1. Decker, Michelle MSN, RN

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Nurse's cap: Taking a walk on the white side

In response to "Color Coding Nurse Uniforms" in the February issue, I've been an RN since 1983 and I began my career on the cusp of nurse whites going out as colored scrubs appeared. I transitioned from whites to cranberry scrubs in the ED and to teal in the ICU. Then, everyone started to wear scrubs. Over the past 15 years or so, there are no rules for anyone. Everyone from nurses to ancillary departments wears scrubs, and these scrubs are as varied as the scrub companies make them.


As Nurses Week 2012 was drawing near, our facility decided that we were to forgo any special gift that week due to budget constraints. As an employee, I understood the need to economize but, as a nurse, I wanted to draw attention to nurses during that special week. I'm currently in an administrative role as my healthcare system's quality and risk manager. I wrote a short statement celebrating nurses. In this statement, I asked anyone who had a nurse touch their lives to thank them during this week, recognizing the impact of nurses.


I normally wear business dress but in preparation for that week, I purchased white scrubs and white clogs. But one additional item was needed-my nurse's cap. My cap had become yellowed with age and the adhesive that affixed the black stripe had turned to dust. But a little bleach and elbow grease, double-sided tape, and love made it ready to wear again. My goal was to draw attention to nursing that week only.


As the week progressed, I had nurses approach me and say that they had never seen a nurse in a cap except in pictures or at best during a school capping ceremony. Most schools don't even do that anymore. I answered so many questions about my cap, such as why I had a black stripe and others used to have green stripes. They had remembered seeing the green stripe in pictures or someone in their family had worn one. My mother wore that green stripe on her nurse's cap with pride.


Even physicians were astounded, and very complimentary, of my professional appearance. That was the key word throughout the week-professional. It was an eye-opening week and, as I went about my duties, I began to see the impact that my professional appearance was having on peers and patients. One day, a visiting cardiologist who always found something to be upset about was causing a bit of a stir on the medical floor, so I was asked to help him with his concern. I introduced myself and asked him how I could assist him. He told me his concern, I assisted him with the resolution, and he actually said "thank you." The nurses who witnessed this were shocked that he didn't continue on his verbal tirade regarding his concern. After he had left the floor, they shared their amazement. I laughingly said, "It's the threw him off."


My plan had been to retire my cap again at the end of the week and donate my scrubs to charity. But life and circumstance had a different idea. I had innumerable staff, patients, and visitors comment on my look. The most frequent was "oh my, a nurse." They would say this as if it was a rare sighting to see a nurse in a hospital. Several comments were actually sending the message of "thank you for looking like a nurse because one couldn't tell a nurse from any other hospital staff member, clinical or nonclinical." I didn't hear the phrase "thank you," but I began to sense it.


I was one of those nurses who crusaded for colored scrubs so many years ago. I work in the ED, I need to look different, I work with dirty things and white gets dirtier, and the list went on. But the one comment that turned my thoughts on their head occurred toward the end of the week. As I walked down the hall one day, a lady in a motorized wheelchair "motored" up to me with a very determined look on her face. I prepared myself for a complaint related to her or a family member's care by the look on her face. She proceeded to say "I want to tell you something. I want to tell you thank you for looking professional! I never go in a hospital and see a nurse who wants to look like a nurse. They don't mind looking like anyone else in the building. It's refreshing to see someone who, when you need help, you know who to stop and ask. Again, thank you so much for looking and acting like a professional. I wish nurses would understand this. And that was all I wanted. Have a good day." At that point, she turned her chair around and motored down the hall as I said thank you to her.


This was the point where I realized my choice of uniform wasn't about me but, rather, about the patients and their families. It was about what they needed. And, after all, isn't that why we all became nurses? I'm coming up on my second Nurses Week anniversary of wearing my whites. Nurses occasionally ask me why I'm still wearing them and I answer, "Because I earned the honor and privilege to wear white and, most of all, patients appreciate it." I never have a week that some patient or family member, visitor, vendor, or random person doesn't make a positive comment about my professional appearance, and it's usually accompanied by a "thank you."


That's what has astounded me the most. People appreciate nurses mirroring their perception of how a nurse should look. I believe it gives them confidence. I equate this phenomenon to a police officer who pulls you over for speeding. What if he or she wanted to "look different" from the other officers and choose a uniform color based on personal preference or feelings of the day? Would you feel safe as he or she approached your car?


Now, I'm not a proponent that every nurse must wear a cap and starched white dress uniforms with traditional nurse's shoes, but I do think we, as a professional group, should recognize the need for patients and families to identify us as nurses. And it isn't about wanting to wear one's favorite color, style, or design. We're here to serve our patients and make them feel that we're caring and competent professionals. I challenge all nurses and facilities to look at the culture of the patients for whom you care and make uniform choices based on what makes your patients feel the safest and most cared for.


I'll close with a parting thought: One patient asked me, "Are nurses ashamed to look like nurses anymore?"


Michelle Decker, MSN, RN