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Nursin' USA - Why the furore over nurse uniforms?

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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.

 

  • 17 Comments

Readers' comments (17)

  • Laura Ellison

    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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  • 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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  • 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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  • 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

    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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  • 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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  • 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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  • 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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  • 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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  • 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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