Nursing dress code

FigureThe nursing dress code is far from standardized. A nurse may be required to wear a specific color and style of scrubs or specific shoes; cover tattoos; display no body piercings; wear natural-looking makeup; keep fingernails short; wear only neutral-colored nail polish; and have their hair in only natural colors and approved styles. A nurse in an alternate facility may be allowed to wear scrubs, shoes, hair, nail polish, lipstick, and eyeshadow in any color they prefer while sporting visible face tattoos and multiple piercings. Commonalities that exist in these two extreme dress codes are often the evidence-based requirements, such as shorter fingernails.1 But even organizations providing guidance on the best practices for preventing infections, such as the CDC, don't offer full guidelines on a safe, universal uniform for the nurse. For example, the CDC notes that there's insufficient evidence to identify if wearing rings could increase the risk for spreading infection.1 In the instances when infection prevention and patient safety aren't a concern, one must question what constitutes the appropriate dress code for the professional nurse. In both examples discussed above, there was nothing allowed that was universally identified as a patient safety risk. This paper will discuss some of the factors that are considered when deciding on a dress code for acute care nurses beyond patient safety, and why each individual facility may decide on such different policies. Identification Patients prefer that nursing staff are easily identifiable.2 Although one study found that patients can better identify different types of nursing staff by the color of their uniforms, another study determined that utilizing badges that clearly identified the nursing role was more useful for this purpose.2,3 Large-print badges with nursing role initials were consistently cited as useful.2-4 Older patients better recognized nursing staff when they wore white uniforms, but younger patients often used badges with nursing initials in large print for this purpose.3 This isn't surprising, given the evolution of nursing uniforms from clean, crisp dresses and caps to modern, comfortable versions that better enable the wearer to perform a multitude of tasks. Older patients were more likely to have been exposed to the crisp, white uniforms worn by many nurses in years past. Additionally, the ability to quickly recognize employees can be useful for security purposes. The Joint Commission requires that facility personnel identify all individuals who enter.5 Although this policy doesn't require or provide rules for the use of employee badges, using badges that easily identify staff enables facilities to implement a quick and secure identification procedure. Furthermore, properly issued badges, especially those with photographic identification, provide a secure way beyond uniforms to identify nursing staff. It's important that patients and facility personnel can quickly identify approved nursing staff. Although particular colors and types of uniforms may facilitate improved patient recognition of nurses, requiring nursing staff to wear easily readable badges for clear identification would be more efficient and provide additional safety. Patient perception The appearance of nurses is often cited as important for the profession, but it isn't a thoroughly tangible concept.6 Nurses need to be recognized as capable and trustworthy; however, the role that the nurse's appearance takes in supporting that professionalism is debatable. Clothing deemed to be professional may increase patients' confidence in nursing staff. When patients perceive that a nurse's attire is more professional, they may feel that the nurse is more qualified to care for them.2,3 The way a nurse dresses could influence how the patient interprets the nurse's level of professionalism, which in turn, impacts the patient's trust and confidence in the nurse and could affect that patient's care experience. Past research indicates that patients may think that nurses who wear graphic T-shirts look unprofessional, whereas those wearing standard nursing uniforms appear professional.2 The color of scrubs may also make a difference in how patients view the approachability of nurses and how much confidence patients have in their nurses.2,3 The preferred color, pattern, or texture of fabric differs. Patients also expressed that a neat appearance, including unwrinkled clothing and clean shoes, adds to the appearance of professionalism.3,4 More permanent physical features, such as tattoos and body piercings, may influence patient perceptions of nurses. Patients perceived that female care providers in the hospital were less professional if they had visible tattoos.7 However, the same patients didn't perceive a difference in professionalism between male hospital providers with or without visible tattoos. Patients perceived a decrease in professionalism in both male and female care providers in the hospital if they had visible piercings to body parts other than their ears, although this effect was more prominent when the provider was female. Patients also perceived that nurses with visible body piercings and tattoos had lower levels of empathy, skill, and competence.3 An integrative review of body art in nursing identified various levels of acceptability and found patient confidence was often decreased when body art was present.8 Nurse autonomy One must question who decides what a nursing professional should look like. Those who are creating the policies that govern what nurses' bodies and uniforms look like would naturally feel that the patient's perception should garner utmost consideration. In what other profession, however, do we disregard the opinions of those who work within it? Studies used to support more rigid dress code policies often cite patients' attitudes toward nursing uniforms and body art.4,8 What's lacking is literature that identifies what current professionals working on the front lines feel is needed for a professional appearance. Some nurses may feel that the change from the all-white uniforms of the past has negatively affected the perception of professionalism and that modern changes occur due to a lack of nurses' desire to look professional.9 On the other hand, even patients often feel that nursing comfort is more important because it directly affects patient care.3 Additionally, there's a need to ensure that nursing appeals to newer generations who have different values from previous generations. Generation Z healthcare workers seek employers who offer diverse and inclusive environments.10 Diversity needs that can affect nursing dress code policies will likely increase because the population of those who identify as members of underrepresented groups is expected to outnumber those who don't within the next 40 years in the US.11 As younger generations take the helm of the nursing profession and diversity increases, flexibility to allow self-expression among professional nurses is becoming increasingly important. Body art is a growing trend in the general public. Tattoos and piercings are some of the most common body modifications in the US.12 Body modification choice may be due to religious beliefs, cultural influences, or personal preferences. In 2021, 26% the US population reported having at least one tattoo. In 2017, 34% of those in the US had at least one body piercing excluding earlobes, and another 14% were considering a body piercing.13 Although many facilities' dress codes forbid visible tattoos and body piercings for nursing staff, the presence of these body modifications is becoming more commonplace to the general public. This may hinder the personal freedom of those working in the nursing field. Space for self-expression Patients' opinions on nursing professionalism are often deemed important when making decisions on nursing dress codes. Although patients are the consumers of nursing care, they alone shouldn't be the deciding factor for what's deemed professional. The world, and what's acceptable in fashion and appearance, is changing. Along with this change, there will be evolving needs for personal expression of those within nursing. In addition to patient concerns, the comfort, individualism, and opinions of those working the front lines should be considered when deciding on appropriate appearance for those in the nursing profession. When infection prevention isn't at stake, nursing dress code policies should have enough flexibility to allow self-expression, diversity, and autonomy.