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Caregiving: Do uniforms matter?

By ALEX CUKAN, UPI Correspondent

Does it matter to a patient what his or her doctor and nurse are wearing? Patients prefer that doctors wear white lab coats and ties, according to researcher Nathan Belkin. Patients prefer that nurses wear white, according to Claire Young, chief nursing officer at the Cleveland Clinic.

"For physicians wearing a shirt, tie and lab coat, it's about looking professional and establishing a standard of excellence," Belkin, who is retired but still publishes research papers, told UPI's Caregiving.

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Young discovered that patients prefer nurses dressed in white almost by accident, with a little detective work.

"Shortly after I was named chief nursing officer in 2003, I spent time on the floors getting acclimated, and I read through the patient questionnaires and saw that someone would say, 'The nurse who brought my lunch was rude to me,' or 'The nurse who emptied my bedpan took a long time,' and I realized patients didn't know who was who," Young told Caregiving.

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The policy for nurses at the Cleveland Clinic had specified that surgical nurses wore white scrubs and the other nurses had their choice of buying any type of scrubs, she said. Many wore nursing pins, but some did not, and name tags can be hard to read for many without glasses.

"I proposed to a focus group of nurses how would they like to all wear white, so patients could identity them as nurses, but there were protests about people losing their individuality by all wearing the same thing," Young said. "So I proposed Plan B and offered to buy six items each year and they could choose whatever style -- skirts, dresses, pants, low-rise pants, pants with zippers -- but the nurses would wear white and the patient-care assistants would wear hunter green, taken from a color from the hospital logo. This got a much better response."

It did not take long for patients and staff alike to respond favorably to Young's changes.

"I feel proud to be wearing white -- I feel proud to feel like a nurse again," Young said one nurse told her.

A patient hand-delivered to Young a letter he had written about the uniform change. "I was sick and then an angel in white appeared," the letter said.

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Nurses' uniforms had not changed much from the 1920s to the 1960s: white, short-shelved, button-down a-line dresses with large pockets. Nurses' ranks were indicated by their cap markings, and they wore pins, white hose and pumps or dress shoes.

Small changes crept in over time, such as more comfortable shoes and zippers replacing the buttons, but scrubs took over in the 1970s.

"Scrubs used to be worn exclusively in the operation room, but surgeons started wearing them everywhere and eventually they took over everyone," Belkin said.

White and green surgical scrubs evolved into every color under the rainbow and many prints were offered.

As a result, not only patients at the Cleveland Clinic found everyone in scrubs confusing. So did Dr. Peter W. Kujtan, who wrote last May in the Mississauga (Ontario) News:

"I came across an elderly patient standing in the hallway dressed in a blue hospital gown and trailing an IV pole. He was having a hearty discussion about his prostate problems with a lady dressed in greens, whom I naturally assumed was the urologist I had asked to consult on the case. Imagine the surprise when I learned that he mistook the kitchen staff for a consultant."

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Kujtan said because of the dress-down revolution, the ancient "chalice of power" -- the stethoscope -- began to be used to distinguish doctors from staff, because physicians tended to purchase expensive models that aided diagnoses. It worked for a while, he said, but then everyone started carrying them.

"At the Cleveland Clinic there is dress code for doctors," Young said. "They must wear shirts, ties and a lab coat, or for women blouses or a shirt -- no more jeans, polo shirts, Capri pants, open-toes shoes or sandals. This applies to everyone -- even students who tend to dress more casually in jeans and Birkenstocks -- but we try to explain that we want those at the hospital to look professional."

Young said she included the $300,000 cost for the new uniforms as part of her new budget, and she encountered few objections, but she added she does not foresee nursing caps returning anytime soon.

"They were always getting knocked off by IV poles and falling off," she said. "Nursing is basically manual labor, and most prefer pants, because you can move around more and crawl under a bed to reconnect tubes."

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Alex Cukan is an award-winning journalist, but she always has considered caregiving her primary job. UPI welcomes comments and questions about this column. E-mail: consumerhealth@upi.com

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