Editorial: Is a ‘mini’ uniform code just skirting around the issues?

This is the authors' abstract. We don't add key points for this paper.

A news report from 2008, freely available as a YouTube clip (http://www.youtube.com/watch?v=sj4IGDbRZvc), claims that nursing staff working in a hospital in Spain are incentivised to wear a ‘miniskirt’ as part of their uniform dress code. Greg Gutfeld, presenter of the American Fox News Red Eye programme, explains that nurses in the Clinica San Rafael hospital in Cadiz will not receive their monthly bonus of 30 Euros if they choose to wear trousers instead of a ‘miniskirt’. The host asks his studio guests and viewers at home in exasperation: ‘Who could possibly be against this dress code?’ One of the panellists, conveniently a male physician turned comedian, responds with temerity: ‘If the nurses had dressed in ‘miniskirts’ when I was a doctor, I would still be a doctor’. ‘Is it possible’, ponders the host ‘that attractive nurses in short skirts might lift the spirits of patients thus increasing their chances of getting better?’ A female panellist, cantering past the evidence base, supports his claim saying, ‘You know what, I believe that every woman no matter what size or shape has something to flaunt, especially the Latina women, they have big butts’. Concluding rather unscientifically but nevertheless very cheerfully she rallies nurses everywhere to ‘Wear the miniskirts and save some lives!’ Bearing in mind that the newly introduced retirement age of nurses in Ireland is 68, I wonder if nurses approaching retirement age avail of the scheme? Equally of interest to the audience is to know whether there are any male nurses in the Spanish hospital and are they motivated by the reward to don the ‘miniskirt’ uniform? If so, are the reporters also hypothesising a positive relationship between patient exposures to florid varicose veins/hairy muscle clad legs and enhanced spiritual well-being? The YouTube clip pans to some snatched footage of only young female ‘miniskirted’ clinical staff at the Spanish hospital. Although on critical examination, it seems that the said skirts cannot be validly categorised as ‘mini’. Admittedly without empirical measurement, it is difficult to determine with certainty, but drawing on aesthetic ways of knowing, the ‘miniskirt’ seems more like a sober, sadly time-warped and highly unattractive, barely above the knee A-line dress. To add insult to injury, the short blue dress is teamed with white pinafore apron and topped with garden gnome like nurses’ hat. Surely, the effectiveness of such spiritual interventions is tenuous? Nevertheless, unfaltering in his efforts to establish a link between nurses’ short skirts and patients’ well-being, the Fox News show host summons other ways of knowing, such as authority to defend his claim where he informs us that ‘the Head of the Clinica San Rafael hospital says: ‘Wearing the skirt is an important part of the nurse’s duty’. It has to be said that there is ample support in the literature for the contention that wearing a uniform is an important aspect of the nurse’s duty. Roohafza et al. (2009) maintain that wearing colourful clothing in paediatric wards reduces child anxiety which in turn is conducive to recovery. Nazarko (2008) asserts that wearing a uniform is essential for infection control purposes. The symbolism of traditional uniforms makes patients feel secure and safe, and they also enable patients to recognise staff which can be reassuring for patients (Richardson 1999). Moreover, uniforms are thought to be central to projecting a corporate and professional image. It is indisputable that the uniform worn at Clinica San Rafael is a source of amusement and, in turn, anxiety reducing for children in paediatric wards. As regards infection control, truncated uniforms arguably harbour less bacterial organisms and, therefore, play a plausible role. However, it is not clear how patients, visitors and other professionals can identify staff and feel secure in Clinica San Rafael if nurses are disguised in garden gnome outfits. Equally unclear is what corporate and professional image Clinical San Rafael is striving towards with the aforementioned uniforms. Evidently patients, visitors and other health professionals have no such difficulty identifying nurses nor do they have any problem with the professional image of nurses which the uniforms portray. By all accounts, patients, visitors and other health professionals generally take nurses’ uniforms very seriously. We know this from tradition. Castledine (2008) explains that the nurse’s uniform is an essential aspect of nursing’s professional status and culture, and that patients and visitors yearn for these traditions which have become standards of identity, meaning and personality. Indeed, it seems nurses themselves wear their uniform proudly as it identifies them as belonging to the nursing profession and the associated education, responsibility and accountability. In short (no pun intended), the uniform forms part of the nurse’s work. Robinson Wolf (1986) explains that nurses’ work involves aspects of human life that are both sacred (responding to events that have an ethical dimension – caring for dying patients, initiating resuscitative measures and medicating patients in severe pain) and profane – nurses’ dirty work, which involves direct contact with bodily products, including secretions, and excretions and with the products of infection. Unfortunately, nurses knee deep in nurses’ work at Clinica San Rafael do not share the same sentimental and nostalgic view of uniforms, especially one which does not – whether sacred or profane, sacredly profane or even profanely sacred – consider the practical demands of the nurse’s work. The Chair of the Nurses Working Committee at the Spanish hospital explains what identity, meaning and personality their unforgiving uniforms hold for them when she says that ‘We feel like ornaments in the skirts. We do not have freedom of movement and cannot bend over to tend to patients. We are made to expose our bodies to do our work’. In other jurisdictions, dress uniforms have been actively phased out in clinical practice in favour of trouser uniforms owing to the increased risk of back injury associated with dress uniforms. Why is that nurses remain captive in these regressive dress codes? Could it be that the ‘mini’ dress code is only skirting around the real issues? Richardson (1999) explains that uniforms have their origins in religious and military influences, and therefore, nurses’ uniforms are used to symbolise their rank, status and class. Evidently by virtue of the fact that such uniform practices obtain, and remain open to public ridicule and thinly veiled puerile comments, indicates that uniform dress codes still serve to keep clinical nurses in their place.