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Scrubs and Inequality: A&E Covid 19 Story Week 8

Week 8: Scrubs and the Inequality Beneath

Today I am going to address something that has come to light due to Covid 19 which I believe deserves addressing, scrubs and inequality.

If you ask people who work in healthcare if they enjoy wearing scrubs, the majority of nurses (myself included) would say they prefer scrubs to the usual uniform as they are far comfier. Historically people adopted scrubs as they began to realise the importance of a clean surgical environment. Since then, in England it is my understanding that most nurses wear a uniform. The exception to this would be surgical/recovery nurses and nurses in some emergency departments. However, due to the Covid 19 pandemic most staff members who work in hospitals are now wearing scrubs. This is for infection prevention and control reasons – to prevent staff members bringing the harmful virus particles home and on public transport on their clothes. 

Pre-Covid-19

In a time before Covid, nurses, physios, health care assistants, domestics and porters wore a uniform whilst doctors seemed to be the exception to this rule. It seems doctors had the choice between wearing their own (smart) clothes or scrubs. This means doctors wear suits/dresses or ‘professional’ clothes whilst working on a ward, despite having contact with bodily fluids.

Whilst there is the argument there to say that doctors are involved in less direct patient contact than the nurses; it does not explain why it is suitable for a doctor to do a rectal exam in a suit with a thin plastic apron on whilst the nurses who hold clinics or research studies are still required to wear a uniform.

Guidelines

The Department of Health published guidelines known as the ‘bare below the elbow’ guidance. It also outlines the three objectives when it comes to what health care professionals should wear. To summarise these are: Patient safety (ie infection prevention and control), Public confidence (clean/professional workwear) and Staff comfort (I.e., cultural practises). Reviewing this guidance, I cannot see any reason there should be differences between what doctors and nurses should wear whilst at work. 

Now I may be mistaken here, but I believe the contradictions present in these rules date back to a time, pre Florence Nightingale. A time when doctors were the Professional staff members who held a degree and nursing was an uneducated profession. Hippocrates who is widely regarded as the father of western medicine, claimed doctors should be “clean in person [and] well dressed”.

I believe that due to nursing being a ‘pink collar’ job i.e. a profession held mostly by females (89% in the UK) there is a long withstanding lack of respect and recognition for the level of education and professionalism required nowadays in the nursing profession. 

Hierarchy

Sadly, there is a very intense hierarchy present in healthcare. Anyone who doesn’t work in healthcare probably couldn’t grasp just how tangible that hierarchy feels sometimes. I have seen some people disregard people in job positions such as health care assistants, domestics and student nurses. I was actively terrified of doctors when I was a student nurse which I now realise was ridiculous. Obviously, most organised workforces involve a hierarchical structure. However, this is a problem when it means people feel that they are less important than others. I find uniforms to be an important reflection of hierarchy. 

What about now?

Nowadays, an RN requires a Bachelors degree. Additionally, nurses register to a professional body, the NMC. The discipline of nursing also encompasses many advanced roles such as Advanced Nurse Practitioner’s and specialities i.e. Heart Failure Nurse. Many of these professionals take an active roles in the Medical team. They often prescribe, advise and consult – skills attributed historically solely to doctors. Many nurses also take on a senior roles in the hospital and community settings as matrons, managers and coordinators etc. So, yes it did raise a bone of contention when I saw an Advanced Nurse Practitioner wearing a uniform whilst the doctor holding the same clinic in the room next door did not. This prompted me to write this post – scrubs and inequality.

Going back to the present day, everyone, despite their role is wearing scrubs. Whilst this is more confusing and this practice will not last, I think we can all learn a lesson from this. Nurses and Doctors deserve equality in their uniform or non uniform policies. 

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