It has been a half-century since the image of the hospital nurse in her crisp white uniforms, white opaque stockings and white stacked heels began vanishing from the medical landscape. Now some hospitals are harking back to that era by forcing nurses to return to white attire in what they say is an effort to restore professionalism to the job.
In hospitals across the country, including Atlanta, Dallas and Philadelphia, nurses are checking vital signs and dispensing medication in solid white uniforms -- a look that distinguishes them from technicians, nurses' aides and housekeepers who continue to wear colors.
Few may advocate a return to starched dresses and Cherry Ames nursing caps, but some hospital administrators say a professional look of white scrubs -- pants and top sets that became popular in the 1980s -- and other comfortable attire are more professional. The white uniforms are the same for women and men.
Other facilities, including Chicago's Northwestern Memorial Hospital, do not require nurses to wear all white, but they wear scrubs in a combination of periwinkle blue and white. Northwestern instituted color-coded apparel for all hospital professionals after patients complained that they could not differentiate among staff members. The hospital hired an image consultant to help in the process.
Although the trend is gaining support among hospital administrators, the return to white uniforms has become a divisive and heated issue among nurses. Many enjoy expressing their individuality by wearing pajamalike scrubs splattered with colorful flowers, images of SpongeBob SquarePants or candy canes.
Message boards on nursing-oriented Web sites are buzzing over the subject, involving older nurses who never stopped wearing white to younger nurses who cannot imagine themselves in anything but black, purple or red.
Many hospitals, like school districts, have been forced to institute dress codes as young teachers or nurses with their more casual style of dress enter the workforce. Often their appearance -- dangling jewelry, message T-shirts and fake fingernails -- is deemed inappropriate in the workplace and creates tension with the patients and the doctors. At the same time, hospitals are grappling with a shortage of nurses, and in a climate of stiff competition they are caught in a quandary over what to allow.
Rhonda Scott, chief nursing officer at Grady Memorial Hospital, the largest hospital in Atlanta, instituted the all-white uniform policy last year for its 1,100 nurses. Almost immediately, she said, morale improved among the staff.
"When scrubs hit the market 20 years ago, it liberated us from the days of Florence Nightingale to where nurses had the opportunity to express themselves," Scott said. "Then problems started showing up. I had a nurse come to work in a gray sweat suit, and I had to send her home. Another wore a T-shirt that had a big Tweety Bird on it, and another liked to wear sneakers and a Harley-Davidson T-shirt with a stethoscope around her neck. And how morbid is a black scrub in the critical-care unit?"
As hospitals struggle with the shortage of nurses, Scott said, returning to professional uniforms helps to restore credibility to the job and encourages others to aspire to become nurses.
"We feel that it is time for nurses to be seen as the educated professionals they are," she said. "We have to go through so much training, so why would we present an image less that what we are?"
David Collins, 40, a patient at Grady, said he has noted a drastic difference at the hospital since the uniform policy was instituted. Three years ago, he said, he had to be very demanding when he visited his partner in the hospital because it was too hard to determine which staffer should be doing what. Now that he is a patient, he said, the experience is different.
"If I happen to be in the hallway, I know exactly who to approach when I need something," he said. "Everything seems much more professional."
Nurse Gloria Taylor, 32, said she initially resisted the change at Grady because she liked wearing prints. Now she has accepted the policy.
"My uniform used to reflect my personality. I felt the colors brightened the environment," said Taylor, a registered nurse for two years. "But now I like the professional look of the white. I am going to get some white skirts, and that is a very big step for me."
Many nurses have gradually warmed to the idea, but not everyone agrees. Sandy Summers, executive director of the Center for Nursing Advocacy in Baltimore, said there are better ways to boost the image of nurses.
"A lot of people have problems with white uniforms because nurses deal with bodily fluids all day, and their uniforms get soiled. It is nearly impossible to keep them clean," said Summers, a registered nurse.
"The white uniform also has the angel image problem," she said. "It harks back to the time when nurses were thought of as spiritual characters who provide emotional comfort, not professionals who save lives. When you are perceived as an angel, people don't have a problem asking you to work 15-hour shifts without a break."
Instead of white uniforms, the Center for Nursing Advocacy is promoting the use of a registered-nurse patch to be sewn on any type of uniform. The patch includes the nurse's name and credentials, signifying a professional who is college-trained, Summers said.
"In a lot of hospitals, nurses are being replaced with technicians to save money. Some hospitals require everyone to wear generic scrubs and forbid nurses to identify themselves as registered nurses," Summers said. "If they did, the patients and families would know just how few nurses there are on staff."
At Northwestern Memorial, every professional staff member wears color-coded attire. Technical support staffers wear teal and gray, and other licensed staffers wear forest green and gray. The tops have either a flower print or the Northwestern logo print. To give a more professional look, their job title is embroidered on the top and everyone wears identification badges.
According to Julie Creamer, vice president of operations and quality at Northwestern, the hospital surveyed about 190 patients before instituting the program. Forty-one percent said they could not differentiate among the staff. Sixty-seven percent said they felt color-coded uniforms would be very helpful.
"Patients have enough to think about when they are in the hospital, and we wanted to make it easier for them," said Creamer, a registered nurse.
In 2003, 64 percent of more than 1,000 nurses who responded to an online survey by the Fabric Workshop and Museum in Philadelphia said they preferred wearing scrubs, compared with 21 percent who said they wanted to wear a uniform. Nurses have flooded Internet message boards with their opinions, ranging from "I would rather change careers than wear that" to "A uniform dress code is essential."
The American Nurses Association has not taken a stand, spokeswoman Carol Cooke said.
"It is good to be able to identify a registered nurse from other hospital staff, but there are ways to accomplish that other than a return to a uniform and cap," Cooke said, referring to name tags and badges.