Nursing Uniforms: From Skirts to Scrubs and Beyond

Melissa Mills, BSN

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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?

katherinebrewer7 · Jan 24, 2019

I'm very interested to see the evaluation data of relaxing restrictions on hair color, tattoos, piercings, and other forms of body art.

Blue_Moon, BSN, RN · Jan 24, 2019

When I graduated I wore all white. I'm thankful that year the hats became optional. I could never get mine to stay on! I even had a white dress. It was very difficult to work in that dress crouching down lady like to empty foley bags or whatever! I had many of old men slip their hands right up my dress as I was reaching above them to adjust oxygen or whatever!😳 The whites ended up looking dingy in no time and some stains just would never completely leave. However, you looked clean (because you immediately knew when you weren't and had to change) and every one knew immediately which one was the nurse! I felt proud to dress for work because I earned the right to dress like that!

Then the hospitals provided solid colored scrubs for the staff and even washed them for us and the color was based on what floor we worked on. Then that became too expensive so we were required to buy and wash our own required colored scrubs. Then we were allowed to wear any color or pattern we wanted for years but now we are back to a certain color for each job (RN, CNA, RT, OT, etc) with a color-coded chart for guests so they will know who is who. I don't think the patients remember or feel like looking at that chart all day long if they see a new color. I also don't like the fact the staff must carry any and all germs out of the hospital and home to wash with their family's laundry. With the development of all these drug resistant germs, I can see that being changed maybe but I'm sure if they did provide laundry services it won't be free.

There's really not a uniform that makes nurses stand out anymore. Everyone wears scrubs. Including housekeepers, cooks, basically anyone in the hospital or service industry outside the hospitals. I no longer feel special. 😔

Davey Do · Jan 24, 2019

22 hours ago, Melissa Mills said:
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.

ACT-SHOO-ALL-LEE, Prof. Melissa, Little Brother had no problem visualizing me in a traditional nursing uniform in 1984:

1014578072_1984nursey.png.c792cc29afae873b818b33b2e0333d45.png

Traditional male uniform, 1984:

265203808_1984.png.7b24c06a0187b391f3867a376b10add3.png

mtmkjr, BSN · Jan 24, 2019

1 hour ago, Davey Do said:
Traditional male uniform, 1984:
I want to see the full picture, skirt and all...

Davey Do · Jan 24, 2019

30 minutes ago, mtmkjr said:
I want to see the full picture, skirt and all...

Okay...

482702618_nurseydavey.png.697082ae42daf1c20ef9bac34b6e7fb5.png

Wuzzie · Jan 24, 2019

2 hours ago, Blue_Moon said:
I also don't like the fact the staff must carry any and all germs out of the hospital and home to wash with their family's laundry. With the development of all these drug resistant germs, I can see that being changed maybe but I'm sure if they did provide laundry services it won't be free.

There are more germs on the handle of the grocery cart you use and the machines at the local gym than you will ever carry home on your uniform.🤢

Blue_Moon, BSN, RN · Jan 24, 2019

2 hours ago, Wuzzie said:
There are more germs on the handle of the grocery cart you use and the machines at the local gym than you will ever carry home on your uniform.🤢

Ok well that makes me feel better then. I rarely wipe down my grocery cart handles. I like to live dangerously. 😆

Wuzzie · Jan 24, 2019

I kid you not, since my local store started putting out antibacterial wipes for the carts my URI count has gone down to nearly zero and the few I've had in the last 5 years have been really mild.

Think about all those germy cart lickers!

Melissa Mills, BSN · Jan 25, 2019

On 1/24/2019 at 11:59 AM, Davey Do said:
Okay...

Love this!

audreysmagic, RN · Jan 27, 2019

The cape, I admit, could be awkward and it's an infection control nightmare. BUT I STILL WANT ONE.

I keep promising myself that for Halloween, I'm going to do an old-school nursing uniform just so I can get myself that dang cape.

Fun memory: My mom's a nurse, too, and when I was a kid, she still had the cap. I remember that it sat on her dresser, and I used to sneak into my parents' room frequently to put it on and "play nurse." At the time, nursing was not my career goal (per her memories, I wanted to be a flower when I grew up), but how time changes things...

audreysmagic, RN · Jan 27, 2019

On 1/24/2019 at 8:34 AM, katherinebrewer7 said:
I'm very interested to see the evaluation data of relaxing restrictions on hair color, tattoos, piercings, and other forms of body art.

Not sure what side of the argument you're on, but I'd like to see it, myself. I had a "fun" hair color for awhile, while it was not outside of my hospital's dress-code policy (they later changed it, alas, and so I changed my hair)...I found that it really engaged a lot of my adolescent clients. They got excited about the hair color and that opened the door to me being able to interview them without the automatic "you're an adult in authority" suspicion.

YuHiroRN, BSN · Jan 27, 2019

On 1/24/2019 at 7:09 AM, Blue_Moon said:
There's really not a uniform that makes nurses stand out anymore. Everyone wears scrubs. Including housekeepers, cooks, basically anyone in the hospital or service industry outside the hospitals. I no longer feel special. 😔

Personally, I don't go to work trying to stand out or feel special. That being said, our hospital supplies color-coded uniforms with our discipline embroidered on the chest. The RNs are very obvious by the fact of the sheer number of people in navy blue scrubs with RN embroidered on the top walking around during any given shift.

I am new-school. Been wearing scrubs since I was 19. I am not a hat person on the best days, least of all the kind that nurses of yesteryear used to wear. I don't wear dresses, ever, nor panty hose... so I am certainly a fan of the modern fashion sensibilities of our profession now.

DoGoodThenGo · Jan 28, 2019

7 hours ago, YuHiroRN said:
Personally, I don't go to work trying to stand out or feel special. That being said, our hospital supplies color-coded uniforms with our discipline embroidered on the chest. The RNs are very obvious by the fact of the sheer number of people in navy blue scrubs with RN embroidered on the top walking around during any given shift.
I am new-school. Been wearing scrubs since I was 19. I am not a hat person on the best days, least of all the kind that nurses of yesteryear used to wear. I don't wear dresses, ever, nor panty hose... so I am certainly a fan of the modern fashion sensibilities of our profession now.

Well that's what things all come down to today isn't it? You'd have all sorts of heck breaking loose if any facility even remotely tried today to get even a largely female nursing staff back into starched whites and certainly caps.

Happily for the Millennial age nurses and those near or coming after them in many local areas dress code decisions have been made for healthcare facilities by local governments.

Here in NYC for instance it would be nearly impossible to mandate caps unless a place agrees/wants male nurses to wear them as well. Ditto for dresses/skirts and anything else that is gender specific. https://www.newyorkcitydiscriminationlawyer.com/dress-codes-uniforms-and-grooming-standards.html

Mandating whites alone (dresses, pants or whatever) is still around for some facilities; mostly LTC, nursing homes and such. IIRC one of the last NYC hospitals that had their floor nurses in whites was Lenox Hill. This was before the place was bought by North Shore-LIJ. Now nearly everyone wears the standard "Northwell" (as NS-LIJ is now known) uniform of blue pants with white top.

Ironically the housekeeping staff at then NS-LIJ (who are 1199 union IIRC) voted to wear the same blue dress with white bib that was standard student nurse uniform for many NYC schools for ages.

Leader25, ASN, BSN, RN · Feb 1, 2019

I Always did my work laundry separately from my family and I dont think super germs live on a food cart,nor TB and ebola.I liked the white because you knew as soon as it was dirty.When they took our green scrubs away and returned to white,I wore my old clean scrubs to work and changed there to the white and reverse to go home .Oh well I was a fan of Howard Hughes.

Phiddy · Feb 2, 2019

I was capped when I graduated from nsg way back in 73. I watched all the changes come and go and the one I like the most was the change from white uniforms to scrubs. I was the first in my hospital to wear scrubs. At first it was only solid one color top and bottoms. When the change came to wearing patterns/themes, I was working peds....now that was a fun time for scrubs. Remember Barney? I wore him. LOL

ataymil8 · Feb 2, 2019

My mother is 92 and I have her cape, just like the one in the picture. My grandmother would be approximately 120 yrs of age if she were living and I have HER cape which is floor length. You can’t imagine how well made these capes are.

**sirI, MSN, APRN, NP** · Feb 2, 2019

21 minutes ago, ataymil8 said:
My mother is 92 and I have her cape, just like the one in the picture. My grandmother would be approximately 120 yrs of age if she were living and I have HER cape which is floor length. You can’t imagine how well made these capes are.

WOW, that is amazing, ataymil8. I know you cherish those.

cjsbaskets · Feb 2, 2019

1965 When I graduated we wore white dresses and a cap at all times unless pt. was in isolation. Wore that for every job I had. Did take my uniforms to the cleaners for pressing and starching!!!

1979 Started in L&D we wore blue scrub dresses, with a slip and pantyhose. We eventually petioned to wear scrub pants under our dresses because of modesty, considering some of the actions required. From there we shortly got to wear complete scrubs but had to be OB blue. Hospital took care of washing. Everyone got in the habit of raiding the linen cart when it came to the unit so you would have clean scrubs for the next shift. Over time other NURSES in the hospital wanted to wear scrubs and so it began......rapid use of scrubs by everyone. Couldn't tell one position from another. Eventually went to color by position. All RNs in one color, unit clerk in pink, housekeeping in green, dietary in ?, lab tech's, radiology personnel in other colors. Helpful for staff but still confusing for patients. Name tags also inbdicated in large letters under name role, RN, LPN, LAB etc.

Not sure when tats and piercings became acceptable but it happened. I know appearance is not a guarantee of knowledge and performance but I believe it is respectful to dress appropriately. I wouldn't wear shorts to church or flip flops to meet the President.

Yes am old fashion but I am alright with that

*CalicoKitty, BSN, RN* · Feb 2, 2019

When I first went to school for lab technology, my school uniform was white. Scrubs were available, but we weren't allowed to wear them. Had to be button up or something. I was not born to wear white. I cannot keep white clean. There are yellow stains after the first washing. And I had to buy more underwear that weren't visible. Never worked that job.

I was super excited that in my nursing school, we didn't wear white! Pants were navy, and shirts were a light color - but not white!

I was sad to lose the nail polish (I used to LOVE painting my nails ALL the colors!). Granted, even when I do wear nail polish now, they get destroyed by gloves. Such sadness.

I was sad to remove all of my earrings for nursing school, and my first nursing job. My new one is much more lenient than my first in terms of hair color, tattoos and piercings. Subsequently, I think I'm much happier in my 2nd position with those reasons being included. Sure, I'm not going to dye my hair blue like I did when I was 18... but, others do, and it makes me smile. And all my earrings are back in.

I got lucky with my 2nd position. I think it had been less than a year that they got rid of the white in their nursing uniforms. Navy rocks! Even better than ceil. Stains don't exist!

Nursing Uniforms: From Skirts to Scrubs and Beyond

How do you feel about your current nursing uniform policy?

Florence Nightingale Had a Vision

War-Time Changes

Uniform Changes with Popularity

Capping it Off

Emergence of Scrubs

Men in Uniforms

Hair Color, Piercings, and Tattoos

Function versus Expression

The Future of Nursing Uniforms

About Melissa Mills, BSN (Member)

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