True Colors
More hospitals turn to standardized attire for nurses to better identify them to patients and to polish their professional image

By Melissa Gaskilla
September 6, 2004

When California nurse consultant KT Waxman, RN, MBA, asked a relative about his hospital care after surgery, she was stunned when the former patient said that he rarely saw a nurse. The people who came into his room wore scrubs or even T-shirts, he reported, and he presumed the nurse was at a desk and didn’t want to be bothered.

“We assume patients know who the nurses are,” Waxman said, “but obviously that’s not the case. I understand moving away from the traditional white, but I don’t believe it was anyone’s intention to promote unprofessional attire. I would advocate we go back to some kind of uniforms, identification that people can recognize.”

A few years ago, Ann Stovall, RN, BSN, chief nursing executive at Christus Jasper (Texas) Memorial Hospital, initiated a hospitalwide move to wearing colors specific to position.

“We have a [substantial] geriatric population and with everyone in scrubs, they didn’t know who was a nurse or a housekeeper,” Stovall said. “There was nothing that looked professional, mismatched colors, some people who were neat and others who were not.”

Nurses wear royal blue and nurses aides, burgundy. Prints are not allowed except on special holidays. “Solid is more soothing than busy prints, which can be disturbing to geriatric patients and disturbed patients,” Stovall said. Nurses can wear a solid blue or white lab coat as well.

Once the nursing departments changed over, hospital CEO Deborah Wiegand, RN, decided to implement color-coded scrubs for all staff involved in direct patient care. The hospital gave employees six months to change over.

As a small rural hospital, Stovall said, Jasper Memorial couldn’t afford to buy staff uniforms, but did have uniform companies bid in order to find the lowest price. The hospital also offers paycheck deduction for uniform purchase.

Cost wasn’t much of an issue for the nursing staff, Stovall said. “Typical cost of a complete outfit, pants and top, is around $15. Patients do notice that everyone looks good. I think it has made everyone more aware of their appearance and caused them to take a little more care.”

Appearance is important in any workplace, said Kim Zoller, owner and president of Image Dynamics, a Dallas corporate training firm that specializes in personal and business effectiveness, including health care.

First impressions

“Studies show that you make an impression in three to seven seconds without even opening your mouth,” Zoller said. “Ninety-three percent of that impression is outside of your words. Appearance does matter. The consistency of uniforms looks better, and the recognition factor is very reassuring.”

In surveys done by Zoller’s firm, for example, physicians’ offices where people wore uniforms were rated cleaner and more professional.

Staff at Christus St. Joseph Hospital in Houston recently went a step further, switching to uniforms that conformed to specific guidelines in addition to color.

“Specific service lines wore colors, but it was all over the map,” said Laura Fortin, RN, BSN, CHE, chief operating officer and chief nursing officer. “Our dress code just got really sloppy. I was concerned about whether we looked professional.”

Patients responded in a survey that it didn’t matter what color nurses wore as long as it was obvious who they were. So, Fortin formed a committee of all hospital departments, which asked a uniform company to present all styles and colors available. Then representatives went back to their departments to negotiate who would wear what.

The result was specific guidelines for uniform styles, with two or three different tops and pants to accommodate tastes and body types. The hospital gave staff 90 days to change over.

Now, all nurses wear royal blue uniforms, and Fortin said response has been positive. “It looks really good. You know who everybody is. We list the colors every department wears in information books in all the patient rooms. For some patients, everybody who walks into the room is a nurse. But now, if a patient says something about what someone did, we just ask what color they were wearing.”

The uniforms are available through a select company at a discount, and typical cost is between $30 and $40, but can be as low as $20, depending on style and size. Nurses who want to get their uniforms elsewhere or have them made can get fabric swatches from the hospital. Color match must be exact, though, Fortin said.

Up to code

“I think attitudes are more professional, and we get a lot fewer patient complaints,” she said. “We’ve seen our patient satisfaction go up a bit, and I can’t say it is all related to the uniforms, but you can kind of correlate it. Managers and staff tell me it has made a significant difference.” Fortin said one key to the program’s success was staff involvement. “You can’t have management get together and make the decision. You need staff to buy in. And once the staff sees, they do buy in.”

Recently, nurses visited from another hospital, all wearing scrubs. “Everyone here said how sloppy they looked,” Fortin said.

Nurses at Marina Care Center in the Los Angeles area wear traditional white uniforms and caps every day, said Matilda Rogers, RN, director of nurses, who advocates a widespread return to the whites. “We need to be professional and look like nurses. Here, patients love it, families love it. Doctors like it. Every place you go, you can identify the nurses.”

Nurses buy the $12 to $14 whites and are given caps.

But that approach won’t work everywhere. “I don’t think scrubs look that professional,” Stovall said, “but this is the real world, and I don’t think you could find uniforms [at Jasper Memorial].”

Waxman recognizes that white uniforms may be a stretch, but thinks scrubs should stay in the OR, and revealing attire has no place in a hospital. She said she has worked in places where nurses didn’t wear uniforms or scrubs, but low-cut tops and low-rise pants.

“I’ve had to send nurses home because a thong showed,” she said. “No one cares what your title is if they are busy looking at that, and we aren’t going far in the nurse-physician relationship if doctors are looking at you just to look at you. You need to be professional.”

“I think it is up to the manager to enforce the dress code policy,” she said, even at the risk of having a nurse transfer or quit. “We need to be consistent about enforcing, even with the nursing shortage. I honestly think it is about accountability and professionalism.”

“If you go to school and get educated, why would you let your dress stand in your way?” Zoller said. “There are so many other issues. Why let someone disregard who I am just based on my dress, before I even open my mouth?”

“We worked hard for our degrees and even harder for our experience as nurses,” said Judy Davidson, RN, MS, clinical specialist at Pomerado Hospital in Poway, Calif., where nurses wear uniforms. “We deserve to be seen as professional, and while actions and words are important, a dress code can put us over the top toward gaining respect and recognition.”