and therefore “safer”, then we are kidding ourselves. I would argue that presenting only your first name–either in a verbal introduction or on a nametag– actually invites more intimacy than it prevents. We invite people we know well to address us by our first names, this is not typical with strangers or people we have just met. I argue: IF we believe that the nametag is the quintessential identifier, and if we wish to initiate and maintain a professional relationship with patients/clients, then we would be much farther ahead to present our last names and credentials “S. Spenceley, RN”.  For an additional view on this, check out what I recently came across in the publication of the College of Registered Nurses of Nova Scotia (the article is on p. 7, in the “Consultant’s Corner”. )

I invite people to use my first name as we establish our relationship, I don’t assume it. I also don’t assume they are comfortable with my automatic use of their first name; I wait to be invited, or ask permission to use the person’s first name.  My nametag clearly states my first initial, last name, and credential. My introductions usually go something like:  “Hello Mr. Smith, I am Shannon Spenceley, and I am the Registered Nurse that will be working with you today–please call me Shannon; what would you prefer I call you?”  And I continue to feel perfectly safe.