Back to basic white

Patient confusion spawns a movement back to plain nursing uniforms

Who’s the nurse?

Is it the person who walks into your hospital room wearing a blue tunic and picks up your meal tray?

The long-vanished white nurse’s uniform at least included a cap with stripes indicating a nurse’s level of training.

Is it the one in a patterned tunic who asks you to take a breath deeply into a special device to check out your lung capacity?

Is it the one in the shirt sporting lots of cartoon characters who takes you down the hall for a hospital test?

Or is it the one who is in the pink pastel jacket changing your IV?

What nurses wear has become a very hot issue as hospitals around the country have started to ditch the colored and decorated scrub tops to return to the white uniform.

St. Clair Hospital in Mt. Lebanon, Pa., and University of Pittsburgh Medical Center Health System quietly have introduced white uniforms for nurses in their noncritical care areas, and Mercy Hospital in Pittsburgh enacted a new dress code beginning Jan. 1.

“I think there’s definitely a problem if patients can’t distinguish among the people who are caring for them,” said Jacqueline Dunbar-Jacob, dean of the University of Pittsburgh School of Nursing.

Nurses Mary Campbell, left, and Karen Schrecengost check out Douglas Kocher, 4, of Carrick, Pa., at Children's Hospital of Pittsburgh. Campbell is wearing a top decorated with figures from the movie Finding

“Patients are in a vulnerable position in a bed in a room, and they don’t know who’s coming in to care for them. They may be asking questions of someone who is not qualified to answer.”

Older nurses remember the starched white dress, white hose, shoes and pointy white cap (an accessory most despised). After hospitals in the 1970s discontinued the practice of laundering nurses’ uniforms, nurses fought for more practical clothing as easy-care fabrics became popular, according to Lynn Houweling, a nursing doctoral student at University of Pennsylvania who has researched the history of nurses’ uniforms.

Many nurses have welcomed the more casual look that allowed them to project their own individual personalities, be it teddy bears in the pediatric ward or flowered tunics to brighten up the geriatric wing. And uniforms had to accommodate the number of men joining the profession, too.

But nurses at many hospitals have become indistinguishable from the dietitians, lab technicians, respiratory therapists and other staff.

And even though the Joint Commission on the Accreditation of Healthcare Organizations requires nurses to wear name tags and titles, those nurses who are working in the ER or psychiatric areas sometimes cover up their IDs to protect themselves from the danger of unruly patients or stalkers.

St. Clair switched to white after reviewing patient feedback about the clothes they wore.

“It was confusing to them,” said Joan Massella, St. Clair administrative vice president and chief nursing officer. The nurses there “were wearing a little bit of everything. They were wearing T-shirts, athletic sports golf-type shirts, uniform floral and patterned tops. It was really a mishmash of everything.”

Though some hospitals are shifting to white uniforms for their nursing staffs, Lawrence Memorial Hospital is keeping its established dress code.”Nurses wear either printed or solid-color uniforms, as designated by their departments. This does include scrub-style dress or pants,” said Janice Early-Weas, LMH’s director of community relations. “Most of them wear scrub pants and tops, with a lab coat or a scrub jacket over it. We do not mandate white.”In the past, LMH has changed the clothing employees wear to clarify their positions.”For a while, our admitting clerks wore scrubs, and they changed because it was confusing,” Early-Weas said. “These were clerical employees, and so they switched to more of a polo shirt, so they would not be confused with a clinical employee.”

St. Clair nurses in the critical care areas, such as the intensive care unit or operating rooms, have continued to wear the traditional blue scrubs. It’s greens scrubs in the ER. But in all non-critical areas, nurses wear white scrubs, a white uniform dress, white pants suits, or white pants with a white golf shirt.

Views among many nurses have been decidedly mixed.

“But I have to say that when I walk on the units, I’m proud of them,” Massella said.

UPMC three years ago began instituting a dress code for the 2,000 nurses in its noncritical medical/surgical floors that calls for white outfits and colored jackets. “Having a dress code is a very personal issue,” said Melanie Heuston, UPMC director of nursing recruitment. “It was a big initiative.”