December 11, 2006, 1:17 am

I’ve Just Gotta Get A Message To You

medicalarm

Precision control?

They hit the ceiling!

Oops, gonna have to replace that ceiling tile!

Again!

Then again, maybe the patient is “going to the light” via a bungie cord.

Hopefully they weren’t attempting laser eye surgery!

They missed!

******************************

I’m excited about starting my BSN program next month. In fact I am so excited I started reading one of the textbooks for my “Leadership and Management” class.

Figured I have six weeks before it starts so I can have all my reading done before I sign in that first day.

This may be old hat to some of you who already have your BSN or MSN degrees, but if you are a nurse and you have never read this book, I suggest that you buy it immediately.

As in now.

The book is called From Silence to Voice: What Nurses Know and Must Communicate to the Public.

I’m amazed.

I’m energized.

And gosh darn it, I might just go militant on y’all!

The book is by Bernice Buresh and Suzanne Gordon. They are not nurses. They are journalists. Journalists who wondered why the largest health profession in the world was silent on the most pressing issues facing health care.

The nursing profession has a huge problem.

We don’t communicate. We’re afraid to communicate. We don’t believe that we have anything worth communicating to the general health care debate.

I’m not talking nursing leaders here. I’m talking the rank-and-file staff nurse on-the-beat.

And when we do communicate we minimize ourselves and our importance. We communicate volumes by our appearance.

I’m three chapters in. Just three chapters.

I will never practice nursing the same way again.

I can’t.

******************************

So what will I do differently?

  • Appearance
    • No more teddy bears, Charlie Brown baseball or Spongebob Squarepants scrubs. (I do reserve the right to wear the rare Notre Dame scrub top.)
    • I don’t work in a pediatric unit and I am not a walking infant. I am a (nearly) fifty-year-old professional woman. I need to dress like one.
    • While solid color scrubs are certainly appropriate, I am going to buy some white scrubs and have my first and last name along with my title (RN) embroidered on the left side.
      • Heck, I’ll put “Emergency” under it too.
      • I’m not saying everybody should dress this way. I believe that I personally will present a more professional first impression in this particular uniform
      • Fushia is a great color on me, by the way so this is a sacrifice.
    • I know for a fact that a nursing cap commands automatic respect.
      • Okay, go ahead and laugh if you want to, but I did this experiment chronicled in one of my first posts to Emergiblog.
        • I dare you to repeat it; you will be blown over by the difference in how you are perceived and treated.
        • Your colleagues, will tease you unmercifully; your patients will treat you with respect. I was truly surprised.
      • I recognige the incongruence of the nursing cap and my new embracement of nursing empowerment, but what can I say? I’ve got one foot in a Cherry Ames book and one foot in a 21st century BSN text and I am comfortable in both.
  • What’s in a name?
    • I will introduce myself by both my first and last name and my full title. This makes me not “Kimmie, the nurse”, but “Kim McAllister, Registered Nurse”.
    • Now I have no problem with patients using my first name, although I find myself calling patients by their last name and title, especially patients older than myself. And most of the doctors I work with use their first names with patients so we are on an equal playing field. However…
      • No longer will I allow a doctor to use my first name only in front of a patient unless I am allowed to use theirs.
        • So…for example, if Dr. Jane Smith requires that I will address her as Dr. Smith within a patient’s hearing, then she will address me as Nurse McAllister or Ms. McAllister.
        • I know it sounds stiff and unnatural but I deserve the same professional respect that they demand. If first names are good for them, they are allowed to use mine. It is definitely a case of quid pro quo.
      • I think I’m going to have some surprised physicians in the next few weeks. I wonder if I’ll have the guts to carry it out – it will be a big change
  • Communication
    • No more starting off a communication with a doctor with, “Sorry to bother you, but…”
      • First of all, I am not sorry I’m bothering anybody! So why do I say it? I’m requesting something for a patient or informing a doctor about a patient – both things are part of the doctor’s job. Why say you’re sorry and demote yourself to a groveling position?
      • When calling a physician outside the emergency department, I will use my full name and title so they know who they are talking to and can respond accordingly. With all due respect to the housekeeper, that isn’t who the doctor is talking to and I expect professional courtesy. I can think of a few
        surgeons doctors who need some “inservicing” in this department.
    • I will accept thanks for what I do and express that it was a privilege to be able to assist the patient in learning more about their disease or explaining their discharge instructions or taking care of their pain issues.
      • The point here is to take credit for what I do as a nurse.
      • Never,ever, ever again will I say “Oh, it was nothing.” or “Hey, that’s what I’m here for.” That is bull****, if you will pardon the language. What I do is important and has a purpose. Every time you do not re-inforce what it is you do as a registered nurse, you lose an opportunity to educate a member of the general public. Which brings me to the next area of communication:
    • Talk about what you do!
      • Talk to your family, your friends, your children.
      • Educate them on what exactly a nurse does.
        • Yes, nurses change bedpans and give back rubs. Does anyone know the extent of the assessment that can be done during those two basic tasks?
        • Unbelievably in this day and age, people still believe that nurses are there to do what the doctor orders and nothing else. So you have to:
      • Inform the public through your everyday conversations that nursing is its own profession with its own body of knowledge.
      • Don’t talk down the profession. Yes, it’s hard work and should be acknowledged as such, but negative information puts the entire profession in a bad light.
    • Tell the world what you do.
      • Write an editorial for the op-ed section of your local paper. Yes, you do know what you are talking about, trust me. A year ago I didn’t think I had anything to say about nursing. Now you can’t shut me up.
      • Start a blog. Put what you do on the internet. Describe what your work is like and you will realize that you have a voice in the great health care debate. Stay silent and people will decide the trajectory of our profession for us. The more you talk about what you do the more you will realize what you know and how important we (nurses) are. Communicate this whenever possible.
      • Everyone has a different style. I don’t carry picket signs in the middle of a Sacramento street or crash luncheons where the Governator is speaking but my nursing practice is better because there are nurses who do. Find your style. I like to think my contribution will be via writing and focusing on nursing recruitment (eventually).
******************************

Boy, how’s that for just three chapters?

I’m totally stoked by this book.

If you’ve read it, you’re already there. If you haven’t, it will re-ignite the passion and sense professionalism you thought had worn away over years of patient care.

It’s already changed my outlook.

For the better.

49 Comments

  • Ron Swartz
    Ron Swartz

    December 11, 2006 at 4:25 am

    Nurse McAllister,

    Thank you for bringing up this issue.

    I am a 47 year old man in my third semester of an ADN program. I have noticed a real lack of professionalism in my clinicals. It seems there is an effort to help patients feel good based on familiarity and “niceness.”

    There’s nothing wrong with being nice, but I believe the patients would feel even better if they percieved their nurse as a professional.

    I’ve got to get that book!


  • DisappearingJohn
    DisappearingJohn

    December 11, 2006 at 5:40 am

    We actually had the “white uniform” debate in class a few weeks ago.

    Personally, especially as a nurse in the ED, I don’t think the white uniform is appropriate. I can’t imagine I would still look “professional” after a 12 hour shift in that environment, wearing a color that shows every bodily fluid and grime I have come in contact with..

    I agree that we as nurses need to come together to get some political pressure on some important issues (I actually wrote a little about that myself today before I came over here) but some of the “changes” you mention are a little too much for me, personally…

    I introduce myself to every patient as a registered nurse. I address patient’s by however they would like to be addressed, and I ask… I certainly don’t mind being first named by the patients, or the doctors, but I don’t first-name them, even though many would prefer it…

    I don’t know, I’ve always felt respect had to be earned, not demanded… I try to earn people’s respect every day, and believe I do a fairly decent job of that…

    I wish you luck in these changes, Kim.. I hope they have the effect you desire…


  • Nursing Professionalism « Tubby’s Corner
    Nursing Professionalism « Tubby’s Corner

    December 11, 2006 at 6:05 am

    […] Wow!  I just found a great entry in the Emergiblog  I totally agree about the not wearing so called fun tops, they just look childish. […]


  • Nicole
    Nicole

    December 11, 2006 at 6:07 am

    woohoo!
    I read that book before I began nursing school. I also started to read “Nursing Against the Odds,” but I only got to like page 160 because then nursing school started!


  • Nicole
    Nicole

    December 11, 2006 at 6:11 am

    And as a nursing student, I am kind of on the fence when it comes to white. Mostly because I have to wear it from head to toe for clinicals and man, it sucks. However, I hate hate hate those ugly scrubs with patterns on them. I’m sorry, but I’ve never seen them flatter anyone!
    I don’t know if I will wear all white when I graduate, but you definitely will not see me in a pattern top, that’s for sure.


  • Nicole
    Nicole

    December 11, 2006 at 6:13 am

    I keep thinking of more to say, sorry.
    Anyway, I think it is so awesome if you have the other people call you Nurse McAllister. You are a professional and you are important, damnit!!
    Okay, now I really need to stop commenting because in 3 hours I have the final Fundamentals HESI exam.


  • PixelRN
    PixelRN

    December 11, 2006 at 8:39 am

    Amen, Nurse McAllister! The things you have written about have been bothering me since I started nursing. How can you treat someone as a serious professional when they are wearing scooby-doo scrubs?

    One thing that’s been bothering me is that we are constantly throwing parties for people at work. As a nurse, I am expected to prepare or buy a plate of food for everyone on the unit. This always makes me feel like I am part of the “secretary pool” (no offense to secretaries.) Of course, if you complain or fail to comply you are pegged a curmudgeon. Oooh – I feel a post coming on inspired by your post…


  • punchberry
    punchberry

    December 11, 2006 at 10:47 am

    I love this post. I think everyone in every profession can use being more professional.

    The only thing I am not sure about is the white scrubs. They look nice in photos, but in real life, I rarely see a pair that looks clean. I think getting your name and title embroidered on solid color scrubs would look really nice.


  • Ada
    Ada

    December 11, 2006 at 11:46 am

    Hmm… you bring up a very good point. I’ve always wondered why women my mother’s age wear “cutesy” scrub tops designed to appeal to the preschool crowd. I usually find the patterns to be way too busy for my tastes. That and the fact that they’re not working around kids. I think you’ll look a thousand times more professional in solid-colour scrubs. As for the cap, why not get a few other nurses to wear one with you? Good luck with this big change!


  • Susan Palwick
    Susan Palwick

    December 11, 2006 at 12:14 pm

    As somebody who volunteers in an ED where people (including me!) wear “cutesey scrub tops,” I don’t think patients see them as unprofessional. I think they see them as an effort to personalize a frightening environment, and I think they appreciate that.

    Nurses are seen as professionals when they know what they’re doing and when they do it well. Their outfits and preferred forms of address are secondary, believe me. As someone who’s been an ED patient, I’d much rather have a calm, kind, competent nurse in Scooby-Doo scrubs than a cold, indifferent nurse wearing all white with a starched cap. (Not that Kim would ever be cold or indifferent!) I’m not evaluating you by what you’re wearing. I’m evaluating you by whether you can start the IV on the first try, and whether you’re kind to me.

    Dealing with physicians is another matter, and one I’m not qualified to address. But where I volunteer, the nurses who seem most professional to me are the ones who have the self-confidence to know that skill and formality are completely separate issues. Frankly, if I heard a nurse saying, “I demand to be addressed as Mr. ________,” I’d think he had a giant chip on his shoulder, and I’d think he cared more about his own self-image than about my welfare as a patient.

    And he would not be the person I wanted taking care of me.

    YMMV, of course.


  • ~RN Faye
    ~RN Faye

    December 11, 2006 at 12:49 pm

    Kim-
    Thanks for posting this! I read this book last year and I had a similar reaction. Nursing is an evolving profession and due to our professional history, I think that we are entitled to demand respect. Professionalism is not only demonstrated it is implied, and picked up subconsciously by our patients and colleagues.

    Becoming Influential: A Guide for Nurses, Eleanor J. Sullivan is also another book that addresses the image of nursing as a professional.

    Best of luck to you Kim on your BSN! Your life and perspective on health care will change after you finish, I guarantee it.


  • laura
    laura

    December 11, 2006 at 12:53 pm

    great thoughts!
    although i still will occasionally wear the baby themed scrub tops or the curious george ones my 4 year old son bought me for mother’s day because i think they work in the nicu setting. i usually though wear solid scrubs but nevr white because i have this personal rule about white….i am a slob when i wear white and i look like death warmed over in that color too. otherise i still make sure my scrubs are always clean and neatly pressed and the clogs are clean because a clean uniform to me suggests a professional.
    no cap. sorry, although i do respect the RNs ho do wear them because they tend to be the exemplary professional nurses that one looks up to.
    i do not have the head for hats and the dean of my nursing school, Dr. Lorraine Hultquist, devoted an entire lecture to why a cap is not necessary and it had to do with getting away from the handmaiden to the phycisian image. i agree with her on that point.
    i always address patients and families formally, well, my patients are babies, but they are Miss or Mr. until I learn their given name then I address them that way. I get teased bcause I address teen parents as Mr. or Ms but I believe thy do deserve a certain level of respect if i am to expect a certain level of respect as their baby’s nurse in return. another principle i learned from Dr. Hultquist. As a nurse herself, she had a gret influence on the nurse that I am today.
    i do believe that we must remember that first and foremost, we are health care professionals and must present ourselves that way. IMHO this is a conscious effort that we must never become complacent about.


  • Jen
    Jen

    December 11, 2006 at 1:36 pm

    Wow, great post Nurse! I was giving myself a day to think about your Centre for Nursing Advocacy post and have just come back, read this and am thinking “Is this the same person?” Here’s why:

    In this post one of your main points is communicating to friends, relatives, patients, etc. and you conclude with:

    “Don’t talk down the profession. Yes, it’s hard work and should be acknowledged as such, but negative information puts the entire profession in a bad light.”

    I also agree that the best advocacy is proactive, but it goes hand in hand with reactive advocacy. You have to fix what’s already going on as well as create new approaches.

    Frankly, proactive approaches are the purview of your professional nursing organisations/ associations/colleges. I don’t know the system in the US, but here in Canada, the Cdn Nurses Assoc (CNA) and provincially in Ontario, the Reg. Nurses of Ontario (RNAO) and College of Nurses of Ontario (CNO) do this by creating policy and NEWS media responses that support the further development and sustainablility of the profession. Their mandate does not cover responses to POPULAR media or other similar campaigns; this is a niche that, it seems to me, the Centre for Nursing Advocacy is looking to fill.

    Why, even though TV is not reality (as in your other post) do I think that the Centre’s campaigns are so important? You can tell all your friends they’ll tell 2 friends, and so on and so on, and you’ll reach a couple hundred people with down home honesty. Yay!

    And then… one episode of Grey’s Anatomy or House will come on, reach over 20 million homes in the US, 3 million in Canada (fitting, since our pop’n is one tenth of yours) and countless others in other countries (also with a nursing shortage). And what will people see? Nurses with nothing better to do than accept bribes from docs to do meaningless work, doctors doing an abundance of nursing interventions and roles and yelling at nurses to get out of the way (and falling in love with patients and killing them, etc. I know, it’s way over the top).

    Remember, you gave people lots of credit to know what was real and what wasn’t… Well, after visiting the Centre for Nursing advocacy site I didn’t have a knee jerk reaction and start a letter writing frenzy, but rather went to the Grey’s Anatomy site and checked out the chat rooms. It’s filled with people (likely teens given how they write) investing considerable time in analysing the mini-details of characters AND wanting to become doctors thanks to the show. And fair enough, how else do teens find out about careers? I’d like to think guidance councellors and Discovery channel, but based on numbers like how much TV the avg. teen watches and the higher ratings for networks, I’m betting it’s big name TV shows. (In fairness, legal/crime/foresic folks have WAY more to complain about on this front than nurses). This is a huge pool of teens and young people who have zero idea of what nurses do and who invest serious amounts of “thought” to a tv show set in a hospital! It boggles the mind…. (before you think I get all knickers-in-a-twistie and boycott these shows, think again- I know the reality).

    Anyways, I think this is a longwinded (sorry) way of saying that TV has way more influence on the minds of Mr. or Ms. J. Public. I think you are giving them too much credit.

    Jen


  • apgaRN
    apgaRN

    December 11, 2006 at 1:48 pm

    Very well-put and passionate thoughts, Kim. I think you’ve sparked yet another great debate.

    I know everyone has their take. Here’s mine: on L&D, the choice of scrubs is easy… we have to wear the hospital-laundered, “sterile” scrubs since the possibility of entering the sterile environment of the O.R. is ever-present with laboring patients. However, the personnel throughout the rest of my hospital are required to wear certain colors of scrubs depending on their rank (RN, NA, ES)… there was much grumbling when this policy was implemented, but I must say that the uniformity appears much more professional than the wide variety of pajama-like scrubs I used to see.

    Perhaps the text has more persuasive reasons, but I can’t see wanting to be called by my last name. Maybe someday that will change. The docs and nurses with whom I work have mutual respect for each other. Those that condescend to the rest of us are scorned by all. It’s a pretty good system. 🙂

    I think the BEST way to change peoples’ perceptions about the nursing profession is, as you say, communication! Be competent and professional in your work, and talk to everyone you know about what you do!

    Thanks for the deep thoughts… good luck with your studies.

    N


  • Susan
    Susan

    December 11, 2006 at 1:48 pm

    I am totally in agreement with you about the scrubs. When I first started in my ED, I wore whites for about a week, just to get a feel for what everyone else wore. I was made fun of relentlessly by the other nurses, but the patients always knew who I was. I never wear scrubs with cartoon characters – I stick mostly to coordinated solids.

    I always introduce myself as ‘your nurse, Susan’ and I always refer to the patients by their titles and surnames. I do have a problem with apologizing for my ‘interruptions’ to the doctor, but I’m getting over that fast.

    I think nurses should all wear the same solid color scrubs, maybe navy or burgundy. White is impractical in the ED.

    I’ve gotta go get that book!


  • Kim
    Kim

    December 11, 2006 at 1:49 pm

    Hi Jen

    Great comment!

    The one thing I never have done is what you did – go see what people really ARE thinking about these shows. I thought they were stupid and figured people would understand they are stupid.

    But teens and young adults are the one audience we WANT to think about nursing. Maybe the credit I am giving is to the older adults, when the target audience are teens/young adults.

    Which is ironic, considering my book (rough though it may be at the moment) is directed right at that demographic.

    Food for thought.

    Lots of thought.


  • Mel
    Mel

    December 11, 2006 at 2:11 pm

    Whoa, Kim! I mean Nurse McAllister. Good luck with your new more professional image. I work with several billers who wear scrubs because it’s either that or “professional” dress. I won’t do it because I am *NOT* a clinical professional and I don’t want those sorts of questions. If that means that I have to wear dress pants and flats, so be it. I know what I don’t know.
    My recent experience with nurses has been with the 6 month old’s nurses – some of whom work in clinical research because he’s in a vaccine study and some of whom work on the peds floor at the local hospital and in the peds office. Today, the nurse at the peds office had on navy blue scrubs and a jacket with snowmen. The nurses on the peds floor all had cartoon characters on their scrubs except the students who were uniformed in navy blue. The research nurses ALWAYS wear solid scrubs. I never thought about it, but it does look more professional and distinguish them from the regular staff.
    Hmm…good thoughts.


  • universalhealth
    universalhealth

    December 11, 2006 at 3:13 pm

    Excellent points, all Kim and congratulations!

    Nurses lost a powerful professional symbol in the cap. However, I believe – and blog about this ad nauseum ;0) that the profession need not rely on a single emblem or symbol, but instead, can integrate professionalism in dress, language and conduct.

    Relative to dress, cover gowns should be a part of standard contact precautions. In theory, any garb underneath should be able to be protected, and so scrubs should not have to be a bottom line consideration.

    In my own experiences, it was the norm for nurses to wear button down blouses and white skirts/pants with a belt. Fanny packs were added, and some nurses wore multi-pocketed vests.

    Other nurses liked the step-in coveralls that veterinarians and livestock farmers wore when providing care. They come in royal blue and also in white, and they, too have convenient pockets and a more tailored appearance than scrubs. I think that flight suits are similarly constructed.

    Scrubs were intially worn in the 1980’s, and nurses saw them as the symbols of interns and residents and more professional independence. Shortly after, they morphed into billboards for hobbies, comics, sports, etc., and now they have lost any professional symbolism they may once have displayed.

    What nurses do so well is to translate the medical jargon into language that patients understand. What we must not do is to throw away the professionalism that underlies that ability to translate and to relate to patients in their own frames of reference. Benner has written about this in From Novice to Expert, and patients who are cared for by expert nurses often refer to this as a valuable component of the care they received.

    What concerns me is nursing’s paralysis in reaching consensus on fundamental issues so that all may move forward as a dynamic, EMPOWERED professional body.

    Whether it’s how to educationally prepare for licensure, how to regain professional power, and how best to practice, nurses remain all over the map. Until nurses reach consensus, I fear that the shortage will only intensify, that nurses’ practice environments will remain unsatisfactory and that patients and nurses will continue to pay a price.

    May you be a leader in bringing nurses together – through your blog, your practice and your education!


  • Derby
    Derby

    December 11, 2006 at 4:25 pm

    I’m a doctor, and I apologize to other doctors when I ask them for something… as well as to anyone else at work. I should work on that.
    As far as the name/title goes, I whole heartedly agree that you should introduce yourself with both. Especially in the ED, patients are inundated with people-docs, nurses, techs, chaplains, aids, volunteers-and it helps a lot to know who people are and their role in your care.


  • Janet
    Janet

    December 11, 2006 at 6:48 pm

    Great post,Kim.

    Jen’s comments about television shows gave me an idea. Since you are very into writing these days, what about a television drama that focuses on nurses instead of doctors? Nursing is so varied that there would be plenty of material for different episodes. Just read any nursing blog out there to find a plot.


  • Dawn
    Dawn

    December 11, 2006 at 7:13 pm

    Nurse Kim – Since I graduate next week, the white scrubs have been donated to my nursing program – I just can’t stand them anymore, but I see your point in wearing them to allow patients to know who you are, and what your title is.

    I agree, the cutesy scrub tops have got to go – nothing like seeing someone wearing Hello Kitty scrub tops who should know better. I have a pair of royal blue ones that I love, and plan to wear once I start on the tele unit in February.

    Great post as always!


  • Dawn
    Dawn

    December 11, 2006 at 7:17 pm

    Kim, can you help me with something? I know this is totally off topic, but I’d appreciate your help (and that of other nurses who hang out here).

    The job I’ve accepted is a 12 hour day/night rotation on a tele unit. I’m not worried about the day shift, but working nights has me a bit worried (how will I stay up and function? how will I fall asleep during the day? And who left that tray out here in the hall anyway?).

    Thanks for your input!

    Dawn, one week away from graduating!


  • A Bohemian Road Nurse...
    A Bohemian Road Nurse...

    December 11, 2006 at 8:24 pm

    Cool post.


  • Bardiac
    Bardiac

    December 11, 2006 at 8:45 pm

    Great post!

    Glad to hear the course is already proving worthwhile!


  • DK
    DK

    December 11, 2006 at 9:07 pm

    I think that the issues of image and respect are barriers to getting more men in nursing. Putting forth a good image is the first step to getting respect. I think white scrubs might be a bit too far (more on this later) but solid color scrubs, that fit, make one look like a healthcare professional.

    Image is more than just how we look. It’s about how we and the profession present ourselves. I also think that we need to protect the title “nurse” more than is currently (that I am aware of) done.

    Example 1: My grandmother was in the hospital a while back and said she had three great nurses watching after her. In reality, she had an RN, a PCA, and an RT.

    Example 2: A friend of mine is a dermatology PA. At the practice where he works they have a supervising RN and a group of Medical Assistants. Every single MA in the practice is referred to as a nurse by the staff.

    In the first example we have a case of the public misunderstanding the role of the nurse. I’d say that most of my family didn’t know the role of a nurse until I started school. It’s not that PCAs don’t do important work, they’re just not nurses. It’s not that RTs don’t have an important job, they aren’t nurses either.

    In the second example we have a case of people either misunderstaning what a nurse is or they simply don’t care. If the public sees unlicensed personel doing the job of unlicensed personel under the title “nurse” they will think that’s what a nurse is. To me, this is an affront to all the hard work and sacrifice I’m putting in to trying to become a real nurse. The rest of the world protects their titles, why doesn’t nursing?

    ———

    White scrubs
    Comic Relief

    My clinical group and I have what we call “White Scrub Pants” moments
    We are blessed to wear burgundy (our school color) scrub tops and bottoms. However, other schools in our area have white pants and colored tops. THIN white pants. One morning while I was taking report. I looked up and across the nursing station was a (wide) nursing student from another school bending over to pick something up off the floor.

    She had on a pink thong.
    With a flower on the back.
    I pointed this out to one of my fellow students.
    Who had to leave before laughing in front of the night nurse giving report.

    Yup. WSP… *shudder*


  • Markie
    Markie

    December 11, 2006 at 10:36 pm

    Nurse McAllister,

    I appreciate your post, and thought you made several good points.

    I happen to disagree on the scrubs though. I’m still in nursing school, but working as an NA during, so it’s possible my perspective is warped, or may change by graduation. I find the patterned and pictured tops tend to make patients feel less intimidated. It may in fact be because I look less professional, but I’m there for their needs, not mine. Conducting myself in a professional manner seems to be more important than the fact that I have a shirt that’s different from a solid color on. If a patient relaxes and doesn’t have a raised BP because of a fear of a white coat, I’m all for it.

    But I do agree with the majority of your sentiments.

    Thanks for the post!


  • Candy
    Candy

    December 11, 2006 at 10:51 pm

    I love to hear a woman speaking passionately! You go, girl!

    Now, you have to admire the irony (serendipity, perhaps) of your nursing school colors (green and gold) and the colors of the favorite people in your new adopted school city (Green Bay Packers — green and gold). Coincidence? I think not!

    I also love the quid pro quo you offer. I have another. Tonight, I had to quietly ask 2 RNS and 2 CNAs not to call my 81-year-old father (retired orthopedic surgeon) “honey,” “sweetie,” or (my personal favorite), “babe.” His name, I informed them as though they had not seen it on his chart, is Dr. Meier and I would appreciate their calling him that, I said. They all did — except his CNA, who insisted on calling him honey or hon, and yelling at him as though he couldn’t hear them. He has CHF, but he’s not deaf. I reminded her again, quietly so my parents couldn’t hear me, and explained to her that his illness didn’t diminish his hearing. His voice may be hoarse and his shortness of breath may make it difficult to speak, but he can hear better than most.

    So like the book explains, act professionally and you’ll be amazed at the transformation that will take place before you (and within you)!


  • Randall Sexton
    Randall Sexton

    December 11, 2006 at 11:33 pm

    I will never wear a white cap so how about a white beret for all nurses…and “RN” in 12 inch high letters on your chest????


  • Scrubs, Tchotchkes, and Chessecake » PixelRN
    Scrubs, Tchotchkes, and Chessecake » PixelRN

    December 12, 2006 at 8:32 am

    […] Beware. Here comes a rant. I blame it on Kim at emergiblog. Her recent post inspired me. […]


  • Ali
    Ali

    December 12, 2006 at 4:09 pm

    I admit it, I am guilty of wearing the evil cartoon scrubs. But I also have a few pairs of solid scrubs. Both have their own pros and cons. I have gotten quite a few complements and comments about the cartoon scrubs from patients, mainly how they brighten things up.
    I enjoy having the freedom to choose what scrubs to wear everyday, but many times I have seen the problem that occurs when everyone wears scrubs. Patients don’t know who is coming into their room. Often the cleaning staff or the food services staff are mistaken for nurses. This is because these positions also wear scrubs. They wear dark blue scrubs only, but only staff at the hospital would know the difference.
    I don’t think that I could wear all white every day… mainly because the scrubs would not last much longer than one shift. It would be inevitable that I would spill something on them. But, I do see the benefits of having a common uniform. Maybe each unit could get together and agree upon a common colour/pattern… and then the patients would know who on the floor is a nurse, who is physio, who is cleaning staff.


  • Derrick
    Derrick

    December 12, 2006 at 4:36 pm

    I appreciate the move towards professionalism among the nursing profession, but think that some of the strategies suggested are counterproductive. One of the most important roles of the nurse is to serve as a liason between the physician and the patient. If you alienate yourself from both by focusing on something as relatively unimportant as your name, you may not be able to function as this liason.

    I do completely agree with you though that all individuals in the patient care arena should have clear uniforms distinguishing them. Long white coats for physicians, white (or some other color exclusive to nurses) scrubs for nurses, non-scrubs for clerical staff etc. I find it annoying everybody from the janitor to the clerk is wearing surgical scrubs and a long white coat.


  • valerie
    valerie

    December 12, 2006 at 4:55 pm

    Nurse Mcallister,
    When I graduated nursing school, RNs were required to wear white uniforms, white stockings (you see we actually wore white dresses on some days), white shoes, AND our nursing caps. Those caps were a pain in the ED! Always being Knocked askew by monitors and other equipment. But, that pointy white cap was something I had worked hard to earn and it was a badge of professionalism.
    For many patients these days the nurse is anyone who comes into patient contact wearing scrubs. While I don’t think all white is always practical, it does set the professional nurses apart from the ancillary staff. Grady Memorial Hospital in Atlanta now requires all RNs and LPNs to wear white on nursing units. Patient response has been favorable since the patients can tell who is a nurse and who is an aide, tech, housekeeper, etc.
    I totally agree that if we don’t tell people what we do, the general public will never truly know. As a patient told me yesterday,”I wouldn’t have come back if you had’nt explained things to me, and been such an advocate for me.” What a compliment! I must be a nurse!
    Good Luck on the BSN. Let’s change the world!


  • sarah
    sarah

    December 12, 2006 at 4:57 pm

    just a few thoughts juming to mind about your post today
    maybe we have been conditioned to say ‘it was nothing’…when we perform a task for a patient or a doctor. I have said it, too and I hear it everyday from other nurses.
    I trained myself several years ago….to get out the ‘aw shucks, it was nuthing’ frame of mind and started saying ‘it was my pleasure’ or I appreciate you noticing my work….instead.
    it works for me.
    ffinally….I have been a nurse for 21 years and sometimes…many times, I am the only one in my life telling me I am a wonderful nurse. everyone else forgets. ‘they’ are often quick to respond if you are NOT so wonderful, but silent suddenly when you reach wonderfulness.
    I lerned to appreciate my efforts.
    co workers, management, and patients often are self consumed and not available to notice.
    so I told myself I was a wonderful nurse over and over and over. I noticed when I did something really well and really hard and really important to the patient….and it helped me get through the dark tunnels of nursing….that lead to burnout.
    ….its not what you wear, its what you do that makes the impression. not the scooby do scrubs.


  • Mel
    Mel

    December 12, 2006 at 5:02 pm

    Uh, Derrick, I don’t know where you got the idea that your name is “relatively unimportant”; however, I must disagree with you. My name is an integral part of who I am, which is why NO ONE is allowed to use a nickname for me without my permission and NO ONE but my husband calls me dear, honey, etc…Well, my Daddy does sometimes call me Sweetie, but not often since I had kids of my own.


  • Fafsa
    Fafsa

    December 12, 2006 at 5:14 pm

    What ward are you working on where you can demand to be called “Nurse X” and be taken seriously? Perhaps it’s just the big academic center atmosphere, but if, say, a RT insisted on being called “Respiratory Therapist Smith” I’d have a hard time not laughing at him. Dressing professionally, etc. are all excellent things, but demanding to be called by a title that essentially nobody else goes by is just silly.


  • ericka
    ericka

    December 12, 2006 at 8:20 pm

    Thank you so much for this post and for your blog. I am getting ready to graduate with my BSN as a second-career student and I hope (hope hope hope) to get an ER position. I have read other books by Suzanne Gordon (I recommend Nursing Against the Odds) and will certainly be insisting on many of the behaviors you list to promote professionalism. Anyway. I just wanted to THANK YOU for your writing; please keep it up. (PS, to above commenters, a name IS very important, and I know plenty of nurses on plenty of units who go by Nurse X or Ms/Mr Y, rather than by their first names. It absolutely works.)


  • Derrick
    Derrick

    December 13, 2006 at 9:35 am

    Mel, I think I may have been misunderstood. I am certainly not advocating for people to address nurses as “honey” or “dear.” That would merit immediate correction. However, if a well-meaning physician refers to you by your first name, I think it would be counterproductive to make a giant stink about it in front of a patient. If the nurse wishes to discreetly speak with the physician in the hall later, that would be fine. That was my only point.


  • Jen
    Jen

    December 13, 2006 at 11:43 am

    Janet, I hope you are still reading/checking comments…. I IMDb’d (www.imdb.com) “nurses” ’cause I remember there being a show on just that. What I remember is that it was a cross between “Melrose place” (but worse) for the plot and the early ’90s version of “as-close-to-porn-as-TV-will-allow”. The Imdb summary is a bit skinny on facts though. The rest of the list looks like there might just be a niche for your pilot: write on!

    Scrolling through the list of titles I had a wee reflective insight (yay journalling–great nursing school skill). Half way down the list is “Lesbian Student Nurses”. I think one of the reasons I react so strongly to the images like the Skeetchers ad that the Centre for Nursing Advocacy rails on about is that prior to 10 minutes ago I was coping with the dominant media representations of 2 important peices of “me” (nursing & being a lesbian) occuring as stereo types in porn.

    Now I have 3, count ’em, THREE important roles (lesbian nursing STUDENT) in that genre. Very upsetting. I’m proud to be a successful student, proud to one day be a nurse, and proud to be a well adjusted lesbian who contributes to her community (GLBT and the broader Canadian fabric). Put ’em together though and what does the entertainment industry get? Porn. This sucks.

    Please write a nursing pilot Janet. Give it great character development and great situations where nurses get to weigh heavy/deep issues with a sense of humor and satisfaction (or not as story lines dictate) in their work–I’m thinking along the lines of “Six feet under”. Include a lesbian. Make her a nerd (like me)not a prude, just a nerd.

    Jen


  • Peggy
    Peggy

    December 13, 2006 at 5:56 pm

    I was in the hospital for three days earlier this year (for the first time in my adult life except to have babies) and never had a nurse or nursing assistant tell me their name or title or function. They were all wonderful and I felt perfectly cared for and safe. I went in as an emergency patient without a primary care doc (hadn’t seen a doc in over ten years) so the surgeon was also a stranger to me. I liked him a lot, and was most impressed that the nurses all seemed to like him and to respect him highly.

    I’m the daughter of a nurse, niece of many nurses, cousin to a dozen doctors. I’m old, so I remember my mom and aunts ALWAYS wearing starched white uniforms and caps. The whites also seemed very clean to my eyes when my mother (an RN) returned home after shift. How did that happen? Or maybe it was my undiscerning child/teenager’s eyes!

    I am mystified that any nurse thinks nurses aren’t respected and greatly appreciated by the general public!


  • karen sykes
    karen sykes

    December 14, 2006 at 8:21 am

    rant about wanting to be recognized as a professional, and half the posts are devoted to what color and style clothes to wear! This is pretty sad.


  • Jennifer
    Jennifer

    December 17, 2006 at 5:10 am

    I’ve been seriously looking for BSN/MSN programs in the area, reading syllabi and entry requirements for second career students. The first nursing course at one state school-45% of the course grade is devoted to making a group collage of “nursing images”. The rest was attendance and spelling your name correctly.

    As a young professional, I’m finding it difficult to find a curriculum that meets my needs. After an engineering degree and an MBA, I got cutting and glue down a long time ago!

    I’m also finding that nursing schools are completely unresponsive to me as a student. I’ve emailed their “contact” addresses to try and set up visits and meetings with faculty, with no reply. I think I’ll try out the book you mentioned, just to get a feel for things until I can find the right place for me!

    Oh, and choosing a program is very important-one program here wears all purple scrubs. I’m more a crimson and cream type of gal. Boomer Sooner!


  • longislandnurse
    longislandnurse

    December 17, 2006 at 7:47 am

    I wish there was a proper hat for men in nursing, cuz I’d love to wear one. Perhaps a baseball hat with RN on it would work, or not.

    The professionalism issue is harder for a man to address through clothing, especially with so many patients calling us “doctor” or “male nurse” and questioning “why did you keep going to school to be a doctor?”

    I stick to solid scrubs, either all white, or white bottom/dark top. Usually works.


  • Aussie
    Aussie

    December 21, 2006 at 12:27 am

    Can anyone enlighten me as to when the American medical system switched to scrubs?

    I’m Australian, where all medicos wear neat clothes – nurses in professional looking shirts with collars and pants or skirts with waistbands and zips. It is very hard for me to take someone seriously when they’re wearing elastic waisted cotton pyjamas, no matter what colour they are. How on earth did surgical outfits make their way onto the rest of the staff?

    (apologies for posting a link from a TV show, but it gives you an idea of the sort of uniform I mean http://www.australiantelevision.net/media/allsaints/cast2000.jpg )


  • karen sykes
    karen sykes

    December 21, 2006 at 1:45 am

    Again, I have to say I’m kind of humiliated to be a profession whose members would spend this much time worrying about the cocor and quality of their clothes, and whether or not they are being addressed properly. Maybe we should worry about issues like that in Jennifer’s post. You know, likr the fact that our graduate degree programs have us makeing arts and crafts. Get real.


  • JustcallmeJo
    JustcallmeJo

    December 24, 2006 at 3:49 am

    Great post, Nurse McAllister.

    Much food for thought. I just posted something whiny and frustrated over on my site, and not I’m thinking again.

    It was a great book. I finished it a few months ago, and have From Silence to Voice on the To Be Read Yet stack….

    Always love to hear a gauntlet thrown down….:)
    /jo


  • Sherri
    Sherri

    February 1, 2007 at 12:29 pm

    When I started at the hospital as a non-nurse, we were required to wear scrubs of a certain color (solid) so that people would know that we weren’t nurses. Only the nurses knew the color-coding scheme, not the patients, visitors, or even the doctors.

    Then they changed so that nurses could only wear two colors: the approved color voted on by all nurses, or white. I only remember a few nurses wearing whites: one wore extremely stylish, and very tailored, scrubs (she was quite attractive and enjoyed the attention of standing out from the crowd). Another was an older nurse, and one was a foreign-born nurse that also wore her cap.

    I now do home-health, and after a few weeks of wearing my single-colored scrubs from my former job, I was asked if I washed my uniform every day after work; they thought I only had one pair of scrubs! I bought my first ever patterned-tops, one of which has a cartoon print, while the other tops are understated prints.

    The only scrub I’ve ever heard comments about is the cartoon scrub top. My elderly patients LOVE it — they smile when commenting on it, and often touch the cartoon. I’ll buy more cartoon scrubs when I find some that don’t come in awful base colors, just for my patients that enjoy them.

    I knew a teen girl that had been hit by an almost hit-and-run (bystanders blocked the escape). Of all her nurses, she remembered the one with ‘cartoon cows print’. I’m sure it was his caring and professionalism that impressed her the most, but she smiled when she remembered her ‘cow scrubs nurse’ taking such good care of her.

    He doesn’t sound like an unprofessional nurse to me, just because he didn’t conform to someone else’s opinions about ‘proper dress’. He’ll always be remembered as ‘my best nurse ever’ by a young lady who was very injured, hurting and scared.

    PS: When I worked at the hospital, I wouldn’t apologize for calling a doctor, if the call happened during ‘normal’ waking hours. But when I called in the middle of the night, I did apologize for waking them. I considered it a courtesy, as well as giving them a few extra seconds to clear the cobwebs from their brain.


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    eskanders

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  • Erica
    Erica

    May 2, 2007 at 7:06 pm

    Do you know if medical code billers have to wear scrubs or do they wear suits to look even more professional?


  • Alan
    Alan

    June 29, 2010 at 10:38 am

    It is interesting that the first change mentioned would be in the area of appearance. When you dress for work, you want to not only look professional but you want to feel good about yourself. This first impression will make a lasting impression. Alan


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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