MandatoryUniforms 
in Healthcare

 

Becoming One of the Herd

Windy R. Munderloh

 College of Saint Mary

 

 

Mandatory Uniforms in Healthcare, Becoming One of the Herd

The purpose of this blog is to discuss critical issues in nursing. Mandatory uniforms in healthcare are a pressing issue in many healthcare facilities today, while this issue may seem like a positive step in the direction of professionalism, a closer look reveals conformity does not necessarily create professionalism. An unspoken hierarchy has developed, dividing healthcare workers and redefining the healthcare team.

Mandatory uniforms in healthcare date back to the 1800’s when the mother of nursing, Florence Nightingale insisted that the nurses working in her ranks present themselves as professionals and dress uniformly with a clean and hygienic appearance. It was then that Florence Nightingale’s Nursing Environment Theory was born. Mandatory uniforms were designed to bring professionalism to the healthcare team. This blog will discuss why recent changes make mandatory uniforms for healthcare workers a critical issue.

So what is the big deal, why are mandatory healthcare uniforms a critical issue in nursing? Chances are that everyone reading this blog has visited a hospital or physician’s office at least once in his or her life. The public can easily identify a member of the healthcare team by the uniform scrub that was functionally designed and designated as the appropriate attire for individuals performing patient care. The healthcare scrub comes in many colors and styles, and can vary greatly in cost. Many healthcare facilities permit the healthcare team to wear any color or style of scrub as long as facility policies for cleanliness and hygiene are enforced. Who wouldn’t want their nurse to have a neat and clean appearance? However, with the push for achieving and maintaining Magnet status being a hot topic today, and an increasing emphasis on patient satisfaction, many facilities are ramping up the professional appearance of the healthcare team by creating a color coordinated unspoken hierarchy within the health care team. This leads to the question does this new color coordinated world within the healthcare facility create unity or division among healthcare workers?

The current trend is to conform, change and adapt in a utilitarian approach to professionalism. The premise for color-coded departments is primarily for ease of recognition of an individual in scrubs. According to a recent research study, “The current multi-variant uniform styles worn by care providers make it difficult to identify the Registered Nurse. Appearance and image are important concepts in nonverbal communication” (Bednarski, and Rosenberg 2008). While this theory of ease of identification of the Registered Nurse sounds good, does it work? Will a patient, during a time of illness and recovery glean the notion that all of the Registered Nurses’ at his or her hospital of choice wear pewter gray while the Certified Patient Aids’ wear olive green? Unless a patient frequents a healthcare facility, all signs point to no. In a recent research study (Wocial, Albert, Fettes, Birch, Howey & Trochelman, 2010) researchers concluded that the patient population paid little attention to what the healthcare team wore as long as it was neat and clean. Many participants in this study could not even recall what the healthcare team member was wearing let alone what color it was, professionalism, was determined by these participants in terms of cleanliness and attitude.

So what determines professionalism? Professionalism is determined greatly upon attitude, pride in appearance, job and cleanliness. There are many variables influencing the need to mandate uniforms however, becoming “one of the herd” does not necessarily mean one will become professional. There will always be those who sift through the laundry basket for something to wear to work, the un-showered, the wrinkled, the odoriferous and the faded-worn-out-should-be-retired-uniforms. These variables can very easily continue to be a problem long after transitioning into mandatory uniforms. As stated in a recent nursing article, “A uniform does not maketh the nurse” (Poultney, 2009). Professionalism comes from the inside out.  

One Midwest facility has found that the transition to color coordinated departments is not one of smooth sailing but rather a bumpy road met with resistance and dysfunction, because let’s face it, there is no delicate way to take away freedom of choice. People in general enjoy the personal freedom of choice –no matter how small. For a facility to transition from personal preferences to an inflexible designated dress code, one must expect some resistance. The road to mandatory color-coded uniforms for this facility has been long and tumultuous. Many balked the notion of mandatory uniforms due to the loss of individuality, personal choice, and cost. Others felt that the democratic framework of shared governance had been taken away as healthcare members were not given the opportunity to vote on the topic. Regardless of resistance the facility persevered and behold the mandatory color coded uniforms are here to stay. Did the facility consider the ethical implications of taking away the employees right to be heard and vote via shared governance? It would appear as though they may have overlooked the importance of the democracy that shared governance brings to the healthcare organization.   

Mandatory uniforms in healthcare affect the healthcare team as a whole. The healthcare team itself is one that is ideally utopian, where each team member works cohesively with one another. The beauty of the healthcare team is that it is multifaceted, with many different departments with many different jobs all working together with the same goal in mind, excellent patient care. The healthcare team itself consists of individuals in various stages of life with varying levels of education ranging from certificate degrees to upper-level degrees and graduate degrees. When transitioning into a mandatory uniform requirement it is important to consider the impact of the change and who will be responsible for purchasing and maintaining the newly required uniforms, in short the healthcare team members will be responsible for them and therefore are the affected population.

The financial implications can be costly. In one Midwest facility, healthcare team members are not only responsible for purchasing one color, one brand, one style of uniform but they are also responsible for the embroidery of the facility logo at a cost of $7.00 per uniform. There seems to be a gap in the consideration of the lower lever pay scale employees and the rising cost of living when these new costs were deemed acceptable. Let’s not forget the single parent employees and those who live pay check to pay check. Something should be done to meet these team members half way.

Healthcare policies in many facilities have a professional appearance policy. Insisting that team members take pride in not only their work but their appearance as well. This is vital to the professionalism of the organization and the healthcare field as a whole. Some polices take it a step further and place standards on facial hair and the use of facial jewelry as well as a no tattoo policy. According to one nursing article, “hiding tattoos will help maintain a professional appearance” (Scovell, 2010).

Access to health care population does not apply to this critical issue. 

Clarity: Florence Nightingale’s Nursing Environment Theory stresses the importance of cleanliness and professionalism. With mandatory nursing uniforms the healthcare team members appear to be unified and driven to provide excellent patient care. The presence of a tidy and polished healthcare member emanates aseptic technique

Simplicity: of Nightingale’s Nursing Environment Theory consists of the following three main concepts:

·         Environment to patient

·         Nurse to environment

·         Nurse to patient

Nightingale believed strongly that the environment was a major factor in illness and disease. Nightingale was ahead of her time when she recognized the potential harm of the environment and worsening of illness vs. recovery.

            Generality: of Nightingale’s Nursing Environment Theory is still considered a corner stone in the foundation of nursing. In nursing today, aseptic technique and frequent hand washing are the key components in preventing illness and disease. Nightingale is also a founder in the professional appearance in nursing today with her high standards for nurses. 

Empirical Precision: of Nightingale’s Nursing Environment Theory in regard to testability it is evident that a clean environment is a healthy environment as bacteria and germs thrive in unclean conditions.

Derivable Consequences: in Nightingale’s Nursing Environment Theory it can be determined through multiple examples that Nightingale’s theory is proven to be accurate, helpful and consistent. Nightingale directed nursing to a higher standard of care with her ideas and nursing practices. Nightingale was able to prove her theory was effective in her nursing practice with an increased survival rate of patients’ and a decreased mortality rate.

Evaluation of desired outcome: Professionalism in nursing does not necessarily mean matching uniforms, although uniforms do have a greater appearance of unity. Professionalism in the healthcare team starts on the inside as an inherent desire to achieve one’s personal best and maintains a reputation of greatness. Professionalism starts with the individual and should to be maintained by the individual. Nightingale’s Nursing Environment Theory has been a part of the nursing and healthcare community for over 150 years Nightingale’s insistence and high standards for the professional appearance of nurses’ will remain strong for many years to come

References

Barkley, E.F. (2010). Student engagement techniques (1^st ed.). San Francisco, CA: Jossey Bass Publisher.

Bastable, S.B. (2008). Nurse as educator: Principles of teaching and learning for practice (3^rd edt). Sudbury, MA: Jones and Bartlett Publishers.

Bates, J. (2007). Dress to impress. Nursing Standard, 21(20), 29.

Bednarski, D., & Rosenberg, P. (2008). Nurses' Uniforms and Perceptions of Nurse Professionalism. Nephrology Nursing Journal, 35(2), 169.

Brady, M. (2009). Hospitalized children’s view of the good nurse. Nursing Ethics, 16(5), 543-560

Fray, B. (2011). Evaluating Shared Governance: Measuring Functionality of Unit Practice Councils at the Point of Care. Creative Nursing, 17(2), 87-95. doi:10.1891/1078-4535.17.2.87

Haughton, G. (2006). Uniform approval. Nursing Standard, 20(25), 26-27.

Poultney, J. (2009). Pride in nursing is more important than uniforms. Nursing Standard, 23(41), 33.

Scovell, S. (2010). Mark of prejudice. Nursing Standard, 24(23), 26-27.

Singleton, C., Lehane, M., Justice, S., & Jeffs, L. (2006). Tailored response. Nursing Standard, 20(29), 26-27.

Wocial, L., Albert, N. M., Fettes, S., Birch, S., Howey, K., Jie, N., & Trochelman, K. (2010). Impact of Pediatric Nurses' Uniforms on Perceptions of Nurse Professionalism. Pediatric Nursing, 36(6), 320-326