Appearance, Individuality & Expected Norms in Healthcare

Doctors Stock Photo - Sergio Santos Blog post by Colin Hung

Last week I stumbled on a story about a nurse, Mary Walls Penney, who was shamed by a cashier for her rainbow colored hairstyle. Penney wrote about the encounter on her Facebook page. The final paragraph of her post was particularly interesting:

Nurse Mary Walls PenneyI can’t recall a time that my hair color has prevented me from providing life-saving treatment to one of my patients. My tattoos have never kept them from holding my hand and as they lay frightened and crying because Alzheimer’s has stolen their mind. My multiple ear piercings have never interfered with me hearing them reminisce about their better days or listening to them as they express their last wishes. My tongue piercing has never kept me from speaking words of encouragement to a newly diagnosed patient or from comforting a family that is grieving. So, please explain to me how my appearance, while being paired with my cheerful disposition, servant’s heart, and smiling face, has made me unfit to provide nursing care and unable to do my job!

While I wholeheartedly agree that appearance has very little to do with the quality of care/work that a person delivers, I also believe that there are prevailing societal norms for appearance. Some of these expected norms are justified – police officers, armed forces personnel and firefighters for example. Others are not: a female vocalist, a flight attendant and a used car salesman come to mind.

Thankfully some norms are changing. It wasn’t that long ago that CEOs of companies were expected to be seen in tailored suits, crisp white shirts and matching ties. It took company leaders like Steve Jobs and other pioneers, particularly in Silicon Valley, to help reset society’s norm for CEO appearance. Along the way, however, I’m sure these CEO fashion pioneers endured criticisms, shaming and veiled comments about their appearance. It’s not right, but when you challenge accepted norms people react – often negatively.

Consider the recent furor caused by Megyn Kelly, a reporter for Fox News who went on air wearing a spaghetti-strap dress while covering the Republican National Convention. The reaction to her attire was polarizing and mostly negative. Many compared her attire to that of an escort and there were numerous live tweets demanding she cover up.

[Note if you want a laugh, do a search for @megynkelly and “dress” and look at the avatars of the accounts that were criticizing Kelly – you will see quite a few have pictures that are much more revealing. Irony]

There were many posts written about the incident. I found the one by Suzanne Lucas at Inc. Magazine to be particularly thoughtful and balanced.

It’s not about women being held to a different standard, and it’s not about sexism. It’s about societal norms. If her male co-host had shown up in a tuxedo or a Hawaiian shirt, that would have been equally inappropriate. This challenging of societal norms doesn’t justify people calling her names or insulting her. Saying “That dress wasn’t appropriate for a reporter” is one thing. Saying “she’s a horrible person because she wore spaghetti straps on the air” is quite another. I firmly believe in pushing back against the new societal norm that says it’s OK to be rude to people as long as it’s on the internet.

Now, does this mean that Kelly shouldn’t have challenged societal norms? It depends on what you think about this particular norm. Personally, I like the norm that spaghetti straps are an evening or beachwear choice. If Kelly wants to make it a news anchor norm, she can certainly work to do so, but she can’t do it without expecting some pushback. She can continue to wear spaghetti straps to work, encourage other female journalists to do the same, and eventually change the norm. If that’s what she wants, super-duper. If not, she should probably put on a sweater.

But what about healthcare? Should clinicians, nurses and administrators look a certain way? Do we need to go back to the days of white lab coats for doctors and white pantsuits/dresses plus hats for nurses? Is that what patients expect in today’s society?

Recently Geisinger conducted a study into exactly that. They asked 400 patients for their opinions on the professional image of nurses at Geisinger Medical Center including their thoughts about jewelry, tattoos and piercings. It turns out that the majority of patients wanted to be able to easily identify nurses/clinicians but were finding it difficult to do so when casual attire was permitted.

From a patient’s perspective I can see how this is a concern. Imagine being in a hospital bed and having someone come into your room wearing sweat pants, a striped t-shirt and a tiny name badge start telling you that they are concerned about your bloodwork. I know personally I wouldn’t be focused on what that person was saying. Instead, I’d probably be trying to figure out if this person was a doctor, a nurse, a lab tech or just some stranger who walked into the wrong room who wanted to play a joke on a friend.

As a result of the study, Geisinger decided to implement a new dress code policy for nurses and other departments are following suit (pun intended).

Dress code isn’t just an issue for nurses. It is a challenge for doctors as well. Wearing a business suit may give patients the impression that the doctor cares more about the business of healthcare versus actual care. Jeans and a short-sleeved polo shirt on the other hand may send a message of “golf-first”. In short it’s not easy for doctors to dress professionally either.

Anna Reisman summed it up best in The Atlantic:

Perhaps the proper conclusion is that there is no one “right” way for doctors to dress. While every patient wants their doctor to look decent, there’s a range of what’s acceptable, and context matters. Facial expressions and body language communicate as much as words; clothing, similarly, should blend seamlessly with a doctor’s ability to emanate trustworthiness, competence, and caring. During a visit to a patient at a local hospice, I was struck by one of the doctor’s outfits: He dressed simply but neatly, in brown corduroy pants and a sweater vest, his sleeves rolled to the elbow. His clothes gave one the sense that he had all the time in the world to schmooze with his patients and their families.

Something important that seems to be overlooked when it comes to healthcare dress codes is the mental and emotional impact clothing/appearance can have. Let’s not forget that healthcare is a very stressful environment. Wearing comfortable clothing and feeling empowered to have your “look” when you go to work can make a difference in the way you interact with coworkers as well as patients.

But what is the right balance between individualism, societal norms and the needs of the healthcare workplace? Should uniforms be the standard? Can there be room for individual “flair”? Would an approach like what Starbucks recently implemented work in healthcare? Or should healthcare leaders just steer clear of this issue and let each person decide?

Please join our #hcldr tweetchat Tuesday August 2nd at 8:30pm ET (for your local time click here) when we will be discussing the following topics:

  • T1 Is there an expected norm when it comes to clinician & nurse appearance in healthcare? Is it fair?
  • T2 Should clinicians & nurses in hospitals wear similar attire or uniforms? Why or why not?
  • T3 How would you approach a doctor or nurse who you felt was dressed inappropriately as a patient? As a co-worker?
  • T4 What guidance or advice would you give to a current nursing/medical student about clothing/appearance?


“Nurse Shamed by Cashier for Her Rainbow Hair”, Emily McCombs, Yahoo Style, 19 July 2016,, accessed 30 July 2016

“Contributing to a Quality Patient Experience: Applying Evidence Based Practice to Support Changes in Nursing Dress Code Policies”, Margaret Mary West et al, Online Journal of Issues in Nursing, 1 Jan 2016,, accessed 30 July 2016

“The Clothes Make the Doctor”, Anna Reisman, 1 Dec 2014, The Atlantic,, accessed 30 July 2016

“Healthcare Personnel Attire in Non-Operating-Room Settings”, Gonzalo Beaman et al, Cambridge University Press, Feb 2014,, accessed 30 July 2016

“How can we take nurses seriously when they are dressed in pyjamas? New push to reformalize nurses attire”, Tom Blackwell, National Post, 17 April 2014,, accessed 30 July 2016

“Should There Be a Professional Dress Code in Nursing?”, Rachel Clements, Nursing Together, 6 Dec 2012,, accessed 30 July 2016

“Uniform policy and hairstyle”,, 14 Dec 2006,, accessed 30 July 2016

“No, Megyn Kelly Should Not Have Worn That Dress”, Suzanne Lucas, Inc, 26 July 2016,, accessed 30 July 2016

“Starbucks Relaxes Dress Code, Allowing Baristas to Show More Flair”, Paul Blake, ABC News, 26 July 2016,, accessed 30 July 2016

“The problem with Starbuck’s new dress code”, Morwenna Ferrier, The Guardian, 26 July 2016,, accessed 30 July 2016

Image Credit

Doctors Stock Photo – Sergio Santos

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