Contributing to a Quality Patient Experience

Applying Evidence Based Practice to Support Changes in Nursing Dress Code Policies

Margaret Mary West, PhD, RN, CNE; Debra Wantz, DNP, RN, CCNS, NEA-BC; Patricia Campbell, MSN, RN; Greta Rosler, MSN, RN, NEA-BC; Dawn Troutman, BSN, RN, CCRN, NE-BC; Crystal Muthler, BSN, RN, MHA, NEA-BC

Disclosures

Online J Issues Nurs. 2016;21(1) 

In This Article

Abstract and Introduction

Abstract

The public image of nurse professionalism is important. Attributes of a professional nurse, such as caring, attentive, empathetic, efficient, knowledgeable, competent, and approachable, or lack thereof, can contribute positively or negatively to the patient experience. Nurses at a hospital in central northeast Pennsylvania offer their story as they considered the impact of a wide variety of individual uniform and dress choices. This article describes an evidence based practice project and survey created to increase understanding of patient perceptions regarding the professional image of nurses in this facility. Exploring patient perception of nurse image provided insight into what patients view as important. A team approach included the voice of nurses at different levels in the process. Ultimately, this work informed a revision of the health system nursing dress code. The study team also reflects on challenges, next steps in the process, and offers recommendations based on their experiences.

Introduction

The goal of healthcare is to provide the best possible outcomes and experiences for patients and families. To that end, registered nurses (RNs) strive for professionalism in all aspects of care and interaction. First impressions are often formed in an instant, so how a nurse appears can have a significant impact on how a patient perceives the nurse. A uniform serves as a reflection of how the public identifies the role of the wearer (Bates, 2010).

Although consistently identified as members of one of the most trusted professions (Riffkin, 2014), contemporary nurses still struggle with image. In the media, nursing is portrayed in various ways: from matronly in a white uniform with a cap to sensual and cute in a tight miniskirt (Kelly, Fealy, & Watson, 2012). In reality, the nurse uniform influences perceptions about nursing practice and thus contributes significantly to the overall image of a nurse (Wocial, Sego, Rager, Laubersheimer & Everett, 2014a).

Nursing uniforms have been a source of tension for well over a hundred years (Pearson, Baker, Walsh, & Fitzgerald, 2001). In the 19th century, Florence Nightingale promoted excellence by creating a vision that was intended to raise nursing to a respectable profession characterized by caring, compassion, and clinical competence. She established a standard uniform for nurses as part of her effort to professionalize nursing (Houweling, 2004). Although the definition of the image of nursing is complex and dynamic, over 80% of Americans continue to list nursing as the most trustworthy profession in every Gallup Poll since 2005 (Swift, 2013).

The image of nursing is comprised of many components that identify nursing as a healthcare profession. Cohen, Bartholomew, Swihart, and Tomajan (2014) noted research study findings in which nurses identified several actions that they felt shape patient perception of them, such as whether they introduce themselves to patients as the nurse, whether they call patients by their names, and the level of their professional appearance. Study results indicated that 90% of the nurses felt that how they dressed had a great impact on their image.

The uniforms that most RNs wear have changed significantly in the last 20 years. Prior generations of healthcare personnel, particularly nursing staff, were required to follow stringent dress codes and work attire policies. White uniforms and nursing caps have been replaced by colored scrubs that have cartoon or holiday print decorations. White polished nursing shoes have been replaced by multicolored sneakers and clogs (Dumont & Tagnesi, 2011). Forces external to healthcare, such as the media and online marketing, have promoted individual preference as the new expression of "teaming and unity," resulting in this more informal attire.

Nurses at Geisinger Medical Center had concerns about the impact of a wide variety of individual uniform and dress choices noted in their facility. This article describes an evidence based practice project and survey created to increase understanding of patient perceptions regarding the professional image of nurses in this facility. Exploring patient perception of nurse image provided insight into what patients actually view as important. A team approach included the voice of nurses at different levels in the process. Ultimately, this work informed a revision of the health system nursing dress code. The article also includes reflections from the study team about challenges and next steps in the process, and offers recommendations based on their experiences.

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