Do Nurses Really Need a Dress Code?

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Nurses wearing scrubs with clear identification badges.Nursing uniforms have changed notably as the profession has advanced. Today, what a nurse wears is a component of the patient experience.

Nursing uniforms through the ages

In the 1800s and the turn of the century that followed, nurses strove to be viewed as legitimate, established professionals, bolstered by their significant role in caring for those injured in the many wars of the time. To aid sanitary conditions in hospitals, long gowns were worn, modeled after what nuns wore, to provide a “fever barrier” against infection. But, there was no covering for hands or for the mouth — only the nurse’s lower body itself was actually protected.

Shortly after, in the early 1900s, identification as a nurse began to creep in, typically through armbands or hats with symbols. Nursing uniforms of aprons and white hats remained standard until the 1980s, when personal expression and comfort became a driving force. Gone were the white hats, and nurses began to dress more casually in personal clothing or scrubs and smocks of varying color and pattern.

At the same time, facilities often didn’t develop standardized uniforms or codes, making it difficult to distinguish different nursing roles or individual caretakers.

How patients identify nurses

Recently, an evidence-based approach for improved patient experience has emerged. The patient experience, that is, how patients identify, perceive and respond to the care of nurses based on the nurses’ appearance has emerged front and center.

At least one major health care chain, Geisinger Medical Center in Pennsylvania, has revamped its dress code requirements as a result. Research into the patient experience has honed in on four key questions:

1. Are nursing outfits projecting the desired level of professionalism?

Patients need to believe their nurses are at the top of their game, providing the best care possible. But this feeling requires trust in the nurse’s professional qualifications and abilities, and visual indicators have a big role in reinforcing the belief that each nurse is qualified and able to perform their duties.

What nurses wear has a big impact on the assumptions a patient makes about their quality of care, and about the qualities a nurse brings to his or her role. Nurses are often starting in an uphill battle, because they have to contend with portrayals of the profession in the media and popular culture, which can range from unflattering to downright demeaning – such as the “sexy nurses” costumes d for Halloween.

2. Are caretakers easily identifiable?

Health care environments are teeming with providers of all stripes, and the average patient interacts with most of them, sometimes in rapid-fire succession. So it’s crucial that a patient know who’s doing what, and what a particular nurse’s role is in their care plan. Patient confidence can be significantly bolstered, and anxiety reduced, when it’s immediately apparent what an individual caretaker’s role is.

3. Are nurses reducing the risk of infection and harm, to both patients and themselves?

On-the-job clothing, jewelry, and personal grooming play a huge part in lessening risks to patients and nursing staff.  Nurses, and the organizations they work for, have a responsibility to ensure the lowest risk possible for everyone involved. Long fingernails, jewelry that dangles or pokes, hanging hair, and exposed skin all have the potential to spread infection or cause injury during care, and thus should be included in guidelines on nursing outfits.

4. Are nurses comfortably able to perform their duties? Are they able to showcase their personal style, without compromising the patient experience?

Nursing is a notoriously tough profession, and not just mentally. Being on your feet for long hours, lifting and moving patients, and undertaking physically strenuous tasks are all par for the course. So it’s imperative that RNs are able to dress in a way that lets them be as comfortable as possible.

Personal style is another serious consideration. In a work environment that’s often stressful, freedom of expression and showing up to work as their authentic self gives nurses a sense of necessary identity in a job that’s all about meeting the needs of others. And in some cases, as for nurses in pediatric wards, adding “flair” to their uniform can actually improve their interactions with patients, because it helps those patients be more comfortable with their providers.

Features of new nursing uniforms

In the Geisinger case, the study found that patients would be best served by nursing uniforms that included gray and white scrubs, with a nurse’s credentials and role embroidered into the uniform.

Another facility, Northwell Health in New York, recently began requiring nursing scrubs made of microbe-resistant materials as a method of limiting infectious transmission.

In both facilities, the jury is still out on patient response to the new uniforms. But as with all good evidence-based approaches, they plan to conduct follow-up research and iterate to further improve the nursing experience in the future.

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