At the first mention of writing or revising a dress code, my blood pressure rises. My view is that nurses should be responsible for making appropriate judgments about what to wear. They should not need a written dress code. However, over the years, my observations suggest that not every nurse dresses in a manner that conveys professionalism and confidence to patients.

In the Nightingale era, uniforms enhanced the image, pride, and work of nurses. The uniforms differentiated nurses from servants, cooks, laundresses, and prostitutes. Civil War soldiers recognized the authority of nurses and treated them with respect. 

The first training schools for nurses struggled to differentiate educated nurses from those pressed into service following arrest for drunkenness or other improper conduct. In those days, uniforms helped create an image of sobriety, public-health protection, and refinement. And they helped change the image of nurses, bridging the divide between working-class women and middle- and upper-class women.    

Later, uniforms identified nursing students and schools, and young women wanted to project a positive image of their schools. Through the first half of the 20th century, nurses remained protective of their image. Their uniforms were white, a color that suggested cleanliness.

But as nursing changed over the years, so did the styles, colors, and fabrics. The white uniform became a symbol of oppression and detracted from autonomous professional practice. Nurses abandoned their caps as impractical. And dresses gave way to pants that accommodated men as well as women. Today, almost universally, nurses wear scrubs, which are relatively inexpensive, easily laundered, fit various body types, allow freedom of movement, and allow for individual expression.

So what does all the change mean for nurses and their patients? The authors of “An evidence-based approach to creating a new nursing dress code” in this issue of American Nurse Today conducted a survey of patients to help answer some related questions: How well can patients identify the nurses responsible for their care? What are patients’ perceptions of the nurses’ professionalism? How do patients prefer to identify nurses? What manner of dress for nurses do patients prefer? You may be surprised that the patients were not concerned about nurses wearing white. But they want nurses to wear a name tag with the large letters “RN,” so they can identify the nurses caring for them. And they want nurses to have neat hair and to avoid wearing long fingernails.

In line with these findings, today’s dress codes try to address safety, infection control, and the ability to identify our caregivers. The Centers for Disease Control and Prevention’s “Guideline for hand hygiene in health-care settings” advises us to keep fingernails short, citing the harboring of high concentrations of bacteria in the subungual areas of the hand. Although study results aren’t definitive, most clinicians accept that wearing artificial nails poses an infection risk. The use of a name tag with the large letters “RN” is popular and well received by patients and families. The name tag assures patients that an RN is close by to provide care or respond to an emergency.

When defining policies on dress and appearance, organizations now must consider body modifications (piercings and tattoos), jewelry with religious symbols, and styles of cultural dress. By law, private employers can mandate dress codes, but the larger issue is how to allow individual expression while maintaining a professional identity.

The article, “The image of nursing” in our May 2007 issue, evoked a strong reader response on both sides of the debate about whether nurses should wear clothing adorned with cartoon characters. Most agreed that the pediatric setting allowed for more light-hearted clothing. Others, however, warned that nurses will not gain the respect they need to be key decision makers and authorities on care when they dress in such a casual manner.

Gone are the days of demerits for wrinkled uniforms and scuffed white shoes. But like it or not, people judge others based on appearance and some degree of conformity. I suggest a back-to-the-basics approach when it comes to dress. Simple and functional designs, plain colors, and a prominent display of “RN” can ensure that our dress doesn’t diminish our roles as professional nurses.

Pamela F. Cipriano, PhD, RN, FAAN

Editor-in-Chief