Nurses in the state of California who obtained doctorate degrees can’t be referred to as “Doctor” after a judge ruled it as “inherently misleading,” Nurse.org reports.
Judge Jesus G. Bernal of the U.S. District Court for the Central District of California upheld a state law placing limitations on how professional titles are used in healthcare. The Sept. 19 ruling found nurses being referred to as “Doctor”—even with a Doctor of Nursing Practice (DNP) degree—without holding the title of a licensed physician can be misleading and ultimately not protected under the Constitution’s First Amendment.
The nurse plaintiffs argued the law put limits on their freedom of speech and violated their constitutional rights.
“The Court finds that it is reasonable to infer that some consumers will assume that plaintiffs are licensed physicians or surgeons if they use ‘Dr’ or ‘doctor’ in healthcare settings and in advertising materials promoting medical services, even if plaintiffs also identify themselves as DNPs,” Bernal wrote.
The suit was filed in June 2023 by three California-based nurse practitioners with DNPs, arguing against the California Business and Professions Code Section 2052 that labels it a misdemeanor for non-physicians to use “Doctors” in clinical settings or in advertisements. The nurses felt it was a part of freedom of speech.
Two plaintiffs previously used the still-banned title on their embroidered clinician jackets, clinical documents, nameplates, and on social media platforms. The third plaintiff’s plans of using the title when opening an esthetics clinic were cancelled due to the law.
One of the nurses admitted to introducing herself to patients as “Doctor,” but would clarify that she was a nurse practitioner.
In a statement, the nurses’ legal representative, Pacific Legal Fund attorney Donna Matias, highlighted the plaintiffs’ disappointment in the court’s failure “to grapple with relevant Supreme Court precedent that protects First Amendment rights.”
“Instead of reining in the state’s power to censor professionals who accurately describe their credentials, the decision emboldens it,” Matias said. “The First Amendment does not allow the government to silence truthful speech simply because some listeners may be confused—especially when disclosure can address any concerns short of a total ban.”
Lorie A. Brown, RN, JD, an Indianapolis-based attorney who represents nurses and healthcare providers, called the ruling surprising and argued that other professionals with doctorates, like educators and psychologists, are permitted to use the title, so it should be the same for nurses in the Golden State.
“So, I guess Dr Jill Biden can still use her title, but yet nurses who have the same level of degree can’t use the title, I think that’s unfair,” Brown said. “All of your hard work and education, you can’t even use the title that you earn, at least in California.”
Medical associations like the California Medical Association (CMA) celebrated the court’s ruling, siding with defendants California Attorney General Rob Bonta and California Medical Board President Kristina Lawson.
“This decision protects patients by providing clarity and transparency about the level of training and education of the person providing their care,” CMA President Shannon Udovic-Constant, MD, said. “Allowing patients to make informed decisions is foundational to our health care system.”
The suit’s plaintiffs can file an appeal on the ruling. IN the meantime, they must avoid using “Doctor” in any patient care settings or promotional items.
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