School Nurse Uniform - To wear or not to wear – that is the question?

We are excited to have Sarah Sherwin @SarahSherwin2 as a guest host for our next chat to discuss the very topical issue of school nursing uniform. The following pre-chat information has been used and adapted very slightly from Sarah's recent article in The British Journal of School Nursing. 

The question as to whether school nurses should wear a uniform or not has been posed periodically over the years, but recently the debate it appears to have gained momentum. Over recent months a number of NHS Trusts have taken the decision for school nurses to wear traditional nurses’ uniform. This has caused considerable discussion as to the advantages and disadvantages as well as to what type of uniform it should be and when it should be worn.  

History

Back in the early days of school nursing, nurses worn clinical nurses uniforms as their role was largely concerned with screening, hygiene inspections and the control and treatment of infectious diseases. By the early 1980s most school nurses relinquished the wearing of standardised nurses’ uniforms in response to the view, that the wearing of uniforms may be viewed as being a barrier (Richardson, 1999). Children and young people who has experienced painful procedures in hospitals or found immunisations to be traumatic were said to have associated a nurse’s uniform with a negative experience and heightened children’s anxiety; although hopefully they would have also experienced some positive aspects of the role in terms of kindness, empathy and compassion. However, much of this research was based in the acute setting as opposed to the community (Roohafza et al, 2009). O’Connor (2011) argues that far from being a barrier, a uniform actually sets out professional boundaries, which is particularly important in relation to safeguarding. Concerns about safety for school nurses working alone in areas which may have been seen as unsafe were also muted. Yet district nurses have continued to wear uniform, and arguably are at more risk as they carry more drugs and equipment. 

Current Day

Generally school nurses have not worn uniform for nearly 30 years. However, it appears that recent changes in the NHS, which have seen school health services move to local authorities and the introduction of the tendering process to provide services, may have caused this issue to be highlighted once more. Anecdotal information suggests that this move outside of the NHS, has identified that school nurses need to project more of a professional identity. Importantly there has also been a significant move to ask users of services what they require. A reoccurring theme in the literature is that children and young people do not know who their school nurse is, therefore they need to be more visible and identifiable to school age children, young people and their families (Madge and Franklin, 2003; Chase et al, 2010; British Youth Council, 2011) and so wearing a uniform could facilitate this identification. The role of a nurse is seen to be synonymous with the attributes of care, compassion and empathy, and it is these qualities that children, young people and their families often seek out in school nurses to share their worries, concerns and problems. Indeed a nurse’s uniform carries symbolic meaning and can help communicate approachability, amicability and confidentiality thus making it easier for school nurses, as young people may want to seek them out as opposed to school nurses having to look for them and then explain their role (O’Connor, 2011).  

Some would argue wearing traditional nurses uniforms reinforces the clinical role and that school nurses maybe seen by some in schools as being there to help look after the sick and injured (medical model), as opposed to working within a public health model thus potentially giving mixed messages to schools, parents and children. Yet the uniqueness of school nurses working with school age children and young people, as opposed to other agencies working in schools is just that- they are qualified nurses.  

It must also be acknowledged that uniforms can also symbolise power and control, as in nursing uniforms including different styles and colours are used to denote various ranks and status within the nursing hierarchy (Richardson, 1999). However, O’Connor (2011) argues that there is a perception that there is poor career progression in school nursing by other nurses which may impact on recruitment. Therefore it is suggested that the wearing of various different uniforms could demonstrate to other nurses that there is opportunity to progress through the grade bands, thus potentially making school nursing more of a career destination of choice.  

More recently Netmums conducted a recent survey amongst parents and of those surveyed 76% identified that they would support the introduction of school nurses wearing uniforms, as it suggests professionalism, reliability and makes nurses recognisable (Anonymous, 2013). 

So to wear or not to wear that is the question but ultimately school nurses must respond to what children and young people want otherwise there is no point in providing a service. We need to listen to their views and there is overwhelming evidence that they want school nurses to be more visible and more accessible and making school nurses more recognisable in schools and other settings would help. Some Trusts have already made this decision and maybe we will see a significant shift nationally so there is a more uniformed approach (pardon the pun) which could provide school nurses with a more corporate image and identity.

The wearing of a uniform will continue to be a contentious issue, this looks set to be lively chat with lots of discussion in favour or against.

Does the wearing of uniform address the issue that school nurses are instantly recognisable as nurses? 

Do you have any experience of wearing a school nursing uniform? How has this been received?

Does the wearing of a uniform raise accessibility and visibility?

Do you think that there are barriers to wearing a uniform?

Who should make the decision whether school nurses should wear uniform?

Please join us on Tuesday 26th May 2015 where will be looking to discuss the above questions and many more in our quest to pick the big uniform debate!

References

Anonymous (2013) Parents polled on uniforms debate. Community Practitioner, 86, (9) p.7. 

British Youth Council (2011) Our school nurse. Young people’s views on the role of the school nurse. London: British Youth Council.[online] accessed 18/7/13.www.byc.org.uk 

Chase, E, . Chalmers,H., Warwick, I., Thomas, F., Hollingworth, K. and Aggleton, P. (2010) Promoting the health of children and young people through schools: The role of the nurse. London: Thomas Corum Unit.

Madge, N. and Franklin, A. (2003) Change, challenge and school nursing. London: National Children’s Bureau. 

O’Connor, S. (2011) What to wear? Community Practitioner, 82(12), pp.42-43. 

Richardson, M. (1999) The symbolism and myth surrounding nurses uniform. British Journal of Nursing, 8 (3), pp.169-175.

Roohafza,H. , Pirnia, A., Sadeghi, M., Toghianitar, N., Talaei, M. and Ashrafi, M.(2009) Impact of nurses clothing on anxiety of hospitalised children. Journal of Clinical Nursing, 18, (11), pp. 1953–1959.

Sherwin, S. (2015) To wear or not to wear – that is the question: Should school nurses wear a uniform?. British Journal of School Nursing, 10(3), pp. 148–149