Nursing Uniforms: From Skirts to Scrubs and Beyond

Melissa Mills, BSN

A sick patient enters the emergency department. Feeling faint, he looks for a nurse. As he scans the room, he notices men and women in colored scrubs. He looks again, trying to find a female in head-to-toe-white. This is his image of nursing. Many years ago, this might have been a logical place to begin when looking for a nursing professional. However, today you might find nurses in solid or patterned scrubs, street clothes, or in a lab coat that looks more like the traditional physician attire.

Nursing uniforms don't end with clothing. It used to be understood that nurses had no visible tattoos, piercings only in their ears and that naturally colored hair would be pulled back or kept short. Hospitals have become more lenient on the clothing nurses wear and these other aspects of their attire, too.

Have you ever wondered how we made it to this point? Whether you feel that your body is not your resume or that the way you dress as a nurse is linked to professionalism, here is a historical view of nursing uniforms from the past to the present.

Florence Nightingale Had a Vision

Uniforms from the 1800s looked similar to a nun's habit, consisting of floor-length dresses in drab colors with white aprons over the front. Many of the first people to care for the ill were nuns, which is why the uniforms were similar.

In the 19th century, Florence Nightingale revolutionized nursing. She entered the profession against her family's wishes because nursing was not seen as a worthy career choice at that time. Florence is known for molding nursing into a respected discipline, writing multiple books, and establishing the Nightingale Training School at St. Thomas Hospital.

Florence had a vision for herself and those she trained. She understood the importance of creating a professional image that also served a purpose. She created uniforms to separate nurses from those still in nursing school, and that protected them from illness, weather elements, and the advances of male patients. The first recognizable nursing uniform included a long dress, apron, and frilly cap.

War-Time Changes

During World War I the nursing uniform underwent some of the first changes. Working on battlefields become difficult in long dresses. Nurses needed to be efficient and move quickly to assist the wounded. The aprons disappeared, and hemlines shortened. Tippets - short, cape-like garments - were added to the war uniforms. Nurses began displaying badges on their tippets to show rank.

Uniform Changes with Popularity

As nursing became a popular career choice in the 1950s, attire needed to be easier to clean and produced in large quantities. Skirts and caps remained a staple of the standard dress code. But, the need for more flexibility caused hemlines and shirt sleeve length to shorten. Many nurses wore starched white dresses with white hose and shoes as the standard hospital uniform.

Capping it Off

It's possible that the most recognizable part of a nurses uniform was the crisp white cap that was worn up until the late twentieth century. An article on Medscape Nurses reports that this change brought about changes from patients who said they could no longer tell the nurse from other hospital staff.

Caps were worn to show dignity and pride in the nursing profession. Many nursing schools ended with capping ceremonies to celebrate the induction of new nurses into the trade. However, lacking practicality was likely the main reason for the demise of the nursing cap, which was no longer required by most hospitals by the 1970s.

Emergence of Scrubs

Scrubs began in the operating room. In the 1940s physicians started wearing white uniforms rather than their own clothing. By the 1960's surgical scrubs changed to the traditional green that you see today to lessen eye strain experienced by surgical staff from white uniforms and bright operating room lights.

As nurses became responsible for the cost and care of their uniforms, they also started to request more comfortable options from manufacturers. This prompted the modern day scrub. By the 1980s and 90s, the traditional nursing uniform was replaced with scrubs in most healthcare facilities across the U.S.

Scrubs are easy-to-care-for, come in a variety of styles and colors, and offer nurses comfort and mobility during long workdays. You can choose styles with multiple pockets, elastic waistbands, drawstrings, and other options and still meet most hospital policies. Some facilities might require nurses to wear a specific color or pattern to help distinguish them from other clinicians. Other employers such as home care, hospice, or other community health providers may wear a combination of scrubs and street clothes to care for patients in their homes.

Men in Uniforms

Not only has the appearance of the nursing uniform changed over the years, but the look of the workforce has changed, too. Finding images of men in traditional nursing uniforms is difficult. Many nursing schools provided men with a shirt made of the same dense fabric that women wore, and no caps were required.

Some hospitals required men to wear uniforms worn by physicians or dentists because there wasn't a standard male attire. As scrubs became acceptable, men followed suit, choosing scrubs in multiple colors and patterns.

Hair Color, Piercings, and Tattoos

For years, many nurses have covered tattoos and refrained from coloring their hair in unnatural colors to conform with facility policies across the U.S. A 2015 article in Minority Nurse even reported hospitals and nursing schools banning all nail polish colors, unusual hairstyles, and earlobe gauges.

In recent years, many facilities have started to change their policies on nursing dress codes. Indiana University Health, the state's largest health system adopted a relaxed policy on tattoos and hair color in 2018. The hospital reported that the changes were made to reflect "authenticity" of their staff. A Becker's Hospital Review article from December 15, 2017, stated that the Mayo Clinic changed their policy on showing tattoos for both nurses and doctors in January 2018. This came just three years after the hospital ended a rule that required female employees to wear pantyhose.

These rules, lodged in societal norms, continue to change and evolve. However, some feel that the uniform is more than just functional attire. It's part of the nurse's expression of self, and it's also one component of the patient experience.

Function versus Expression

The nursing uniform has long been positioned as a way to keep nurses safe. The functionality of the first long-sleeved and floor-length frocks met the safety standards of the day. As the need to become more mobile emerged, changes began to happen that made the uniform more functional. With the emergence of infection control practices, other equipment was added to the attire that is now considered standard, such as gloves, masks, and even isolation gowns, when needed.

As nursing gained popularity, nurses found their voice and demanded respect in many forms. The choice of wearing a uniform, changing their hair color and even showing their ink is a part of self-expression and acceptance that many nurses have welcomed with open arms.

The Future of Nursing Uniforms

Where do we go from here? Will nurses one day be roaming the halls of hospitals in street clothes while they care for patients? Or, will nursing "whites" come back into style either on their own or at the requirements of employers?

It's hard to tell what's next for nursing uniforms. We have come a long way indeed. How do you feel about your current nursing uniform policy? Do you want more leniency or do you think that we've gone too far?