Is This School Perpetuating an Unprofessional Nursing Image?

Recently, I read a comment on an online nursing forum regarding the female writer’s newly issued student uniform and her displeasure with it. She included a photo of the uniform, apparently from a catalogue and worn by a professional model, slender and smiling. The student described the uniform as a dress constructed of poor quality thin white fabric, the hem of which falls about two inches above her knees. The photo supported her description and certainly does remind one of a particular nurse image the profession is trying to eradicate.

Her complaint, the photo and some of the 54 responses that have been posted so far have brought some thoughts to the surface. Anyone who reads this blog knows that I am of the “old school” era—the dark ages of no electronic charting, no laser surgery, no surgical scrub-style uniforms.

First of all, I wasn’t aware that any nurse or nursing student wore dresses anymore, so that this student is required to wear one—or that they are even available—is a big surprise to me. Second, since they are available, I don’t have a problem with uniforms that are white dresses as long as they are functional—sorry, I just like that look—but two inches above the knee is ridiculous. The fact that a nursing program would approve of such a hemline is astounding to me because I remember my nursing school director admonishing my graduating class, in reference to our matching white graduation uniforms, “Please, ladies, no knees.” I’d be willing to guess that the uniform is shown as short in the catalogue in order to make it less frumpy and more appealing. Unless the advertising copy describes the dress as ‘two inches above the knee,’ I’ll bet it is longer and the hem can be adjusted to suit the student.

Having said that, I do see that a uniform such as the one this student will be wearing presents a number of problems. First among them is that this uniform is well suited to a slender body but would be unflattering and uncomfortable for someone of more heft, or of greater height. Bending and stretching could result in some unwanted exposure. When we are hearing so much about body image leading to all sorts of negative behaviors (bulimia, anorexia, damaged self-esteem), why would anyone deem a slender-cut uniform good for all body types? Then, there is the fact that a dress presents the need for accompanying panty hose. They are evil things, I tell you! Oh, sure, they have their place and I wear them occasionally but the thought of having to wriggle into them daily is downright depressing. Besides, they’re expensive and have to be replaced way too often.

I don’t have a solution for this student. One responder suggested that the female class members band together and lobby for a style that is more practical, more flattering and constructed of better quality fabric. That almost sounds too sensible, doesn’t it? I plan to follow this forum to see how it all turns out.

If any of you are still wearing dress-style uniforms, either by choice or by requirement, please share your feelings about their comfort, practicality, and appearance.

Television, Nurses and the Media

I have always admired dedication. The kind of dedication to a cause that is like a pit bull that lunges for your ankle, gets a mouthful of your jeans instead, but won’t let go because the prospect of achieving his original goal—sinking his teeth into your ankle—is too compelling.

With or without lipstick, Sandy Summers, RN, MSN, MPH, is just such a pit bull. In 2001, she and six graduate school classmates decided to address the nursing shortage by focusing on inaccurate portrayals of nurses on television. The formation of a nonprofit, The Center for Nursing Advocacy (The Center), soon followed.

In the ensuing eight years, as her former classmates left the project, Summers has relentlessly monitored TV programming and advertising, calling to task those in media who are responsible for misrepresentations of nurses, both flagrant and subtle. Recently The Center has decided to close and Summers’s former classmates have returned to help her new organization, The Truth About Nursing, continue the mission.

After eight years of what has amounted to research, in a collateral sense, Summers and her husband, Harry, have recently released SAVING LIVES: Why the Media’s Portrayal of Nurses Puts Us All at Risk. The book details how the media’s erroneous characterizations and negative stereotypes of fictional nurses have a dire effect on real nurses and their patients.

Essentially, a lack of respect for nursing, fueled by far-reaching television juggernauts, produces a domino effect that leads to paltry funding for nursing and a decreased interest in becoming a nurse, followed by an increased shortage of nurses and, ultimately, leading to unnecessary patient deaths due to an insufficient nursing force to care for them adequately.

In addition to citing myriad media infractions and the destructive effects they wreak on the nursing profession, Summers’s book empowers nurses to take action to get the respect they need to save lives.

The book is entertaining and irreverent; an enjoyable read about the seriously damaging and potentially deadly practice by the media of demeaning the nursing profession. It may open your eyes to the pervasive harm caused by what, on the surface, might be seen as innocuous amusement. You will most likely never watch TV the same way again

Are Nurses in White Making a Comeback?

There are still many nurses of, shall we say, a certain age who remember the era of white uniforms—and it doesn’t seem all that long ago. Speaking from a female’s experience, those uniforms were white dresses, never pants, always starched and crisp because Perma-press hadn’t yet found its way into uniform shops.

Then, ever so surreptitiously, white pants suits began to replace the dresses. Before long, the tunic part of those suits began to show little details of color—piping around the hem of the sleeve, on the button placket, on the edge of the collar. Next thing we knew, the entire tunic was a solid color and, soon after, the pants were, as well. In short order there was a uniform free-for-all. Soft colors gave way to bright ones, which opened the door to multi-colored small prints, which paved the way for large graphic prints, all in the style of surgical scrubs.

Asked to put a time frame around the demise of the nurse-in-white, a source who has actually researched the subject figures the extinction of nurses dressed so as to be recognizable as nurses was complete by the beginning of the 1990s. It didn’t seem to matter that the patient couldn’t tell his nurse from the unit secretary, phlebotomist, dietary worker, physical therapist, housekeeper or some college kid visiting grandma. Hospitals were focused on keeping their nursing staffs happy and a relaxed dress code seemed to help with that effort.

But, then, hospitals began to feel the need to compete with one another for clients, so patient satisfaction moved way up on the importance scale, to at least an equal level with the happiness of the staff. Exit surveys of patients asked about every aspect of their hospital experience, the results of which soon brought about changes aimed at keeping them and their families as satisfied customers who wouldn’t think of going anywhere else for medical care.

Lo and behold, the surveys underscored the importance patients placed on wanting to be able to recognize their nurses. The patients spoke and the hospitals—at least, some of them—listened. There now seems to be a slow trend toward putting nurses back into white because that is what patients prefer.

Nurses often don’t, to borrow from Dylan Thomas, ‘go gentle into that good night’ when it comes to making the change—for some it’s more like kicking and screaming. But, once the change has taken place, nurses are surprised to find that they are taking pride in the fact that they, as a group, certainly do look more professional. The CNO at a hospital that recently instituted a white-for-nurses policy reports that the nurses are enjoying being recognized as nurses in situations outside the hospital. While waiting in line at the supermarket, for instance, other shoppers will ask if they are nurses and strike up a conversation. It is a brand new experience for them—and a positive one.

It hadn’t occurred to me that anyone who began working as a nurse after the early 90s had never experienced the joy of admiration by regular folks they might meet while picking up a loaf of bread on the way home from work—and that’s too bad. While I never sought the recognition, I remember that I really liked it. I’m glad that the return to white uniforms is providing this experience to a new (or, not so new, given that it has been nearly 20 years) generation of nurses. If any of you are reveling in this newfound experience, please share your story.

Childhood Constipation can be Painful, Costly and Dangerous

I am writing as a mother, not a nurse, about a personal failure I experienced in my dual role as a mother and a nurse. By the time I became a mom, I’d had some pediatric nursing experience, but not much. Never, while in nursing school or on the job, was I made aware of the potentially serious ramifications of something that seems so innocuous—pediatric constipation.

So, what’s the big deal you may ask? A dose of laxative, maybe some prune juice or an enema should take care of the problem, right? It’s not quite that simple, as I learned through painful experience—physical pain for my daughter, emotional pain for my husband and me.

I’ll get to the details in a minute but first I have to mention the results of a recent study that investigated the occurrence of pediatric constipation and how it affects medical costs. The study determined that the burden of illness in children suffering from constipation, and the costs associated with this condition, are roughly of the same magnitude as those for asthma and attention deficit hyperactivity disorder (ADHD).

Results show that children with constipation use more health services than children without the condition, amounting to an additional cost of $3.9 billion each year for children with constipation. Despite this significant cost impact and its prevalence during childhood, constipation has not received the amount of attention in public health campaigns that similarly occurring asthma and ADHD have.

Our experience began when our daughter was 14-months old, still in diapers and being diapered by her mother, the nurse, who didn’t notice anything unusual in the diapers. The bowel movements were regular and the stools were not hard. I saw no cause for alarm.

Then, one evening she was standing, holding onto a doorframe, screaming in obvious pain, red-faced and appearing to strain as though trying to have a bowel movement. I was upset and my husband didn’t help anything by saying (loudly and pleadingly), “You’re a nurse, do something!” Honestly, all I could think to do was to use a glycerin suppository, and it did help.

But, that episode was followed periodically by others and we began making the rounds to pediatricians. A correct diagnosis of a rectal fissure as a result of constipation was made from the onset. An effective treatment, however, was eight months in coming.

It took an examination by a pediatric gastroenterologist to yield the magic bullet that eliminated my child’s pain.

The specialist confirmed the diagnosis and then handed me a pre-printed treatment regimen. It was so simple. Daily doses of mineral oil for a sufficient length of time (3 months) to allow the fissure to completely heal, no ABCs (applesauce, bananas and carrots), a footstool (rather than dangling legs) when sitting on the toilet and increased water intake. And, it worked!

I was happy that the solution was so easy to put into practice but the simplicity of it caused me to wonder why the other pediatricians we’d seen didn’t know about it. I photocopied the short list of instructions and sent it to them. I hope they kept it at hand.

A couple months ago I read a report that persons who have suffered rectal tears or fissures are vastly more at risk for developing rectal cancer. So, now, thirty years after my daughter’s bout with a fissure, I am left to worry about her developing something even more serious as a result.

I want my story to stick with those of you who work with children in the hope that you might help avert this painful and potentially dangerous aspect of pediatric constipation. It isn’t as benign a condition as it seems on the surface.

Cherokee Inspired Comfort Awards Honor Exceptional Nurses

Nurses don’t get enough recognition—agreed? There are precious few opportunities to showcase nurses who have gone above and beyond what is expected of them in their workaday world. I am sure many of you know a nurse who has earned your admiration because of an exceptional caring act and here is your chance to put the spotlight on that nurse.

Since 2003 Cherokee Uniforms, a leading supplier of medical attire, has sponsored the Cherokee Inspired Comfort Awards, that laud outstanding service, sacrifice and innovation by non-physician health care workers. Cherokee’s mission is to bring attention to the tremendous skills of and the work performed by those in health care. Such acts are most often underreported, if at all, leaving the public unaware of the significant impact the compassion and devotion exhibited by these individuals have on the lives of others.

Nominations for the 2009 awards are open until May 31. Details can be found at http://www.inspiredcomfort.com/ ---click on award resources. If you wonder about what to say in your nomination (which can be done entirely online) or the sorts of exceptional achievements (there is a broad spectrum) that qualify for recognition, you can find direction and inspiration by taking a look at the letters of nomination for the 2008 winners on the Web site. There are five award categories: RNs, Advanced Practice Nurses, LPN/LVN, student nurses and other non-physician health care professionals.

Within each award category is a grand prize winner, plus several top national winners in addition to several national winners. The prize packages are generous and there are even prizes for those whose nominee wins the grand prize.

I nominated a nurse for the 2008 award because I was so impressed by her efforts in helping end-of-life patients with projects that tie up loose ends, whatever they may be, allowing the patients to achieve peace of mind and, therefore, to have more peaceful deaths. My nominee was honored to be selected a top national winner. Just because she was not a grand prize winner doesn’t mean I was not rewarded. There is immense satisfaction in knowing my nominee received several wonderful prizes and that national recognition was focused on her and her profoundly touching project.

I urge each of you to nominate a deserving health care professional for the Inspired Comfort Award. Cherokee will donate $1 to Nurses House, a non-profit that assists nurses in dire financial need, for each nomination received for the Award. Look at the benefits: you get to honor an extraordinary person, feature his/her acts of compassion, raise funds for a charity that helps nurses, perhaps see your nominee showered with prizes (grand prize is a cruise for two!), maybe receive prizes for yourself and definitely feel good that you made the effort.

Nurses rock!