NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST
Dress Code and Uniform Policy
Documentation Control
Reference
Approving Body
Date Approved
Implementation Date
Version
Summary of Changes from
Previous Version
Supersedes
Consultation Undertaken
Date of Completion of
Equality Impact Assessment
Date of Completion of We
Are Here for You
Assessment
Date of Environmental
Impact Assessment (if
applicable)
Legal and/or Accreditation
Implications
Dress Code & Uniform Policy
Version 5
November 2014
HR/P&C/008
Trust Board (Director of Workforce and OD)
25 November 2014
25 November 2014
5
Version 4 in new policy format
Emphasis on importance of adhering to the
policy
Includes new section referring to wearing of
a full veil/niqab
Clearer instructions regarding jewellery and
piercings
Clearer instructions regarding returning
uniforms including managers responsibilities
Version 4
NUH Dress Code and Uniform Policy review
group
Human Resources
Staff Side
NUH Policy Sub Group
Director’s Group
Reviewed March 2014
Reviewed March 2014
Reviewed March 2014
•
•
•
•
•
Equality Act 2010
Employment Relations Act (1999)
Rehabilitation of Offenders Act (1974)
Human Rights Act (1998)
Trade Union and Labour Relations
(Consolidation) Act 1992
1
• Part Time Workers - Prevention of
Less Favourable Treatment
Regulations (2001)
• Fixed Term Employees - Prevention of
Less Favourable Treatment
Regulations (2002)
• Health & Safety At Work Act (1974)
• Agency Worker Regulations (2010)
Target Audience
Review Date
All managers, new and existing employees,
Accredited Trade Union / Professional
Organisations representatives
November 2017
Lead Executive
Director of Workforce and OD
Author/Lead Manager
Human Resources Manager
Further Guidance/Information Human Resources Managers
Assistant Human Resources Managers
Human Resource Officers
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CONTENTS
Paragraph
Title
1.
2.
3.
4.
5.
6.
4
4
4
5
6
6
Appendix 1
Appendix 2
Appendix 3
Introduction
Executive Summary
Policy Statement
Definitions (including Glossary as needed)
Roles and Responsibilities
Policy and/or Procedural Requirements for
all staff
Training, Implementation and Resources
Impact Assessments
Monitoring Matrix
Relevant Legislation, National Guidance
and Associated NUH Documents
Care Guidance for office wear garments
Care Guidance for Healthcare Garments
Equality Impact Assessment
Appendix 4
Environmental Impact Assessment
21
Appendix 5
Appendix 6
Here For You Assessment
Certification Of Employee Awareness
23
25
7.
8.
9.
10.
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3
1.0
Introduction
1.1
The aim of this policy is to ensure that all staff (both directly and
indirectly employed) whilst on duty within the Trust are dressed in
such a way that maximises staff and patient safety, and projects a
professional image.
Agency staff/work experience students and contractors are required
to adhere to this Policy.
1.2
Employees and volunteers represent the Trust to our patients/visitors
and the public. It is important that they can recognise staff and have
confidence and trust in them. In order to achieve this and to ensure
compliance with the Trust values and behaviours the highest
standards of appearance are essential at all times.
1.3
This policy and guidance incorporate current Health and Safety,
Infection Prevention and Control, and Department of Health (DoH)
guidance on dress and uniform codes.
2.0
Executive Summary
2.1
Nottingham University Hospitals NHS Trust (NUH) aims to provide
the highest standards of quality patient care. The highest standards
of appearance are essential at all times to project a professional
image and ensure safety.
3.0
Policy Statement
3.1
All employees must ensure that:
•
•
•
Dress Code & Uniform Policy
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their overall appearance is appropriate to their role, smart,
clean and safe
jewellery is discreet and will not put patients, themselves or
other employees at risk
they do not present themselves in a way that might
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undermine confidence in the Trust or its services
3.2
The Dress Code and Uniform Policy, including the wearing of ‘theatre
greens’ and, or any other protective clothing is mandatory for all staff.
A number of areas have specific departmental guidelines for uniform
and will need to ensure staff are aware that these supplement this
policy e.g. orthopaedic theatres, sterile supplies or pharmacy.
3.3
A Trust issued identification badge must be worn in a visible place
while the staff member is on-site or representing the Trust off-site.
3.4
Personal protective equipment (PPE) consists of items of additional
clothing e.g. gloves, shoes with protective toe-caps or anti-slip soles,
aprons, white coats or other items worn on the person (e.g.
respirators) which protect the wearer from a hazard. Gloves and
plastic aprons, used for clinical care, must not be worn outside
clinical areas unless following infection control special precautions
(e.g. transporting a patient who is MRSA positive), and must always
be removed when exiting a clinical area (when hands should be
washed).
The need for personal protective equipment is determined by
departmental risk assessment, with the assistance of Health and
Safety/Infection Prevention and Control teams if required. Where the
need for personal protective equipment has been recognised in the
risk assessment, its use must be made compulsory by the manager
and monitored. Details should be recorded in the Health and Safety
Compliance Review.
Failure to follow a Trust Policy could result in disciplinary action being
taken, up to and including dismissal.
4.0
Definitions
4.1
GMC : General Medical Council
4.2
NMC : Nursing & Midwifery Council
Professional crocs
4.3
Croc type shoes with fully covered top/front of shoe and strap around
heel.
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5.0
Roles and Responsibilities
5.1
Individual Officers
5.1.1 All line managers must ensure the uniform policy and dress
code are adhered to, they must ensure training is provided if
necessary and must monitor compliance. They must also
ensure when requests for replacement uniforms are made that
old uniforms are returned to the Linen Room in exchange for
new ones. Uniforms must also be returned on leaving the
Trust.
5.1.2 Staff will wear and maintain their uniforms in accordance with
the uniform policy. Staff, when not in uniform or protective
clothing, but on Trust business will dress in a professional
manner and in accordance with the Trust Dress Code (as
described in this policy).
5.1.3 Management Action
Where dress is not in accordance with this policy it is legitimate
to ask staff to rectify this immediately. If it requires staff to
return home to change the time off duty will be unpaid.
Repeated disregard of this policy will be considered in line with
the Trust’s Disciplinary Policy/Procedures.
6.0
Policy and/or Procedural Requirements
6.1
Dress Code and Uniform Policy for ALL staff
6.1.1 Clothing and appearance must project a professional image
and must not cause embarrassment or offence to patients,
colleagues, other staff or visitors to the Trust.
6.1.2 The following are general requirements relating to ALL staff.
• Clothing must be clean, safe, smart and in good state of repair.
• It is important to attend work in clean odour free clothes, to
change clothes regularly and to demonstrate good body
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•
•
•
•
•
•
•
•
•
•
•
hygiene. If wearing a uniform it must be changed daily.
Jewellery whilst acknowledging that piercings are seen as a
form of individual expression, it is important that staff do not
lose sight of the Trust’s aims. These being: to promote a
professional image, not to undermine service user’s trust and
confidence and to maximise staff and patient safety.
Therefore, no visible body or facial (including oral) piercing
jewellery may be worn. Ear piercing should not be excessive.
Please see below for additional guidance for clinical staff.
Clothing must allow for full range of movement and must not
hinder staff during moving and handling procedures.
Tattoos must not cause offence. Inappropriate tattoos including
offensive language must be covered. It is acknowledged that
some religions/cultures use henna to decorate their bodies at
certain times and this is acceptable.
Footwear must be clean and smart and not put the wearer at
risk of injury. Flip flops or very casual shoes/sandals are not
permitted. Departmental risk assessments will indicate where
and which staff are required to wear specific footwear.
Lanyards used for displaying ID badges must have a pull
release catch on them. Any decoration should be health
related. Lanyards must not be worn when involved in direct
patient care. They should also be removed when off duty and
off site.
Very casual or high fashion trousers e.g. ripped jeans, denim
etc. are not permitted.
Low waistband trousers showing the abdomen/lower back or
allowing underwear to be visible are not permitted.
Cropped tops, showing the abdomen/lower back are not
permitted.
Strapless or cleavage revealing tops are not permitted.
Very short skirts or dresses are not permitted.
Other items which do not project a professional image including
chewing of gum in areas where public/visitors are present are
not permitted.
6.1.3 Wearing of a full veil/niqab.
It is important that patients feel able to build relationships of trust
and to communicate freely with each professional providing
healthcare. In some situations this may require the professional to
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set aside personal and cultural preferences in order to provide
effective care. An example is that a patient may find that a face
veil (as in a niqab) worn by the healthcare professional presents
an obstacle to effective communication and the development of
trust.
In such circumstances NUH expects employees to respond to a
patient’s individual needs (and to remove the face veil). NUH does
not expect an individual patient to have to ask repeatedly that a
healthcare professional take such action. When such a request is
the typical response of patients or when sensitive communication
is crucial for the clinical interactions typical of a particular clinical
setting, the Trust expects employees to reasonably anticipate that
patients will perceive the wearing of a veil to be a barrier to
communication (and therefore remove the face veil). The Trust
considers this is in line with the views of professional regulatory
bodies (notably GMC and NMC).
6.2
Dress Code and Uniform Policy for staff working in the clinical
area
The following key principles relate to all staff working in the
clinical area whether in uniform or wearing own clothes. This is
also relevant to our staff working outside of the Trust premises
i.e. in the Community.
6.2.1 Only two small silver or gold stud earrings may be worn, one in
each ear.
6.2.2 One plain gold or silver ring or plain bangle may be worn for
cultural or religious reasons. Bangles must be pushed up the
arm and secured in place when undertaking hand hygiene and
direct patient care activity. All other jewellery, including
watches must not be worn.
6.2.3 Nails must be short not longer than fingertip. False nails, nail
art and varnish must not be worn.
6.2.4 No sleeves below the elbow to be worn when in clinical areas.
In exceptional circumstances where disclosure of forearms
causes concerns on religious grounds advice should be sought
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by the manager from the Infection Prevention and Control
Team.
6.2.5 Neck ties can be worn but must be tucked into the shirt; bow
ties may also be worn.
6.2.6 Plain black, navy or brown shoes of a cleanable material with
covered toe and heel areas, anti-slip, quiet soles and heels no
higher than 2.5cm (1 inch) must be worn. Trainers, if black or
navy and ergonomically suitable, may be worn. Clogs (with
antistatic properties) are only worn in theatres. Only
‘Professional Crocs’ in navy or black may be worn. If in the
clinical area, but not in uniform, shoes must have soft soles and
closed over foot/toe.
6.2.7 Hair must be clean, off the face and tied back off the collar
(long pony tails are not acceptable for reasons of health and
safety) with a plain clip/band when in clinical environment.
Nursing staff must wear navy or black.
6.2.8 Pens, scissors, fob watches, other sharp or hard objects must
not be carried in outside breast pockets for reasons of safety. If
required, they should be carried inside clothing or in hip
pockets.
6.2.9 Black or neutral tights/stockings must be worn with uniform
dresses. Socks must be plain navy or black.
6.2.10 Plain cardigan or directorate sweatshirt/hoody, of a colour
appropriate to the professional group/directorate may be worn
when not in the clinical areas, contact with patients or
undertaking direct clinical care.
6.2.11 Outdoor wear is provided dependent on the role and must be
worn as appropriate.
When in uniform (even outside of the clinical areas) staff must abide
by the rules for working in a clinical environment under Section 6.2.
6.3
Operating Department Attire
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This protocol sets out the correct wearing of operating department
attire within and outside the operating department. The protocol was
designed with the following factors in mind:
• The need to protect staff against contamination from blood and
body fluids and the risks of cross infection and cross
contamination.
• The need to promote a clean environment.
• The need to promote a professional image.
6.3.1 Standard peri-operating department attire
6.3.2
Clean attire as issued by the Trust must always be worn in a
clinical area. Any item of operating department clothing must
be changed as soon as possible when contaminated with
blood or body fluids.
6.3.3
All jewellery must be removed prior to entering the operating
department.
6.3.4
All hand jewellery must be removed prior to scrubbing.
6.3.5
Operating department footwear - clogs, wellington boots or
other appropriate footwear as determined by risk
assessment to ensure protection against penetrative injury.
The colour restriction detailed in 6.2.6 does not apply to the
Theatre environment.
6.3.6
A single use fluid repellent mask must be worn correctly for
each operation where aerosolised blood & body fluids are
present and where the individual is less than 45cm from the
site of surgery. Dispose of the mask, handling ties only,
directly into an appropriate waste bin.
6.3.7
A disposable head covering must be worn covering all hair.
6.3.8
A full mask covering beards etc. must be worn.
6.3.9
Eye protection, spectacles/ goggles, visors must be worn if
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there is a risk of splashing or spraying of blood or body fluids
and when reconstituting a chemical solution.
Standard operating department attire outside of an operating
department
area,
but
within
the
clinical
area;
CICU/AICU/HDU/ED or Ward.
6.3.10 Clean operating department attire, including hat, without
mask.
6.3.11 Operating department footwear may be worn provided it is
clean.
Attire when outside operating department areas and outside
clinical areas.
6.3.12
Items of operating department attire (including foot wear)
must not be worn when visiting non- clinical areas including
the dining room, shops, outside the main building, out on the
street and any other area that is considered to be outside an
area where patient care / treatment occurs.
6.3.13 When clinical reasons dictate that operating department
attire has to be worn outside a clinical area, every item must
be changed before entering an operating theatre, with the
exception of staff working in the Burns Theatre at City
Campus.
6.4
Issue and maintenance of Uniforms
6.4.1 The number of uniforms provided is dependent on the average
number of shifts worked per week:
Full time – four uniforms
Four shifts – three uniforms
Three shifts – two uniforms)
Two shifts – two uniforms
One shift – two uniforms.
6.4.2 Uniforms must be changed every day.
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6.4.3 When washing uniforms, individuals must ensure they are
washed at the hottest temperature for the fabric.
This can have personal tax implications for further information
contact the link below.
http:www.hmrc.gov.uk/incometax/how-to-get.htm
.
6.4.4 Uniforms soiled with blood/body fluids must be changed at the
earliest opportunity. Appropriate soluble wash bags are
provided in clinical areas to transport garments home.
6.4.5 Uniforms must be maintained in good condition.
6.4.6 Veils should be treated the same as uniform items with regards
to laundering
6.476 Alterations to the uniform may only be made following
discussion with the sewing room. Where considerable loss or
gaining of weight renders the uniform(s) provided impractical to
wear then these will be replaced by the Trust at reasonable
time periods.
6.4.8 Uniforms damaged by the wearer, e.g. not following care
instructions, making alterations, will be replaced at the wearer’s
own cost.
Care instruction guidelines are attached to this
policy (Appendix 2).
6.4.9 It is the individual’s responsibility to return uniforms to their
manager when employment with the Trust ceases. Failure to
do so will result in a charge to the individual/deduction from
final salary being made. The manager will be responsible for
returning uniforms to Linen Services. Where uniforms have
not been returned, the manager will need to inform Linen
Services and request costings so that they (the manager) can
send appropriate costings to Pay Services in order for the
relevant charge/deduction to be made to the individual.
Information on charges can be obtained from Linen Services
Management.
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6.5. 6.5.1 Requests to wear uniform outside Trust premises for formal
occasions or where promoting the Trust must be authorised by
the Matron/Department Manager as appropriate
7.0
Training and Implementation
7.1
Training
Managers need to ensure all staff are aware of the requirements and
adhere to the policy.
7.2
Implementation
7.2.1 All line managers must ensure this policy is cascaded to their
current staff and monitor implementation and compliance
7.2.2 All new staff and volunteers must receive the policy. This
should include employees of the Trust and employees of other
organisations who work at the Trust. Agency staff, work
experience placements and contractors must also be made
aware of and adhere to the Policy
7.2.3 The policy will be reviewed every 3 years
7.3
Resources
7.3.1 Application of this revised policy will be in line with the existing
resources of the Human Resources department.
8.0
Trust Impact Assessments
8.1
Equality Impact Assessment
A review of the equality impact assessment has been undertaken on
this document and has not indicated that any additional
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considerations are necessary.
8.2
Environmental Impact Assessment
An environmental impact assessment has been undertaken on this
document and has not indicated that any additional considerations
are necessary
8.3
Here For You Assessment
A Here For You assessment has been undertaken and has not
indicated that any additional considerations are necessary.
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9.0
Policy / Procedure Monitoring Matrix
Minimum
requirement
to be
monitored
Responsible
individual/
group/
committee
Adhere to
dress code
and uniform
standards
All Managers
Partnership
Committee if
any issues
10.0
10.1
Process
for
monitoring
e.g. audit
Any issues
raised
Frequency
of
monitoring
Responsible
individual/
group/
committee for
review of
results
Responsible
individual/
group/
committee
for
development
of action plan
Responsible
individual/
group/
committee
for monitoring
of action plan
Ongoing
Human
Resources
and Staff
Side
Partnership
Committee
Human
Resources
Partnership
Committee
Partnership
Committee
Monthly
Relevant Legislation, National Guidance and Associated NUH
Documents
•
•
•
•
•
•
Equality Act 2010
Employment Relations Act (1999)
Rehabilitation of Offenders Act (1974)
Human Rights Act (1998)
Trade Union and Labour Relations (Consolidation) Act 1992
Part Time Workers - Prevention of Less Favourable Treatment
Regulations (2001)
• Fixed Term Employees - Prevention of Less Favourable
Treatment Regulations (2002)
• Health & Safety At Work Act (1974)
• Agency Worker Regulations (2010)
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APPENDIX 1
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APPENDIX 2
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APPENDIX 3
Equality Impact Assessment (EQIA) Form (Please complete all sections)
Q1. Date of Assessment: March 2014
Q2. For the policy and its implementation answer the questions a – c below against each characteristic (if
relevant consider breaking the policy or implementation down into areas)
a) Using data and supporting
b) What is already in place in c) Please state any
Protected
information, what issues,
the policy or its
barriers that still need to
Characteristic
needs or barriers could the
implementation to address
be addressed and any
protected characteristic
any inequalities or barriers to proposed actions to
groups experience? i.e. are
access including under
eliminate inequality
there any known health
representation at clinics,
inequality or access issues to
screening
consider?
The area of policy or its implementation being assessed:
Race and
Ethnicity
Gender
None
Not applicable
Not applicable
None
Not applicable
Not applicable
Age
None
Not applicable
Not applicable
Religion
None
Not applicable
Not applicable
Disability
None
Not applicable
Not applicable
Sexuality
None
Not applicable
Not applicable
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Pregnancy and
Maternity
Gender
Reassignment
Marriage and
Civil Partnership
Socio-Economic
Factors (i.e.
living in a poorer
neighbour hood
/ social
deprivation)
None
Not applicable
Not applicable
None
Not applicable
Not applicable
None
Not applicable
Not applicable
None
Not applicable
Not applicable
Area of service/strategy/function
Q3. What consultation with protected characteristic groups inc. patient groups have you carried out?
Q4. What data or information did you use in support of this EQIA?
Q.5 As far as you are aware are there any Human Rights issues be taken into account such as arising from
surveys, questionnaires, comments, concerns, complaints or compliments?
Q.6 What future actions needed to be undertaken to meet the needs and overcome barriers of the groups
identified or to create confidence that the policy and its implementation is not discriminating against any
groups
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What
Q7. Review date
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By Whom
By When
Resources required
June 2017
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APPENDIX 4
Environmental Impact Assessment
The purpose of an environmental impact assessment is to identify the environmental impact of policies, assess the
significance of the consequences and, if required, reduce and mitigate the effect by either, a) amend the policy b)
implement mitigating actions.
Area of
impact
Environmental Risk/Impacts to consider
Waste and • Is the policy encouraging using more materials/supplies?
materials
• Is the policy likely to increase the waste produced?
• Does the policy fail to utilise opportunities for
introduction/replacement of materials that can be recycled?
Soil/Land • Is the policy likely to promote the use of substances
dangerous to the land if released (e.g. lubricants, liquid
chemicals)
• Does the policy fail to consider the need to provide adequate
containment for these substances? (e.g. bunded containers,
etc.)
Water
• Is the policy likely to result in an increase of water usage?
(estimate quantities)
• Is the policy likely to result in water being polluted? (e.g.
dangerous chemicals being introduced in the water)
• Does the policy fail to include a mitigating procedure? (e.g.
modify procedure to prevent water from being polluted;
polluted water containment for adequate disposal)
Air
• Is the policy likely to result in the introduction of procedures
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Action Taken (where
necessary)
Not applicable
Not applicable
Not applicable
Not applicable
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•
•
Energy
•
Nuisances
•
and equipment with resulting emissions to air? (e.g. use of a
furnaces; combustion of fuels, emission or particles to the
atmosphere, etc.)
Does the policy fail to include a procedure to mitigate the
effects?
Does the policy fail to require compliance with the limits of
emission imposed by the relevant regulations?
Does the policy result in an increase in energy consumption
levels in the Trust? (estimate quantities)
Would the policy result in the creation of nuisances such as
noise or odour (for staff, patients, visitors, neighbours and
other relevant stakeholders)?
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Not applicable
Not applicable
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APPENDIX 5
We Are Here For You Policy and Trust-wide Procedure Compliance Toolkit
The We Are Here For You service standards have been developed together with more than 1,000 staff and
patients. They can help us to be more consistent in what we do and say to help people to feel cared for, safe
and confident in their treatment. The standards apply to how we behave not only with patients and visitors, but
with all of our colleagues too. They apply to all of us, every day, in everything that we do. Therefore, their
inclusion in Policies and Trust-wide Procedures is essential to embed them in our organization.
Please rate each value from 1 – 3 (1 being not at all, 2 being affected and 3 being very affected)
Value
1.
Polite and Respectful
Whatever our role we are polite, welcoming and positive in the face of adversity, and are always
respectful of people’s individuality, privacy and dignity.
2.
Communicate and Listen
We take the time to listen, asking open questions, to hear what people say; and keep people
informed of what’s happening; providing smooth handovers.
3.
Helpful and Kind
All of us keep our ‘eyes open’ for (and don’t ‘avoid’) people who need help; we take ownership of
delivering the help and can be relied on.
4.
Vigilant (patients are safe)
Every one of us is vigilant across all aspects of safety, practices hand hygiene & demonstrate
attention to detail for a clean and tidy environment everywhere.
5.
On Stage (patients feel safe)
We imagine anywhere that patients could see or hear us as a ‘stage’. Whenever we are ‘on stage’
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Score (13)
1
1
1
2
2
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we look and behave professionally, acting as an ambassador for the Trust, so patients, families and
carers feel safe, and are never unduly worried.
6.
Speak Up (patients stay safe)
We are confident to speak up if colleagues don’t meet these standards, we are appreciative when
they do, and are open to ‘positive challenge’ by colleagues
7.
Informative
We involve people as partners in their own care, helping them to be clear about their condition,
choices, care plan and how they might feel. We answer their questions without jargon. We do the
same when delivering services to colleagues.
8.
Timely
We appreciate that other people’s time is valuable, and offer a responsive service, to keep waiting to
a minimum, with convenient appointments, helping patients get better quicker and spend only
appropriate time in hospital.
9.
Compassionate
We understand the important role that patients’ and family’s feelings play in helping them feel better.
We are considerate of patients’ pain, and compassionate, gentle and reassuring with patients and
colleagues.
10. Accountable
Take responsibility for our own actions and results
11. Best Use of Time and Resources
Simplify processes and eliminate waste, while improving quality
12. Improve
Our best gets better. Working in teams to innovate and to solve patient frustrations
TOTAL
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1
1
1
2
1
2
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APPENDIX 6
CERTIFICATION OF EMPLOYEE AWARENESS
Document Title
Dress Code & Uniform Policy
Version (number)
5
Version (date)
25 November 2014
I hereby certify that I have:
• Identified (by reference to the document control sheet of the above
policy/ procedure) the staff groups within my area of responsibility to
whom this policy / procedure applies.
• Made arrangements to ensure that such members of staff have the
opportunity to be aware of the existence of this document and have the
means to access, read and understand it.
Signature
Print name
Date
Directorate/
Department
The manager completing this certification should retain it for audit and/or other
purposes for a period of six years (even if subsequent versions of the
document are implemented). The suggested level of certification is;
• Clinical directorates - general manager
• Non clinical directorates - deputy director or equivalent.
The manager may, at their discretion, also require that subordinate levels of
their directorate / department utilize this form in a similar way, but this would
always be an additional (not replacement) action.
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