What happens when an “angel in white” is caught wearing a hint of black?

A 27-year-old nurse working at a university hospital in Tokyo quickly learned the answer.

“What color are your socks?” her supervisor asked her at the nurses’ station. “Why are they black?”

Only a sliver of her black ankle socks could be seen beneath her trousers, but it was enough to earn a scolding for breaking the “white-socks-only” rule for nurses there.

“I ran out of spare white ones,” the nurse told her boss, explaining that she was so exhausted from work that she had no time to do her laundry.

In an interview with The Asahi Shimbun, the nurse railed against the sock regulation and other “absurd” hospital rules, which have been criticized by other health care workers around Japan.

“I don’t understand why only nurses have to follow these rules,” she said, noting that doctors can wear whatever color socks they like.

She also said nurses cannot wear cardigans over their short-sleeved uniforms when they are around patients, even on frigid winter days.

The nurse says she feels so cold on night shifts.

She also mentioned the “unspoken rule” that nurses must not hydrate themselves, even with water, at nurses’ stations. Instead, they have to wait until their lunch break to quench their thirst in a common room.

“We are the ones who constantly encourage people to hydrate themselves,” she said. “Don’t you think it is unreasonable and makes no sense?”

She said she recently asked her supervisor why nurses must wear white socks.

“It’s tradition, that’s why,” her boss said, without elaborating.

Another nurse, 26, who works at the internal medicine department of a general hospital in Chiba Prefecture, said the white-socks rule is also applied there.

Day shift nurses must wear uniforms with white tops and pants, while night shift nurses wear non-white tops.

“There is no sense of unity, and I don’t know if the only reason for the rule is to look clean,” she said.

Just like the Tokyo hospital, the nurses at the Chiba Prefecture hospital cannot wear jackets over their short-sleeved uniforms in front of patients.

“I feel (these rules) benefit no one in particular,” she said. “I believe they remain in place for no special reason.”

Classico Inc., a company based in Tokyo’s Minato Ward that develops and sells medical products, conducted a nationwide online survey in April about such rules at health care facilities.

It received valid responses from 342 female and 58 male nurses in their 20s through 50s.

They were asked to provide examples of what they thought were unreasonable or frustrating rules about their appearance, clothing and how they spend their time in hospitals.

Rules against dyeing their hair in bright colors were cited by 160 nurses, while 153 pointed to regulations on sock color.

In addition, 79 criticized rules against drinking liquids in nurses’ stations, and 42 cited the rules that force them to wear white or plain color underwear to prevent see-through incidents.

When Classico asked 400 former patients about the rules for health care workers, 75.7 percent said the restrictions on hair color were unnecessary, while 83 percent said there was no need to require nurses to wear white socks and white underwear.

“It is possible that rules whose intentions are beyond comprehension remain in place for no apparent reason,” said a Classico representative, adding that the level of tolerance differs at each hospital.

CLEAN AND OBEDIENT

Mitsuko Nakashima, a Tokyo Healthcare University professor specializing in nursing management, said she thinks these long-standing rules can now be called “conventions.”

“The idea of white representing cleanliness and (the rules on) hair color are groundless,” said Nakashima, who worked as a nurse for at least 20 years.

She said a former employer required nurses to wear white socks and refrain from dyeing their hair in bright colors.

“Nurses are called ‘angels in white’ and are appreciated for obediently following doctors’ instructions without saying anything,” Nakashima said.

“I think it is a manifestation of selfish prejudices against nurses who are expected to be ‘neat and clean looking and obedient’ that remain at medical sites,” she said.

But she said that if front-line nurses want to change unreasonable rules, it is important for them to understand how their behavior and appearance are viewed by patients.

“If they think their actions and looks are not offensive to patients, I think it is fine for them to ask chief nurses and other higher-ups to revise such rules,” she said.

Yuka Nishioka, a nurse who was involved in analyzing Classico’s survey results, also said a better understanding of why the rules are enforced is needed.

She said one view is that nurses should not drink water at their stations to prevent possible spreads of infections.

“That’s another reason why it is important to share common views among front-line workers, including doctors, on preferable hospital environments, and to foster understanding for the rules,” she said.

* * *

Unreasonable and frustrating workplace rules cited by 400 nurses

(Survey by Classico, multiple answers allowed) 

*Hair must not be dyed in bright colors (160 respondents, or 40 percent)

*Socks must be white or other specified color (153 respondents, or 38.3 percent)

*No drinking liquids in the nurses’ station (79 respondents, or 19.8 percent)

*No use of elevators (57 respondents, or 14.3 percent)

*Underwear must be white or plain color (42 respondents, or 10.5 percent)

*Wear thin eye makeup (42 respondents, or 10.5 percent)