Some rules on physical appearance in hospitals and other institutions can be off-putting to nurses, especially students entering the profession. “Why can’t I wear nail polish?” they might ask, or “Why do I have to cover up a tiny butterfly tattoo on the back of my neck?” Sometimes, these rules are based on concerns about infections, backed by rigorous scientific studies. But in many cases, the rules are based on less definable concerns, such as concepts of nursing professionalism or what is thought to bother patients.
The rules vary widely by institution, and they are evolving as social norms change. For example, a growing number of young nurses wear tattoos and piercings, pressuring hospitals to relax rules. Also, the Civil Rights Act of 1964 protects discrimination against racially based hairstyles such as afros and dreadlocks.
The following is an analysis of some of the most controversial rules, based on dress codes posted on institutions’ websites and nurses’ comments on message boards.

Banning Nail Polish and Gel
Some hospitals and nursing schools ban all form of nail polish, which can upset some nurses. For example, a nurse on the allnurses.com discussion forum wrote that a ban on all nail polish would make her seriously consider finding a new job. “I think that ‘no nail polish’ is a pretty ridiculous requirement,” she wrote. “Seeing a cheerful color on my nails brings a smile to my face.”
Such bans are based on studies showing that when the polish chips, infections can lodge inside the crevices. That’s enough reason to ban all nail polish, according to Beverly Malone, PhD, RN, CEO of the National League for Nursing. “Patient safety should be the paramount concern,” she says.
However, many institutions only ban long fingernails and artificial nails, which have been shown to have higher risks of infection than ordinary nail polish. And other hospitals, focusing on the problem of chipping, simply ban chipped nails or require new polish on nails every four days, to reduce the risks of chipping. But this requires strict enforcement.
The problem is that rules that are nuanced may be difficult to carry out, and enforcement relies on frontline managers who may be less than enthusiastic about them. “A policy that says ‘NO…but!’ is no policy at all,” another nurse wrote about nail standards on allnurses.com. “If they make allowances (4 day changes, etc.), they might as well just shut up about the issue and everyone can wear what they want.”
The introduction of gel and shellac nails over the past few years has only complicated matters. These polishes last longer than traditional products and are touted as chip-free. Although they are still too new to be well-studied for infection risks, some hospitals have included them in bans of artificial nails, and this has caused uproar among some nurses.
Tess Walters, a manicurist in Logansport, Indiana, says a ban on gel nails at a nearby hospital brought in six nurses who needed emergency redoes. “Hospital policies lump gel polish together with artificial nails,” Walters says, adding that “sweeping policies make for disgruntled employees.”

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