Recently, I rushed to the emergency department (ED) at my local hospital to meet a relative who’d been taken there by ambulance. When I arrived, in my desperation I fled for assistance to a uniformed police officer standing nearby. Why did I choose the police officer?
Because as I looked around the ED, I couldn’t tell who the nurses were; I latched onto the first person who symbolized confidence—a person in a distinctive uniform.
In the past, nurses stood out because we wore white dresses, caps, and nursing shoes. Today, we opt for individuality and comfort, wearing clogs, crop tops, and baggy pants on the premise that it’s what’s inside that counts. And it’s inside where our skill and knowledge reside; our attire isn’t relevant.
Yes—nurses are crucial to successful healthcare outcomes no matter how we dress. But have we taken the need to express our unique identity too far?
The purpose of this article isn’t to tell you what to wear, but to encourage you to consider how you look to others while on the job. Remember—it takes only a few seconds to make a lasting impression. What sort of lasting impression are you making on patients and their families? On physicians and administrators?
The uniform dilemma
Wearing a uniform indicates affiliation with a group and evokes a sense of pride in the wearer. Some people also believe a uniform builds a spirit of comradeship, enthusiasm, and devotion among nurses—something that’s missing from many hospitals these days.
The earliest nursing uniforms focused on both functionality and feminine virtue, to better establish the profession as one of the few in which respectable women could pursue economic independence. The original nurse’s uniform was gray or blue, reflecting a nun’s habit and the uniforms worn by Florence Nightingale’s nurses during the Crimean War.
Today, nursing attire blurs the line between female and male, emphasizing the unisex appeal of the profession. Uniforms are a $10 billion-a-year industry, yet nurses can’t seem to agree on what kind of attire is most suitable. Most hospitals leave the decision up to employees, while a few require nurses to wear uniforms. Perhaps the only way to end the debate at any given facility is for one person to stand up and say, “This is what we’re going to do, like it or not.”
White makes a comeback
In the early 20th century, new findings about germs and their role in spreading infection helped popularize the white nursing uniform. Nurses continued to wear white until the 1960s, when feminists decided white symbolized diminished power. Elizabeth Norman, nursing professor at New York University and author of two books on the history of wartime nursing, states, “In the constant struggle for independence from doctors, some nurses started to see the white uniform as a symbol of the angelic, demure, dependent woman—not of the tough, resourceful professional she really is.”
The nurse’s white dress soon gave way to pantsuits and then to scrubs in the 1980s. Nurses found they could lift and maneuver patients more easily when wearing scrubs—and that scrubs were cheaper than uniforms. But nurses weren’t the only ones who found scrubs more comfortable; so did orderlies, technicians, aides, and maintenance and dietary staff. So now we all look alike—except physicians, many of whom continue to wear white lab coats over business clothing.
In 2005, Dr. Rhonda A. Scott, chief nursing officer of Grady Health System in Atlanta, Georgia, pioneered the return of the white nursing uniform at Grady. The change was implemented after patients expressed the desire to be able to identify nurses more easily. Dr. Scott notes that when “the patient asks the housekeeper, ‘What’s my blood pressure?’ you have a problem.”
Some nurses are happy white uniforms are back because they believe it reflects a level of respect and recognition achieved through years of schooling and training. When I contacted nurses at Grady to get their opinions on the white uniform initiative, I found that overall they’re pleased with it because “the patients know who the nurses are” and “it helps with our professional image.” Although some think the white uniform takes away from individual choice, this opinion hasn’t affected Grady’s nursing retention.
But other nurses believe the white uniform is a throwback to a bygone era. Some find that it frightens children, creates homogeneity, is perceived as depressing, and isn’t practical for working in an environment where clothing regularly becomes stained by blood and other stubborn substances.
Do scrubs disguise the nursing shortage?
Managed healthcare has forced many hospitals to cut costs by replacing nurses with ancillary workers who have limited training or with contract workers. Such workers wear scrubs of their choosing, making it difficult and sometimes impractical for hospitals to enforce a uniform dress code. “Putting everyone in scrubs makes it possible for hospitals to hide the fact that there aren’t many nurses on the floor,” notes Linda Aiken, a nursing professor at the University of Pennsylvania.
In fact, it may be a calculated move on behalf of hospital administrators to have all categories of employees dress in similar attire, masking the fact that most of the “caregivers” are unlicensed, unskilled, and uneducated. I’m appalled to think that the business of healthcare could diminish or hide the nursing shortage from the consumer.
YOU, Inc.
The late 1990s brought new thinking into the workforce. As company loyalty to employees began to fade, individual employees began considering what assets they brought to the company that their colleagues lacked. Annette Vallano, author of Careers in Nursing: Managing Your Future in the Changing World of Health Care, explores how nurses must consider their niche in the changing workforce. She recommends they see themselves as a stand-alone business: YOU, Inc.
Vallano asks, “Is your service—what you have to offer—at least as good as or perhaps even better than similar nursing ‘businesses’ of other nurses?” She stresses that appearance is an important part of YOU, Inc. because your packaging does matter.
In other words, nursing is a business. The sooner we acknowledge this, the more successful we’ll be—both at the bedside and in the boardroom.
Mirror, mirror
Personal comfort versus professional credibility. Individuality versus regimentation. Style (appearance) versus substance (nursing skill and knowledge).
These dichotomies may seem cut and dried. But there’s a simpler way to help you decide what to wear on the job every day. After you’ve dressed for work, take a good look in the mirror; then ask yourself these questions:
• What impression does this ensemble make on those around me?
• Does this outfit distinguish me as a nurse?
• Do I feel professional in these clothes?
• Does this clothing provide comfort while projecting a serious image?
Selected references
Center for Nursing Advocacy. New attitude. Available at: http://www.nursingadvocacy.org/news/2004jul/28_atlanta.html. Accessed August 23, 2006.
Clavreul, G. The great uniform debate. Working Nurse. Available at: http://www.workinorld.com/magazine/viewarticle.asp?articleno=
443&wn=1. Accessed July 1, 2006.
Fussell P. Uniforms: Why We Are What We Wear. New York, NY: Houghton Mifflin Co.; 2002.
Saver CL. Dress up. Nursing Spectr. November 3, 2003. Available at: http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=10765. Accessed August 23, 2006.
Seabrook J. The white dress: what should nurses wear? The New Yorker. March 18, 2002:122-127. Available at: http://www.nursingadvocacy.org/action/seabrook_white_dress.html. Accessed August 23, 2006.
Sue Tobin, RN, CPCC, MM, was a medical-surgical and oncology nurse at South Shore Hospital, Weymouth, Mass. Sadly, Ms. Tobin died unexpectedly last month. As the founder of Coach4Nurses, based in Plymouth, Mass., she helped nurses rediscover passion for their work and life through workshops and coaching. The entire staff at American Nurse Today will continue to keep Sue’s family in our thoughts and prayers.
23 Comments.
Really Wonderful Blog. It is very useful
my cousin was a rn for 40 years,then retired.
I found it interesting when you talked about a nurse’s uniform and how it shows professionalism to patients. In my opinion, certain types of jobs need to require uniform attire in their operations. I believe that a chef or a firefighter needs their uniform as protection, so I’d say I agree with you on wearing professional attires. Thanks for the information on nurse uniforms and their impact on their service.
Whether it is wearing scrubs outside of the health care setting, hand washing … had the following comment, which has been edited for our Member Blog.
I know this is an old post, but i still wanted to leave a comment….from the perspective as a patient who has frequent medical appointments and hospitalizations because of multiple medical issues.
Any hospital I have been in, whether NYC, NYS, Mass., NH, CT, VA, WV, OH, AZ, and CA, all had specific uniforms for different roles. Nurses wore one color of scrubs, LVN/CNAs another, ARNP/RNP wore another with a long white lab coat, surgeons wore another, while physicans who wore scrubs instead of business attire and a lab coat yet another. These often even changed with different departments (e.g., a cardiology provider may be in burgundy, while pulmonary in green, neurology in ciel blue, radiology in a mocha color, surgeons in mint green, trauma team in black, etc.) but it was ONLY healthcare providers who wore scrubs. Housekeeping/environmental services wore attire that resembled what you’d expect of a mechanic or a 1980s school janitor. Food service had a different, non-scrubs, uniform. So, while it sometimes was unclear which scrubs-wearer was a nurse instead of a surgeon or an LPN/LVN/CNA instead of an RN, you at least knew they were healthcare providers. I’ve also never seen a ER/ED not have a receptionist-type individual — easily identifiable by the fact they are sitting behind the desk. Perhaps I just haven’t been in places where hospitals/staff are fewer seen than Bigfoot, but just my experience over the last 30 years.
I totally agree with you when you said that white scrubs for nurses reflect respect for their profession. My cousin is studying to become a doctor and she is excited to know that she will be able to help people be healthy. It would be nice for her to choose scrubs that provide her with comfort so she can move in case of emergencies.
I like your tips about comparing individual choice and personal comfort with professionalism. My sister is working on becoming a nurse. She was worried about her uniform choices being too casual. She’ll have to wear different ones and see how she feels.
I realize this debate and the comments posted were posted long ago. However, I felt compelled to add to it. I am not a nurse, nor in anyway otherwise connected to the medical profession. I have been, however, a hospitalized patient, several times for very serious, if not life threatening situations. There’s nothing quite like waking up to a priest trying to give one Last Rites. It’s disconcerting.
I was hospitalized in a hospital where the nursing staff did not wear white, nor any set identifying uniform. The nurses – and everyone else who wasn’t a doctor – wore a hodgepodge of scrubs, hoodies and cardigan sweaters. Most of time, I had no way of knowing the role of the person who was leaning over me, responding to my hitting the call button or was performing vitals checks, bringing me meds, etc.
Quite frankly, to expect a patient, who is by definition under stress – if not extreme stress, pain, anxiety and fear – to A) Necessarily remember one’s self identification to a patient B) Read one’s ID tag – often obscured/flopped over – is not entirely practical, nor at the risk of seeming rude or disrespectful, not entirely reasonable.
Not only that, I point to a nurse’s post that he or he was often asked by patients for ice water, which is evidently something “not done” or outside the prevue of a nurse. Despite my numerous hospitalizations, this was new information for me. I must ask how could a “civilian” be expected to know such a distinction, let alone know to whom one should ask without identifying uniforms?
Being able to identify key personnel, persons in authority – such a nurse – not only in emergencies, but in general situations is key. Speaking from my own experience as a civilian, not only as a patient, but being a family member of hospitalized persons, not being able to easily identify who’s a nurse and who’s not, adds to the stress and anxiety level. As a patient and a family member, one often wants questions answered about one’s condition, etc. It’s hard to explain the high level of anxiety induced by the sense one’s being “pawned off”, when in actuality one had been asking questions or relaying concerns not to a member of the nursing staff, but to a passing dietitian.
Personally, I feel reassured by the idea of a white uniformed nurse – be he or she in scrub-type gear or not – because to me such a presence says “I’m a skilled and professional healer. I’m person in authority to whom you can look for help and guidance. I’m respected, confident and competent, proud of my profession and calling and I’m here to relieve your suffering and fear. You can put your confidence in me. I’m a nurse.”
That’s my two cents, given at the risk of giving offense, which certainly isn’t my intention.
To Gary RN, Gary, My wife was a floor nurse for 30 years and loved it. How dare you assume. The article is Susan’s opinion and if you don’t agree with her opinion then have the ba**s to voice your own.
(5) NURSES TO WEAR THEIR HAIR UP IN THE INTERESTS OF THE PATIENTS HEALTH IN ALL CLINICAL WORKING ENVIRONMENTS. (6) MEMBERS SERVING THE COMMUNITY WITH THEIR ORIGINAL UNIFORM ARE: ALL THE ARMED FORCES INCLUDING FIRE FIGHTERS ALL HAVE HATS IDENTIFYING THE SIGNIFICANT ROLE AND AUTHORITY THAT EACH MEMBER REPRESENTS COMMUNICATING TO THE COMMUNITY. WORLD GOVERNMENTS HAVE SELECTED UNIFORMS WITH HATS TO SPECIFIC COLORS NECESSARY FOR CRITICAL REASONS. NURSES WHITE UNIFORMS URGENTLY NEED TO BE REINSTATED.
CAP RANK STRIPES FACILITATE IDENTIFICATION TO SENIOR MEDICAL STAFF MONITORING FROM A DISTANCE IF NURSES ARE ATTENDING THEIR CORRECT DUTIES(3)IDENTIFIES AND REASSURES TO THE SICK PATIENTS THAT A NURSE IS ATTENDING THEM, AND WHEN THE NURSE SPEAKS TO A PATIENT, THEY CAN CLEARLY SEE A NURSES CAP ON THE NURSES HEAD AND MOST IMPORTANTLY, INCLUDING THOSE PATIENTS WHO MAY BE DROWSY.(4) RECOGNIZING THE NURSE AS A PROFESSIONAL AGAIN AS A HEALTH AUTHORITY REPRESENTING COMMUNITY HEALTH.
TOO MANY INCIDENCES HAVE OCCURRED WITH GERMS,DIRT HIDDEN IN COLORED UNIFORMS CONVENIENTLY RE-WORN. THIS HAZARD IDENTIFIES ESPECIALLY IN CHILDREN’S, GERIATRICS INTENSIVE WARDS. REASONS FOR QUICKLY IDENTIFYING NURSES AND THEIR RANKS FOR THOSE THAT DON’T KNOW ARE AS FOLLOWS: WHITE (1) IS FOR ‘’ALL’’ PATIENTS, RELATIVES, ALL STAFF, AMBULANCE OFFICERS, SECURITY, AND POLICE ALL URGENTLY NEED TO IDENTIFY NURSES AT ALL TIMES ESPECIALLY IN EMERGENCIES. (2) ORIGINAL WHITE NURSE CAP (A NEW DESIGN FOR MEN)
GOVERNMENTS HEALTH DEPARTMENTS POLICY REFORM.
WHITE NURSE UNIFORM RETURNING PERMANENTLY:
WORLD HEALTH DEPARTMENTS IMPLEMENT PERMANENT WHITE UNIFORM POLICY TO NURSES BOARDS. PATIENTS REQUESTS FOR HEALTH, SECURITY AND AWARENESS IN RECOGNIZING NURSING STAFFS CAPS WITH RANKS STRIPES IS CRUCIAL. PRIORITIZE REGARDLESS OF THE NEVER-ENDING DEBATES OF THE NURSES UNIFORM CHOICES. ALL COLORED UNIFORMS HIDE DIRT, WHITE CANNOT HIDE DIRT. TOO MANY INCIDENCES HAVE OCCURRED WITH GERMS, GRIME AND DIRT HIDDE
To Will Med!c: you just sound bitter, and your post has absolutely NOTHING to do with the topic of discussion. You falsely assume you know about ALL nurses’ behaviors–get over it, Dude.
I much preferred scrubs when I still worked in clinical areas: much more comfortable for 12 hour shifts in critical care where I was bled on, puked on, peed on, crapped on, etc. WHITE is too much trouble to keep clean. I always introduced myself as “your nurse” AND wore my ID badge in PLAIN SIGHT.
So what do you suggest?…in terms of the blurring of femininity as it pertains to to female and male nurses.
As a male Nurse…what exactly do you suggest I wear?
And when you accentuate the wearing of white, it informs a very american-centirc perspective.
I worked in England and the wearing of white shoes (which I had always done as a Canadian Nurse working in both Canada and the US) was intensely frowned upon. Black was the shoe colour to be worn. It is a matter of cultural perspective.
That’s the problem with nurses Mary RN… They think they are above bringing a pt some ice because every single moment of their shift is dedicated to saving lives 100 percent of the time… I bet you refuse to bring the PTs socks too…
Years ago I wore white, then I went to white pants and a printed scrub top. Now I wear street clothes and a lab coat. Different nursing requires different clothing. But in a hospital setting point of view, from which this article was written, I worry about anyone asking a housekeeper about their blood pressure. If a person is doing their job, there should be no doubt as to who you are. The tools you carry can easily determine what your duty in that particular place is.
In 1983 I started with white uniforms, now I love the colored scrubs, I would never want to go back wearing all white, All of us wear name badges which state what our role is, and we introduce ourselves as “Your Nurse”. and yes, I am asked to get the patients “fresh ice” because most patients do not know what the nurse’s role is. That is the perfect time for education. “I am your nurse”, & I tell them exactly what I do.
Problem then cleared up. I then tell them who their nurse tec is.
I used to work at a rehab hospital that required nurses to wear all white. The CNA’s wore white pants and aqua tops and the respiratory staff wore white pants and green tops, etc. The theory behid this was the patients would know who the nurses were by the color of their scrubs. This did not work. If you are female you were thought to be a nurse, if you were a male you were thought to be a doctor, it didn’t matter what color you were wearing.
Obviously written by a nurse who doesn’t work on the floor attending to patient care. Go back to your desk already.
I have worn white uniforms and a lab coat since I graduated from RN school in 1990. I often get addressed as “Doctor,” because I am male and wear a stethoscope around my neck, but once I correct that misconception, most patients and family members compliment me on wearing white. I do have to wear scrubs on occasion, because I work in an ER and sometimes I get bloody or soiled, but white on a nurse makes it easier for me to get the impression across that I am a professional nurse.
Great article , and certainly food for thought. I think all of us nurses have experienced times when patients were confused as to the role of caregivers. Any male must be “the doctor”. While I can’t embrace the idea of white because of the impracticality, I do support something that is reflective of our education and professionalism.