Uniforms

There is a theory, developed by Ellen Langer, Professor of Psychology at Harvard that there is a thing going-on with uniforms.

Yes, none of us needed a US academic to tell us that uniforms do something, it is more the effect they have, not just on those who engage with the individual in said togs, but for the wearer themselves.

I will not go into the details of Prof Langer’s theory suggesting that those who wear uniforms age more slowly than others, rather, I will narrow the search and bring the discussion closer to home; hospitals.

Sorry to be so predictable.

Where to begin?

Hospitals, our biggest modern-day workhouses of health and treatment have most of their staff wearing uniforms.

Uniforms can tell you much – if you are informed – excuse the pun.

Take nurses as the easiest example to follow:

In any hospital, a nurse will be able to tell you the grade of another nurse just by looking at their outfit. The colours and design vary across the country (and, in each organisation many hours are spent either determining the right colour/shade/tone/pattern or in working groups assessing ways to change the uniform) (this is when you discover your head nurse should have been a fashion designer).

When you consider the origins of the word, uniform, well, it says it all. It is an aspiration to make people appear the same. A way to ensure that everyone in your battalion or football team knows who is friend and, who is foe. Who to trust and who to challenge.

Ironically, despite this aspiration for uniformity, within the team, tribe, company, there are always subdivisions within that reflect the lack of similarity.

You can look at nurse A, B or C and immediately have an insight into their rank and position and, in the UK their salary.

Nurses on the wards or, running clinics – the ones who make physical contact with patients – blood pressure, caring, supporting, generally fit in to one shade or another, those nurses who have become elevated to positions of management are allowed to wear what they like – within reason, so long as they are ‘smart’ – whatever the organisation’s dress-code says.

The other week I jokingly suggested I hand-out stars (like they used to do in Macdonald’s) (do they still?) for every nurse measuring lying and standing blood pressure in my patients who has fallen without being asked. We all agreed that this would be patronising, although it is part of quality improvement to reward good practice; a conundrum!

So, uniforms say that everyone is alike, yet some are a little different to others.

We are all created equal although some are more equal than others, said Mr Orwell.

In most places doctors can wear what they like, so long as it is within the realm of decorum, although I have seen some GPs in particular, in pretty ropey get-up!

In a local hospital – Chesterfield, they make the doctors wear uniforms, which when first established led to an outcry; I think most people just get on with it. Oh, to be so accepting!

Uniforms have another hidden, I don’t want to say sinister side, as that isn’t right, but, for lack of a better word, I will; they establish the difference between you and me – not just within the hierarchy, but between those in-tribe and other out;

Patient and nurse.

Distance, remoteness, disconnection.

I’m the nurse, I wear navy-blue; you, patients are in an ill-fitting, bottom showing, one-size-fits-all gown.

When I was at medical school, much was made of paediatric and psychiatric nurses wearing normal clothes, in order to mitigate the divide.

Nowadays, I think this has gone.

Funny, and, we are meant to be about progress.

I have always wanted nurses to wear normal clothes – especially those working in nursing homes and wards that aren’t overwhelmingly clinical (most wards for older people, say) – I am sure this would make patients feel more relaxed and happier to ask difficult questions.

Sure, some of the work is messy, dirty, infections are present; I can’t believe there is not a way round this;

Uniforms rob us of our identity, our personality.

Yes, you wouldn’t want folk appearing for work in too flamboyant attire (here I am thinking of the artist Grayson Perry).

Anyway.

In our attempt to deconstruct the hospital.

To wheedle-out what isn’t working, to take away the non-value adding components, could we start with this?

School teachers seem to mostly manage to pull it off; although the staff who come-in to clean are often forced into uniforms.

And yes, I know, in many instances uniforms are easier; like Einstein, they save having to decide each day what to wear, they protect the wearer from bodily fluids; but, when those fluids are apparent, aren’t they just washed-off; 60 degrees in the Hotpoint? (You wouldn’t want too many synthetics that might shrink).

Have I made things too complicated?

Think of the benefits?

Think of the chaos.

Nurse? Doctor? Molly, Megan, Moira – Can you please help me on to the commode? I was afraid to ask, I wasn’t sure if you were staff; I couldn’t quite see your badge;

Should hospitals be more like homes? Should Care Homes be more like homes?

Will it ever be possible to undo the accepted norms?

Will I be advised tomorrow that I can no longer wear my pink-stripy shirt and must don a uniform; green or blue or black?

Please go ahead, if you want me to truly lose the plot, if you want to push me over the edge;

Sure, when I am jumping into those bodily fluids, when blood and saliva and poop are flowing, but when holding the hand of the old lady, when offering reassurance, orientation, comfort, a uniform could get in the way.

A little like my watch, missing, I have no idea of the time, I squint to see the hour on the desktop, I use my patient’s time-piece.

Sigh.