Whatever Became of Nursing Caps?

Frilly or starched, they were once icons of the profession

White nursing cap with frills on the base, lays on top of a black counter

Ask a working nurse today about nursing caps and she will probably tell you about the oversized paper bonnet that covers the hair during surgical procedures and is tossed out after a single use.

Ask a retired nurse, however, and it’s likely her eyes will glaze over with nostalgia. She’ll tell you about her early career and the pride she took in her spotless uniform and neatly starched white cap.

Finding out where one era stopped and the current capless one began took a little bit of sleuthing. Like so many things in our profession, the transition didn’t happen all at once.

From Nuns to Nightingale

First, let’s recap (no pun intended) some history of nursing. The first nurses — if you were lucky — were members of your own family, probably women, who learned how to be medical caretakers from friends and other family members.

Many early midwives fell into this category. Few of these early lay nurses had any formal training, and they didn’t wear a distinctive uniform.

Later, nuns (and occasionally monks) took on this same role for the indigent and those with no families to care for them. Because many early hospitals were founded by religious orders, care for the sick became associated with the nun’s habit.

It was Florence Nightingale (1820–1910) who fought to transform nursing into a secular profession by setting standards of practice for nurses. Part of that process was establishing a “look” for her nurses that would clearly identify their role while distinguishing them from nuns.

Thus, around the 1860s, the nun’s bandeau and veil gradually gave way to a shorter, simpler head covering.

A Cap for Every Program

In the late 1800s, New York City’s Bellevue Hospital became the first nursing school in the United States to be founded on Nightingale’s principles, offering a one-year training program.

By 1900, our country had more than 400 hospital-based nursing schools, with curriculums ranging from six months to two years.

Filling hospital positions was the central goal, so nurse training soon evolved into a three-year apprenticeship, with student nurses working long hours on the floors while continuing some additional academic classes.

Just as each school set its own standards, each hospital also adopted its own student nurse uniforms. The designs varied, but most included a cap as well as a dress and smock or pinafore, often covered by an apron.

A nursing student usually started with a basic white cap, to which stripes or ribbons were added as she advanced. These cap variations enabled patients and hospital staff to easily distinguish trained nurses from students on the floor.

The distinctive designs were also an early example of “branding”: Your cap signified that you were part of a particular program.

Although most hospital-based nursing programs were intended to prepare you for a job in that hospital, if you left to seek employment elsewhere, you took the cap with you. Knowledgeable colleagues could identify where you had trained just by looking at your cap.

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Receiving your cap marked a milestone in your career. It was a badge of honor that promoted a sense of identity and a feeling of community.

Since most places didn’t yet have mandatory nurse registration (the first state to establish formal licensing procedures for nurses was North Carolina, in 1903, and it wasn’t required until years later), your cap was also evidence of your formal training.

Wartime Need

Nurses — and nursing caps — took on a new importance during World War 2. After the U.S. entered the war in December 1941, the government quickly realized that the country didn’t have sufficient nurses to handle the needs of both the civilian population and the wartime military.

Congress responded by passing the Bolton Act, also known as the Nurse Training Act of 1943. This law established financial incentives for schools that would shorten the length of nurse training as well as expanding enrollment.

The goal was to recruit 65,000 female high school graduates in 1943–44 and another 60,000 the following year.

Many new nursing programs appeared as two-year colleges and diploma schools entered the fray, chasing the federal funds. Soon, nurses were finishing their training in less time and delegating to Red Cross volunteers some of their former tasks that required less education.

By the war’s end in 1945, about 10 percent of young women finishing high school in the U.S. were entering nursing training. All this made registered nursing more prominent and more prestigious than ever.

It’s at this point that the real value of the cap became evident. It was a symbol that people immediately recognized and respected.

Nurses Reminisce

Recently, while attending a luncheon for about 30 retired nurses from Hackensack Hospital in New Jersey, I asked the nurses sitting at the table with me about their caps, which generated some spirited conversation.

Sarah Frietag, who now lives in Oregon after a long career as a nurse practitioner in VA hospitals, was my best friend in nursing school 40 years ago. She remembers receiving her cap from her father at a ceremony during her sophomore year, although she doesn’t recall ever actually wearing the cap in the hospital.

My neighbor Sheila Kutik, who received her nursing training in Davenport, Iowa, remembers two separate ceremonies: receiving her basic cap (to which stripes were added as she advanced) and another “lamp of learning” ceremony at the beginning of her nursing studies.

Caps came in all shapes and sizes. Mary Ellen Cameron, who trained in a diploma program at Hackensack Hospital and worked with me in labor & delivery in the ‘80s, recalls a simple paper folded cap that couldn’t really be cleaned and had to be replaced frequently.

Sheila Kutik says her cap had cufflink-like buttons that held its folds in shape.

Nurses who trained at Bellevue Hospital in New York City wore something that looked like a ruffled maid’s cap. One nurse from New Jersey told me that her cap looked like a miniature white witches’ hat.

Nursing Education

While I was talking to the head librarian at my local library about finding background information for this article, another employee overheard our conversation and said, “My mother would love to talk to you about that.” She gave me her phone number.

I later spoke by phone with her mom, Michelle Kaufman, who finished her nurse training in 1969 at Mt. Sinai Hospital in Cleveland, Ohio.

She told me that in her first year, she was issued five grey uniforms with full skirts and aprons. She vividly remembers the white linen cap, which needed to be starched and then folded in a particular way. She laughed when she remembered row upon row of caps drying on shelves in her nursing dormitory.

Decline and Disappearance

By the 1970s, caps were becoming less commonly seen in hospitals. Men were slowly entering the profession, and there were no requirements for them to wear a head covering for most tasks.

As evidence-based practice came into being, it was also acknowledged that unless a cap covered all of the wearer’s hair, it was not effective for infection control. Caps were really more of an ornament, and not a very practical one.

Along with nostalgic memories, I heard many complaints about nursing caps. Mary Ellen Cameron told me that she began to get a bald spot in the area where her cap was pinned on her head, and had to stuff the cap with tissue to prevent the spot from getting worse.

Nancy Healy, another Hackensack Hospital nurse, recalled that when she was working in orthopedics in the mid 1970s, nurses on her floor were constantly hitting their caps on the frames that held the trapezes patients in body casts needed to move in their beds.

The nurses finally went directly to the administration to ask for permission to stop wearing caps, which was granted.

Eventually, just like doctor’s ties, nursing caps began to disappear. Michelle Kaufman thought that it was around 1974 when nurses were permitted to wear white slacks and tops as an alternative uniform choice. Most of the other nurses I asked had similar recollections, give or take a year.

Then came the unisex movement and the increase in specialty units. Soon, the main means of identification was the color of the popular scrubs everyone wore, and you had to look very carefully to discern who was an RN and who was a tech.

Some units barred name tags, which prompted the New York State Nurses Association to launch their “Ask for a real nurse” campaign around the year 2000.

As caps became less common, younger nurses’ fond memories began to focus more on the pinning ceremony and pins, which are easier to wear, more durable, more costly and probably more valuable.

So, what happened to all the caps? I found that many of the older nurses I talked to still have one, wrapped in plastic and stored in their attic. They would get a little misty when explaining that they folded and cared for it and just couldn’t throw it away.

The Last Holdouts

I graduated in 1979, a transfer student in my junior year to a four-year university nursing program. The last capping ceremony had been held the year before I arrived, so I never had one and never wore one. No administrator ever asked me where my cap was, so I believe by the early ‘80s, nursing caps were gone, at least as an official requirement.

However, old habits die hard. Nancy Blumenthal, another nurse from the Hackensack Hospital luncheon, told me an interesting story that was echoed by nurses from several other hospitals.

It seems that well into the next decade, each of their hospitals had at least one nurse — usually an older one, and often on a night shift — who continued to wear a full white uniform with heavy stockings, white shoes and a cap, long past when they were required.

That nurse was often the one you counted on when there was chaos because she was so experienced.

I think I knew a nurse like her too. She’s long since retired by now, but I’ll bet if you could find her, she would still know exactly where her cap is stashed.

CHRISTINE CONTILLO, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.

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