Nurse Practitioners Would Be Banned From Using Title "Doctor" in FL if Bill Passes

Source: Facebook 

The Florida State Legislature convened for the 2023 Regular Legislative Session on March 7, 2023. Lawmakers are considering two bills that would affect those who have earned a doctoral degree in the field of nursing. 

House Bill 583 and Senate Bill 230

House Bill 583 and Senate Bill 230 pertain to healthcare practitioner titles and abbreviations. Specifically, they refer to “deceptive or misleading terms or false representation.” 

The bills propose that nonphysician health care practitioners, including advanced practice nurses who have obtained doctoral degrees:

• May use the letter “D.” before their practice-specific abbreviations.

• May not use “doctor” in any advertisement, telehealth interaction, text message, or verbal communication without clearly specifying their profession. 

In other words, advanced practice registered nurses (APRNs) would only be allowed to display these applicable titles:

• Certified registered nurse anesthetist, nurse anesthetist, or CRNA

• Clinical nurse specialist or CNS

• Certified nurse practitioner or CNP

• Certified nurse midwife or CNM

• Certified psychiatric nurse, psychiatric mental health advanced practice nurse, or CPN

• Autonomous advanced practice nurse or A-APRN

Nurses who introduce themselves as “Doctor Jones, a nurse practitioner,” would be subject to disciplinary action, including denial of a license. These bills would also affect nursing faculty, who would be prohibited from using the title on business cards, emails, letterhead, webpages, and any other form of communication.

If passed, the bills would take effect on July 1, 2023.

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Response from nurse advocacy groups

Several professional organizations suggest that the bills’ language is restrictive and unfair. Some have called professional nurses to speak up in opposition. 

A position statement by the American Association of Nurse Practitioners (AANP) states that it believes patients have the right to know who is providing their care, including the academic preparation of those individuals. Therefore it opposes regulations and legislation prohibiting APRNs from clearly representing their credentials to the public. 

The Florida Association of Nurse Practitioners (FANP) urges Florida residents to contact their legislators and ask them to withhold support from these bills. 

Response from Florida’s doctoral nurses 

A local news station, NBC 2, spoke to APRNs about the proposed legislation that could strip nurses who’ve earned a doctoral degree from their title. 

Nurse practitioner Dr. Sue Hook runs a practice that cares for uninsured and underinsured patients in Cape Coral, FL. She told NBC 2 that she opposes any plan to take away the credentials she has earned. She argued that the title “doctor” is not owned by any profession and that removing the title of doctor from thousands of nurse practitioners is degrading. “A pharmacist can use the title doctor; a veterinarian can use the title doctor,” Dr. Hook said.

During the interview, Dr. Hook’s sentiments were echoed by another nurse practitioner Dr. Arlene Wright. She told NBC 2 that it is scary to consider the state stripping her of her title. 

“When nurse practitioners go on for further education, they’re not doing it for the doctor title,” said Dr. Wright. “They’re doing it so we can provide the best care and outcome for our patients.”

Source: Florida Coalition of Advanced Practice Nurses

Previous legislation to remove doctor title

This legislative session is not Florida’s first attempt to strip the title from doctoral-prepared nurses. 

In 2019, the Florida Coalition of Advanced Practice Nurses warned nurses about a similar bill, House Bill 309: Prohibited Acts by Health Care Practitioners, which was introduced in the 2020 legislative session. It was ultimately postponed and withdrawn from consideration.

Before that, in 2013, Senate Bill 612 proposed restrictions on the use of the title “Doctor” or abbreviation “Dr” with a third-degree felony penalty. This bill died in the Senate.

Response from medical professionals and groups

Dr. Gary Gaddis, MD, Ph.D., FFIFEM, MAAEM, FAAEM, FACEP, is a clinical professor of emergency medicine in St. Louis, MO. He recently published an article about nurses calling themselves “doctors.” 

He supposed it is appropriate to call doctorally prepared nurses “Doctors” in an academic setting. However, he argued that referring to them as “Doctors” in a clinical setting is misleading and fraudulent, which defies patient trust. 

He further said that a DNP who “is, in essence, impersonating a physician ignores the substantial knowledge and training gaps that exist between a physician and a nonphysician.”

Gaddis went on to say that medical education is more selective than advanced nursing practice (ANP) education since some ANP programs have 100% acceptance rates. He suggested that many ANP programs need more depth of instruction and hours of preparation for clinical roles. 

During its 2022 Annual Meeting, the American Medical Association (AMA) adopted a report in opposition to DNP and PhD-prepared nurses who want to use “doctor” titles in clinical settings. The Council on Medical Education (CME) Report Number 4 stated in part, that the AMA “will advocate that all health professionals in a clinical health care setting clearly and accurately identify and communicate to patients and relevant others their qualifications, degree(s) attained, and current training status….”

For safety, the AMA has requested that The Joint Commission develop and implement hospital standards requiring direct care staff to display badges indicating the person’s name and credentials (MD, DO, RN, LPN, DC, DPM, etc.) to differentiate between those who have achieved a Doctorate and those with other credentials. 

To find out more

To advocate for nurses in Florida or for questions about this legislative session, email the FANP at legislativecommittee@flanp.org.

For more information about current bills affecting nursing practice in Florida, visit the Current Bills page here.