Get ahead, get a hat?

25 May, 2010 | By Mark Radcliffe

Let’s be honest, nurses need hats like giraffes need driving gloves.

At worst they are an irrelevant piece of head trivia that turn nurses into ornaments and on some occasions (in those hospitals that demanded absurdly tall architectural headwear to distinguish their staff from the rest of humanity) they have prevented nurses from passing under low bridges. At best they are a symbol of something alluding to pride and social distinction - like a priest’s collar or a rock star’s sunglasses.

I can only imagine that hats retain for some people a resonance or retro-irony of some value, or that the fashion student responsbile for them is both patronising and colour blind, and is a bit jealous of people who are doing something useful with their lives.

‘While the requirements of the job demand that student nurses look to the future, the profession itself demands that instead they cling to the past’

Don’t get me wrong, I am a big fan of the recreational hat - who doesn’t like to accessorise? But a uniform needs to be functional and, unless the hat can turn into something useful in an emergency like a crash trolley or a submarine, it is a waste of material. And time.

But of course it doesn’t matter. It’s just a hat and no doubt some people like them, not least nurse milliners.

But it is useful I think to ask what we as a profession do to our students when we integrate them into nursing. Mostly we like to think we do good things don’t we? We like to think we teach them skills and knowledge and professionalism and responsibility. That we accompany them as they sculpt the human qualities that attracted them to nursing - a desire to help, a need to construct a meaningful working life - into something that will resonate into the hundreds of lives they have not yet encountered.

And we know that we teach them the “rules”: what the role is and what we can and can’t do, and what is OK to say and what isn’t. (“Don’t call the consultant with the hairpiece ‘carpet head’!”)

So what are we doing when we put a hat on them and tell them about the 19th century? Are we helping them to recognise the grand traditions they are joining? Are we asking them to embrace the same selfless principles that founded the great activity that is nursing? Or are we asking them to walk around with serviettes on their head in order to remind them not to stand too tall? That while the requirements of the job demand they look to the future, the profession itself demands that instead they cling to the past?

I think the student experience is hard enough, without us attaching anachronistic symbols to their foreheads. Given the responsibilities of student nurses these days, surely the second thing that we should be giving them - after the priority of ensuring they get the education and experience they need to become brilliant - is help and support. Whatever symbols nursing has should be liberating not stigmatising, particularly when applied to students.

Readers' comments (26)

Flo40 | 26-May-2010 9:08 am
I am very proud to be a nurse and was pleased to gain my buckle at the end of my training. I also wore a hat and a cape but I am not over 50. I did not feel as if i could not stand tall, in actual fact,I felt taller due to my hat. Patients liked them as they could tell who you were along with the dresses, we are here (supposedly but this seems forgotten sometimes)for patients.Nurses look very scruffy and unprofessional most of the time with hair not tied back and jewelery, even if we can't have hats at least make an effort with what we have. I do think the Scottish have a good look.
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Latterlife Midwife | 26-May-2010 10:15 am
Excellent points, Mark. There is absolutely no functional reason for nurses to wear caps. It may have originated as a way to actually cover the hair (it is said that Flo had her nurses wear head coverings to keep their nits out of patient's wounds!) but nurses now can use scrub caps when their heads need covering.

Wearing white caps nowadays is simply ridiculous and only serves to minimalize the professional level of nurses' roles in health care. Visualising your current male nursing colleagues wearing the same caps (absurd!) shows immediately that caps were a way to keep women nurses (pretty much the only kind then!) 'in their place' in our society.

As a nursing student many years ago, I was enthralled with the image of what we wore - including the cap and cape, and even gloves sometimes! But then I grew up and became aware over time of the inequalities of this 'system.' It is only too clear now that caps were a symbol to relegate nurses to that lower status they were not to aspire above. That is a society I do not want to revisit. Tradition is only a good thing when no one's rights or status is being suppressed, subtly or otherwise.

For those who feel this sort of thing puts us on a pedestal, well no thanks. I am a full partner in health care provision, and that's *alongside* doctors and other colleagues. Being put 'on a pedestal' is just another way to marginalise someone. As for patients and the public who like seeing caps and dresses on nurses, I guess they'll just have to keep dreaming. I'll consider wearing a silly white cap when male colleagues do, too.

@ Flo40 - The issue of recognition by patients of their nurses is a totally separate issue and does need logical resolution. It should not be that difficult to design better name tags and enforce their use, and to apply the initials 'RN' somewhere on the uniform.
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Anonymous | 26-May-2010 12:26 pm
I have to say that whilst I agree with some of the above I was very proud of the hat we wore and the individual uniform of the hospital I trained at. Cost effective no, practical no but a great sense of pride.
What you find now are staff dressed in scruffy uniforms of so many types and colours it makes it hard to distinquish from a nurse/phlebotomist or cleaner. Hair is all over the place hanging over dressing trolleys and patients. Surely we have to have a balance of a practitcal uniform but restore a sense of pride and set some standards for how staff should look.
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Matthew Lloyd | 26-May-2010 3:54 pm
TO be honest I feel that there is absoloutely no need for hats to go with the uniform, as I feel they serve no practical purpose at all, except perhaps to get in the way when we are trying to do our day to day tasks such as those that involve moving and handling. I'm sure infection prevention and control teams would have something to say about them!!
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Anonymous | 26-May-2010 4:08 pm
Yes it may be useless, but what happened to having a pride in our uniform! I have had the pleasure of working along side the forces nursing staff and they make the NHS uniform or rather the way it is worn like a bag of rags. The old adage"if you cant take a pride in your uniform you wont take pride in your work" is something that rings true. If wearing a cap again helps to make nurses look smarter I am all for it.
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Anonymous | 26-May-2010 4:18 pm
Its just like putting you hands in your pocket - slovenly dress equals a slovenly mind! Beware Nick Clegg!
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Anonymous | 26-May-2010 5:34 pm
The hats worn by student nurses at Westminster Abbey on 12th May are not intended to be worn in practice.
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Anonymous | 26-May-2010 10:55 pm
I was a nurse when the decision was made at a major hospital to ban hats. The reason was that the hats encouraged snobbery among the school's own graduates. We also found that mental health nurses were less likely to be struck by patients without uniforms. Hats are a nuisance to keep clean, therefore an infection control hazard, and they can fall off at inopportune times. Enough reasons?
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Martin Gray | 26-May-2010 11:19 pm
The old nurses hat/cap/study in linen origami did llok nice and professional in its day, but times have changed and we have to move with them. They are not practical nor do they serve any real purpose in todays nursing profession.

However, there is no excuse for hair to be dirty, unkept or untidy, or dyed in fluorescent colours, or not tied back if too long. That is only common sense fromn the point of view of hygiene, cross infection, and safety (aggressive patients are surely more likely to grab hold of dangling hair?). Uniforms should be cleaned, pressed and well maintained - that shows pride in appearance and reflects the personal standards a nurse posesses (is that too many or too few 's'?).
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Steve Williams | 27-May-2010 0:31 am
An excellently encapsulated article Mark and an equally apposite follow-up by Latterlife Midwife.

Step back for a second and ponder this...

Nurses are desperately trying to convince society that they are “professionals” and yet they still cling on to symbols of female servitude like caps, capes and buckles. How many other professionals (doctors, architects or lawyers) wear hats to denote their status?

Nonsensicle and yet deeply sad how 21st Century nurses cling to meaningless attributes from 200 years ago. The MOST important part of any uniform I have ever worn is my name badge which reads - STEVE W. RN - that’s all I, my fellow professionals, my charges and their relatives need to know.

Don’t get me wrong, I am not ‘Limey-bashing.’ It is no better over on this side of the pond either. In our local Ontario hospitals I see nurses in scrubs that make them look like “Boco The Clown” and then they drape a technically-redundant stethoscope around their necks in order to pronounce their status - duality or what?

Good one Mark, keep serving up the bedpans and we will keep gulping them down!
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Anonymous | 27-May-2010 7:06 am
It is hilarious that the UK is still having this conversation. It is the 21st century and these ridiculous hats are a way of demeaning the nursing profession. They are something servants were forced to wear.
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Anonymous | 27-May-2010 9:07 am
I agree that hats have no functional place in the modern world of nursing. However they represented something else, other than being a symbol of subservience or heirarchy. A nurse who pays attention to her appearance is likely to pay more attention to patients. "Shiny shoes - shiny mind" is an army phrase that is similar to one mentioned already. As a student nurse I was taught that looking smart and showing pride in my appearance would give the patient confidence in me. Isn't reduced patient confidence and lackadaisical approach to care a problem today?
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Liz Thorp | 27-May-2010 10:44 am
I remember in the very late eighties, starching a piece of material to make into a hat. However I do remember a colleague who had the same hat for the whole of her training which she religiously reapplied shoe whitetener and tippex so that appeared clean!
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jjjez@hotmail.com | 27-May-2010 6:06 pm
To be honest i'm quite sure that unrses today wash their hair far more than in the 50's, 60's and 70's where hair was often 'set'.

so it's a bit of a non argument.

being pleased to recieve a badge and a hat and a cloak is more of a symptom of the society you were living in to be fair.
I mean those things probably meant something because you had very little else to call your own (am i right?) so of course you would be thrilled.

Patients assumed a smart uniform meant competence but that is an assumption and tidy looking people can also be incompetent - it's just that years ago you would have been fired without question and your mistake covered up. lucky for you husbands were there to financially support you eh?

by constantly insisting that a clean uniform has some hidden meaning is the same as saying a clean house and neatly dressed children means that there is domestic abuse or child abuse inside....

You know Beverly Alitt and Ken Cobb were both very well presented people....

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Jacqueline de Laporte | 27-May-2010 7:48 pm
On my first day as a student nurse I was presented with my uniform dresses, aprons and a piece of starched linen which I hadn't a clue what to do with. I don't think I ever quite mastered the art of the perfectly folded and pinned hat without it looking too large on my head and ready to power a small dinghy.

I had many a run in with the screens and the old steam tents we used to nurse patients with respiratory problems in. After attending to a patient in a steam tent the starched linen took on the appearance of a hanky on ones head.

Having said that, when I first became a Sister, my Organda hats were beautiful with ironed frills on the top. Practical no, but pretty yes.

When the ancillary workers went on strike for 6 weeks in the early 70's, our frilly hats were replaced with paper ones with coloured stripes to donate our seniority. We hated them and the poor lady in the laundry, who was employed solely to hand launder and iron the Sisters' hats, lost her job!

I am not sorry to no longer wear a hat or cape but I still wear my uniform with pride and yes I do still wear a silver buckle and my S.R.N badge. It is who I am and my patients in General Practice respond positively to their Nurse not looking like a beauty therapist/cleaner/scrub nurse or all the other indistinguishable shapeless uniforms around.

As for the Student Nurses and those horrendous frocks, it was only the hats that gave a clue that they were nurses! I suspect that as it was Nurse's Day they had attended the service at the Abbey. They were respectfully wearing the traditional head wear that was worn by the rest of the congregation, a Nurse's hat.
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Anonymous | 28-May-2010 6:06 am
when nurses wore caps and capes they were not running around trying to do the work of doctors like we are doing now!They were all providing good quality nursing care, had time for patients and the patients respected nurses.
I agree in this day and age when we are all running ragged and short staffed, trying to provide a service under the continued government cuts, caps would serve no purpose.
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Anonymous | 28-May-2010 9:40 am
i am a nursing student finishing my degree this year and i have to say i dont like wearing dresses i dont wear dresses outside of work wither i find them uncomfortable however i do think asour uniform is white it feels and looks clean and bright i dont wear a hat but my hair is not scruffy and yes my hair is almost down to my bottom i pin it up and spray it down so there is nothing hanging and touching my collar or dangling in wounds as per hospital policy but yes i have have seen staff that could maybe revisit their image i am very proud to wear my uniform as a stdent nurse and for the role it represents but i also agree that all the different uniforms even as staff is very confusing who is who even i have been called sister and im a student this happens to me frequently which has a nice ring to it but im not a sister and i could not yet perform the responsibilities that come with this title and what the patient would expect.
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Anonymous | 28-May-2010 2:08 pm
I used to be in the Army and hats were definitley part of the uniform. Different hats denoted different grades of nurse. We were definitley expected to always have a clean hat and I doubt whether anyone would have got away with shoe whiting one!!
While they are still a part of dress uniform in the forces we stopped wearing them routinely on childrens wards at the end of the 80s, It was heartbreaking to have a newly starched hat be grabbed by a chocolatey or paint covered hand and have to go and do another that night! Even so we still had to have one ready for trips to Matrons office or to wear when outside of the ward.

I do remember something being published about 25 years ago highlighting just how many bacteria can be harboured on a nnurses hat.
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Anonymous | 30-May-2010 1:16 am
Interested in the Anonymous posting of final year degee student above with no use of any punctuation!

Interesting...
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Anonymous | 30-May-2010 7:27 am
Get real this is 2010!
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