Uniforms in Mental Health Nursing…or not?

 
Andy Hamilton honoured
(Perhaps the last time our Mental Health Nursing graduates will wear a uniform?)
 

This post looks at some of the issues around the wearing of uniforms in mental health nursing, as usual we would welcome any comments that you may have.

Currently, although most mental health nurses do not have to wear uniforms this is under review at our local trust – (Birmingham and Solihull Mental Health NHS Foundation Trust ). According to Deputy Director of Nursing Martin Herriott, the Trust are looking at re-introducing uniforms in some areas such as acute in-patient and older peoples services.

Feedback from both service users and carers indicate that staff are often very hard to identify, uniforms might make this less of a problem as well as making staff appear more professional? Of course, there are ongoing concerns around infection control in areas where staff are likely to be exposed to bodily fluids of any sort.

In some areas it is likely that the Trust will avoid uniforms, such as for example long term residential areas where service users are likely to live for any length of time in home like environments. Also, staff going outside of care areas with clients (for instance escorting people to hospital appointments etc) will need to cover up uniforms.

Obviously, this is a potentially controversial idea – although some people are in favour of wearing uniforms, others are likely to be less keen. I found a recent survey amongst patients in a US mental health unit (Miller,T. Mann, N. Grim, R 2010). This study set out to examine patients attitudes about what nurses wore and whether their attire made nurses appear more approachable, competent and professional. Whilst most did have any particular preference what staff wore there was a lot of concern that nurses were difficult to identify. Interestingly, whilst over half of the respondents felt that attire made no difference to approachability, 29% felt that ordinary clothes made nurses seem less approachable!

Another, earlier study conducted in London (Tham, S & Ford, T 1995) concluded that it was other staff who had difficulty identifying nurses whilst 36% of patients felt that uniforms made staff less approachable. For some reason, patients in ‘old age wards’ were excluded from this study – (old age = ‘assume that everyone has dementia?) a shame as this is a client group most likey to encounter nurses wearing uniforms. This aside, it was generally agreed that identification of some sort was really important.

Across at Mental Nurse blog there was a discussion about uniform – most contributors were opposed although there was a contribution from a service user who flagged up the issue of nurses being identifiable (although in fairness, uniform/ identification might not have been at the top of my list of priorities to sort out in this example).

We did a quick (and totally unscientific survey) with a BCU student group and asked them what they thought about this issue.


(thanks to Kate Hopley, Oliver O’Connell & Kimberley Zilke for filming and BCU pre reg MH group Dip HE 0409 for appearing in the film)

REFERENCES.

Miller, T. Mann, N. Grim, D (2010) Clothes Encounter: Patient Perception of Nursing Attire in a Behavioral Health Unit. Journal of the American Psychiatric Nurses Association. 16(3):178-183, May/June 2010
Tham, S & Ford, TJ (1995) Staff dress on acute psychiatric wards Journal of Mental Health 4, 297-299

6 thoughts on “Uniforms in Mental Health Nursing…or not?

  1. Recent studies suggest that uniform has a lot to do with self-image and confidence in being a professional nurse,and that the profession could be divided between traditionalists and modernisers of nursing.Traditionalists who recognise the symbolism of what nursing and nurses represent, and that modernisers see nursing as a response to what the media sees as nurses and how nursing interacts with other professionals.Scotland and Wales have brought in corporate uniforms throughout the NHS so as to reduce role ambiguity and for patients to know who they are talking to.Cross infection is another issue and has a lot to do with being stringent about where to wear uniform and how frequently uniforms are cleaned.In terms of mental health and learning disability for some years now we have worn mufti in an attempt to break through the relationship differential of control, and those boundaries between staff and patients/clients or service users which has entered an equitable person-centred paradigm.Personally,I feel that professional contact with people who are in distress or vulnerable requires that such a professional should demonstrate personal respect through being of smart appearance and is able to give an air of confidence in their transactions. I wouldn’t appreciate for example if a male nurse relating with me had his backside showing and the crutch of his trousers were down to his knees – to me that would reflect more of a concern for their own image rather than me who was anxious or depressed. Rings through noses and ears are also not so easy on the eye and are a hazard when working with “unpredictability”.For me its about being professional in the way we dress not a uniform which displays status.

  2. Service users should be able to identify nurses through their behaviour and actions. Service users needs to know who the nursing staff are, to ensure they feel comfortable and safe. Surely this can be done in ways other than identifying the ‘white coat’
    By wearing uniform, mental health nurses are in danger of looking ‘in charge’. The uniform suggests power and authority. With locked doors on acute wards, and uniformed staff, there would be little difference between acute wards and prisons.
    While government campaigns are trying to educate people about the stigma surrounding mental health, introducing this new policy would be reinforcing the stigma from within.

  3. From the perspective of an acute in-patient nurse, my role is to resolve immediate crises and work towards discharging our patients in a ‘better’ place, (mentally, sometimes if we can, physically and socially too). Early into admissions, we often have to do deliver immediate interventions, often without any chance of a ‘therapeutic ‘ relationship having been established. In the longer term, I do not agree that the trust and understanding that such a relationship is built upon is adversely affected by a uniform. This takes time, effort and a non-judgemental approach and is more about the skills of the practitioner, not their appearance.

    I would also like you to consider if we would ever be having this debate within adult general in-patient wards. I would have been horrified during my admission to general hospital if I couldn’t identify the staff from the visitors. As health care workers, we should be easily identifiable to patients and visitors. I think that this can be an issue at the moment and although dress codes exist, a standard uniform would ensure consistency and convey that we are professionals. However, I do wonder how this works with temporary agency or bank staff who I presume would still be able to wear their own clothes.

    Personally, I feel the adoption of a uniform would be a positive move within the in-patient environment. I understand the ‘them and us’ argument and the comparison with prison guards in the other postings, but the reality is that as acute in-patient nurses we are there to provide care and in some cases , containment. As mental health professionals, our focus is to build relationships and environments that facilitate the patient’s journey to recovery, however…….isn’t a power differential inevitable? If you are bought into hospital under Section the power exists to stop you leaving when you want to and to compel you to take medication you may not want. Not an equal relationship is it? Against these issues, the uniform debate seems almost superfluous?

  4. I think that mental health nurses shouldn’t wear uniform but at least look smart, I believe that when a nurse is dressed the same as you (non uniform), you feel more comfortable talking to the nurse about your feelings issues, and uniform can be quiet intimidating, maybe it should be compulsory to wear your lanyard with your ID on or a retractable one on your trousers and you can usually tell who the nurse is on the in-patient wards

  5. Remember a uniform has a function, it identifies you as occupying a group role, not as an individual. If you are doing embarrassing things to people they can think of you as a nurse not a person, very useful in some settings. If however your principle work is in relationships with people, a unifom would be counter productive. However we live in a time when appearence is everything, shiny badges being far more important than interpersonal skills. We can make it very clear that we are not patients ( for some reason this is important? ) and proudly serve our corporate masters.

  6. its a sad state of affairs this discussion is taking place. The deputy director of nursing should be leading an agenda around recovery, person centred care and the therapeutic relationship, not uniforms. Just when you think mental health nursing is progressing, it steps back 20years

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