I stopped wearing my nursing cap in 1988 when I started a new job where clinical nurses no longer wore white uniforms or caps. I did not miss having my cap knocked off by an overhead trapeze or the cap marks on my hair when I removed the cap at the end of the shift. I never thought that patients, families, or healthcare professionals treated me differently or with less respect after I stopped wearing my nursing cap. At the time, I believed that the cap did not make the nurse, but rather the nurse's knowledge, confidence, professionalism, and compassion.
Thirty years later, when I was teaching a Fundamentals of Nursing clinical rotation at a skilled nursing facility, the nursing administrator invited me and my students to dress up for Halloween. The staff and many of the residents would also be in costume. My students (a group of individuals who identified as female) and I discussed the pros and cons that might be related to dressing up for Halloween. The pros included increasing collegiality with the staff and residents, enjoying an opportunity to not take ourselves too seriously, and hopefully making a resident smile. The cons included losing role recognition by residents, families, and staff; encountering issues when wearing personal protective equipment; and having potential contamination or injury from costume glitters feathers, and other decorative objects.
In the end, my students decided to wear their traditional uniform (scrubs) with an embellishment, such as a Halloween pin, a decorative headband, and even fairy wings. The students hoped that this compromise would allow others to recognize their student status while also participating in the fun of the holiday.
I shared many of the students' concerns and goals. Rather than come in costume, I chose to return to my nursing roots as a traditional 1970s RN who wore an all-white uniform and a nursing cap. When I retrieved my cap from the bottom of a dresser drawer, I was horrified to find that it had turned yellow, undoubtedly from age and long-term storage. Scrubbing with a bleach cleanser returned the cap to its original whiteness. The black velvet ribbon was reapplied using a water-based, water-soluble lubricant (a time-tested trick that nurses used back then). After putting on my nursing school and Sigma Theta Tau pins, I headed to the facility for Halloween. At the last minute, I decided to bring along pictures from my nursing pinning ceremony as well as a headshot of me in uniform taken during my first nursing faculty position.
I expected to get reactions and questions from my students, such as "Did every nurse wear the same cap?" (Answer: No, each nursing program had a unique nursing cap), "How do you keep the cap on your head?" (Answer: a bobby pin attaches the cap to a folded piece of facial tissue which is bobby pinned to the top of my head1), or "Does it feel weird to be wearing a cap?" (Answer: once the cap is on, I never feel it).
What I had not anticipated was the reaction from the residents.
My students and I had been providing care in this skilled nursing facility for 5 weeks. We were well known to the residents. However, as patient rounds began, I noticed that the residents responded differently to me that Halloween. After commenting on my cap, one older adult resident said, "My wife was a nurse." "My sister was a nurse during World War II," shared another. Throughout the evening shift, I heard a variety of comments about me wearing my cap, my pictures, and stories of loved ones who had been nurses. I was touched and surprised by the intimate memories that the residents shared.
The next week, I returned to the nursing home wearing my usual uniform (white pants and shoes with a pink top) for another evening shift rotation with my nursing students. The evening progressed as usual. Only one resident asked, "Where is your cap tonight?" I realized that the connection I had formed on Halloween while wearing my nursing cap was gone. No more stories about family members who were nurses. At the end of this shift, I wondered how wearing my nursing cap created a different nursing image for these older adult residents and sparked their memories. Did the traditional all-white uniform and nursing cap help the residents to recognize my professional nursing persona? Maybe on a future Halloween, I will wear my nursing cap again and listen to memories of nurses past.
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