What Happened to the Cap? The Dawn of the Cap

Part 1

Laura A. Stokowski, RN, MS

Disclosures

May 03, 2011

In This Article

Nurses' Caps: A Search for Meaning

Don't worry. No one is trying to bring back the cap. Whether we wear it or not, however, the cap is a universal symbol of nursing and always will be.

When nurses stopped wearing caps in the late twentieth century, the biggest complaints came from patients, who claimed that they could no longer tell the nurse from the housekeeper. Nurses tend to react poorly to such comments, believing that their actions (not their clothing) should convey their professional abilities to patients, arguing strenuously that professionalism "comes from within, not from a cap."

But why did nurses stop wearing caps in the first place? Asking this question does not imply that nurses should not have discarded their caps; rather, it expresses a desire to know what it was about the cap that nurses felt they no longer needed. Why did something that at one time symbolized the dignity, dedication, and educational attainment of a profession become superfluous?

Back to Caps: An Experiment

Even nurses who have never worn caps are aware that many patients, particularly the elderly, have a strong attachment to the nurse's cap. Older patients find it comforting, and believe, however subconsciously, that like the white dress and shoes, it represents professional skill and knowledge.

I've never worn a cap, but I've often wondered what would happen if nurses did return to wearing caps. That's precisely what happened at the John F. Kennedy (JFK) Medical Center in Atlantis, Florida, in the spring of 2010. Nurses in the hospital's cardiovascular step-down unit were brainstorming ways to raise patient satisfaction scores, and their nurse manager, Cheryl Farrell, proposed returning (temporarily) to caps along with white uniforms and shoes. The staff were thrilled with the idea.

It seems that the problem voiced by patients ever since nurses stopped wearing caps -- that they couldn't tell who the nurses were -- was, if anything, growing. With just about everyone in the hospital, from radiology techs to nursing assistants, wearing scrubs, patients still can't pick their nurses out from the crowd. In fact, this was one of the main concerns voiced by patients at JFK Medical Center. Cheryl Farrell also observed over the years that dropping the cap had altered the public's attitudes toward nurses. "People used to have more respect for and trust in the nursing profession," she said.

Cheryl and her staff kept their plans a secret, even from the rest of the hospital. "None of the nurses still had their original caps, and the younger ones never had a cap, so I ordered new caps for everyone and hid them under my desk," relates Farrell.

The day that the cardiovascular step-down unit nurses came to work in white uniforms and caps was a memorable one (Figure 1). JFK public relations representative Nicole Baxter will never forget the excitement in the facility that day. "It really created a buzz in the hospital. Employees from other units were all going up to see the nurses wearing their caps, and before long, we were getting calls from all the local news outlets wanting to do a story. We got a strong reaction from the community."

Figure 1. Nurses wearing caps and white uniforms in the cardiovascular step-down unit. Image courtesy of JFK Hospital, Atlantis, Florida.

The reaction was all they were hoping for, and more. "The patients loved it," recalls Farrell, "especially the older ones who remembered nurses in caps. And surprisingly, the physicians loved it, too. They knew exactly who to go to -- the person wearing the cap."

The 8-week experiment was so positive and successful that the hospital decided to change their nurse's dress code to require white scrubs or uniforms, but not caps. "A cap or a uniform doesn't make the nurse," observes Farrell, "but it does create a perception and changes behavior in subtle ways. That cap really meant something, even if it was sometimes a nuisance to wear. It was a symbol of pride; the nurse wearing the cap really cared about it and what it stood for."Research supports Farrell's theory. Patients, especially the elderly, associate "nursing whites" with professional abilities.[1]

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