Professional Appearance | Nurses

Nurses, like other healthcare professionals, have functional dress and appearance codes. Dress codes and professional appearance standards promote infection control, patient confidence, and other institutional and professional interests. However, nurses also resist dress codes for various personal, professional, and cultural reasons. Improper dress or appearance violating functional nursing standards can result in disciplinary charges. If you face discipline by your state nursing board for your professional dress or appearance, retain the Lento Law Firm's premier Professional License Defense Team to defend those charges. Call 888.535.3686 or complete this contact form now for the highly qualified attorney representation you need for your best outcome.

Common Professional Dress Issues

Professional appearance standards address not only the clothing and other items with which one dresses and adorns one's body but also grooming issues. Nurses can face patient and employer objections and can incur state nursing board disciplinary charges for both professional dress and professional grooming issues. Here are common examples of professional dress issues, drawn from a guide developed and published by the Nurse Journal and typically addressed in healthcare facility dress codes:

the expected monotone, simple “scrubs” versus other pants and shirts or blouses, or one-piece clothing the nurse wears in place of scrubs;
head coverings, whether as part of surgical dress such as a surgical cap, or for personal, grooming, or religious reasons, such as a hijab, burka, niqab, kippah, or yarmulke;
jewelry on the fingers, wrists, neck, ankle, earlobes, ear rims, or other locations;
hairpins, feathers, bandanas, weavings, and other ornament tucked, wrapped, or woven into the hair;
buttons, stickers, pins, pocket protectors, or other items displayed on the clothing or from the body, from official identification badges to personal, commercial, political, or religious words, logos, graphics, and symbols;
watches, earbuds, armbands, belt packs, belt holders, and other wearable or clip-on devices; and
shoes, boots, sandals, slippers, and other foot coverings.

Common Professional Grooming Issues

Professional appearance standards and dress codes also reach personal and professional grooming, referring not to how a nurse covers, adorns, or outfits the body but instead to how the nurse cleans, marks, or otherwise cares for, alters, or displays the body. Common grooming issues, once again drawn from the above Nurse Journal guide, that may trigger professional standards and disciplinary issues include:

hair, whether long or short, restrained or free, braided or banded, up or down, over or around the eyes, colored or natural, curled or frizzed, or shaven with or without words or images;
fingernails, whether long or short, painted, polished, or natural, artificially pointed or extended, or clean or unkempt;
makeup, whether obscure or extravagant, conventional or unconventional, or for men or women;
tattoos, paintings, stainings, or other visible marking or coloration of the body, whether hidden from view under clothing in most circumstances or visible on the face, neck, hands, or arms under most circumstances, and whether religious, textual, graphic, patriotic, profane, threatening, or offensive;
piercings, from the ear lobes to ear rims, nose, eyebrows, lip, tongue, chin, or other exposed or hidden body locations, adorned with rings, pins, loops, plugs, or hole rims of various sizes and configurations;
facial hair, whether mustache, beard, trimmed, partially shaven, or full, and whether twisted, oiled, braided, or straight;
perfumes and other fragrances

Dress Codes Grounds

Professionals may debate the utility and necessity of dress codes. Professional appearance standards may also gradually change over time or show different interpretations in different settings or locations, stoking questions about their utility. However, the nursing profession still generally recognizes and values the traditional function of professional appearance standards for nurses. Nursing requires such close contact with such vulnerable patient populations that nurses, perhaps above most or all other professionals, find good reasons to conform their dress to professional standards. If you face disciplinary charges over your professional dress, your defense may benefit from our close analysis of the impact of that questioned dress on the functions for which the profession maintains dress codes. Those reasons include:

ready recognition of nurses, facilitating their critical care role;
ready cleaning and disinfecting of nurse clothing;
lower cost of nurse clothing for ready replacement;
non-distraction of patients and professionals in the facility;
safety of nurses in the ready execution of their duties;
safety of patients in nursing care, including infection control;
ease of nurse movement for lifting, turning, and other strenuous care;
reduction of competition among colleagues over dress standards;
covering the body to reduce distracting or enticing disclosure; and
patient trust and confidence in the nursing profession.

Controversy over Professional Appearance Standards

Professional appearance standards are, on the one hand, traditional marks of acceptance, competence, and community to which many nurses may aspire. Many nurses properly consider wearing scrubs in and even outside of the facility as a privilege and point of distinction, identifying them to patients, colleagues, friends, family members, other acquaintances, and the public as skilled and respected professionals. However, nurse attire and professional appearance standards can also generate inordinate controversy. Americans pride themselves on their cultural diversity and individuality. Dress and personal appearance can be important points of identity, association, and expression. Nurses and other healthcare professionals may also see strict dress codes as unnecessary and unhealthy efforts to compel conformity without grounds for doing so. If you face disciplinary charges over your professional dress or appearance, we can help you give appropriate context to your decisions about your dress and appearance while exhibiting your respect for the functional value of nurse appearance standards.

Factors Influencing Appearance Disciplinary Charges

Several factors can influence whether you face a disciplinary charge alleging your failure to conform to professional dress standards and whether those charges result in a violation finding and discipline. Our attorneys know how to identify factors that either aggravate or ameliorate disciplinary charges alleging dress code or grooming violations. We also know how to marshal your defense evidence and arguments to deploy those factors in your favor. Some of the factors likely to influence the pursuit and outcome of professional appearance disciplinary charges include:

the frequency of your dress code departures. A one-time departure may not be enough, especially when combined with an explanation for the singular departure, but consistently departing from standards may spur a serious complaint;
whether your employer or others instructed or directed you to correct your professional appearance in a clear manner or, instead, whether the appearance code was vague and open to interpretation;
whether you complied with instructions or directions to correct your professional appearance or, instead, objected in a manner suggesting insubordination or disrespect;
whether your departure from appearance standards disrupted the workplace, whether by distraction or objection, or over safety, morale, or management concerns;
whether you had a reasonable explanation for the departure from the dress code and grooming standards;
whether your dress code departure injured, harmed, or offended any patient or patient family member;
whether your dress code or grooming departure exposed any patient to risk of harm or offense;
whether your dress code or grooming departure led to departures by other nurses or healthcare professionals in your facility, undermining compliance and
whether your professional appearance violation occurred in conjunction with other misconduct, such as impairment by drugs or alcohol.

Defenses to Professional Appearance Charges

State nursing board disciplinary charges do not mean that you will or must suffer discipline. We may be able to raise one or more complete defenses to the charges so that you suffer no finding of any violation, or we may be able to present evidence in mitigation of the charges so that you incur no penalty. Your defenses will depend on the circumstances of your alleged violation, including the above factors. We will investigate and advocate any of the following defenses that may apply to your professional appearance disciplinary charges:

the complainant or complainants misidentified you for a violation for which another nurse was solely responsible;
your dress, grooming, and demeanor were within professional standards at all times, even if not meeting the expectations and desires of the complaining witness or witnesses;
your dress or grooming was necessary and appropriate for your medical condition or disability accommodation, whether or not known to the complainant or facility personnel and supervisors;
your dress and grooming were within the rights of religious freedom and free speech and expression, recognized within your professional community;
your employer or facility manager granted special relief from dress code or grooming requirements for seasonal celebrations, weather and travel conditions, emergency schedule management, employee recognition, or other good cause;
your professional appearance violation was due to extenuating circumstances beyond your control, such as assault, accident, or other trauma, and you corrected your appearance as soon as relieved of the extenuating circumstance;
your record of nursing is clear of any other violations, and your employer and patients highly value your nursing experience, commitment, and skill;
your response to the disciplinary charges alleging appearance violations was timely, considerate, helpful, and accepting of responsibility and
remedial education and training will serve to protect patients, the public, and the profession without the necessity or advisability of punitive sanctions.

Disciplinary Grounds for Appearance Charges

Your discipline for professional appearance violations must fall within the statutory or regulatory grounds for discipline. Your state nursing practice act and state nursing board rules may state several grounds that implicate professional appearance, even if not expressly listing professional appearance as distinct disciplinary grounds. In other words, your professional appearance charges may depend on a catch-all provision in your state's nursing standards. The disciplinary grounds that state nursing practice acts and administrative rules commonly authorize, that may support professional appearance charges, include:

unprofessional conduct or unprofessionalism;
insubordination toward supervisors or disrespect of orders;
conduct violating accepted nursing standards;
conduct departing from customary nursing practice;
conduct exposing patients to risks of harm or offense; and
conduct constituting incompetence or impairment.

Example Provisions Reaching Appearance Charges

The Maryland Board of Nursing provides an example of general standards that could support professional appearance disciplinary charges. Maryland Administrative Code Section 10.27.26.07 codifies the Maryland Board of Nursing's sanctioning guidelines, including “practice inconsistent with generally accepted standards,” “unprofessional conduct,” and “unacceptable behavior directed to an individual.” The Ohio Board of Nursing provides a more specific ground for professional appearance discipline in its regulation of a state nursing program. Ohio Administrative Code Rule 3364-25-06 codifies the Ohio Board of Nursing rule articulating an elaborate hygiene, clothing, and personal device code for the University of Toledo Medical Center healthcare staff.

The Oklahoma Nursing Practice Act provides another catch-all example, prohibiting in its Section 567.8 “unprofessional conduct as defined in the rules of the board.” The Oklahoma Board of Nursing, in its Rule 485:10-11-1, defines unprofessional conductas “behavior (acts, knowledge, and practices) which fails to conform to the accepted standards of the nursing profession,” arguably reaching professional appearance violations. The Oklahoma Nursing Practice Act also provides a smaller and more specific example, requiring in its Section 567.14 that nurses on duty at all times wear a badge or insignia indicating their licensure. Our attorneys can determine whether your state nursing practice act or state nursing board rules have similar specific or general provisions arguably authorizing discipline for professional appearance violations.

Testimony on Nursing Appearance Standards

If, as is likely, your professional appearance charges depend on proving professional appearance standards customary for the nursing profession in your practice setting and location, the evaluation, opinion, report, and testimony of an expert nursing consultant may go a long way to defending your disciplinary charges. Professional standards do not always appear in a detailed writing formally adopted by a governing body. Indeed, professional standards often depend on customary practices in the field. Nursing experts familiar with those practices testify as to what they entail. Our attorneys have the relationships with expert consultants to retain them to evaluate, opine, and testify in professional licensing cases. We may be able to present expert witness testimony establishing that your professional appearance was within customary practices, establishing nursing professional norms and standards under the peculiar circumstances of your case. We can also challenge by cross-examination, qualifications, and conflicting testimony the testimony of experts whom your state nursing board may present to support the disciplinary allegations.

Avoiding Charges over Professional Appearance

You may be able to forestall disciplinary charges alleging your professional appearance violations if you act promptly to retain us the moment you learn of such allegations. The patient, patient family member, colleague, or employer representative who objects to your professional appearance may share those objections with you or with others who share them with you before complaining to your state nursing board. We can help you gather, organize, and present the exonerating and mitigating evidence and explanation for your professional appearance in a sensitive and diplomatic way that may convince the complainant not to make an official report to your state nursing board. It is imperative that you not pressure or coerce any complainant lest you face discipline for retaliation. But diplomatically communicating your reasons for your unconventional appearance may enable us to negotiate a resolution without a formal complaint.

Nursing Board Investigation of Appearance Charges

If allegations of your professional appearance violations reach your state nursing board, and the board judges the allegations to be credible and sufficiently concerning, it will assign an investigator. See, for example, Oklahoma Nurse Practice Act Section 59-328.15A, authorizing the Oklahoma Board of Nursing to assign investigators on disciplinary matters. If you learn that your state nursing board has an investigator at work on your case, we may be able to reach the investigator to present your exonerating and mitigating evidence and explanation. The investigator may wish to interview you, with which we can assist, to ensure that your information is truthful, accurate, complete, consistent, and presented in a reliable manner that ensures no later disputes over what you said or didn't say.

Do not submit to an interview without retaining us and consulting with our attorneys. Your failure to provide truthful, accurate, complete, and consistent information and documentation may result in further disciplinary charges or in credibility issues that undermine your defense case. Let us communicate and negotiate with the investigator for a voluntary dismissal of the investigation, with appropriate proposals for remedial measures like education, training, and assurances that avoid any discipline.

Formal Hearing on Professional Appearance Charges

If an investigation of the professional appearance allegations against you results in formal disciplinary charges, and those charges proceed to a formal hearing, we can ensure that you have our representation with all your available defense evidence at the scheduled hearing. Your state's nursing practice act ensures that your state nursing board follows procedures guaranteeing you constitutional due process of law. Your state nursing practice act may state those procedures or incorporate your state's administrative procedures act detailing due process protections. The Oklahoma Board of Nursing provides an example, adopting the state's administrative procedures act in its Administrative Rule 458:10-11-2. Under these protections, your state nursing board will present its evidence supporting the charges at a hearing before an administrative law judge or similar official. We can cross-examine the board's witnesses and challenge its evidence while presenting your defense witnesses and exhibits. The hearing official must be impartial, unbiased, and without conflicts of interest. We can make your best case for relief from the charges.

Post-Hearing Relief from Appearance Discipline

If you have already lost your formal hearing and are suffering discipline for professional appearance violations, we can take all available appeals under your state's procedures. An appeal is generally to a higher official or panel, if not to the full state nursing board. Alternatively, your appeal may go directly to a state civil court. In either case, we can research, prepare, file, and argue your appeal, pointing out the specific legal errors, procedural violations, lack of necessary evidence, or other anomalies in the adverse formal hearing decision. Let us exhaust all available avenues for relief until you obtain your best possible disciplinary outcome.

Disciplinary Sanctions for Appearance Violations

State nursing practice acts generally authorize state nursing boards to exercise a substantial degree of discretion in the sanctions they impose or do not impose for various disciplinary violations. Your state may have no hard-and-fast rule for specific sanctions relating to specific charges. That broad discretion of your state nursing board gives our attorneys the best opportunity to advocate for remedial measures that you can readily perform or have already undertaken instead of punitive sanctions. Your state nursing board may accept your reassurance of compliance or your education, training, counseling, or mentoring as sufficient to forego discipline. State nursing practice acts may also authorize such minor discipline, in the form of cautions, warnings, oral reprimands, or probation, that your sanctions carry no employment, reputational, relational, or other impact. Let us help you make your best case in mitigation of sanctions, even if your state nursing board finds you committed professional appearance violations.

The Qualifications of License Defense Counsel

You should recognize from the above that effective administrative license defense requires substantial administrative law knowledge, skills, and experience, like those qualifications our attorneys possess. We focus our practice on administrative license defense, building not only our skills and experience but also our national reputation and state nursing board relationships. We know how to gain the trust, confidence, and respect of state nursing board officials. Do not turn your nursing license defense over to an unqualified local criminal defense attorney who, though wise in criminal court law, rules, and procedures, doesn't know administrative license defense.

Premier License Defense Attorneys Available

If you face state nursing board disciplinary charges alleging that your professional appearance violates state nursing board professionalism standards, retain the Lento Law Firm's premier Professional License Defense Team now for your best disciplinary outcome. Join the hundreds of other nurses and healthcare professionals whose licenses we have successfully defended nationwide against state board disciplinary charges. Call 888.535.3686 or complete this contact form now to protect your nursing license, employment, and career.

Nursing License Issues: Failure to Maintain Professional Appearance