Paradise Lost Or Paradise Regained

This article was first published on the old Nurse Uniforms - Past & Present website ( around 1999-July 2018, created by Kevin Dycken. It is now offline, this is a remake in a modern look.

Dresses vs Scrubs

Paradise Lost - Paradise Regained? (The views in this article might not necessarily agree with those of the Webmaster), written by David & Dee, March 2002.

This article is a mutual discussion on the Dresses v Scrubs Debate. The ongoing debate as to whether nurses should stay with the standard uniform dress or change to a tunic/scubs style as a uniform is an ever increasing topic of conversation. However, there are numerous viewpoints, different perspectives and various kinds of attitudes involved in this discussion. The history and development of nurses` uniforms is constantly changing and no doubt it is still a part of it`s own evolution today. Like everything else around us, transition from one form to another has to be assessed on its merits and hopefully this debate will do exactly that. It should not only be confined to nurses alone to voice opinions, but to ordinary people that respect the difficult and undervalued job that nurses engage in. Whether it`s a patient, doctor, partners, friends or anyone who has been affected by this caring profession at some stage of their lives, it`s imperative that we preserve the integrity of what is both a challenging, rewarding and ironically, a frustrating choice of career.

As there are different areas of the "dresses" or "scrubs" debate perhaps we should begin by taking a look at the identity of a nurse. Comparisons vary from country to country, so for sake of argument we shall take the UK as our example. Until recent years, a person entering a UK hospital never had to enquire who was a nurse as distinct from other ancillary staff. Staff nurses, sisters and student nurses were recognisable to the public in their various uniforms, the colour of the dresses denoting their different grades and position within the hospital. The dress offered nurses a position of privilege in being easily and immediately identifiable to the general public. It also has an underlining psychological effect acknowledging that a dress does not have a gender, but denotes attributes of femininity, nurturing and caring, akin to nursing. In the same sense, it enhances and reinforces this image to the public, and in return the public fully support their nurses, a trait often called upon in industrial disputes. If one was to disagree with what nurses are fighting for in terms of pay and conditions, then they would have to lessen the public`s perception. This can be done in many ways over a long period of time so that the erosion is not that noticeable especially among a large turnover of part-time, temporary and new recruits of nursing staff, many on contracts. I have often wondered if there are nurses out there who do not want to be readily identified in a general sense as they may feel that some invisibility is a good thing in dealing with the public, as like forming a protective shield in fear of complaints or litigation? Is the NHS becoming more Americanised as a result?

In many hospitals one will notice that tunics and scrubs are now becoming increasing visible with the influence of television programs like Holby City and ER. Undoubtedly, it is a trend most popular among young nurses entering the profession from college based education. As sister-in charge of a large unit, I had to consider all viewpoints in relation to what the staff wanted to wear so tunics and trousers were brought in on a month trial. The trial was conducted in 1999 at Louth Regional Hospital, incidentally one of the few hospitals where some nurse units chose to retain dresses as tunics/trousers became the norm. Some nurses thought it was a great idea in the sense that it was more practical to wear. After numerous questionnaires there came some interesting results. Some said tunics were more practical in work, however most said they were more practical in travelling to work especially on winter nights, and easier to disguise going for a drink after work. There was also agreement that tunics required less ironing and care than a dress, although most admitted that a ironed dress looked better visually. I noticed that many of the staff entered that they didn`t have to wear tights as required with dresses, but many wore tights under their uniform trousers with their black shoes. When asked if their day`s work was made any easier or any harder by wearing tunics, the majority said it was the same. However, there came a discrepancy on the last point! The staffs` day was the same in the physical sense with regard to moving and lifting patients, no difference. There was much confusion in being identified as a nurse by the public as they were deemed to be caterers, carers, cleaners and clerical staff also, and after a while it becomes annoying to even the most patient nurse. I thought that their most important contribution to the findings was that a nurses` image had altered even in a month trial, although not a lot now, but would on a permanent basis. That perception was a more detached and strictly objective attitude from the public. In conclusion, about 34% of the staff would opt for tunics/trousers only permanently. Then about 46% wanted to retain uniform dresses only, followed by 20% wanted a choice to wear both. The hospital authorities would not facilitate both uniforms which I feel they should have.

A constant observer to Dycken`s "Nurses Uniforms Past and Present" will have noticed some of the dresses that student nurses have to wear. While not that bad in the UK it is considerably worse in the US. When in training myself, I hated a particular style of dress that was like wearing a strait-jacket as it was difficult to be mobile. In the US, there seems to be a retention pattern to keep those uniforms as a form of discipline. Fortunately, nowadays this is not the norm as dress designers have taken advice from nurses rather than from a less competent source. I am not in the least surprised by the conversation of nurses graduating in the US, vowing never to wear a dress again. Then they opt to wear scrubs that would be more favourable on vacation in Honolulu and trousers a size larger than the norm. I am reiterating that detached and clinical objectivity which is so different in attitude and patient care. Uniforms are, after all, a statement of the service that one provides and in this case, it is all the vicissitudes that a nurse empowers to the community. I have come across statements from various hospital spokespeople saying that change has to be from dresses to scrubs as in this direction it must be modern, actually unwittingly endorsing the description of scrubs that I just written. Change is equally niche in the 21st century, in modifying from a uniform dress of the previous year. The issue of health and safety as a form of argument against dresses, always used but only serves to dilute that claim. Nurses have a large choice and range of excellent dress uniforms available (Suppliers Index) with Health and Safety Approved shoulder and back vents, front and back pleats in the skirt if required. They are distinctly made for comfort and ease of movement unless one is vain enough to squeeze in to a smaller size. It is precisely because of this that most nurses in the uniform trial I mentioned, preferred to retain a uniform dress, because it was designed to be so.

Another claim that scrubs/tunics are safer than dresses is not validated in nursing accidents in the workplace. In Ireland where nurses have been wearing tunics now for a few years, evidence of their being safer than dresses has not materialised. In the US, Nursing Unions figures for uniforms being detrimental to safety are harder to obtain, but in two studies at Ann Arbour University, Michigan , between 1984 and 1995, the figures for the latter are higher than the former, given that more US nurses wore dresses in 1984. What should be borne out is when a nurse in a dress or nurse in scrubs lifts a patient, both use the same lifting technique and both require extra assistance when required. Regardless of what one wears, bad technique will result in the same! As this point is often used in debate, as a nurse who wears a size 14 dress and chooses to always wear one, I move patients around also. Another generality that I came across with a few student nurses and this may sound amusing, is if you wear a size 10-14 then you wear a tunic, and any size after you wear a dress. Of course it may be just youthful presumptions but nevertheless attitudes can be developed to create stereotyping of who wears a dress, and who does not.

Finally, we are all too well aware of the abuse suffered by A&E nurses, working at the coalface of weekend admissions and putting up with the antics and verbal abuse of half-plastered and doped up individuals. However, perhaps it is only a coincidence but since the recent changeover to tunics/trousers here, the physical assaults on female staff in A&E has shot through the roof. There are numerous articles and newspapers highlighting the increased level of violence because of affluence, but as there is a turndown in the economy seemingly the violence has not abated but increased. Does the individual who visits A&E under such circumstances, psychologically perceive nurses now as being less feminine (as a condition) thus lessening their tolerance to physical abuse? Allowing that there are a few weirdoes that would attack a woman regardless, but does a nurse in a uniform dress portray a different, more feminine image, one that is a degree less likely to be abused? I think so to some extent, as it could be the balance in assaulting, or giving verbal abuse! At the time this article was written, a work to rule has began in hospitals in Dublin and elsewhere precisely because of such increased assaults.

As this article is co-written by one that has to put up with the trials and tribulations of a nurse, it is proper that a male perspective be included here. The arguments are still the same with men and women as to what one prefers, except it`s the nurse in question whose choice it is to wear the uniform. When I look at the many pages and expressions from nurses articles on this site, it`s such a shame really to view in picture form and read of what has already been lost in reality. I know that nurses will complain at times about the care of their uniform and I when I have to iron it when she`s in a rush, but that part is living and real. So many nice uniform dresses have gone over the years, and now is the time that nurses and friends try to keep what they have, in order to preserve that distinctive image. It`s a credit to the owner of this exquisite site that we are more aware now, and importantly, more people are also. As we know now, Paradise Lost - will it not be Paradise Regained?.

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