Appearances: Judging a nurse 'by its cover'
By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com, Sept. 24, 2001
My mother, who was fond of New England Yankee aphorisms, told me on more than one occasion that you "can't tell a book by its cover." I'm sure there is at least a grain of truth in that; however, the cover often determines whether or not you take a further look at the book.
And so it is in nursing. I'm reasonably sure that there are good nurses whose appearance belies their skills. However, I'd like to suggest to you that their appearance may say a great deal about how they feel about themselves, and therein lies the problem. Let's explore the subject from A Nurse's Viewpoint.
From one extreme to another
Once upon a time, in the halcyon days of nursing, one could readily discern the Registered Nurses on any given hospital unit. They wore starched white uniforms - AND CAPS! At least in the hospital wherein I honed my basic nursing skills, you could identify just about anyone in the care setting by the uniform that s/he wore. The rationale behind all of this probably speaks to healthcare's origins in the military and the monastery. Many object to caps as a symbol of servitude. So be it. I know that the day of rigid uniforms has gone, and few lament its passing.
The pendulum has swung - and, as it is wont to do, it has gone to the other extreme. Dress codes seem to have gone the way of the dinosaur. The mode of dress for the day is most kindly described as casual. Although there remains a staunch cadre of folk whose appearance gives credence to the word "professional," we are too frequently presented with caregivers who look as though they are on their way into or out of the garden.
"So what? After I've worked 12 or 16 hours, who cares what I look like?" There is a certain amount of reason in that statement. With the shortage of staff today, is it not sufficient to have caregivers appear, regardless of their appearance? The answer to that is "yes, but . . .". "Yes, we value you regardless of your appearance. But your appearance frequently serves as an indication of how you feel about what and who you are."
Nurses, and other caregivers, who value themselves usually define that value by their dress, which, even when casual, is professional. Their scrubs
are pressed and their shoes are clean. They are well-groomed and walk, talk, and interact as people who know who and what they are.
"Yes, but . . .". Patients, regardless of age, have more confidence in staff members who present themselves by dress, demeanor, and discourse as professionals. Many patients, especially the elderly, frequently comment about the appearance of their caregivers to their physicians and to their families. It is interesting to note that the majority of those physicians understand the rules of dress. To the elderly, casual dress imparts the potential for a lack of attention to those in their care.
Some aspects of today's "habits of attire" are, quite frankly, risks to the patient. Several articles have appeared which speak to the infection control risks associated with artificial nails. Body piercing and tattoos are associated not only with a certain mindset, but pose health risks to the individual.
Appearance also makes a statement to the public. Look at the advertisements for nursing or the videos about nursing. When nursing is conveyed in a positive light, the nurse - woman or man - is neatly attired and well groomed. When nursing is being subjected to satire or coarse attempts at humor, the nurse's appearance often defines the role. Appearance, then, appears to have more than surface value. If you accept the premise that you define who you are by your appearance, and if we want to convey to our colleagues, to our patients, and to each other that nursing is a profession, we need to look the part.
What to do
The transformation of the "ultra-casual" dressers into something that conveys a more professional demeanor is not an easy task. While imposition of a "dress code" by the titular department heads offers the speediest mode for change, it will not sit well with the staff who are already feeling abused and stressed.
Consider, then, a different tactic. Teach by example. There are videos taken of units whose staff members portray their professionalism by what they wear, and by the manner in which they interact with patients and professional colleagues. Starting with that sector of staff that "almost" makes the professional grade, show the video and ask for feedback about the staff members who appear in it. "What do you notice about this group?" "Are there things that you see here that might be appropriate to adopt in our hospital?"
Another tactic would be to assemble a group of staff members who convey the professional image. Ask them how they feel about themselves and about nursing. Ask for their input about improving nursing's image within their facility. Ask them how they would like to bring about the requisite changes. Work with them to develop and implement an action plan. Make dress the first step in a series of actions designed to ameliorate the image and conditions of nursing within the facility.
If you accept the premise that we feel as we appear, inappropriate dress is a sign of more damaging problems with the staff. Changing appearance must be accompanied by other changes that will alter the way in which the staff members feel about themselves, their colleagues, and the place where they work. Once the staff members begin to change their outward appearance, they need to change the way in which they function.
Proactive change agents will anticipate that once the nursing staff begins to improve its appearance, the staff will be ready for a series of "next steps" to improve the world of nursing. Wise leaders will be prepared to meet with their staff to develop and implement a plan to meet its expressed needs. It goes without saying that these needs will include increases in professional and, perhaps, support staff. Other anticipated needs will probably include a "presence at the table" where decisions are made, and perhaps development of phenomena including collaborative practice committees and professional practice councils.
Our world of nursing must step back before we can go forward. We need both to show and to tell people - patients and colleagues - who we are, why we are, and how we are. Improvements in appearance and attitude are a manifestation of our value system. The path forward will require major investments of time and resources. We will have to work with our elected representatives to provide legislative actions (including Medicare reimbursement rates) that will assist in the economics of healthcare delivery systems. I believe that those investments will be rewarded by improvements in recruitment and retention, and improvements in patient care.
Those are the goals. They are achievable. You can "make book" on that.
Roberta B. Abrams, a regular columnist for HealthLeaders.com, uses her education and experience to help further the evolution of healthcare delivery systems through her consulting group, RBA Consults, in Farmington Hills, Mich. She also is on the adjunct nursing faculty at Madonna University.