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Practice comment

"If the cap fits: does nursing need to rebrand its image?"

Only the most ardent retro fan would seriously entertain a return to the days of the nursing cap.

Why is it then, that alongside fob watches, starch and matrons, it continues to remain a dogged symbol of all that was good about nursing?

Until the 1970s trained nurses were instantly recognised by their caps. The origins can probably be traced back to the nuns’ habit, which, when adapted and endorsed by Florence Nightingale to distinguish her new “trained” workforce, became the norm.

Today this “hallmark of a profession” - once considered the very symbol of knowledge and caring - has all but disappeared. Reasons for its decline range from the practical (such as they harboured infection) to the more symbolic: the hapless cap representing an outdated subservient attitude to men as well as linking the profession uncomfortably to the domestic maid’s servility.

If the cap was superfluous did this mean its associations of dignity, dedication, caring and knowledge were also less important? Is there an argument to suggest that the baby was inadvertently thrown out with the bathwater? Certainly many of the public feel that way. The whites and the cap, as well as making nurses easily identifiable, also seem to be associated with a sense that the wearer is professional and compassionate. An experiment in a cardiovascular setting in the US provided such strong validation that it actually led to the permanent reintroduction of both to this day.

Though it’s extremely “old hat” (pun intended) to suggest clothing and appearance can imply professionalism, the evidence nevertheless suggests that we have not yet found a successful replacement for the uniform in which the public and patients placed so much trust. Should we continue the trend for purely functional (ever more multicoloured sack-like scrubs and Crocs) or could our uniform be part of a kind of rebranding of the profession?

Several years ago in the US, a proposal was put forth that all nurses wear a patch on their uniforms that said simply “RN” in big red letters on a white background. It was described at the time as “the solution to nurses’ identity crisis” but perhaps not surprisingly hasn’t really caught on -nurses were markedly split in their views. It is probable that any similar attempts at rebranding would produce an equally divided response. Maybe the extraordinary evolution of the cap, cape, buckle and whites and their attendant associations is just impossible to recreate.

It’s actually irrelevant anyway. Rose-tinted views of the virtue of past nurses and gloomy prognoses on the declining standards of modern nurses are both inaccurate and unhelpful. Let’s look to a future where appearance or obsession with professional development and educational attainments take a back seat to what you actually do: “I knew she was a nurse because she treated me skilfully, respectfully and in a caring manner”. If that cap fits, we should all be proud to wear it.

Stephen Riddell is a district nurse working in Dumfries and Galloway

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Readers' comments (44)

  • I went to a very old fashioned school of nursing in Oregon,US. It was the best three years of my life. I always wanted to be a nurse. We were capped. It was huge. Every hospital had a different cap. We wore white stockings,white shoes, a white uniform with navy blue piping around the collar,we could pick white or navy blue for our sweater.We were taught the traditions of nursing but also we spent most all of our time in the hospital taking care of patients. By the end of three years we could work anywhere with skill and competence. I moved to Boston and got a job in a very large teaching hospital affiliated with Harvard University Medical School. It was a total academic environment and over the 25 years. I have watched nursing evolve. I have watched nurses talk about the good old days. I have taught so many nurses to be nurses and critical care nurses. I know that people can not be taught to care. Some nurses are more empathetic than others. Some wear their heart on their sleeves and become heartbroken when patients do not do well. I have seen unbelievable tragedies and unmeasurable joys. I have seen nurses go from having a strong personal identity to having fracture within the body of nursing. A fracture between those academics who say that nurses must persue advanced degrees, that the entry level into nursing should be the Masters in Science in Nursing Degree, and those who say that nursing should be taught at the bedside as in the Diploma in Nursing. I was and remain very proud of my Diploma. I never persued an advanced degree because I could afford not to. I was often pushed but always refused. I am not a big believer in Nursing research. I am more of a get in and get to work kind of nurse. I believe nursing at the bedside is an Art not a Science. An art based on science to be sure but an art none the less. They are patients needing care not subjects in some academic exercise.I believe that nursing needs to heal the fracture within itself and cure itself with a good old fashioned care plan and the hard work and dedication that it has provided to others for all these many years.

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  • tinkerbell

    Catherine Sofikitis | 12-May-2012 3:33 am

    Well said.

    Although i like hats (use to wear one in general nursing) and dressing up i don't really want to add a hat now but to be honest i don't feel strongly about it either way, but might feel a bit silly after all these years. I could get over that though. With or without a hat it does not change the person inside, and that person inside the uniform is what is most important and their attitude. I have worked with or without a uniform/hat but never naked.

    As we discussed in our conference yesterday 'the value of nursing' nursing is is about
    'head, heart, hands'.

    Think we are all getting lost somewhere in being a jack of all trades and master of none. We need to get back our focus (laser like) and its needs to be right at the heart of the matter without any red herrings thrown in to muddy the waters so we are not left confused as to our role and function.

    I read a saying 'i can deal with risk, i can't deal with confusion'. Nursing seems pretty confused at the moment and lacking identity but i know what i am without a hat.

    Let's try and keep it all a bit more simple because i think we are in danger of being educated out of all the common sense we were ever born with. Nothing against education of course. It's a privilege to get one but it's the doing that creates the understanding, both should compliment one
    another and not be at odds.

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  • When I trained caps were the thing to wear along with the smart dress uniform and belt.
    I was sad when the caps were removed. I to this day believe that they looked smart and were excellent in hiding untidy hair. You would tie up your hair and tuck it under the cap which always looked smart and professional. It had its uses although it did used to get knocked by the curtains at times.
    Bring back a smart professional uniform again including the caps. That's what I say!

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  • I dont feel that is important what the uniform is as long as it is standard across the UK, so that everyone knows who we are, and can identify different grades of nurses wherever they go in the country. Nurses also need to take pride in their appearance, not wearing scruffy shoes or having hair falling down eveywhere and keeping whatever uniform they wear clean and tidy. I wouldnt particularly want to go back to the 'old days', but would like to see more pride in what nurses wear.

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  • We do need to go back to basics and try look after the patients in a professional and caring manner as well as look professional. We did wear a cap I when trained 24 years ago and would not neccessarily want to wear it again,but rather that than scruffy nurse's uniforms that we wear nowdays.Every hospital wears different uniforms and some of them do look terrible.We DO need to bring back white uniforms,smart black shoes not trainers,tidy hair,no piercing or false nails...

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  • my hat was a disaster as we had to make them up fresh for the 7 o'clock shift every morning. they had to have 5 flutes behind and as I wasn't very adept at needlework mine always ended up with 4 or 6! Then there was a general strike after which the laundry started cutting back on starch and that was in the days of the spray on stuff!

    Donned with this most extraordinary superstructure one didn't stay neat and tidy for long as invariably a strand of hair would start to poke out - no time or mirrors on the ward to check, or a frightened patient would try and grab you by your hat, or it would go squiffy when you had to dive under a bed to retrieve your patient or some other object or hide from Matron, sister or escape from one of the doctors!

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  • The cardinal point - made above - is that the cowl doesn't make the monk, and never has done.

    As for scruffy uniforms, trainers etc.: I have yet to see anything of the sort at my large London teaching hospital but perhaps that's exceptional?

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  • ""If the cap fits: does nursing need to rebrand its image?""

    it is what nurses do and how they apply their skills and expertise which is important and makes an impression. not their sartorial elegance! for crying out loud!

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  • "it is what nurses do and how they apply their skills and expertise which is important and makes an impression. not their sartorial elegance! for crying out loud!"

    'First Impressions Count!' If a nurse looks scruffy and untidy it says a great deal about general attitude

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  • "'First Impressions Count!' If a nurse looks scruffy and untidy it says a great deal about general attitude""

    obviously! that is common knowledge and you are stating the obvious!

    nurses don't need to look scruffy just because they are not wearing a hat from some museum!
    or maybe you prefer nuns with no hair showing at all.

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  • "obviously! that is common knowledge and you are stating the obvious!

    nurses don't need to look scruffy just because they are not wearing a hat from some museum!
    or maybe you prefer nuns with no hair showing at all."

    I may be stating to obvious, but some people think that they dont need to look smart. I dont think we should go back to the old days of wearing hats. Its not just about being a caring profession, its the whole package and that includes appearance.

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  • Anonymous | 16-May-2012 2:35 pm

    with respect, you are repeating the obvious again. in over 30 years of nursing I have never come across a scruffy nurse although after a 12 hour shift where one has little time to titivate and fix one's hair and make up one sometimes gets scruffier as the day wears on but as we have both more or less said it is who you are and what you are capable of doing and a positive attitude which are of most importance so perhaps one can be given towards the end of a particularly hectic day. Besides, ever tried carrying a change of tights, spare hat, hair brush, powder puff and a squashed and molten lipstick in your uniform pockets besides your purse and tools of the trade and some even carry their mobile phone or mini computer - all because wards do not always provide nurses with personal spaces for their belongings?

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  • Well, I can certainly remember my female colleagues wearing caps! I can also remember the squeals of protest as the caps and starched aprons were phased out ! Fortunately I was never required to wear any of that stuff !!

    I must admit that I felt female nurses were a bit "odd" in their attachment to an archaic uniform while other professional female heath care providers had adopted practical and easy to wear clothing.

    Working in A&E I was one of the first people to adopt "scubs" I was followed very quickly by my medical colleagues but the ladies were very slow and reluctant to give up their "nurses" uniform !!

    Its not what you wear its how you behave,
    introduce yourself to your patients, treat them professionally, respect them as individuals and you will be remembered as a NURSE !!

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  • I have mixed views on this topic. To some degree I agree that it's the professional behaviour associated with nursing practice that we need to encourage and develop. I should not matter what style of unitform you wear or what colour it is - as long as it is worn in a smart manner.

    However, when you see nurses who blatently ignore uniform policies (despite address from senior colleagues), it makes me wonder if a return to old fashioned values is what is needed. Some health care professionals really lack an awareness of their apprearance - waering uniforms that are obviously 2 sizes too small or well worn out. I agree that first impressions count and if you give the impression that you cannot even care for your own appearance, what might this say about your standard of care towards patients.

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  • What about the male nurses - baseball caps?

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  • Male & female nurses - baseball caps on backwards - excellent idea!

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  • Anonymous | 21-May-2012 5:20 pm

    cool! could solve the problem of where to stick all the badges too and maybe resolve the hygiene debate!

    great idea - but optional as they can damage your hair and could precipitate baldness in men!

    wearing a cap indoors isn't such a healthy idea because of the heat, sweat, etc. unless they could be made of a suitable light and breathable material.

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  • Nurses should don the Star Trek red jersey (the one worn by the never-before-seen crew member whom you just knew was not going to be beaming back from the planet with the lead characters). Better still, paint a target with a bullseye on the back of the jersey. That's about the level of respect we can hope to receive in this day and age. Oh and why is that funny little, green chap with a head like a bum, looking at me in that menacing way? That's a tad worrying. Beam me up Scotty. Eh? Well, don't you have any spare Di-Lithium crystals in the boot? Oh cr*p!

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  • There's more pressing concerns affecting nursing at the moment apart from whether we look cute in hats.

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  • Anonymous | 21-May-2012 7:00 pm

    absolutely right, but if we loose our sense of humour too, what then?

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