Once upon a time, nurses wore pristine starched caps and white dresses. And scrubs were only seen in and around operating theatres.

Comfort and practicality saw dresses give way to tunics and trousers, then loose-fitting scrubs or scrubs-style uniforms became increasingly popular. And not only for nurses.

Patient confusion was one of the reasons why the nursing leaders of Waikato and Auckland District Health Boards decided a few years ago to shift away from a generic scrubs look and single colour uniform.

“You couldn’t tell who was the registered nurse, the charge nurse or who may have been an administrator or even a cleaner,” recalls Sue Hayward, chief nursing and midwifery officer at Waikato DHB.

Margaret Dotchin, chief nursing officer at Auckland DHB had similar concerns.

“We heard from our patients that they didn’t always know who was who.”

Along with being able to better identify at a glance who was a healthcare assistant and who was the senior nurse on the ward, Dotchin and Hayward say they were also seeking a more professional look for their nurses.

“A new uniform is a small, but important part of raising professional standards not just for nursing but for Auckland DHB as a whole,” Dotchin wrote in a DHB blog in October 2014.

Selecting a new uniform that is comfortable, practical, affordable, professional, and acceptable to most staff, was not a simple or speedy process for either board. What you get to wear to work each day is naturally a topic nurses have strong and diverse views on.

Some of these views have grabbed media attention over the years, including a “Please don’t take away our scrubs” petition started at Auckland District Health Board, a “Mickey Mouse outfit scrubbed” headline in the Waikato Times and “Some nurses unwilling to wash uniforms” in the Otago Daily Times (after ED nurses had to swap DHB-laundered scrubs for take-home uniforms).

Auckland

Reaching a consensus on a uniform that suits everyone is always going to be difficult, says Dotchin. But the Auckland DHB was keen for its nursing and midwifery workforce to have a say on uniform styles.

Dotchin and a group of nurses and midwife representatives worked with their chosen uniform supplier and came up with three options regarded as breathable, hard-wearing and easy-care.

The next step was having about 30 nurses, midwives and health care assistants trial the uniform so staff could see the options in action and also test how practical the uniforms were for carrying out the duties required of them.

Staff got to see the styles on the ‘runway’ in a series of roadshows, plus a special Grand Round fashion show, before voting on their preferred option. Dotchin says it received more than 2,300 responses on the proposed uniforms and 1,500 votes on the colour choices. The feedback led to the uniforms being restyled and a second trial taking place.

“Taking the time to involve nurses and midwives in our design, listening to feedback, making adjustments and then allowing some choice in design was an important part of the process,” says Dotchin.

Board feedback included the 420-signature “Please don’t take away our scrubs” online petition that argued scrubs did look professional if fitted and were closely linked to the nursing identity. “A good looking uniform which is practical, comfortable and able to be kept clean makes a huge difference in promoting team cohesion, pride in who we are, personal discipline and staff morale,” said the petition.

Dotchin said when the board heard that some people were very attached to the scrubs-style uniform they currently wore, it went back to the uniform suppliers and came up with a new option that is more like a fitted scrubs-style tunic top.

The new uniform decided on has three tunic top options for female nurses (cross-front, collared or zip front) and, based on feedback, just one option for males (a fitted-scrub style tunic). There are also two trouser options for males and three trouser options for females. Auckland opted for three colours to help patients distinguish who was who: light blue for health care assistants, dark blue for nurses/midwives and dark grey for senior nurses/midwives.

Dotchin says the board took its time with its decisions, and she is really pleased with the process and the resulting options that she looks forward to seeing staff wear later this year.

Waikato

Updating Waikato’s nursing uniform was initiated by Hayward about four years ago.

One of the most important lessons she says she learnt along the way was that the relationship developed with your uniform company is “incredibly important”.“We couldn’t have been able to be as flexible and as responsive to nurses needs if we didn’t have that relationship.”

Feedback from nurses wearing the first version of the new tunic and trousers uniform saw them change the fabric, add extra colours, change the cut of trousers and add more trouser options.

Hayward says nurses didn’t like the feel of the first fabric used or think it was fit for purpose. “We’ve finally got a fabric that actually washes well and irons well. We’ve got a fabric that is beginning not to fade and we’ve now got a uniform that doesn’t fall to pieces after a few washes.”

‘Red coats’ and trims added

Hayward was very keen for the uniform to identify the role of the person wearing it. Waikato opted for one style of tunic in initially just three colours: green for enrolled nurses and different shades of blue for registered nurses and charge nurse managers.

But Hayward says it then began to see needs for other groups of nurses to stand out – this time not for patients but other health professionals on the ward. So it added trim in another colour to the uniform of the Patient At Risk (PAR) team nurses so people on the ward could quickly identify a PAR nurse arriving in response to an emergency.

It also created the ‘red coats’ – a red tunic for associate charge nurse managers in large units like ED, intensive care or the neonatal ward – so a doctor, nurse or other health professional arriving through the door of a large unit like ED, intensive care or the neonatal ward can quickly spot and find what are now known as the ‘red coats’. (Theatre staff still wear standard scrubs but now have different-coloured disposable hats to distinguish the different roles.)

Hayward says the collared tunic option chosen (one option for women and one option for men) allows movement and includes side pockets. The three trouser options now include elasticated versions but with a cut she says that is both comfortable and smart.

The biggest tension at Waikato was over the uniform options for the paediatric ward. The Waikato Times back in 2014 reported paediatric nurses’ disappointment at being expected to wear the new blue tunic and no longer being allowed to buy and wear their own cartoon-patterned scrubs to work.

Hayward says there were “many, many discussions” on the topic including whether the new tunic could be in a cartoon style fabric for paediatric nurses. “What was difficult was to source fabric that was going to be cost-effective and was able to be washed at the temperature required.” Eventually the board decided to go with the standard blue tunic for all registered nurses.

From start to finish the uniform selection and ward-by-ward rollout took about two and a half years. The DHB is now rolling out a new and different style uniform for healthcare assistants – a tailored scrub-style top in burgundy.

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