National Post on Nurses Uniforms

The National Post’s Tom Blackwell chimes in on the push by some of Canada’s nurses unions to re-formalize nurses attire.

[ ]‘How can we take nurses seriously when they are dressed in pyjamas?’: New push to re-formalize nurses attire

National Post
Tom Blackwell | April 17, 2014 6:49 PM ET

In her 30 years as a nurse in rural Newfoundland, Karen Morris has seen the physical image of her profession change dramatically.

The starched white uniform and distinctive cap first gave way to plain-coloured surgical scrubs, then to brightly coloured and patterned scrubs and then, well, to just about anything, from spandex pants to short shorts and even low-cut tops, she says.

“When you see a nurse coming in wearing jogging pants … it shows the patient, ‘I don’t really want to be here. I’m here and I want to be as comfortable and as casual as I can be,’ ” said the ambulatory-care nurse at Carbonear General Hospital on the Avalon Peninsula. “The professional level is not there.”

Similar garb, meanwhile, was adopted by an array of other hospital staff, leaving patients to guess who had arrived to clean their toilet and who to measure their blood pressure, she said. A year ago, Ms. Morris decided to make a statement, voluntarily adopting an all-white uniform that recalls, in part, a more formal past.

Now the Newfoundland & Labrador Nurses’ Union is urging all its members to move to a standard uniform of white top and black pants. They are part of a surprising movement across Canada’s health-care system, as employers and some employees push back against the informality in hospital corridors.

Canadian studies published over the last few years have suggested many patients find the increasingly casual attire to be less than professional, voicing a preference for plain-coloured, neat-looking outfits. A rule instituted in 2012 requires every nurse in Nova Scotia to wear a black and white uniform, subsidized by the province.

Nurses’ groups in Alberta, Saskatchewan, New Brunswick, and Prince Edward Island have taken similar steps, encouraging members to adopt white uniforms. A major Toronto hospital engaged the Roots company to design a standardized ensemble. One in Thunder Bay, Ont., is planning to implement its own nurse’s uniform shortly.

“This really has sparked the interest of nurses across the country,” said Jean Candy, executive director of the Nova Scotia Nurses Union. “This is really picking up speed.”

Nursing advocates and educators maintain that the informal apparel often leaves patients confused about the identity of their health-care providers, while undermining confidence in some of the professions.

“Nurses will walk in with Mickey Mouse cartoons, pumpkins, St. Patrick’s Day vibrant greens, thinking that that’s perhaps entertaining, but the patients themselves do not perceive that,” said Caroline Porr, a nursing professor at Memorial University of Newfoundland [MUN].

Yet the beginning of a move back to more standardized, formal attire does not sit well with everyone in the health-care world. Many nurses have rejected the idea, arguing that how they express themselves sartorially says nothing about their professional skills.

The Canadian Union of Public Employees (CUPE), which represents many workers at the Ottawa Hospital, challenged the precedent-setting dress code imposed by that institution in 2011.

The code did not establish a uniform, but banned certain types of clothes, called for tattoos to be covered up and piercings limited. A labour arbitrator struck down the policy last year, saying it unjustifiably restricted staff members’ right “to present themselves as they see fit.”

The policy, prompted in part by public complaints, set a troubling precedent where patients could essentially dictate the appearance of their caregivers, Peter Engelmann, CUPE’s lawyer, argued at the time.

“You can imagine the slippery slope that could lead to … ‘I don’t want this someone to wait on me because I don’t like the colour of his or her skin,’ ” he said.

Theresa French, a Winnipeg nurse, called Nova Scotia’s move depressing. “Really, in the 21st century?,” she commented in a letter to Canadian Nurse magazine. “What if I told you that you had to wear the same orange tie and purple shirt to work every day? It would crush your spirit.”

Formal uniforms seemed to fall by the wayside in the mid-1980s, replaced by scrubs — loose-fitting, unadorned cotton outfits designed for the operating room and glamorized by medical-TV shows. Scrubs in a variety of sometimes-vibrant patterns arrived in the 1990s, followed in the last 10 years by a “whole cacophony” of outfits, said Prof. Porr.

Housekeepers, dietary staff, physiotherapists and even some doctors have largely taken up the look.

A smattering of recent research suggests that the recipients of health care, at least, may want that to change.

Prof. Porr headed a small study at MUN, published last year in the International Journal of Nursing Practice, where 43 adult patients were shown photographs of the same nurse wearing eight different outfits. Asked to rate each according to how the get-up projected qualities ranging from empathy to professionalism, the highest marks went to the most traditional-looking white uniform.

Another study, also published last year, surveyed 642 nurses and 30 patients and family members at Ontario’s Thunder Bay Regional Health Sciences Centre. More than half the patient group said the nurses looked unprofessional and almost 80% favoured standardized uniforms. Yet 95% of the nurses themselves indicated they already looked professional, reported a paper in the journal Nursing Leadership.

Prof. Porr admits the sample size in her Newfoundland study was small, but said the results paralleled those of much larger studies in the U.S. and anecdotal reports.

She has, for instance, heard from housekeeping staff they are tired of being asked by patients — mistaking them for nurses — to bring their medication. A pharmacist once told her, “How can we take nurses seriously when they are dressed in pyjamas?”

Still, she and some other experts concede it is chiefly middle-aged and elderly patients who seem to favour standardized uniforms.

The idea has been driven as vigorously by some nurses’ unions, who see jobs disappearing and their role as “critical-thinking” health professionals replaced by less-educated, “task-oriented” workers. Uniforms are seen as a way of setting them apart as valuable personnel.

Newfoundland’s union has gone farthest in following in Nova Scotia’s footsteps, though its recommended uniform of black top and white pants is not yet mandatory. Alberta, Saskatchewan, P.E.I. and New Brunswick are all calling for at least “wear-white Wednesdays.”

The Hospital for Sick Children in Toronto was one of the first to try to turn the tide on the casual trend, urging nurses in 2007 to choose from a small selection of outfits that includes colourful polo shirts and cargo pants, all designed by Roots.

But forcing modern nurses to wear the white uniform of old — with its image for some of the stern, no-nonsense matron — is not the way to go, argues Pam Hubely, the hospital’s chief of nursing.

“These are individuals with university degrees, master’s degree. It’s a knowledge profession and people do like to have some sense of autonomy,” she said. “To go backward is not necessarily the way nurses want to be portrayed.”

Ms. Morris, though, said her switch to a white uniform has met with only positive feedback from patients. The Newfoundlander recalls a first-time chemotherapy patient who was clearly frightened by her treatment.

“Afterward, she told me, ‘When I saw you coming toward me with your white uniform on, I knew it was going to be OK,’ ” she said. “Obviously, it does say something to the patient.”

National Post

Dave Cournoyer
Communications Advisor
United Nurses of Alberta
Office: 780 425 1025
Mobile: 780 913 1563

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