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iHV publishes position statement in response to national discussion on health visitors wearing uniform

4th August 2013

 

 iHV Position Statement

Health visitors wearing uniforms

 

  • Health visiting is a non-uniformed profession.  
  • Health visitors should follow a personal dress code that conveys a neat, neutral and professional appearance, acceptable to the families and colleagues they are likely to encounter in practice.
  • Personal identity cards, indicating name and employer, should be visible

 

The Oxford English dictionary defines a uniform simply as “distinctive clothing worn by members of the same body e.g. by soldiers, police, and school children.” Wikipedia expands this definition to suggest: “A uniform is a type of clothing worn by members of an organization while participating in that organisation’s activity. Modern uniforms are most often worn by armed forces and paramilitary organizations such as police, emergency services, security guards, in some workplaces and schools and by inmates in prisons.”  This expanded definition draws attention to the organisational purpose and authoritarian focus of most uniforms.

 

The Institute recognises that uniforms are widely used and may be purposeful for groups and situations other than health visiting.  As the quote above suggests, uniforms are often associated with ‘authority,’ which is helpful in crisis or security situations and uniforms may also be used to indicate status (high or low).  It may be argued, too, that the depersonalising effect of uniforms is useful in clinical situations, because distancing a nurse (for example) from patients receiving intimate body care reduces embarrassment.  In retail or service occupations, uniforms help to distinguish workers from the public and in school children they can promote equality and a sense of unity, which is also useful in sports teams.  Commercial organisations may also use uniforms to promote their brand.  However, such situations do not apply to health visitors, whose practice would be inhibited by uniforms precisely because of these common connotations of uniforms.  In summary, the key reasons for health visitors to avoid uniforms are:

 

  1. Uniforms depersonalise, so they would act as a barrier to relationships between parent and health visitor.
  2. Uniforms give the wrong message – nurse-type uniforms imply a biomedical, clinical focus for the work, whilst ‘business suits’ suggest an authority figure
  3. Uniforms could be frightening for small children.
  4. Uniforms announce to the neighbourhood that a family is receiving ‘official visits’ so they compromise anonymity.
  5. It is an old-fashioned idea, associated with post-war health visiting, so a step backwards, not forwards.
  6. Uniforms are expensive for the organisation:  at least four outfits; winter, summer, indoor and outdoor would be needed, along with suitable clothing for minority ethnic groups, maternity wear etc.  Laundry/dry-cleaning costs need factoring in.
  7. Where uniforms are worn, staff need changing facilities with secure lockers and showers, which is rarely feasible in the community.

Further guidance is given in an article by Cowley, which draws on Goffman’s classic theory about ‘presentation of self.’  Goffman uses the theatre as an analogy, to explain the importance of personal appearance, including ‘costumes’ and ‘props’ that all convey a message in encounters.  Cowley writes:

 

“Preparing for a home visit requires care in the choice of ‘costume’. Health visitors’ apparel may vary depending on the area, the weather, and the kinds of families being visited. One health visitor said she always kept wellington boots in her car for visits to traveller camps, since drainage is often missing from temporary sites. The families respected her awareness of the difficulties they faced and this was part of gaining acceptance. Other health visitors have referred to the need to ensure a neutral appearance, i.e. no designer clothes, as that would be insulting to families struggling to make ends meet, but sufficiently tidy to convey interest and respect. To be practical, clothing needs to be washable and suitable for sitting on the floor to play with toddlers, and shoes need to be suitable for standing, walking and driving.

Presentation of self is a key health visiting attribute, which is usually taught by example, role modelling and discussion between practice teachers and students. It will be difficult for students to achieve this where uniforms have been implemented, yet it is an embedded, essential part of practice.  A key expectation of the Health Visitor Implementation Plan (DH, 2011:19) is ‘to restore professional autonomy and decision making’. Choosing an outfit is the first decision of the day, and introducing uniforms is just one example of how an organisation that fails to understand the culture and nuances of health visiting can inhibit good practice.”

 

Cowley S (2013) Presentation of (health visiting) self in everyday practice’ Journal of Health Visiting Volume 1 Issue 4, Page 66

Department of Health. (2011). Health Visitor Implementation Plan 2011-2015: A call to action London:  Department of Health.

Goffman E (1959) The Presentation of Self in Everyday Life.  New York: Anchor Books, Doubleday