From the Editor-in-Chief

Several years ago, a nurse manager described her interaction with a registered nurse working in an ICU dressed in an outfit that might otherwise be described as beach ready. The nurse's response to a challenge that this might not be appropriate attire for the clinical work setting was: "Surely you don't expect me to dress like you?" Taken aback by this nurse's affront to the challenge of her garb, and in the absence of any policy detailing appropriate dress, as the manager mulled over a "suit"able response, she was most dismayed at the need to explain the merits of projecting a professional image. While many organizations, including professional associations, have articulated guidelines for an appropriate professional appearance (including attire, hair, nails and jewellery) and acceptable approaches for identifying oneself to the public (ARNNL 2013), recent decades have seen the disappearance of a consistent uniform for nurses.

Over the course of time, we also seem to have lost many traditions – celebratory events marking passage into the profession, such as capping and pin dinners. Probably not essential to a professional image, but there was something about those celebrations that unified us in a common purpose and afforded a sense of camaraderie. Even our physician colleagues continue the tradition of conferring "white coats" on medical school trainees – a good idea? Maybe, maybe not, but the practice prevails and imbues a sense of professional pride and status for the long term. Consider the impact of such traditions: Are they just sentimental milestones, or is there a genuine sense of unity that derives from shared celebration and the adoption of a common manifestation of one's profession?

White uniforms, white stockings and white shoes were for many years the distinguishing hallmark of registered nurses in institutional settings. Community and public health nurses were also historically identifiable by their uniforms, and in many cases remain so. Beginning my own career in an era of whites, including caps (not bibs or aprons – I'm too young), I do think that in some cases the pendulum has swung too far. Call it freedom of expression or simply a relaxation of dress code policies, individuals' chosen presentation of professional self has become the prevailing norm in most jurisdictions and settings. Anecdotally, the resultant confusion about "who is who" is often lamented by the recipients of care. Empirically, nurses who have studied the impact of the trend away from a "uniform" uniform among nurses have found these anecdotes to be supported (Albert et al. 2008; Tolbert and Bilstein 2010). In the Albert (2008) study, white uniforms rated very high among older adults, aligning with attributes such as confidence, competence, attentiveness, professionalism and caring. While a white uniform is not the only answer, consistency of dress does appear to make a difference to some people.

In the face of confusion, not just by those on the receiving end of care, some workplaces have set expectations for uniforms that distinguish different providers by virtue of colour, style or both. Inspiration for this editorial arose from my attention being brought to a group who took action to reclaim their identity as registered nurses. Frustrated by the increasing obscurity of their professional designation, the New Brunswick Kennebecasis Valley Extramural nursing team decided to make sure that other care providers, clients and families would be able to easily identify the registered nurses by virtue of their attire. Adopting a white smock with an embroidered Registered Nurse designation and complemented by black scrub pants, these nurses' group photo conveyed a smart and distinguished look – and, by the way, did they look proud! Did their employer mandate this change? Nope. But it is their hope that this attire will be adopted by all. I must admit that I found the actions of these NB nurses refreshing and encouraging. Indeed, if this group of nurses felt the need to reclaim their identity and present a unified image, imagine the corresponding relief of clients and families to be able to easily differentiate the nurses from other staff.

For those who believe that the physical image doesn't matter, hark back to the profession's collective distress expressed in reaction to the media's portrayal of the sexy nurse, the drug-addicted nurse or the nurse in otherwise compromising situations. While the "uniform" in some of these instances has served as a vehicle for typecasting, let's be clear that the uniform still denotes nurse. Some nursing organizations provide their members with registered nurse identifiers such as lapel pins. Similarly, many healthcare organizations provide employees with nametags that prominently differentiate the registered nurses and others from one another. All well intended, but is it enough?

Not to suggest that we revert back to the stiff and impractical uniforms of days gone by, but why is it that we reject the notion of a consistent presentation of our professional image? Other professions wear uniforms that clearly convey their role with nothing short of pride. Think about public reaction if other professions were to present themselves in non-standard outfits – police, military, airline pilots – would they be easily identifiable? Would they evoke the same public trust, confidence or respect?

So, where do you stand on the issue of nurses' image? Does a nurse's attire matter to the conveyance of image or not? Is there a need to reclaim the image of registered nurses with some consistent manifestation of dress – one that indisputably identifies nurses to all? And I ask you, nurse leader: What is your role, if any, in addressing the issue of nursing image?

In this issue, we share an interview with Rachel Bard, who has well served the interests of the Canadian nursing community as chief executive officer of the Canadian Nurses Association over the last five years. As she readies for retirement at the end of this year, I asked her to reflect on the milestone events of her career and tenure as the top exec at CNA. A leader in healthcare and nursing, Rachel spoke passionately about her work and, specifically, her pride in identifying as a nurse. Most striking were her reflections on the importance of our unity as a profession and the potentially powerful influence of our collective identity.

Our emerging leader columnist Kandis Harris also writes about the significance of image. She questions whether we have done enough to "make visible the scope, breadth and depth of nursing knowledge" and are we "missing the expanse of leadership contributions of direct-care nurses enacted in the course of daily practice?" Further she challenges us to consider everyday practice AS leadership in order to discourage offensive stereotypes and evoke positive perceptions of the profession in the future.

So think about it. Is the often ambiguous, inconsistent or inappropriate manifestation of nursing hindering our efforts to present as a unified profession? I'm imagining the image that I would like to see. What about you?

Lynn M. Nagle, RN, PhD 
Editor-in-Chief

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