History American Nursing Uniforms

AMERICAN NUSING HISTORY

Davida Michaels, MSN, M.Ed. RN (Retired) 1/5/2021

Table of Contents History of American Nursing Uniforms ...... 3 Background ...... 3 Civil War Nurse Uniform ...... 4 Nurse Uniforms – Image amd Function...... 5 Role of Uniforms in Identification of Graduate Nurses...... 6 Graduate Nurse Uniforms – Though the Years ...... 7 Graduate Nurse Uniforms 1880’s to 1910 ...... 7 Graduate Nurse Uniforms 1911 – 1920’s ...... 7 Military Uniforms - Nurses World War 1...... 8 Military Uniforms WW2 -1940’s ...... 9 Combat Uniforms...... 10 Military Uniform Korean Conflict 1952 ...... 11 Uniforms 1950’s ...... 11 Uniforms 1960’s ...... 12 Uniforms 1970’s ...... 12 Nurse Uniforms 1980’ 90’s ...... 13 Today’s Nurses ...... 14 2020 Caring for COVID 19 Patient ...... 14 Men in Nursing ...... 14 Nursing Students Uniforms...... 15 1880’s to early 1900- Student Nurse Uniforms ...... 16 Associate Degree Nursing Student Uniforms ...... 17 Bachelor Degree Nursing Students ...... 18 History of Nursing Caps ...... 19 History Nursing Shoes ...... 22 References ...... 25

History of American Nursing Uniforms

Background

Florence Nightingale designed the uniforms worn by staff nurses in the Crimean War at Scutari to project soberness and respectability. The uniform consisted of a gray tweed dress, called a “wrapper,” a gray worsted jacket, a plain white cap, and a short woolen cloak. Over the shoulders was worn a Holland scarf described as “frightful,” on which was embroidered in red the words “Scutari Hospital.” Miss Nightingale believed that Scutari was a disorderly camp, teeming with drink-shops, prostitutes, and idle troops, a distinguishing dress was deliberately designed to be unattractive as necessary for the nurses’ protection.i ii Probationers at the Training School for Nurses at St Thomas's Hospital founded by Florence Nightingale wore a simple brown uniform with white apron and cap. Figure 1Florence Nightingale at St. Thomas Hospital File from the (Wikimedia Commons)

Civil War Nurse Uniform

iii Civil War volunteer nurses. Dresses were usually made dark cloth with a white apron.

When Dorothea Dix, Superintendent of Army Nurses for the Union Army, assigned northern women as nurses, she placed restrictions on their type of dress. "All nurses are required to be plain looking women," she stated. "Their dresses must be brown or black, with no bows, no curls, no jewelry, and no hoop-skirts." However, for many nurses of the North or South, such regulations were not significant. As the War progressed, female nurses learned to adapt their clothing to the conditions at hand. Dresses were often dark in color, either solid or patterned, so that filth and other stains would not easily be seen. iv v 2 Dress worn by a Mrs. Beach during her service as a nurse

The civil war was the beginning of public acceptance of women nurses providing care for persons of both sexes. Revenby credits the Civil War experiences of women who had either nursed during the war or participated in the Sanitary Commission or other relief agencies for the reformation of hospitals and nursing.vi “With their Civil War experiences freshly behind them and the Nightingale model for hospital and nursing reform already in place in England, the efforts of a number of elite reformers thus turned toward hospitals and nursing. The Civil War campaigns had given these women a political education in organizational battles as they became skillful in the intricacies of infighting and pressure politics.”vii

Nurse Uniforms – Image amd Function.

Florence Nightingale viewed the uniform as a “means of enhancing the image of the nurse and the work of nursing” . Trained nurses wearing a uniform helped change image of the nurse from Dicken’s “Sairey Gamp” and the “fallen women” working off their sentences by caring for the sick in the almshouse.

As a general rule, nursing uniforms followed the fashions of the time. In Victorian England respectable middle and upper class women wore dresses which consisted of a tight laced corset, narrow waist and ‘leg of mutton’ sleeves. While Victorian women of middle and upper class, who had servants to perform domestic tasks, women could wear fashions of that era. Uniforms based on this fashion were not well suited to the work of nursing. Goldenberg illustrates problems with this fashion for nurses. “Consider a nurse taking care of a patient with an infection could not be on duty more than half an hour without getting her sleeves contaminated”. Function needed to be considered when designing nurses uniforms Stimson, points out that in the United States traditions are not such hallowed things as they are in other countries. “Getting away from tight bodices, high collars, cumbersome kerchiefs, voluminous skirts, long stiff cuffs, and other time honored relics, has certainly been in the line of progress, for comfort, simplicity, economy of money and time, and also good looks and inconspicuousness should be the criteria by which a nurses uniform should be measured.”

A basic rule in designing clothing such as uniforms is that ‘form follows function’, uniforms need to consider the following factors: viii

Mobility – whether the nurse is working in a hospital, clinic, an office ,home care, or the military, he or she must be able to easily move in order to care for patients ;

Comfort – a nurse must concentrate on patient and their needs. To do so, nurses need clothing that is comfortable.

Ease of maintenance – while starched aprons may have looked nice, they were not easy to maintain. ‘Wash and Wear’ fabric allows nurses to easily keep their uniforms clean.

Uniforms should, while considering all the factors, be made to be “stylish and practicable and at the same time economical and good to look at.” As fashion changed with the times and skirts became shorter at first allowing ankles to be observed then gradually shortened until lower limbs were visible. The ‘mini skirt’ arrived on the scene in the 1960’s leading to the challenge to bend over to care for the patient in the bed without revealing undergarments.ix In the 1970’s pantsuits arrived and allowed for mobility, comfort and easy maintenance of uniforms. In the 1980’s nurses found they could lift and maneuver patients more easily when

5 wearing scrubs—and that scrubs were not only easy to maintain but were less expensive than ‘standard’ uniforms.

Role of Uniforms in Identification of Graduate Nurses

Historically, the public image of a graduate nurse was usually of female wearing a white dress, a cap and a school pin. While there were male nurses dressed in a white tunic and pants, the public image usually of a female nurse. The uniform worn contributed to identifying the role and function of the person caring for you or your family.

Consider the rise of correspondence schools such as the Chautauqa School of Nursing as seen in their advertisement. Without setting foot in a clinical setting, the student could read materials sent in the comfort of their home. They then took a test to judge their knowledge. If they passed they received a certificate, a uniform including cap, and a school pin thus making them indistinquishable from graduates of reputable hospital schools resulting in confusionin members of the general public. Correspondence schools and their poorly prepared graduates compteted with hospital prepared graduate nurses for private duty jobs - usually the correspondence school graduate charged a lower fee. They wore the same type of uniform that graduates of hospital school of nursing did. How could the public judge which nurse would be the ‘best’ to care for their family? This is one factor leading to the advent of registration and state nursing licensure, in the early 1900’s which was vital to protect nurses and patients.

With the arrival of pantsuits in the 1970’s and later scrubs it has again become difficult to identify nurses. xPatients and families often report that they have difficulty identifying the members of their health care team because “they’re all wearing scrubs.” This has led some hospitals and other facilities to review their dress code policies.

Western Maryland Health System considered the problem and cited the “inability to distinguish nurses from housekeeping or dietary personnel by reading name badges resulted in delayed responses to patient’s requests because they are being routed through multiple channels before reaching the nurse.”xi Additionally patients and visitors cited the “inconsistency and varied styles of scrubs/uniforms created, in some instances, a chaotic and sloppy appearance throughout the health system.”

Western Maryland Health System solution to this problem was to establish a Professional Apparel Committee (PAC) to research solutions that would be appropriate for their institution and acceptable to our staff. Staff was surveyed as to color preferences. Departments chose colors for their staff to wear for easy identification; color choices were limited to solid colors absent of any designs and/or patterns. Patients surveyed indicated designating disciplines by specific uniform colors provided comfort and reassurance while making it easier for them to identify who is providing their care.xii

Graduate Nurse Uniforms – Though the Years

Graduate Nurse Uniforms 1880’s to 1910

1890 Lillian Wald 1880 1893

Graduate Nurse Uniforms 1911 – 1920’s

Nurse graduating class ? c. 1911

Military Uniforms - Nurses World War 1

African American Nurses WW1

WWI Nurses wearing Gas Masks

1930 Wilderness Hospital Nurses

1930 Memorial Hospital Maternity Nurses

Military Uniforms WW2 -1940’s

Navy uniforms worn by women serving in the various 1940s nursing units during World War Two.xiii

The service and dress uniforms worn in the US Army Nurse Corps in WWII (US Army Medical Department, Office of Medical History)

Combat Uniforms

Army Nurse Combat Uniform WW2 Group of Army Nurses 10th Field Hospital WW@

Military Uniform Korean Conflict 1952

xiv

M*A*S*H for Real: 46th Mobile Army Surgical Hospital, Korea 1952 series of photos was taken by a U.S. Army photographic unit to document operations at the 46th Mobile Army Surgical Hospital, supporting the 45th Infantry Division, the 40th Infantry Division, and the Philippine Expeditionary Forces in Korea from a point about 10 miles behind the front lines. Casualties from well known battles such as the Punch Bowl, Sandbag Castle, Heartbreak Ridge, and Christmas Hill were treated here.xv

Uniforms 1950’s

1956 nursing team at Hartford Hospitalxvi

Uniforms 1960’s

Blue Ridge Healthcare Foundation

Uniforms 1970’s

1970's Nurses at Central Station Documenting

xvii Introduction of Pantsuits

Nurse Uniforms 1980’ 90’s

Today’s Nurses

xviii

2020 Caring for COVID 19 Patient

xix

Men in Nursing The Pennsylvania Hospital School of Nursing for Men was founded in 1914 at the Institute of the Pennsylvania Hospital in West Philadelphia. It was the first training school of its type to be headed by a man. The School of Nursing for Men was dissolved in 1965, after graduating more than 550 male nurses during its 51-year history.xx Image via: upenn.edu

Class of 1924

Male Nurse - 1968 - 1990xxi

Nursing Students Uniforms

At Bellevue Hospital School of Nursing ( New York), one of the first three “Nightingale” schools of nursing,xxii.administration felt that a uniform, however simple, was indispensible for its economy, neatness and the “moral effect on a corps of nurses is the same as on a company of soldiers’xxiii The idea of requiring American nursing students to wear a uniform was acceptable to students from working class families but students from middle and upper class did not agree as they felt the uniforms were similar to that of a domestic servant, As a result they wore an assortment of garments. One day a member of the first class at Bellevue described as “very beautiful, tall, and dignified” member of a prominent family “made her appearance in the wards dressed in grayish-blue stripe and with apron and cap of white.” “So charming was she to behold, and so dowdy and insignificant did all the other members of the class feel they were glad to adopt a similar dress.xxiv

Bellevue Students 1874

1880’s to early 1900- Student Nurse Uniforms Hospital Diploma Programs

In general the student uniform consisted of a dress – some made of dark materials, others were lighter colors some solid others with stripes or checked paterns. The dress was usually covered with a stiffly starched white apron..Hospitals was responsible for laudering nurses uniforms, including student uniforms .

With the advent in the 1970’s of ‘wash and wear’ materials,nurses including students were responsible for caring for their own uniforms. The wash and wear uniforms did not have an apron and students were responsiible for their care – including laundering them.

Photo left -Presbyterian Hospital School of Nursing Students - “Nurses of A Different Stripe

Anna Maxwell, founder of Presbyterian Hospital School of Nursing in New York wanted to ensure that ‘her’students would stand out figureatively and lterally to be “of a different stripe. She designed their uniform which consisted of expensive gingham imported from Glascow Scotland with wide blue and white stripes with white apron. Maxwell is quoted as saying “I want a uniform which my nurses will be proud to wear always”.xxv xxvi

Riddle, dicussing nurses uniforms in a 1915 AJN article, stated that pupil nurses, while required to wear their student uniform while on duty on the wards of the hospital, were not allowed tp wear the uniform on the street or any other place, unless in the care of the sick as the uniform cannot be kept clean. Of note at that time it was the custom for many hospital schools of nursing to provide students to work as private duty nurses delivering care in private homes. xxvii xxviii

Associate Degree Nursing Student Uniforms

Mississippi Gulf Coast Community College

Charity School of Nursing Delgado Community College

Bachelor Degree Nursing Students

Our Lady of the Elms College

Westfield State University

History of Nursing Caps

Nurses caps are thought to have evolved from the nun’s habit and the custom of women covering their hair in public. Stokowski quotes Lavina Docks 1920 Short History of Nursing wrote that the nurse's cap was "a perpetual reminder of St. Paul's strange injunction that women must cover their heads or be shorn."xxix

In the nineteenth century women’s hair was kept long; a hair covering such as a cap or kerchief was sanitary and kept hair away from her eyes so she could see what she was doing. Florence Nightingales’ Cap Caps also identified the school attended as well as the status of the wearer…from student to graduate. Stokowski refers to nurse caps as “Caps of Distinction”

“What started out as a pragmatic head covering gradually became a hallmark of a profession. Because a nurse's cap had to be earned, it was highly coveted and bestowed upon its wearer the status of an educated, self-supporting woman outside of the hospital and a well-trained, respected, and dedicated professional within. Early schools of nursing quickly realized that the nurse's cap could become a "brand" for their institutions, and it became desirable to design a unique cap to represent their school and the image they wished to convey.”xxx

Florence Nightingales’ Cap Capping Ceremony:

First Capping Ceremony 1948 Kingston General Hospital The cap marked a student’s progression from probationer to student. Authors note: My initial nursing education was at Genesee Hospital in Rochester New York I was excited and proud when I started tp wear the plain white cap as a first year student. Nursing student’s progress was measured by the color and number of stripes. First year was plain white; second year one blue stripe across the top of the cap; third-final- year a second blue stripe was added on each end crossing the first blue stripe. At graduation we received our black stripes along with our school pin .I still remember the pride I felt as I changed the color of ribbons from blue to black.

While I have continued my education – bachelors and masters degrees, the education I received at Genesee Hospital gave me a solid foundation in both clinical and the principles – theory of nursing to build on. While I still am very proud of earning my stripes I stopped wearing my school cap sometime in the late 1980’s as my role changed.

In the spring of 2010 nurses in John F. Kennedy (JFK) Medical Center in Atlantis, Florida hospital’s cardiovascular step-down unit decided to wear all white uniforms including their school caps. The day that the cardiovascular step-down unit nurses came to work in white uniforms and caps was a memorable one,"The patients loved it," recalls Farrell, "especially the older ones who remembered nurses in caps. And surprisingly, the physicians loved it, too. They knew exactly who to go to -- the person wearing the cap.xxxi

Excerpt from Oral History: Springfield Technical Community College ADN Graduate (1972- member of the first graduating class) discussing history of school cap: “ it was a new school so we did not have a nursing cap. So a group of us, and one of them was Shirley L .she was an older woman in the class she spearheaded this group of us that wanted to design a cap and, of course, we were back and forth to Mary O’Leary (Director) about the cap and she looked at us one day and she said, listen to me, it’s not what is on the head, it’s what in the head. If you want to get a cap, then go ahead and do it. Well we did design this cupcake like cap. It was sheer, it was...in fact there is one up there, it’s a little bit different design, this cupcake like cap, and we wore it as students with great pride. We handmade them at the time until Mary found a manufacturer to make it, but we had...as students we had burgundy and gold ribbon on and when we graduated we had black ribbons.

History Nursing Shoes

Staff nurse Eliza Brown (Australia) 1944 Smithsonian

The long dress uniforms in the nineteenth century generally covered the feet. Shoes generally were only visible when the wearer walked or sat down. When looking at pictures of nineteenth century nurses with their long dresses, erect posture, who worked long hours caring for patients, I wondered whether their feet were comfortable. While today when we picture a nurse his/her shoes were white, nurses in the nineteenth and early twentieth century wore black stockings and black shoes.

According to Houweling, black shoes continued to accompany the all-white uniform for some time, especially since white shoes would quickly get dirty. In the 1920s nurses wore white canvas shoes, but only after the development of white leather shoe polish in the 1930s did they begin wearing white leather shoes routinely.

Portrait of a nurse 1889 -note dark color shoes peeking out under skirt.

Bed making class - Note black stockings and shoes worn by student nurses (1920’s)

Close up of student’s footwear.

1930 nurse shoes

Pair of nurse's shoes worn by Pauline Brown Payne 1944: xxxii]. (Smithsonian Institution)

Nurses worked long hours with very little opportunities to sit down. Were their shoes Comfortable?

FASTEP Powder to increase comfort.

Nurse Shoes –2021 – what the past teaches us:

xxxiii xxxiv

Shoes for workers that must be on their feet for long periods of time should be comfortable, allow for mobility, be easy to clean and have a ‘stylish design.

References

i https://www.countryjoe.com/nightingale/uniform.htm ii Houweling, Lynn, April,, 2004 .Image, Function and Style: A History of the Nursing Uniform, American Journal of Nursing, vol. 104, No.4 iii Civil War volunteer nurses. North Carolina Nurses: A Century of Caring. https://vimeo.com/11450353. Accessed via Asheville Junction: A Blog by David E. Whisnant. iv https://en.wikipedia.org/wiki/Dorothea_Dix v https://cwnurses.tripod.com/how.html vi Reverby, Susan, 1987, Ordered to Care: The Dilemma of American Nursing 1850 to 1945, pp 11 -12 vii Ibid p.44 viii https://gadgetssai.com/history-of-nurses-uniforms/ From; History of Nurses Uniforms – History, Evolution and Transformation ixAuthors Note – the mini skirt was ‘banned’ in the hospital where I was employed at that time. x Who’s My Nurse?: New Dress Code Helps Patients Identify Caregivers, from MPSC 2010 Annual Conference Solution Submission, Western Maryland Health System Maryland patient Safety Center.

xi MPSC 2010 Annual Conference Solution Submission. Johnson, Lori, Western Maryland Health System, Who’s My Nurse?: New Dress Code Helps Patients Identify Caregivers. 2010 xii Ibid xiii https://glamourdaze.com/2018/05/1940s-nurse-uniform-fashion-of-ww2.html xiv https://olive-drab.com/gallery/description_0087.php xv Ibid xvi https://hartfordhospital.org/hh-school-of-nursing-alumnae/our-history xvii https://nurseslabs.com/look-hospital-nursing-1970s/ xviii https://www.myamericannurse.com/how-do-you-look/ xix https://www.fox10phoenix.com/news/the-home-front-stories-from-nurses-in-the-fight-against-covid-19 xx upenn.edu xxi https://history.amedd.army.mil/ancwebsite/uniformpres_files/whiteduty.html xxii In 1873 three hospitals established the first ‘Nightingale’ nurse training schools in America. These were New York Training School at Bellevue Hospital; Connecticut Training School at New Haven State Hospital and Training School at Massachusetts General Hospital xxiii Stimson, op. cit.p. 371 xxiv Ibid xxv Goldenberg, 1992, op.cit. xxvi Source of Photo https://blogs.cuit.columbia.edu/hslarch/the-health-of-humanity-125-years-of-the-columbia- university-school-of-nursing-1892-2017/ Note Presbyterian School of nursing later became Columbia University. xxvii Riddle M. Nurses’ uniforms. Am J Nurs 1915;15(2):406-8.(see Hospital and training School Administration) xxviii Author’s note: I was a student in a hospital diploma program from 1967 to 1969; hospital regulations strictly forbid wearing of any part of the uniform outside the hospital. In my freshman year, I wore the ‘old fashioned’ stripes dress with a starched white apron. This was laundered by the hospital. The uniform was changed to a light blue ‘wash and wear’ so we were responsible for washing our uniforms. Those of us who were married and lived ‘off grounds’ were cautioned that the uniform was never to be worn home. xxix Laura A. Stokowski, What Happened to the Cap? The Dawn of the Cap. May 03, 2011. www.medscape.com xxx Stokowski, Laura, What happened to the cap? The Dawn of the Cap. Part 1 May 2, 2011, www.medscape.com

xxxi Ibid xxxii White pair of shoes fastened with white laces in a wingtip style. Shoes covered in white shoe polish. Shoes have a slight heal with sole guards added. The heels have the brand name in the center [WINGFOOT/GOODYEAR ]Smithsonian https://nmaahc.si.edu/object/nmaahc_2013.90.2.3ab xxxiii KURU xxxiv Snibbs