Oldest Trick in the Book


I’ve never been to nursing school. But I like to imagine it goes something like this:

On the first day, you walk into class, surrounded by other bright-eyed, eager young students ready to learn the art and science of nursing. Textbooks weigh down your bag, and your pencils are sharp and ready.

Before you stands your instructor, an impressive-looking MSN whose carriage suggests many, many nights spent awake amidst the cool blue lights and quiet beeps of a MICU. As you watch, she strides to the whiteboard and writes in block letters:

Lesson One: The ID Flip

Lesson two is eye-rolling.

Most hospitals, just like most ambulance services, require that clinical staff wear an ID badge at all time. This identifies them by name and role (nurse, doctor, PA, etc.), and often gives them access to secure areas as well.

Long ago, some canny soul discovered that when patients know your name, they can complain about you. If they decide that they don’t like you, whether justified or not, they can call people — like your boss — and unleash angry, entitled, and very personalized tirades about “Sarah Roberts, that mean witch who told me to shut up and stop smoking heroin.”

“Well,” we figure; “if they don’t know our name, they can’t complain.” So although the powers-that-be did insist that badges be worn, we started hanging them in odd places, like from our belt, or inside a pocket. Or covering them with stickers and other things. But the best of all answer of all was elegantly geometric, made especially easy by free-spinning retractable ID clips: simply twist the card so it faces your chest, and the only thing visible is whatever text happens to be printed on the back. Technically, you’re still wearing the thing, and if the boss notices you can just say “whoops, it got twisted,” but nobody can actually read your name, and, ninja-like, you can move through the ward unseen, a bescrubbed ghost.

The nurses have turned this into an art-form, and in some places it’s like finding a four-leafed clover to see an RN with a visible ID (usually I figure they’re new there). But we’ve become awfully fond of this in EMS as well.

People, I realize that the world’s a rough place, that patients can be impossible to please, and that even the best of us need to take steps to ensure we still have a job tomorrow. I do understand this. But there’s a certain point where you have to stop digging trenches, and realize that if you’re giving great care, following procedure, behaving professionally, and generally toeing the line, then you should be willing to stand behind your work. If you’re employed at the kind of place that’s willing to take any complaint as reason to show you the door, I assure you that no amount of ID-flipping will save you. Your days are numbered. Of course, even a good service will eventually start clearing their throat and looking at you pointedly if your personnel file begins to grow particularly fat, but at that point, maybe you really should consider managing your douche coefficient.

Besides, this should all be moot, because when you meet your patient you’re introducing yourself by name anyway. Because that’s just common courtesy when you greet people. And patients are people. Right?

Strive to do the kind of work that allows you the confidence to stand behind it. When someone points at you with forehead veins a-pulsing and demands to know your name so your supervisor can “hear about it,” tell them and tell them proudly. Sometimes, doing the right thing won’t be a defense against trouble — but you can be sure that playing “who, me?” will run out of rope even sooner than that.

Clip your ID somewhere obvious — mine goes on my shoulder — where patients and staff alike can easily see it, and know what to call you and what role you’ll be playing in this show. When I see somebody with a visible ID, I take this as a good sign about their responsibility and willingness to own their work. And those are qualities we need in EMS.


  1. Agreed. I’ll argue a bit, though… I have a company ID and two hospital IDs, required to access secure areas. This means that I not only need to keep my ID visible, but also reasonably easy to “swipe”. I adamantly refuse to keep my ID on my shoulder or collar– the prospect of being strangled or choked by the string is too significant. My company-issued ID keeper doesn’t attach to my pockets, so it must live at my belt, where it flips turns with every step.

    I’m not trying to conceal my identity (although I do cover my last name on the IDs), but simply haven’t figured out how to display it properly…

    • For these among other reasons, I ditched the retract-o-cord and just use a simple clip. I clip it to my lapel and it doesn’t rotate, dangle, or strangle anyone. Like so: http://degreesofclarity.com/misc/id_clip.jpg

      Swiping means I have to unclip and reclip it (for RFID doors I can just bend down and “shoulder” the sensor), which is a little annoying, but otherwise it works well. If I needed more frequent swipe access I might consider putting my visible company badge on my shoulder and putting my access cards on an extendycord on my belt, for the best of both worlds.

    • Having multiple IDs, I’m sure you “stack” them on one clip. What I find works best is having the ID on each end face outward. In my case, this means my company ID is visible when I step with my left foot, and a hospital ID flips over every time I step with my right. In either case, you can see who I am. Even if it’s not technically the ID for that situation, it’s still a medical ID that shows my name, face, and level of training.

  2. My name is embroidered on my chest. Well, embroidered on the shirt, which I wear over my torso at least. I also wear an ID on my right shoulder, and carry cards with me on which I can write my name.

    I’ve gotten more compliments than complaints by giving everyone a card with my name on it. And I give everyone a card. Even the drunk frequent flyer.

    • Calling cards! I like it.

      • I think that as a child, I promised my parents I would never have a job that would involve my name sewn on my shirt… until it happened without realizing. I came home this Thanksgiving and was confronted by a cousin. It was almost like an intervention.

        Good points, Brandon, I will think/work something out.

  3. I hate the way my ID tags feel hanging off of my collar, so I usually keep them on my belt. This is more of a problem than it normally would be because I’m required to keep a set of protocol reference cards attached to my ID, so it’s extremely heavy.

    If I’m wearing a sweatshirt over my polo, then I hang it off of the sweatshirt’s chest pocket (which, on ours, is perfect for an ID). Luckily, since I agree with you about the importance of prominently displaying your ID, I can wear my sweatshirt most of the time since it gets pretty cold here. Of course, my sweatshirt has my name embroidered on it, but for some reason they decided to stop giving us embroidered polos a few years before I started volunteering here.

  4. If employers want to make sure that patients can tell the name (at least the first name) and qualifications of the people taking care of them, they will use name tags that have the same information on both sides and prohibit having other cards on the same name tag holder. But they don’t.

    The idea of carring a protocol book on the same clip as a name tag is ridiculous. It is the wrong answer to whatever problem they are trying to solve with an overly simple rule.

    I never have understood how to keep a name tag from being knocked off. I carry a drug bag, a monitor, and other equipment on my shoulders. I pick up patients and carry them (which makes a complete farce of the idea of gloves on/scene safe).

    • I agree that the protocol reference cards attached to my ID are pretty ridiculous, although they aren’t as ridiculous as you make it sound. It’s less of a protocol book than it is half a dozen cards with protocols on a few, triage criteria, and a few useless things like radio channels (which are printed on the front of the radios, for the few radios that don’t have screens on them that tell you what the channel is…). They’re pretty pointless and I might stop carrying most of them and only carry the ones for the protocols that get used least frequently, just as a memory aid.

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