In my opinion, it is proper to use of the term "client" for those for whom I provide nursing care. It represents a shift in healthcare that recognizes the central importance of the care recipient as an active participant in their care. Evidence of this shift is seen in the nursing and medical literature. In preparing to write this article, I ran a literature search on the keyword "client," using the CINAHL database. Prior to 1985, there were only 62 citations that included the term; however, within the last 10 years, more than 7,500 citations used the term. Although the use of the term has become commonplace, nurses still debate its relevance; some find using the conventional term "patient" objectionable, feeling it suggests an attitude of paternalism (Deber, Kraetschmer, Urowitz, & Sharpe, 2005).

How nurses refer to the persons receiving their services depends on two factors: (a) how nurses view and define the relationship between the person receiving the service, and the one providing the service and (b) how nurses define themselves within the profession. If nurses view recipients of care as passive receivers of services, then the term "client" is probably inappropriate because the recipients are being acted upon by the nurses. The relationship may be viewed as limited by time, illness, or injury. The word "patient" implies that the service provided is limited to "sick care" and does not take into account other roles nurses assume in caring for individuals. The term also implies an unequal relationship between the providers and the recipients of care, where the providers are viewed as knowing what needs to be done, and the recipients as doing what they are told. Although it may be appropriate to refer to individuals as patients during certain short-term, disease- or injury-oriented events, in my opinion this terminology is contradictory to the aim of the nursing profession, which is to improve clients' health through their active participation in the care process, while recognizing their right to self-determination and autonomy (American Nurses Association, 2003).

If, on the contrary, nurse-client relationships are viewed as partnerships that address the needs and concerns of clients from a holistic perspective, then "client" should be the word we use. This word connotes a collaborative relationship that expands to include issues of wellness, health promotion, illness prevention, and empowerment. The focus of the relationship is on more than just the treatment of diseases; it is rather on working together to assist the recipients of nursing services achieve the highest level of health and wellness as identified by the clients. In these relationships, it is implied that clients are active participants in the healthcare planning process and as such are accountable for their health and well-being. The relationships are also seen as ongoing rather than episodic or event driven.

Finally, using "client" to refer to recipients of our care speaks on how nurses define their role in the profession. Nurses wear many hats regardless of where they actively practice their roles. If they define their role as only providers of care to the sick, then for them "client" may not be an accurate way to refer to the people who receive their care. I believe, however, that as professional nurses, our roles far exceed just the provision of sick care. We provide services not only to individuals but also to communities. Among our many roles, we are educators, counselors, social workers, epidemiologists, advanced practitioners, political activists, and community servants. We are concerned with the health of our communities, and as such we have communities as clients; we are involved with families and their function within society, and, therefore, we also serve families as our clients.

In conclusion, the services nurses provide are more expansive than sick care, and our services extend well beyond those prescribed for individuals with illness. Using the term "client" for the people we serve implies a relationship that encompasses all of the nursing roles and one in which partnering can occur.

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