Who's the nurse?

Is it the person who walks into your hospital room wearing a blue tunic and picks up your meal tray?

Allegheny General Hospital The long-vanished white nurse's uniform included a cap with stripes indicating a nurse's level of training. Click photo for larger image. Related coverage From long gray dresses to lab coats and scrubs Nursing advocate bringing message of profession's value here Cameos of Caring awards

Is it the one in a patterned tunic who asks you to breathe into a device to check your lung capacity?

Is it the one in the shirt sporting cartoon characters who takes you down the hall for a hospital test?

Or is it the one in the pink pastel jacket changing your IV?

What nurses wear has become a hot issue over the last couple of years as hospitals in Georgia, Texas, Illinois and other hospitals around the country have started to ditch the colored and decorated scrub tops to return to the white uniform. Locally, St. Clair Hospital in Mt. Lebanon and UPMC Health System quietly have introduced white uniforms for nurses in their noncritical care areas, and Mercy Hospital plans to enact a new dress code beginning Jan. 1.

"I think there's definitely a problem if patients can't distinguish among the people who are caring for them," said Jacqueline Dunbar-Jacob, dean of the University of Pittsburgh School of Nursing.

"Patients are in a vulnerable position in a bed in a room and they don't know who's coming in to care for them. They may be asking questions of someone who is not qualified to answer."

	Tony Tye, Post-Gazette Bright uniforms, like those worn by Mary Campbell, left, and Karen Schrecengost at Children's Hospital, became popular as a way to brighten patient moods and give nurses easier care uniforms. They are with Douglas Kocher, 4, of Carrick. Click photo for larger image.

Older nurses still remember the days of the starched white dress, white hose, shoes and pointy white cap (an accessory most despised). After hospitals in the 1970s discontinued the practice of laundering nurses' uniforms, nurses fought for more practical clothing as easy-care fabrics became popular, according to Lynn Houweling, a nursing doctoral student at University of Pennsylvania who has researched the history of nurses' uniforms.

Many nurses welcomed the more casual look that allowed them to project their own personalities, be it Teddy Bears in the pediatric ward or flowered tunics to brighten the geriatric wing. And uniforms had to accommodate men joining the profession, too.

But nurses at many hospitals have become indistinguishable from the dietitians, lab technicians, respiratory therapists and other staff.

And even though the Joint Commission on the Accreditation of Healthcare Organizations requires nurses to wear name tags and title, those who work in the ER or psychiatric areas sometimes cover up their IDs to protect themselves from unruly patients or stalkers.

What the patients said

Tony Tye, Post-Gazette Nurses in the hematology/oncology unit at St. Clair Hospital wear white. From left are Leesa Vitek, Lisa Fairgrieve and Heather Martorella. Click photo for larger image.

St. Clair made the switch to white after reviewing patient feedback.

"It was confusing to them," said Joan Massella, St. Clair administrative vice president and chief nursing officer. The nurses "were wearing a little bit of everything. They were wearing T-shirts, athletic sports golf-type shirts, uniform floral and patterned tops. It was really a mishmash of everything."

St. Clair nurses in critical care areas, such as the intensive care unit or operating rooms, have continued to wear blue scrubs. It's greens scrubs in the ER. But in all noncritical areas, nurses wear white scrubs, a white uniform dress, white pants suits, or white pants with a white golf shirt.

Views among nurses have been mixed. "But I have to say that when I walk on the units, I'm proud of them," Massella said.

UPMC three years ago began instituting a dress code for the 2,000 nurses in its noncritical medical/surgical floors that calls for white outfits and colored jackets. "Having a dress code is a very personal issue," said Melanie Heuston, UPMC director of nursing recruitment. "It was a big initiative."

Going white hasn't been uniformly embraced nationally. Various Internet bulletin boards have posted a range of reactions.

"The thing I most resented throughout my nursing education was wearing white," wrote one nurse on the bulletin board at the Center for Nursing Advocacy. "I felt so totally demeaned and exposed. I was teased by my non-nursing friends."

Others said the debate over a uniform switch was diverting the public's attention away from more important issues:

"There are so many things wrong with nursing these days that the color of scrubs is really the least of our problems."

Sandy Summers, executive director of the advocacy center in Baltimore, is concerned that white conjures an "angelic image" of nurses.

"The white, angelic, virtuous nurse is not helpful to nursing," she contended. "It makes people believe nursing is all about virtue and morality and not about education and hard work. They believe it's OK to give them eight, 10, 12 critically ill patients and you can give perfect angelic care of them.

"Of course angels don't have to pay their rent either, so you don't have to pay them."

At Mercy, committees representing nurses and other staff came up with a plan to provide a consistent appearance among the hospital's 500 nurses, said Sister Carolyn Schallenberger.

Every unit was allowed to choose a color. The bottoms of the outfit must be in that solid color; the tops will have a white background with the chosen color in a pattern. The change will take effect Jan. 1.

	The Fabric Workshop and Museum A prototype of an ideal nurses' uniform features a highly visible "RN" patch. Click photo for larger image.

The Fabric Workshop and Museum in Philadelphia, which showcased an historical exhibit on nurses' uniforms this year, included artists' version of the ideal nursing attire.

Using the results of a national survey of more than 900 nurses conducted by the museum and American Journal of Nursing, artists Mark Dion and J. Morgan Puett designed outfits from antibacterial, silver-plated fibers. The outfits included zippers instead of buttons or snaps and pockets -- lots of them.

Many survey respondents preferred a more fitted look. Caps got a big thumbs down, and most often, according to the journal, nurses wanted to be easily identified.

The artists created a patch with large red letters "RN" for each outfit to help with identification.

The journal, the official publication of the American Nurses Association, published an editorial in the spring praising the patch and urged hospitals across the country to incorporate it into nurses' uniforms.

"We believe this could be a simple, yet elegant solution to nursing's identity crisis."