With the establishment of the Medicare Act of 1965, access to affordable health care services for low-income and elderly patients significantly increased the demand for high-quality care. The existing physician-led care model was seriously strained.

To increase the primary care workforce, qualified registered nurses (RNs) entered newly developed programs in higher education and began to train as nurse practitioners (NPs): advanced practice registered nurses (APRNs) with more training and responsibilities than RNs who can diagnose and treat patients — and in some states prescribe medication.

Earning an MSN degree online is one of the first steps to joining more than 355,000 NPs currently treating patients in the United States.

Qualified to diagnose illnesses and conditions, prescribe medication, and offer wise counsel regarding disease prevention and healthy lifestyles, NPs take a holistic approach to medicine. Given their knowledge, training, and experience, how should an NP be addressed then?

When it’s time for a checkup or visit to the emergency room, addressing the attending physician comes easily. Without giving it much thought, patients simply say, "Doctor" or "Doctor Jones." When an NP is the health professional on call, however, what to say isn’t always clear.

Since NPs are diagnosticians, treatment providers, and caregivers, it may seem more respectful to add a sense of formality when addressing them. Is it better to say, "Nurse Abigail," "Ms. Abigail," or simply "Abigail"?

Although no specific rule of etiquette on the subject exists, determining how to address a nurse practitioner is easier than imagined: Just ask. NPs often introduce themselves using their given name when meeting a patient for the first time, and, in that case, a patient is free to use that name in conversation.

However, if an introduction isn’t made, perhaps the best way to clear the air is to simply ask the NP directly. As a general rule, NPs are used to informal interactions that make working on a first-name basis both useful and natural.

In a medical setting of any type, offering a friendly and informative introduction is only the first step in creating a professional and welcoming environment. As in any workplace, the interactions between colleagues, as well as the physical appearance of the room and people, send a message to every visitor and client. Here are some suggestions for creating an inviting setting.

• Greet everyone who walks through the door with respect and undivided attention. This means turning away from the computer screen and putting pencils, pens, and cellphones down.
• Office attire doesn’t have to be expensive, but it should be clean, neat, and appropriate for the type of work.
• Patients are in a waiting room or in an exam room because they’re concerned about their own well-being. Conversations between professionals should never include complaints or gossip, and workers in every area should be mindful of who’s listening.
• Patients and clients are more likely to respond in a positive and an understanding way when mistakes are acknowledged timely and when apologies are voiced quickly and authentically. Defending errors or passing the buck will create a sense of distrust among and between everyone involved.

The etiquette blueprint for health care settings is, in many ways, very much like that for other professional settings. However, some important issues are unique to the field of medicine, including in-person and remote bedside manner.

How health care professionals interact with patients, or their bedside manner, must include the best of human interaction, such as eye contact, undivided attention, and a pleasant countenance. Whether in person or meeting remotely, however, when dealing with difficult medical conditions, good bedside manner is one of the keys to ensuring a trusting relationship between patient and provider.

Standing bedside, with a clipboard or tablet in hand, health care providers have the unique privilege of guiding patients and families through difficult situations. Care facility environments — where sleep is interrupted, specialists come and go on a regular schedule, and room sharing can double the amount of disruption — can compound patients’ stress. Medical staff members must serve with respect and compassion.

In addition to the general rules of etiquette, in-person bedside manner requires special attention. Here are some of the most important issues faced by health care professionals.

• Working within a schedule. Medical offices and hospitals move at a quick pace, providing services for many people every day. However, rushing patients through even the most routine visit leaves the impression that their concerns and questions aren’t valued.
• Sharing information. No matter how encouraging or difficult, sharing facts, test results, or a diagnosis with a patient and any loved ones present must be delivered with empathy, honesty, and sensitivity.
• Respecting privacy. Especially when conferring in a shared patient room or a waiting room, any and all necessary measures must be taken to respect the privacy of the patient.
• Taking time to listen. A bedside caregiver must also be prepared for questions; listen carefully, without judgment or interruption; and allow patients sufficient time to come to decisions in the manner they see fit. Patients should feel like partners in the journey to wellness, and empathy is crucial to high-quality health care.

With the development of telemedicine, health care visits aren’t always in an office. Although many of the same rules of etiquette apply when interacting through a phone or a laptop screen, some unusual characteristics of online conversations should be considered. For example:

• Create a professional, quiet, and undisturbed space for online visits.
• Prepare for the visit as if it were scheduled in an office. Having notes and files ready, making sure that the audio and visual components are working properly, and dressing for business as usual gives patients the sense that virtual appointments are as important as in-person ones.
• Allow for unpredictable internet lag time and technical difficulties. Also, give patients additional time to process information and questions.
• Look at the webcam instead of the face on the screen to create that all-important eye contact.

From knowing how to address medical professionals to knowing appropriate protocol when working with patients, the field of medicine holds care providers and staff in all positions to a high bar. At the front lines of health care, well-prepared and highly qualified NPs present the best in both etiquette and patient care. Whether serving the underserved, working with multigenerational families, or meeting the mental health needs of individuals of any age, the responsibilities of a NP are both challenging and satisfying. HPU's online MSN program can help you find new opportunities in the remarkable world of medicine.