Although many of us are looking forward to the upcoming football season and holidays, they are often tough times for the patients and caregivers who would rather be anywhere than at a medical facility. Nurses, too. Nurses with lots of team spirit may have to miss high school, college, or NFL games. Nurses who have to work during the holidays may dread those shifts and the sacrifice of missing family events. With such mixed emotions, it’s not surprising that nurses might want to wear a team jersey at work or a costume for Halloween, even dress in holiday-themed scrubs. On the flip side, nurses must also consider that reminding patients of the traditions and shared events they are missing due to their cancer may evoke negative emotions.
Is dressing for the season in the workplace inappropriate, insensitive, or unprofessional? It may be difficult to determine whether a team jersey, costume, or accessory is appropriate. Before donning that elf costume, ask yourself 3 questions:
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- Is there any guidance from your human resources team about the dress code in your organization?
- Could it cause any harm?
- How might the costume be perceived?
Employers usually have a dress code that guides what is appropriate and acceptable in the workplace. Their goal is to establish professionalism, as employees must represent their employers in a positive way. Although it may seem insignificant or trivial, studies show that nursing attire can have a significant impact on patient perception, trust, and the professional-patient relationship.
Most dress codes speak to holiday wear but are not very specific. For example, one organization’s policy states, “During holiday seasons, sweatshirts or sweaters with holiday decor may be worn with department head approval. Holiday wear cannot have dangling decorations.” Interpreting this statement can be challenging. What constitutes a holiday season? Does it include only select holidays like Christmas, Easter, and the Fourth of July? What about other minor holidays, such as St. Patrick’s Day? What about holidays celebrated by certain cultures, such as Chinese New Year? What about days that some consider a holiday, such as Super Bowl Sunday? There is a holiday for almost every day of the year in the United States.
“Holiday wear” can also be an ambiguous term. Does it include costumes or apply to holiday scrubs? What about holiday jewelry or accessories such as cat or bunny ears? Would you consider holiday makeup (eg, green eyeshadow and red lipstick for Christmas) holiday wear? Your definition and your organization’s definition may not be the same, so it is important to check the details of the dress code.
COULD COSTUMES BE HARMFUL?
Anything that extends past your person could present a challenge to keep clean and prevent transportation of germs from patient to patient. Take into account how costumes, jewelry, and accessories may interfere with your ability to safely care for a patient. Most policies have very specific details about jewelry worn in the workplace, such as the size of earrings, length of a necklace, or number of rings.
Nurses must always think about transporting germs, especially in the care of patients with cancer. Some areas caring for patients with severe neutropenia, such as hematopoietic cell transplant (HCT) or leukemia units, may take extra precautions to prevent infection. They often have policies about not sharing equipment (eg, stethoscopes or scales), significantly limiting or eliminating jewelry, and not wearing fake fingernails. They may require nurses to change into scrubs and put on work shoes once they get to work instead of at home. In these areas, holiday wear usually is prohibited.
Be sensitive to how a costume, accessory, or even face painting might scare some patients or cause concern to a caregiver. If a patient is taking medications that can cause confusion or hallucinations, such as narcotics or antiemetics, or has brain metastasis that alters cognition, a clown face or angel’s halo may cause alarm and distress. In addition, think about how you might feel if you need to provide caregiver support or comfort after a patient takes a turn for the worse or dies.
A nurse’s dress should convey professionalism and confidence to patients and caregivers at all times. Many nurses claim that patients like it when they dress up or wear holiday scrubs. However, when 200 outpatients and 200 inpatients were asked about this in a research study, holiday scrubs had a mixed ranking (41% supported; 59% did not).1
Perhaps those who vocalize that they like holiday attire represent a smaller portion of your patient population. Also, there may be a population of patients who feel uncomfortable with their nurses wearing certain attire, especially if they are of a different culture or religion. Nurses must consider patient opinion, as today’s healthcare environment is very competitive and patient satisfaction matters.
Besides considering your employer’s policy, patient perception, and potential harm, also ask yourself why you want to dress for the holiday. Is it to express your individuality? “Self-expression is great, but not in the work place,” advises Imee Unto, MSN, RN, OCN, vice president/chief nursing officer, Florida Hospital Ocala, Adventist Health System, West Division. Unto is responsible for enforcing the dress code at her organization. “The dress code is in place to define what is acceptable to the organization.”
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- West MM, Wantz D, Campbell P, Rosler G, Troutman D, Muthler C. Contributing to a quality patient experience: applying evidence-based practice to support changes in nursing dress code policies. Online J Issues Nurs. 2016;21(1):4. doi: 10.3912/OJIN.Vol21No01Man04.