April 28, 2022By Lance Baily

Should Clinical Learners Wear Uniforms During Healthcare Simulation Experiences?

In the clinical setting, healthcare professionals frequently wear uniforms that identify the healthcare profession the wearer belongs to and their boundaries of practice e.g. nursing department scrubs may be one color and physical therapy department scrubs may be another. Uniforms may differ in style as well as color. Some facilities do not have any uniform requirements other than regulations related to items such as covered shoes and clean uniforms. Union contracts may govern uniform requirements. Institutions may have to pay for staff uniforms if they make them mandatory. There is debate about the benefits of uniforms.

For example, do uniforms make it easier for patients to identify the role of the wearer, create pride in and a sense of belonging to the wearer’s profession, or do uniforms contribute in a negative way to the hierarchy within an institution? Students are often required to wear specific clothing that identifies them as students whilst in the clinical setting.

Leaving the above issues aside, should both students and licensed learners participating in healthcare simulation be required to wear uniforms during their educational experiences. This applies to both clinical education activities within healthcare institutions and within academic settings. The majority of nursing schools require simulation participants to wear clinical apparel during simulation with the idea that such clothing helps the learner take on the professional role and become fully involved in the simulation.

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In a recent LinkedIn post by HealthySimulation.com Founder and CEO Lance Baily, which was viewed over 3,000 times, a number of healthcare professionals commented sharing their thoughts. Ranging from “absolutely they should” to “time to drop all those ‘expected attires’” these professionals contributed a variety of discussion points. Here are a few additional responses:

  • “I agree that students should wear uniforms for simulation, as they would for clinical. What I struggle with is mandating uniforms for skills labs and independent practice. I want students to be able to drop in and practice anytime they want, between classes, etc, no matter what they are wearing. I also feel like it is important for students to feel as comfortable as possible for skills checkoffs to reduce anxiety. Anyone who has taught skills knows the incredible levels of anxiety that students experience during checkoffs.”
  • “It has always been my practice, as we are often trying to replicate clinical situations I have students attend in uniform and be bare below the elbows as they would be in the clinical environment.”
  • “Not only is it considered a clinical day – if you expect students to buy in and suspend disbelief how can they be expected to do that if dressed in street clothes and interacting with a patient in a scenario.”
  • “Simulation is a controlled representation of the clinical environment in which patient trust and rapport are essential. The uniform is a symbol of the partnership that a nurse builds with the patient and it contributes to the professional relationship. How can we expect nursing students to value this critical aspect of patient care if we reduce it to casual social encounters in a simulation setting?”
  • “Immersive experience… Right?! Show up ready to be immersed.”
  • “I think it depends on the type of simulation (e.g. skills practice versus fully immersive scenarios). Having said that, in my experience with paramedic students (anecdotally), those who are reluctant to wear uniforms on simulation days are generally also those who struggle with other aspects of the course. Exceptions to every rule though!”

Prescott et al., (2010), reported that one student claimed that by wearing uniforms they “felt better and looked much better.” Another stated, “It was weird, it made you compelled to be bothered. I do things in my uniform that I would just think ‘no way! I am not doing it.’ But in my uniform, I just think it is part of my job and I just don’t think about it, no question, I just do it!”

Nursing schools vary in their policies regarding uniforms requirements while on campus. In the skills labs, students may be required to bend and move their bodies when practicing skills such as making beds, moving patients or completing assessments. Inappropriately dressed students may inadvertently provide views of their bodies they never intended. This may be distracting or embarrassing. Some schools may require that students wear loose fitting clothes with full length pants and no sleeveless shirts. Vague guidelines often lead to vague compliance. Many schools have now instituted policies that require students to wear uniforms in all skills lab.

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One Southern California ADN program required students to wear white uniforms in clinic. Faculty were reluctant to require students to wear these white uniforms for skills labs and simulation assuming they would become dingy and worn. The school made the decision to require students to wear maroon scrubs anytime they were on campus including both lecture and lab. Students could buy any design of scrubs they wanted at any price providing they were maroon. White uniforms would be required for simulation. The students were overwhelming enthusiastic about the scrubs. The uniforms were convenient, inexpensive, comfortable and easy to care for. Nursing students identified with fellow nursing students around campus. This helped bond the division together. In the skills lab the students met professional standards and were comfortable and appropriately covered whatever the activity. The scrubs were so successful that other healthcare departments opted for colored scrubs. Skills labs often contain expensive equipment and with the colored scrubs, staff could quickly identify students who didn’t belong in the labs. This added to the security of the department. Students could potentially wear the scrubs when they graduated.

Medical simulation allows students to practice skills, improve clinical judgment and practice professional behaviors. In order to encourage professional behaviors, Nursing schools want students in simulation to copy behaviors observed in clinical practice. This might include wearing a uniform. Uniforms help take students out of the role of student and into the role of nurse.

While today the determination of whether or not a uniform is required among healthcare simulation learners is dependent on a school’s individual policies, a workaround can be the administration of short white coats (that can easily be worn over street clothes) or some combination of colored scrubs. A benefit of these uniforms is that they are specifically designed to promote flexibility and movements associated with medical skills, treatments, and procedures. For example, learners may find themselves tasked with making beds, transporting patients, or assisting with overall assessments. In these situations, certain clothing may be considered restrictive and not conducive to academic compliance.

Ultimately, healthcare simulation is intended to help transform a learner from the role of a student to the role of a healthcare administrator or practicing professional. While clothing is not necessarily reflective of a learner’s skills, it can inhibit their ability to learn and perform these skills appropriately. This is one of the many reasons why the industry’s determination of best practices, including as they relate to uniforms, has become a current focus.

Just as the INACSL Standards of Best Practice provide guidance on topics such as pre-briefing, debriefing, and standard operating procedures, research and standards relating to uniforms can help position the clinical simulation industry to achieve even greater success regarding learner outcomes.

More About INACSL Standards of Best Practice

The standards, which are free to everyone, provide an excellent foundation for all simulation programs ranging from one-room simulation laboratories to multimillion-dollar facilities housed in large medication centers and universities. If you are new to simulation, this is the place to start. Do not be overwhelmed by the number of standards, but instead focus on a few at first and gradually add in more standards.

Many educational accrediting bodies are requiring proof that simulation programs are using best practices. Adequate documentation that a simulation program is following the INACSL standards will go a long way to satisfy these accrediting bodies that the simulation activities are based on sound educational principles. Some simulation programs seek a separate national accreditation specifically for their labs from groups like ASPiH or SESAM, or certification for their staff from organizations like SSiH.

Learn More About Healthcare Simulation Standards of Best Practice

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