Nursin' USA - Why the furore over nurse uniforms?

19 February, 2010

Our resident US nurse Sara Morgan wonders why nurse uniforms are the subject of such heated debate in the UK

Thank you to everyone who took the time to comment on my first blog post. It was great to read your feedback, both positive and negative. As for the negative feedback, as a nurse, I can always use a slightly thicker skin, so thanks for helping me to develop my dermal armour. It was fascinating to read about other international perspectives - I think the more we share about our different experiences, the easier it is to identify best practice and adopt it, whether that best practice is here in the UK, in the US, Italy, Canada or anywhere else.

I was interested to see that many people had comments about uniforms and caps - clearly this is a hot topic.

Why are uniforms the subject of such heated debate here? Universal uniforms, colour schemes, and in what settings uniforms should be worn - all are topics guaranteed to stimulate debate. I like uniforms, if for no other reason than it lessens my chance of making a fashion faux pas on a daily basis. And as a rule, they make people look neater and more professional. But here in the medical world of the UK, they also make a hierarchical statement. Depending on your role, your grade, your band, your Trust and sometimes your speciality, there is probably a specific uniform that defines who you are within the organisation.

“Are you my doctor?”
“No, even better, I’m your nurse.”

In my job as a senior nurse, I spend most days in clothes of my own choosing, but every Friday, all of the senior nurses don a uniform and we spread through the halls of the hospital. Because we wear a special colour, everyone knows when a senior nurse is approaching on the Friday rounds. It has been a new and slightly uncomfortable experience for me to be eyed suspiciously when I appear on a ward, just because of the colour I’m wearing.

There are plenty of reasons for people to be suspicious of me - my accent, my belief that the words ‘pants’ and ‘trousers’ are interchangeable among others - but my uniform shouldn’t be one of them. Even colleagues who see me regularly during the rest of the week often fail to recognise me when they first see me in uniform.

Maybe as an American I like to blend in. We are not usually a fashionable people, and using clothing to express oneself is usually left to New York hipsters, musicians, and goth high school students. I relish the opportunity to be judged and underestimated based on appearance, and then shatter whatever bias has been applied to me. For example: friends are always surprised that I am a halfway-decent billiards player. My theory is that they assume I look too clean-cut to have spent enough time in smoky billiards halls to gain any skills with a pool cue. Think of Susan Boyle on Britain’s Got Talent: would her performance have been as much of a shockingly pleasant surprise if she looked like Cheryl Cole?

I’m not the only American who has noticed this phenomenon of outward appearance not always matching stereotypes. A friend of mine who lived in Baltimore once noted that when she walked down the street, it was difficult to distinguish the homeless men from the 22-year old internet millionaires since they seemed to share the same wardrobe of wrinkled, unwashed, mismatched clothes. It all means that we Americans learn very quickly not to judge anyone based on their appearance, especially in the hospital setting, where there is often very little in terms of a dress code to guide what you wear to work.

I understand the argument that having specific uniforms makes it easier for patients and the public to identify who is who. When I worked as a nurse in a busy ER in the US, everyone - doctors, nurses, technicians - wore scrubs. To minimise confusion among the patients, though, we all quickly learned to introduce ourselves to the patients. Every time I walked into a patient’s room for the first time, I recited the same line: “Hi, I’m Sara, I’ll be your nurse today.” And if I forgot to introduce myself and began assessing the patient or taking their history, they would usually remind me by asking “Are you my doctor?” And then I always took the glorious opportunity to reply, “No, even better, I’m your nurse.”

About Sara Morgan

Sara Morgan trained and practiced as a nurse in the United States before coming to work in the UK. She has worked as both a nurse practitioner and as a lead nurse on the Productive Ward initiative.

Readers' comments (17)

Laura Ellison | 19-Feb-2010 10:59 am
What an insightful blog. I agree uniforms are a particularly hot topic amongst Nurses in the UK. As a Student Nurse, I am often mistaken for a fully qualified Staff Nurse by patients, as there is little to distinguise between the two groups. As a result, I get Doctors approaching me on the wards asking me to do things that I am not qualified for. From this perspective, I would like to see bigger differences in the way Student Nurses and Staff Nurses' dress, however, I can see Sara Morgan's point. An introduction to the patient should never be forgotten, regardless of what you are wearing. I would be happy for all staff to wear scrubs on my ward - but would they all remember to introduce themselves to patients every time they approach them?
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Anonymous | 20-Feb-2010 9:48 am
Sara, do you think this blog identifies best practice and shares it? If you do, perhaps a brief on what is considered practice in the US may be helpful!

From my own experience as a patient , and the relative of a very ill patient, I found it very helpful to know who was who and who was in charge of the shift.
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Anonymous | 21-Feb-2010 9:52 am
I really agree with Sara, so much energy, time and money is spent here on uniforms. I have worked in different areas in the hospital and found myself in really uncomfortable uniforms. Scrubs would be so much better to work in. I don't think that in any other country they are so obsessed with uniforms and colour coding. I think it is us in the profession who want the uniforms to be colour coded to establish our rank, not the patients, they know who we are as we introduce ourselves, I don't even think that the general public understands the different colours. How could they, as there are different ones in each hospital/trust.
The money spent on uniforms could well be spent better on patient care, even better wages would be nice. You see nurses here who have 2 slightly different jobs during the week and they have to wear the uniform according to what they do on the day, an unbelievable waste of taxpayers money...
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dots | 21-Feb-2010 9:55 am
I smiled when you mentioned your dermal armour. I am a British nurse who spent 12 years in LA and having returned a few years ago I too had to polish my armour.

My experience in the US was invaluable and it certainly shaped me as a person and as a nurse. If only you could merge the best of both sides of the pond.

The uniform issue is a class system all of its own. The comment of being happy on knowing who was who, shouldn't we be introducing ourselves as to who we are? It is what I was taught to do and it isn't common practice. Sorry but it's true.

Your column is refreshing.

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Latterlife Midwife | 21-Feb-2010 12:24 pm
I enjoy your new blog, Sara! I am an American nurse who's become a midwife in Britain, and am quite unhappy with the uniform system of style (fitted) and colour (grey) for midwives when away from the Delivery Suite. I was used to lovely loose blue scrubs in all maternity areas!

I agree identification can be a problem, so would like to see scrubs with role designations imprinted right onto them somehow; second best would be badges with larger print for easier reading by patients.

You mentioned caps - is anyone anywhere still worried about caps??

Btw, it would be fun to have you post more about English/English terminology differences between practicing in America vs UK. I'm still tripping up 3 years on!
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Anonymous | 21-Feb-2010 1:09 pm
Hi there, I really enjoy reading your blog and learning about nursing around the world.

Just to offer another perspective, I live and practice as a nurse and midwife in Australia. In all maternity areas at the major hospitals in my city (aside from theatre and ER where we wear scrubs), we are actively encouraged AGAINST wearing uniforms - the theory being it encourages the patients not to see us as "authority figures" and by breaking down this hierarchy, patients subsequently become more involved and proactive in their own care and decision making, as opposed to being "passive receivers" of health care.

As others have already pointed out, not wearing uniforms puts the onus back on the health professional to introduce themself properly (and repeatedly if necessary), a very basic but effective method of beginning positive and therapeutic relationships with your patients.
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caroline weedon | 21-Feb-2010 2:49 pm
I have been a nurse for more years than I care to remember and have worked most of that time in the UK but I have also worked in the US. The answer is very simple. Scrubs (of good quality) are still a uniform when worn by everyone. They are practical to wear and to wash. They can be colour coded for ranks or departments and may reduce the number of staff wearing their uniform in public (it would be a bit like going out in pyjamas!) and therefore more infection control freindly! I have never understood the uniform issue in the UK. At the end of the day nurses need to wear something that is comfortable and practical and scrubs meet that criteria.
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sylvia luck | 21-Feb-2010 3:07 pm
hi there,
as above ... scrubs with name and qualification/rank printed on them, washed in the hospital laundry and delivered to your ward.
i trained and worked in germany for several years before i came to london.
all the places i worked had no issues with that. no drama about it. and certainly no walking around outside with the uniform/scrubs. (unless you accompany a patient on a way to the shop or x-ray etc).

have a nice day.
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Anonymous | 21-Feb-2010 8:06 pm
Brilliant Idea Scrubs!
it can be bench marked across the NHS
all must make it a point to practice good patient approach skills & introduce themselves , patients will also be more comfortable there is no great need to show hierarchy, does hierarchy provide excellent and holistic nursing care or does the individual nurse provide ?
nhs could do away with the cost of uniforms , control risk of infection as so many of us have to travel by public transport & take the infection home as well with our uniforms .
If one works sincerely with dedication why would one want to know if it was the Marton who was around would it matter ? so no need for coding etc just a name badge would do.Last of all imagine the comfort.
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Anonymous | 22-Feb-2010 7:39 pm
enjoyed your blog! I trained many many years ago in Germany. Although I enjoy working in England, I have many happy memories of working in Germany. All qualified staff wore the same uniform and had the same title "Schwester", meaning sister, regardless of rank. It meant no difference to the patients and hierarchy was non existing. Happy days.
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Anonymous | 23-Feb-2010 6:02 am
I have been a nurse for 20 + years and I worked and trained in Scotland, mainly ER and then worked and lived in Australia ER. Scrubs are the answer, not dresses, not tunics but plain and simple scrubs.
I now work for a cruise line company in America and for many years had to wear the officer uniform, pleated front trousers or skirt with a white shirt tucked in a belt and epaulletes.. very impractical and very uncomfortable.. We now have the right to wear scrubs and people recognise us as health care professional better when wear scrubs..
Although many nurses like the idea of having the officer status and the uniform to go with it... Not me.
Scrubs win.
I must admit though, progressing to a Staff nurse and having the hat with the big broad blue band on it was a huge achievement and I really didnt mind the dress when I was skinny....
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Anonymous | 23-Feb-2010 8:44 am
Scrubs are OK, but what about in Primary Care?? The PCT I work for are having massive debates about this at the minute!

It seems strange that on one hand we have the "there is no evidence that wearing a uniform in a public place increases the danger of cross infection" (this was in a recent circular regarding uniforms by the way). Then on the other theer is the "the public's trust in the healthcare professional may be damaged if they see them in a public place wearing a uniform"!!

Come on what is it to be?

Do we need the navy for sister, royal blue for staff??

At present I wear a shirt and plain trousers and my patients (130 on my case load) know me by my first name! Just as it should be!
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martha langdon | 23-Feb-2010 4:15 pm
I am a nurse from the U.S. I work in a critical care unit. We, in our unit, wear any color of scrubs we want to. The O.R., Cath Lab and Women's Center wear scrubs specifically colored for their units. However,there is a movement afoot in the U.S. to go to uniforms again. We wear large special tags under our badges that denote our job titles so even the patient with bad eyesight knows who is the RN and who is the CNA. Our doctors are required to wear ID badges so they are not mistaken for nurses(imagine that!).
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Michael Sandiford | 25-Feb-2010 11:45 am
Interesting blog!

In my previous job as a district nurse, uniform was not always compulsory. My concern was that certain collegues stated they chose to wear uniform as they feel wearing it gets them respect. My arguement was that your performance at your job should get you any due repect, not how you look.

My current job, running a treatment room at a needle exchange in central Manchester, uniform is referred to as "drug worker chic". Basically borderline casual/scruffy! Our clients don't respond well to traditional uniforms!
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Anonymous | 16-Mar-2010 9:12 am
The difference in attitudes when wearing civvies to uniforms is immense!

I work in primary care and have noticed more respect from patients, and doctors when i started wearing a shirt and trousers to work instead of the ridiculous uniform!

In a uniform you are 'just' a nurse. In civvies you are something more.
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Anonymous | 21-Mar-2010 3:57 pm
nurses are people too and should be identified as such and not by the colour of their uniform. As for frilly 'caps' they belong in a museum and I certainly would not take on a job where I was expected to wear one.

Uniforms are there for are there for purposes of hygiene and functionality and not to make a statement about the self or rank. Pity the poor nurses who wear them to mask poor and superficial self images and low self-esteem. The different colours are only worn to feed their egos and to distinguish themselves from other colleagues of different ‘rank’ in the same profession. However, experience and maturity show the difference between a ‘sister’ and a student and not the colour of a ‘frock’ or belt, etc. As a nurse I would want to be seen as, or be nursed by, someone who looks smart efficient and relaxed and places importance on skills and knowledge, reflective practice and self development in identifying the needs of patients in his/her care and not on self-obsession about their appearance and the colour of their uniform. Nurses are nurses and should wear the same uniforms, and uniform means uniform.
OXFORD CONCISE DICTIONARY 11TH EDITION
uniform
? adjective the same in all cases and at all times; not varying.
? noun
1 the distinctive clothing worn by members of the same organization or body or by children attending certain schools. ?informal a police officer wearing a uniform.
2 a code word representing the letter U, used in radio communication.
? verb make (something) uniform.

DERIVATIVES
uniformed adjective
uniformity noun (plural uniformities).
uniformly adverb

ORIGIN
C16: from French uniforme or Latin uniformis (see uni-, form).
This should be smart, simple, comfortable and functional in materials which allow for daily laundering at adequate temperatures to kill germs, allow for changes in temperature in the workplace and freedom of movement. A rainbow of colours is totally unnecessary and not only confuses the public and colleagues but make nurses look very tawdry and unprofessional. These colours only serve as an ego trip between nurses and do not help or impress patients and other interdisciplinary colleagues in the slightest. Doctors, physios, dieteticians and other professionals do not have to put up with all this nonsense so why should nurses.
In many hospitals clinics, pharmacies, clinical laboratories and general and private practices in the rest of Europe personnel wear well cut, elegant (for women these can also be feminine) and functional white uniforms which denotes they are working in a health service and which gives an air of efficiency, and professionalism, sadly lacking in the UK. Nor is there fuss about a small degree of personalisation, (individuality and personal responsibility for appearance is important for morale and well-being of the staff - and believe it or not, they are adult enough to make such decisions for themselves), such as hair style (not having to scrape long hair up into a bun), a minimum of jewellery, a coloured cardigan and coloured leggings or tights as the season dictates, and bare legs with sandals when the weather is very hot, if they are not wearing trousers, as well as shoes of their own choice and colour. It is also the responsibility of the individual to make sure that these are comfortable and safe on the flooring where they work and that any jewellery worn will not harm their patients. I have never seen a scruffy nurse or other healthcare worker as a result of this personal choice of lack of coloured uniforms!
Why can't the UK learn a few lessons from this and everything else concerning nursing care and health services management from our smart, efficient and caring European counterparts? I already know the answer to this; the dowdy old NHS management are suspicious and critical of anything outside their own narrow little domain and are sadly totally unable to learn from others' more enlightened experiences, to their own detriment. They always think their way is right and the best – and even in this rapid world of rapid change (? and improvement) they won’t budge!
Anyway, why aren’t nurses, management, researchers and professional journals concentrating on patient care instead of wasting precious time and resources on such trivialities? If these studies are being done during free time would it not be better to have fun and recharge batteries in to provide the energy for further motivation to produce the highest quality of care that all patients in the UK, and taxpayers at that, deserve and which should be their right.

I am disgusted by the fact that the American writer feels the need or is coerced into putting on a uniform once a week just for reasons of self-identity! I thought Americans were more democratic like the Europeans outside the inward looking UK.

Uniforms are there for the purpose of functionality and hygiene to protect the patient and staff from injuries which could be caused by more restrictive clothing and not to try and tell the world or other nurses who we are or what rank we hold! Or is it an ego trip and demonstration of superiority and narcissistic desire to dominate, overawe and manipulate other younger or less experienced nurses, other ward staff and colleagues and patients who 'you consider' beneath you?
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Anonymous | 19-Aug-2010 11:03 pm
Hey,its good to have you writing on here.I worked in the US for a few years as a CNA and was really surprised when i came to the U.K to work and found that the trust seemed to care more about uniforms and image than patient care!!I just could not believe it.Seems to me its the same ALL around the U.K as this seems to be such a hot debate as you have mentioned.It is as simple as this,INTRODUCE yourself to the patient,as i was immediatley taught to do on my 1st shift in the U.S.We are meant to communicate effectivley with patients and colleagues....then just do that.But yes the problem there will be that not every nurse will remember or can be bothered.So make sure you have your I.D clearly visible AT ALL times and if a patient asks who you are just tell them.Is that really so hard.Works in the U.S and other countries around the world but the U.K just seems to want to make everything about this so difficult.Who really cares what colour of uniform staff wear.I dont.Alot of hospitals have ALL nursing staff no matter what the band/grade on the ward/dept in blue with piping to determine who is who,but I.D clearly worn.Problem is that not all nurses like this because how dare a HCA be in the same colour as me the STAFF NURSE!!Our trust has wasted a fortune in constantly changing the uniforms and putting the HCAs in a green tunic that i have seen cleaners wear downtown outside a building.Concentrate more on direct patient care and managing the NHS properly,who by the way in serious money troubles instead of wasting MORE money on changing uniforms AGAIN.
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