Who are you?

 
April 8, 2010 -- Today the BBC web site posted an unsigned report about the launch of a new program under which all 36,000 Welsh nurses and midwives will wear a national uniform, in colors determined by their specialty or level of authority. As the piece explains, the idea is to make it easier for confused patients to see who is who, which is a chronic problem in many areas today because of the proliferation of different workers in modern hospitals. Wales is the first nation in the United Kingdom to introduce a national nursing uniform. The BBC report includes quotes from the chief nursing officer for Wales and the ward sister who apparently first raised the idea of the national uniforms with the Welsh health minister. The report suggests that a significant reason for the initiative is that nurse managers did not believe that their authority was being adequately recognized. In any case, although some may not favor requiring all nurses to wear a single uniform, we have long urged hospitals and others to consider some method, such as the RN patch, to help nurses distinguish themselves from other hospital workers. When patients (and physicians) cannot tell who is a nurse, they may assume everyone is, and this tends not only to confuse but also to undermine understanding of nursing expertise, which is already too limited. In addition, the new uniforms' distinguishing of different types of nurses lets people know that nurses, like other professionals, have different specialties and levels of authority. The BBC report on the new uniforms could have included more detail, but it is generally helpful, and we salute the Welsh government for this bold effort to tell society who the nurses are.

The BBC report says that the new uniforms have already been introduced at one hospital, and will be phased in across Wales in the next few months, at a cost of £1.4 million. The uniforms have been "designed to make it easier for patients to see who is in charge of hospital wards after research found many were confused." The piece might have offered a little detail about this research. The report does note that the program was recommended in the "Free to Lead Free to Care report," published by "an expert group set up by the Welsh Assembly Government to look at enhancing the role of hospital ward sisters [managers] and charge nurses." The piece then says that the expert report found that "some patients were confused over who was in charge of a ward due to the range of uniforms used in different hospitals." The piece might have explained this in a little more detail; how did the group determine that? Was this the same research mentioned earlier in the piece?

The piece also includes a few quotes from nursing leaders involved with the new program. It quotes Wales chief nursing officer Rosemary Kennedy:

It is essential that patients have confidence in the nursing profession. The national uniforms will help to remove any confusion over who is in charge, making it easier for people to direct a query and to have confidence in the reply they receive.

This is a good quote because it suggests why the patient confusion is bad:  It undermines patients' sense of who is doing what in the hospital, and more specifically, who knows what, as well as "who is in charge." We assume this last part means which nurses have authority over other nurses or other staff, although in our view it is even more important that people be able to distinguish those who are nurses from those who are not.

The piece also quotes Ward Sister Marie Williams, who the piece says "raised the issue with Welsh Health Minister Edwina Hart on a previous visit to West Wales General Hospital in Carmarthen," the hospital in which the new uniforms have just been introduced. Williams says:

I'm stunned that an initial conversation between myself and the minister has led to the launch of the new All-Wales uniform. I am sure the new uniform, along with the other changes to empower ward sisters, will enhance the sense of pride nurses have in their profession.

This quote suggests that a key reason for the change was that ward sisters in particular felt that patients were unaware of who they were, and perhaps that they did not feel they were receiving the respect they needed to do their jobs effectively. Of course, nurses might benefit if their own colleagues, including physicians, also had a better sense of their authority and expertise.

The report includes a sidebar listing some of the specific uniform colors:

We assume that none of the categories of nurses will have pink uniforms, which could be an unhelpful endorsement of the stereotype that nurses are female. We wonder what steps the government or hospitals might take to tell the public which color means which type of professional--handy charts in each room, maybe?

The piece also notes that "bi-lingual signs" may be stitched into the uniforms for Welsh speakers, in accord with recommendation from Welsh language groups. The report does not say whether any other deviations in the uniforms will be permitted. The report also does not describe any opposition to the uniform initiative. We wonder if some nurses have chafed at wearing the same uniform as all others in their category. In the U.S., some nurses have resisted such initiatives, arguing that they do not allow for sufficient individual expression.

The article also notes that "hospitals are working to make on-site laundry and changing facilities available to control infections." The piece does not elaborate, but this is a critical issue in modern hospital uniform policy. With the rapid spread of deadly infections like MRSA, it is vital that measures be taken to address the role of health workers' attire, including the attire of physicians and anyone else who has close contact with patients. The piece might have made more of the Welsh nurses' leadership in this regard, and explored further measures that might be taken, such as the use of bacteria-resistant fabrics.

On the whole, though the piece might have explored some issues in more detail, it does effectively highlight an initiative with the potential to improve public understanding of nursing, and we thank the BBC.

See the article: "Nurses start wearing national uniform in Wales: Nurses and midwives at a hospital in west Wales have become the first to start wearing new national uniforms," published by the BBC on April 8, 2010.

See our page on nursing uniforms.