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The DO | Opinion | To the Point

Clothes do communicate in hospitals

Patients conversing in a hospital room:

“Was that a doctor in the brown scrub suit?”
“I don’t think so. He may have been a transport worker or a nurse.”
“No, I think the nurses wear white pants with a flowered top.”
“But some of them wear jeans. Are they different, like a student nurse or nurses’ aide?”

Maybe that’s not exactly the way it happens in your hospital, but it’s a safe bet that conversations like this happen in every hospital every day—due to confusion over all of the hospital personnel. (The conversation is manufactured, but the outfit descriptions are real—I observed them only recently.)

Arnold Melnick, DO

Arnold Melnick, DO

We know that in the medical field we communicate in a number of ways: verbally, with body language, in how we practice, in how we operate our offices. All modes send messages to patients. Hospitals, too, communicate messages in the same form. And most hospitals send confusing messages as to who is who and what he or she can or can’t do.

When that man appeared with a wheelchair without anyone telling us about it, how do we know his legitimacy? And when a lady appears with some pills, is she a nurse—our nurse—or a student or an aide? And is she supposed to be doing this?

There was a time years ago when hospital personnel could be identified by their uniforms—nurses in starched white, student nurses in colored tops with white apron skirts, interns with clinic jackets or clinic shirts, physicians with long white clinic coats. It was easy to know. Dress was uniform, and jobs were obvious. Everyone, including patients, immediately recognized each health care professional. It is more difficult today, with more and more male nurses and more and more female physicians, the increase of paramedical health care workers, and the widespread trend toward informal attire by all groups.

But the era of informality is with us. Apparently hospital employees wear whatever they wish. In a large hospital that may employ several hundred nurses, even a sharp administrator coming on the floor cannot decipher who is who.

So what communication does this send? To me, it says, “We don’t care whether you know who we are or not, or like it or not, just follow orders. If you are uncomfortable with that, tough. That’s just the way we operate.”

Facetiously—no, semifacetiously—I think the problem could be solved if everyone wore a T-shirt labeled, front and back (like a football or baseball uniform), with “NURSE” or “STUDENT NURSE” or “INTERN” or “RESIDENT” or “TRANSPORT” or whatever. Maybe even include the employee’s name in large letters—no numbers necessary. But, nah, that wouldn’t look professional.

Hospital administrators, who solve so many problems every day, could easily come up with a dress code that would be instantly recognizable. Try this one as a simple (and incomplete) sample: white slacks and flowered tops (which seem to be popular) for female RNs (with a masculine version of the uniform for male nurses), white slacks with solid tops for student nurses, purple scrub suits for aides, and so forth. This could be complemented by an explanation sheet (maybe even illustrated) that would be given to each patient on admission and would simplify recognition and give a brief description of the duties of each uniform wearer.

One other change would help patients recognize the roles of hospital staff: hospital badges. The person’s name and title should be large enough for every patient to read from 10 feet away—the geriatric population, younger patients not wearing their glasses—everyone.

Some attendants introduce themselves on entering a room, but not all do. Such introductions should continue, even when badges are worn and a dress code is in place. Patients, almost all of them, are uncomfortable because of the strange environment, fearful in many cases, and anxious. They wonder who is coming in next and what the attendant is going to do—hurt me, stick me, take me to some unknown area? What will result?

Good identification—no, instant identification—is important in relieving some of these problems and making patients more comfortable in the hospital. In today’s hospital milieu, stays are shorter—too short to develop a full understanding of what is going on.

This new (or return to the old) dress code will communicate a different message: We care for you. We want you to know who’s who and what’s going on and who’s doing what. We want you to have the least possible anxiety. By our letting you know who’s who, you can relax. Welcome to our hospital.

A former president of the American College of Osteopathic Pediatricians and the American Medical Writers Association, Arnold Melnick, DO, is an experienced writer and public speaker, as well as a nationally known leader in pediatrics. Dr. Melnick was the founding dean of what is now the Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla.

amelnick@nova.edu

6 Responses

  1. Leslie Huzyk on Feb. 25, 2010, 9:43 a.m.

    I never gave this a lot of thought, but Dr Melnick is spot-on. For several years I made frequent hospital trips with my elderly mother, whose treatment was complicated by Alzheimer’s disease. Shift changes occur and teams change and it is made worse by not knowing who is treating this vulnerable patient for what, and where is the nurse, the doctor, the decision-maker?

    Every means to communicate clearly to patients and–in my case, the caregiver–is vital. Even clothes!

    I hope hospital management reads this!

  2. KATHY on March 1, 2010, 1:46 p.m.

    I have worked in an organization that implemented this dresscode. It made no difference to the patients. Unless you introduced yourself, it made no difference to them. Most were not in the hospital long enough to remember anyone’s color. They failed to conceptualize the idea. The patient had no idea if a tecnologist was from the lab or from ultrasound. They would still tell you if their sheets needed changing. I thought the idea was silly and typical of some upper management would implement prior to knowing what and who are doing the jobs.

  3. Nick on March 4, 2010, 5:32 p.m.

    As a future physician, and advocate of nursing, it has always puzzled and frustrated me why the nursing profession allows physicians to dominate the “first-impression” power struggle with patients. A nurse, dressed in some version of a pink/purple/flowered/multi-patterned/multi-colored outfit, often with sneakers, has no chance of earning due-respect from the patient, when the physician enters the room in a shirt and tie and white coat, or tucked-in scrubs and white coat, with leather shoes. This is the often encountered out-patient scenario across America. It would behoove the nursing profession to mandate or encourage a uniform and professional dress code- appropriate for the respective clinical setting.

    The other problem that this article hit on the head is proper introductions. Perhaps because personnel are performing tasking often viewed as higher level in patients’ minds (i.e techs performing phlebotomy instead of nurses; nursing taking full histories instead of physicians; PAs/NPs carrying out procedures instead of physicians, most people are negligently not stating their name and title. “Hello, my name is Sue, I’m a registered nurse..” This is a huge problem in our healthcare system. I applaud Dr. Melnick for discussing these issues.

  4. Alison on July 2, 2010, 8:15 a.m.

    As a healthcare professional who works at hospital, I would have to agree with Kathy. Most patients are not there long enough to recognize or remember the color coded uniforms. I always walk in and introduce myself and which department I’m with and many times I am still asked questions that do not pertain to me. Things like when are they going to get their next dose of “x,” or they need to be cleaned up, or why haven’t they been given “x” medication they always take at home. My name and my department are also on my badge. This still does not help the patient with identification.

    So, professionals like doctors or administration who come down the hall in suits get more respect because they are not wearing scrubs. You look around and think you will solve all the patient’s problems by making staff wear color coded scrubs so they are easier to identify. Easy for you to say since you “know the color system” where patients do not. Meanwhile, your staff is no longer happy about having to wear uniform colors, especially after they have carefully chosen designs that help brighten their usually very stressful days. Besides being cheerful to the person who wears the colorful uniform, many patients have given me compliments on my selections.

    Even as a patient myself, I have not had trouble identifying people because I look at their badge. Or when I walk into a doctor’s office who has their staff wear uniform colors… guess what… you can’t tell the difference between secretaries and nursing. You only know they work at that office. Unless, you look at theie badge of course! Hmmm… maybe color coded badges are the right way to go with large printed identifiers at the bottom for “RN” or “CNA” or “NP,” etc. Or lanyars/pulleys with the same identifiers on them.

    I would agree that patients probably do get confused at times about “who” is in their room to do “what” with them. But, I would argue that most would be fine leaving health care professionals to chose their own scrubs versus having to follow uniform colors. Like you said, the patient’s hospital stay is “too short to develop a full understanding of what is going on.”

  5. William on April 27, 2011, 2:58 p.m.

    So, nurses think so little of their patients that they believe patients are dumbells who can’t figure out what’s happening? Wearing professional clothing is beneath you? Why is it about the nurses anyway and who cares how they feel? IT’S THE PATIENTS, PEOPLE, not you. It’s not about YOU, idiot. Half the people in hospitals I visit don’t even wear name tags. I assume this is an overt attempt to keep their identity a secret so the lawyers can’t find them. Is that it, Alison and Kathy? Keep the patients befuddled so you can feel rested? I can assure you that patients do indeed care who’s sticking them and poking them and who the hell is in the room! Clothing matters a great deal. And certainly a patient should be your first concern instead of whether or not you look pretty in your horrible little flowered print uniform. I hope I never have to deal with either of you giving me health care while one of your eyes is in the mirror!

  6. Patti Rivenbark on Feb. 19, 2012, 1:03 p.m.

    Hi Dr. Melnick. I agree with hospital employees having a dress code. I would like your opinion about doctors offices requiring the same dress code as a floor nurse. This is comng down from a military person who is now a cilvian. I have been working as an LPN for over 25 years and my nursing uniforms have never been a problem. I pride myself on my dress ethics but now they want me to wear all green everyday and I think it is obscured. Can you give me your thoughts. I work for a large corporation and they just keep saying we are a hospital based facility but they will not give no other answers. I have tried as well as the doctor I work for but they have to keep going from one person to another with no resolution. Can you please give me your thoughts. Thanking you in advance.

    Patti Rivenbark

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