J. Morgan Puett | Home | RN: The Past Present and Future of The Nurses's Uniform
Installation view Installation view Installation view Installation view Installation view The Bioterrorism Nurse (ca. 2015) Diagrams in collaboration with Iain Kerr The Diagnostic Nurse (ca. 2027) Diagrams in collaboration with Iain Kerr The Post-apocalyptic Nurse (ca. 2130) Diagrams in collaboration with Iain Kerr The Intergalactic Nurse (ca. 2206) Diagrams in collaboration with Iain Kerr Photographs by Jorge Colombo Photographs by Jorge Colombo Photographs by Jorge Colombo Photographs by Jorge Colombo Photographs by Jorge Colombo Photographs by Jorge Colombo Photographs by Jorge Colombo		RN: The Past Present and Future of The Nurses's Uniform J. Morgan Puett and Mark Dion in collaboration with the Fabric Workshop and Museum Philadelphia, PA, 2003 All diagrams in collaboration with Iain Kerr "The RN project spans many years and covers a vast terrain. From the nation’s first hospital founded in Philadelphia in 1751, to a factory in Troy, New York that opened its doors in 1845, through the gender revolutions in the 1960s and 70s, and an artistic collaboration in 2000, through galaxies far away, into the 23rd century and beyond: this is a project of truly epic proportions. When The Fabric Workshop and Museum invited Mark Dion and J. Morgan Puett to do a residency, it was with the usual openness and flexibility, following the philosophy set by the FWM’s founder: trust the artists. When they later came and told us that they wanted to do an exhibition about nursing uniforms, we were not entirely sure what to expect. But the more objects the artists began to unearth, the more collaborators they began to involve, and more the FWM studio staff began to dig—foraging into nursing history and experimental materials—the more captivating the terrain became. Bringing together an incredible range of people, ideas, institutions, objects, and approaches, the artists have created not just a series of new works, a gallery installation and a publication. They have created a new nexus, an original mode of participation, borne out of simultaneous encounters with history, relevance, poetry, memory, culture, and experience. It has been a fabulous gest, one that extends before us, and one which will continue after we have all moved on. Such a project could only be achieved through a truly contagious curiosity, a sense of adventure, abundant openness and respect, not to mention ingenuity, imagination, intellect, and a vast vision. Fortunately, Mark and Morgan possess all of these traits personally and artistically, individually and collaboratively, in spades; this is ultimately what has made this such an extraordinary journey." By Ellen Napier Introduction A uniform is a distinctive form of attire worn to communicate the particularity of a group, as well as the specific role of an individual within a network. The uniform’s goal is immediate universal identification, which results in specific behavioral patterns in both the un-uniformed person, as well as the uniformed subject. This exhibition considers the past, present and future of uniforms worn by American nurses. Throughout the space of the exhibition, we will attempt to chart the evolution of nurses’ apparel in order to explore how design changes shadow transitions in the broader social sphere, as well as in the medical field. Through the uniform, this exhibition examines the transitions in the symbolic role of nurses and the redefining of the conceptualization of the profession. Consequentially, it also explores the function of style in the production of knowledge. The Historical Nurse To obtain the public’s acceptance of the trained nurse, an image of feminine virtue and professionalism that enforced social distinctions was required. The uniform ensured that a nurse would not be mistaken for a domestic servant and assisted in establishing nursing as a respectable occupation at a time when women had few professional or economic options. The first standard uniforms in America were developed by Bellevue Hospital Training School in New York in 1874. Most early standard uniforms were somber, nearly floor-length dresses with long sleeves and detachable starched collars and cuffs. The cuffs of white or brown linen covered the sleeves from wrist to elbow. Long, pinafore-style, belted aprons were worn over the dress. From the apron belt hung a utility bag containing a pincushion, forceps, a pencil, a case for matches, the key to the rum closet and other tools. Until about 1912 a bone corset would be tightly laced beneath the dress to produce an “hourglass” silhouette. The uniform’s dress was originally dark blue or gray wool for winter and blue or gray striped calico for summer. By the 1890s the seersucker of blue and white had become a standard student uniform, while graduate nurses and superintendents began to adopt all white uniforms. Nursing shoes were sensible black leather with little or no heels. The final components of the uniform were the school pin or badge (introduced in 1880) and the distinctive cap. Most early caps were of lace-trimmed organdy, oval shaped, and worn directly on top of the head. Later, each nurse-training program developed a unique cap style. The Military Nurse The presence of nurses has been essential to the success, morale and overall health of the American Armed Forces. Professionally trained nurses first participated in the Spanish-American War, which led to the establishment of a permanent Army Nurse Corp. The style of the military nurse’s uniform paralleled the uniforms of other military personnel. The cap of the military nurse was small and close-fitting, similar to an aviator’s cap. Uniforms were issued to meet the particular demands of combat areas, and to prepare the nurse for duty in all types of conditions. An emphasis was placed on versatility, as the Nurse Corp jacket conveniently had detachable lining and the hospital uniform had a detachable piece underneath the arms to prevent excessive perspiration. Special arctic field uniforms were also issued to nurses in cold climates, which included a ski suit and a parka lined with alpaca and mohair fabrics. The Modern Nurse The nurses’ uniform in the United States continued to evolve along with fashion trends, tempered by the factors of perceived suitability, comfort, economy, convenience and textile innovation. In the twentieth century shorter sleeves, hems, more colors, new closures, and new fabrics were made available by a number of uniform supply companies throughout the United States. In the 1960s, nurses rebelled against the traditional virginal white uniform and cap, perceiving them as no longer promoting an autonomous professional image but rather a submissive, angelic one. An increasing number of male nurses helped to emphasize the inappropriateness of the traditional cap and uniform. The introduction of the elastic waistband pantsuit in the late 1970s was the most conspicuous change in the daily apparel of nurses. Scrub vests and pants, previously confined to operating theatres where one “scrubbed” before entering surgery, began to be worn into the wards. Popular because they are unisex, pajama-comfortable, inexpensive and easy to clean (since they are not white), scrubs soon became a standard for a wide variety of hospital workers. Despite their comfort and versatility, scrubs obscure the historical function of the uniform since so many different hospital staff wear the identical garment. It is difficult for the public, patients and other health care professionals to identify a nurse by a mere glance. The Student Uniform The student nurse’s uniform was adopted by American schools in the 1870s to codify the profession and to persuade “gentlewomen” of higher social classes to take up nursing. Each school decided on its own regulation uniform, cap and insignia design. The student nurse’s uniform of the late nineteenth century generally consisted of a dark flannel dress in the winter and a cotton dress of blue and white or pink and white stripes in the summer. Various parts of the student nurse’s uniform signified the rank and level of training of the student nurse. The uniform was often decorated with colored chevrons or other small insignia to mark the nurse’s status. These distinctions supported the nurse’s pride in her profession and respect for rank. A proliferation of nursing schools in the 1950s and 60s lead to an increase in the variety of colors and styles in the student nurse’s uniform across the United States. Each school took pride in the appearance and uniqueness of its uniform. After the first three to six months of training, the “probationer” was given her cap in the Florence Nightingale ceremony, which generally consisted of a candle-lighting ceremony, followed by the Nightingale Pledge and the singing of the school’s alma mater. The cap was a distinctive part of the traditional nurse’s uniform. Although caps were first included in the uniform for the practical purpose of covering the hair, more modern hairstyles forced the cap to the back of the head and into an ornamental role. In some training schools, graduates were distinguished from students by a black velvet band on the cap. The student uniforms on display are from the Dion/Puett archive. Most of them were manufactured by the Marvin Nietzel Coporation. The Double Frill One of the most remarkable styles of nurses’ caps was Philadelphia General Hospital’s Double Frill. The cap was worn by all graduates of the hospital’s School of Nursing since the school was started by Alice Fischer in 1885. Fischer originally designed two caps. The undergraduate cap, known as the Single Frill, was made of organdy with a single row of fluting at the bottom. Graduates bade farewell to their undergraduate caps by throwing them into the fireplace of Graduation Hall. The “Blockley Frill” or “Double Frill” was bestowed upon the nurse at graduation. It was made of linen with two rows of fluting that joined together at the back. The caps required special shaping with a fluting iron. Graduates sent their Double Frill back to Philadelphia for regular laundering and care. In 1950, laundering and return postage for the cap would cost the nurse $1.50. The tradition of the Philadelphia General Hospital’s Double and Single Frill was passed through generations until its School of Nursing graduated its last class in the spring of 1977. Starch Immaculately starched and laundered uniforms contributed to the nurse’s hygienic and professional image. For nurses’ uniforms, starching was important both aesthetically and functionally. Starch stiffened caps into gravity defying peaks, while also sealing the fabric against the penetration of dirt, lowering surface friction, and thus lengthening the life of the fabric. Philadelphia General Hospital’s Double Frill only needed to be laundered about once a month, thanks to a starching solution that offered a wonderful shield against dirt and oil. Generations of the same family laundered and starched the caps at the Philadelphia General Hospital from 1885 until the mid-twentieth century. Their secret recipe called for a mixture of water, Argo cornstarch, potato starch and borax. Variations in starch formulas would affect color, stiffness and finish. The starching process was filled with possible problems, as the starch mixture could become too thick or thin, or even “sour” and ferment (most often in hot weather). Unclean utensils or other impurities could cause streaking or spotting of the uniforms. It took months of training for a starcher to master his or her craft. With changes in nursing uniforms through the decades, starching became less popular. By the 1970s synthetic materials made starching virtually obsolete and no longer part of the nurse’s uniform’s preparation and care. The Marvin-Neitzel Corporation (adapted from a text by Michael Oatman) Marvin-Neitzel traces its history to the renowned detachable collar industry that originated in Troy, New York, and gave the city its moniker of The Collar City. In 1845, William Gunnison and Walter Stewart established Gunnison, Stewart and Company as a manufacturer of linen collars and cuffs in Troy. The business expanded into nurses’ bibs and aprons by 1917, when Raymond Neitzel was hired, and under his guidance the company began producing a complete line of hospital garments. In 1931 the business name was changed to Marvin-Neitzel Corporation, reflecting the leadership of Neitzel and E.W. Marvin, a partnership that lasted from 1886 to 1914. By 1945 Marvin-Neitzel was thriving, employing more than 200 people and distributing its products throughout the nation. During the 1950s however, competition from larger manufacturers using cheaper labor grew intense. Finding its niche, Marvin-Neitzel began to specialize in made-to-order uniforms for student nurses, something bigger companies were not able to do. Marvin-Neitzel supplied many schools in the area, including Albany Medical School, Samaritan Hospital, and Maria College, as well as nursing schools in Boston, Chicago, and across much of the Eastern seaboard. In the early 1970s, a combination of circumstances put further strain on the business, such as the high cost of the skilled labor needed to make made-to-order uniforms, the dwindling number of women going into nursing as other career opportunities opened up, and the development of wash and wear fabrics, an innovation that reduced the need for multiple outfits. These factors led Marvin-Neitzel to standardize sizes for uniforms, but the company continued to produce a wide variety of student nursing uniforms until the venerable firm closed in 2001. The Image of The Nurse In addition to signifying the specific role of an individual within a network or group, the uniform is also an important part of a profession’s social image. Uniforms are visual signifiers of society’s characterization and expectations of a profession. However, depictions of nursing in mass media often have little to do with the daily reality of the job. Our culture’s perception of nursing has been colored by its representation in literature, film, and television, which have depicted the nurse as an angel of Mercy, erotic fantasy, and shades of gendered conceptions in between. These conceptions can be organized into eight categories. At the turn of the nineteenth century, nurses were often depicted as angels of mercy in order to mask the novelty of female independence with traditional female values. While this image-construction presented the nurse as a saint and martyr, the motherly nurse embodied the social expectations for American women. The motherly nurse was depicted as the quintessence of morality and self-sacrifice. The heroic nurse, who often appears in dramas of war and crisis, is a courageous warrior and defender of freedom. The fetishized nurse depicts the profession as sexual fantasy for men, while the bitch-nurse and nurse as love-interest also involve the nurse in a psycho-sexual or romantic fantasies. More recent images depict the nurse as a career-oriented professional. Finally, there is the more recent phenomena of the soap nurse, the “Nurse Betty” type, where the mass media’s fascination with the image of the nurse is represented and critiqued. Of course, these socially constructed images of the profession have not always cast the nurse in the most accurate or complementary light. A profession as storied and socially important as nursing is faced with the challenge of overcoming the limitations of its public image, as certain stereotypes are often unproductively replaced by other equally damaging and detrimental misconceptions. The Ideal Uniform The task of designing an ideal uniform was undertaken in order to match the benefits of a professional uniform to the needs and desires of contemporary nurses. This attempt to construct the ideal nurse’s uniform, which would perfectly meet the expectations and demands of all nurses, occurred with the full acknowledgment that the goal would be impossible to reach. Although the idea of creating a uniform that would satisfy all needs was far-fetched and unrealistic, the opportunity to collaborate with nurses proved to be the project’s most important benefit. The uniform was to be conceptualized by nurses, benefiting from their opinions and expertise, rather than created by the artists’ imagination. In order for the input of nurses to most directly contribute to the design for the ideal uniform, the artists—in collaboration with the Center for the Study of the History of Nursing at the University of Pennsylvania—organized three focus groups of nurses. The groups represented three different generations: student nurses from the University of Pennsylvania, practicing nurses at the University of Pennsylvania Hospital, and retired nurses. The artists facilitated discussions in each group on the importance and practical nature of the uniform, as well as specifics on what the ideal nurse’s uniform would look like. Although each group had varying opinions on the necessity and practicality of a uniform, there was a general consensus that the uniform is important and beneficial to the profession. However, nurses were unwilling to give up the comfort and economical advantage of scrubs. Curiously, many nurses did not identify the scrub as a suit at all. The nurses’ feelings on the importance of the uniform were accompanied by a resistance to changing established habits and conventions. This transformed the question of what the ideal uniform would look like into what might be added to scrubs so that these garments could gain a more legitimate status as a nurse’s uniform. For example, responding to the unanimously acknowledged need for nurse identification, the artists developed the clear red and white RN logo, a graphic that could be instantly interpreted at a distance. A fourth focus group was composed of Visual Art students in the M.F.A. program at the Vermont College of Union Institute and University in Montpelier. This group was formed in order to consider the input of the nurses’ focus groups and conduct a critical inquiry into what the ideal uniform would look like. This investigation was based on the desires expressed by the nurses in the focus groups, as well as in a questionnaire that was distributed throughout the nursing community by The American Journal of Nursing and Medscape Online. Nearly 800 nurses responded to the questionnaire. After analyzing the data received through the questionnaires and looking closely at select samples of clothing submitted by nurses from their own wardrobes, the Vermont College students attempted to design a small collection of garments that would suit a wide range of nurses. The garments were designed with new technologies and fabrics that considered the needs and desires expressed by the focus group nurses. Using samples of contemporary garments submitted by the nurses, this design team composed an ensemble of mix-and-match uniform pieces that could be added to hospital scrubs. The uniform pieces feature fabrics marketed through Noble Fibers and Sauquoit industries of Northeastern Pennsylvania, companies that specialize in cutting edge anti-microbial fibers. The ideal uniform proposed by Dion and Puett consists of an ensemble of seven interchangeable elements that respond to both the practical and designatory requirements of today’s hospital environment. The Bioterrorism Nurse (ca. 2015) Immediately following the commencement of the Great Middle Eastern Resource Wars, in the early 21st century, the nurse’s uniform was subject to a series of new adaptive measures. The tragic episodes in Dallas, Houston, and Salt Lake City made it painfully clear that medical professionals would first have to protect themselves if they were to successfully administer aid to others. The biohazard protective response suit (BPR suit) became a fixture of many urban trauma centers. This uniform provided the nurse with protection not only from biological warfare products, such as anthrax and Ebola, but from a wide range of chemical agents including Lewisite, Mustard, Soman, Nerve, Sarin and Tabun. The example on exhibit is typical of the period of 2015 and features a 40-mil PVC, 5-mil Teflon, FEP, splash-resistant face shield, which provided superior strength and durability while improving visibility. By the early 20s, the viability of bioterrorism strategies had run their course. Given this lack of necessity and the suit’s cumbersome bulk, the total-encapsulating vapor protection nurse’s uniform was slowly phased out. The Diagnostic Nurse (ca. 2027) Largely responding to the home patient’s rejection of robotic delivery health care systems, the diagnostic uniform allowed real nurses to best combine human compassion and contact with a wide range of medical bio-sensing technologies and infrastructures. This uniform’s fabric contains an external woven membrane of highly sensitive conductive yarns that interface to produce a complete medical patient profile which is instantaneously transmitted to a central medical facilities data bank. Vital signs, endocrine levels, fluid samples, and DNA sequences are obtained when the nurse hugs, strokes, or holds the patient. Through touch-driven sensors and aperati drugs, electrostatic changes and environmental stimulus therapies are administered. With the system of direct feedback from a central medical databank and the ability of the nurse to take on the patient’s condition (a literal/material empathic response), therapies could be first experimentally administered to the nurse, corrected, and then directed through the nurse to the patient. The uniform’s biometric sensor also monitor the nurse’s own stress levels and adjust his or her sensory stimulation and medication. The honeycomb pads on the gloves are remarkably precise sensors capable of micro-sampling, ultrasound and other non-invasive imaging techniques. The uniform features a ganglia of smart-fibers, which correspond to the patient’s organs to produce a total system analysis and response delivery vehicle. The Post-apocalyptic Nurse (ca. 2130) By the close of the 20th century the proliferation of micro-fundamentalist dictatorships resulted in the collapse of the newly formed global alliance. Without a central secular governing body, national federations spiraled into a vortex of civil and ethnic unrest and finally a series of large-scale conflicts of unprecedented chaos and devastation. The spontaneous appearance of loosely affiliated caregivers was one of the first signs that the barbarism of the post-war decades was waning. In the absence of medical institutions, the uniform of these pioneer nurses functioned as nomadic hospitals containing all apparatus and drugs required for making their rounds (usually 20-50 square mile territories). The highly modular garment was constructed from scavenged material, which had survived the firestorms, radiation waves, and looting. The fabrics most available were architectural fabrics made of poly-tetrafluoroethylene fibers, which provided abrasion-resistant protection against ultra-violet radiation, acid rain, and a wide range of environmental toxins. The lightweight but high strength nature of the salvaged materials also assisted the nurses in better performing under the rigors of the earth’s post-war gravity. The Intergalactic Nurse (ca. 2206) The institutions that had propped up the civilizations of the past five hundred years have vanished. The tenants of the modern period—its conceptual horizons of nation, religion, architecture, art, law, science and nature—are all now meaningless. The event of “first contact” caused humans to affirm their status as biological organisms, which precipitated the need for a new generation of caregivers. The Intergalactic nurse uniform embodies the boundary collapse of alternative, scientific, and extra-terrestrial medical traditions. The caregiving organism, the garment and the larger space of the trans-stellar data field form a triboelectrically charged symbiotic entity, capable of empathic expunging illness as a distinct category by treating the self/other as a crisis based fluid organism/event. Knowledge, information and therapies are continuously proprioceptively exchanging in a fluid transmission of expressive non-subject centered forces. The garment consists of a consortium of data systems materialized as the panels of the uniform. Each fiber panel contains receptor-transmitters accessing data fields of astro-biological information for all known territories and for all self-conscious entities and systems. Acupoint sensors collect data continuously, adapting the symbiotic caregiver (as collective environment) to new situations and circumstances in a directly haptic and pre-cognitive manner. Read "Nursing History’s Factory of the Future" by Iain Kerr