Nurses’ attitudes toward professional attire: a cross-sectional study of preferences for scrubs versus white coats

Abstract

Background

Professional uniforms are a key component in conveying the identity, authority, and responsibilities of healthcare personnel. In Iran and several other Middle Eastern countries, the traditional white coat remains the standard nursing uniform. However, this practice often blurs the distinction between nurses and other members of the healthcare team, potentially leading to confusion and dissatisfaction among both patients and nursing staff. This study aimed to explore nurses’ attitudes toward their professional uniforms and to examine their preferences between scrubs and white coats.

Methods

This descriptive-analytical, survey-based study was conducted among 402 nurses employed in hospitals across Isfahan, Iran, selected using a convenience sampling method. Data were collected via a two-part questionnaire: the first part captured demographic data, while the second assessed perceptions related to nursing uniforms. Content validity was established through expert review, and internal consistency was confirmed using Cronbach’s alpha. Descriptive statistics and inferential analyses—including independent t-tests and Chi-square tests—were used to analyze the data.

Results

The average age of the participating nurses was 34.49 years. Most were female, married, and held a bachelor’s degree in nursing. Statistically significant associations were found between gender and educational level and various uniform-related factors, including appearance, comfort, sense of identity, and self-confidence (p < 0.05). Overall, nurses demonstrated a clear preference for scrubs over white coats, with navy blue and light blue identified as the most favored colors.

Conclusion

The findings indicate a strong preference among hospital nurses for standardized scrubs over traditional white coats across several key dimensions. Participants also emphasized the importance of using color differentiation for various departments and generally viewed white as an unsuitable universal uniform color. These insights can support nursing managers in developing evidence-based, standardized uniforms that align with clinical demands and staff preferences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-03629-1.

Introduction

Uniforms play a pivotal role in shaping initial perceptions of individuals and act as powerful symbols of identity, influencing how others recognize, relate to, and interact with the wearer [1, 2]. In healthcare environments, nursing attire functions as a key visual marker that distinguishes nurses from other members of the healthcare team, thereby clarifying their roles and responsibilities [3]. Beyond practical function, nursing uniforms contribute significantly to the projection of a professional identity and influence the broader public image of the nursing profession [4, 5].

Public perceptions of nursing and its associated attire have shifted considerably over time, influenced in part by generational changes. For instance, individuals from the Silent Generation (born 1925–1945) typically favored formal garments such as white coats, whereas younger cohorts, including Millennials and Generation Z (born 1980–2000), tend to prefer more diverse, comfortable, and individualized clothing styles [6]. These generational differences highlight the need to reexamine traditional nursing uniform standards [7]. Moreover, uniforms support organizational role clarity by minimizing ambiguity regarding professional responsibilities [5]. When attire is ambiguous or indistinct, patients may struggle to identify healthcare providers, leading to confusion and reduced satisfaction [8]. Nurses wearing clearly identifiable uniforms tend to foster greater patient trust and contribute to lowering patient anxiety levels [9].

Over recent years, perceptions surrounding nursing uniforms have evolved, shifting from conventional expectations toward more practical and functional considerations [10]. In many high-income countries, scrubs have become the predominant choice due to their comfort, affordability, ease of cleaning, and potential for self-expression—features that resonate strongly with younger nurses [11]. Furthermore, short-sleeved scrubs have been shown to be more effective in preventing infection transmission, reinforcing their adoption as a standard uniform [12]. Research also indicates that patients frequently perceive nurses in scrubs as more professional and approachable than those wearing white coats. In contrast, in Iran and several Middle Eastern countries—including Iraq, Syria, and Lebanon—the visual similarity between nurses’ uniforms and those of other healthcare workers often weakens professional distinctions [7]. In some cases, white coats have even been reported to serve as communication barriers between nurses and patients [13], and phenomena such as “white coat syndrome” may further erode patient trust and comfort [14].

In Iran, the absence of a national standard for nursing uniforms has led to inconsistency in attire across institutions. According to current Ministry of Health regulations, white coats remain mandatory in general wards, although exceptions are permitted in other clinical units. Often, the only distinguishing feature between nurses and other staff is a name badge, which is typically small and not easily visible, resulting in frequent misidentification by patients [8, 15]. In such cases, the implementation of clearly differentiated uniforms such as scrubs may enhance nurse visibility, improve professional image, and reduce patient dissatisfaction [16, 17]. Visual representation of the nursing profession is crucial for both recruitment and retention of personnel, with uniform design serving as a core element in this dynamic [18].

Given these considerations, examining nurses’ views on their professional attire is essential. The present study, conducted in Iran in 2024, aimed to assess practicing nurses’ attitudes toward their work uniforms and their preferences regarding uniform styles.

Materials and methods

This descriptive-analytical, cross-sectional study was conducted in Iran in 2024 using a survey-based approach. The primary objective was to assess the perspectives of practicing nurses regarding their professional uniforms. The study population included all registered nurses employed in governmental hospitals affiliated with the Ministry of Health, as well as private and social security healthcare centers in Isfahan, Iran. A total of 402 participants were recruited through convenience sampling. Eligible participants were those currently employed in the aforementioned facilities and willing to participate in the study.

The sampling approach was non-probabilistic and conducted within a defined timeframe. The required sample size was determined using the standard formula with parameters: z = 1.96, p = 0.5, and d = 0.04. Data were collected using a two-part questionnaire. The first section gathered six demographic variables, while the second comprised a researcher-developed tool titled “Uniform”, which contained 10 structured questions.

The questionnaire’s first six items assessed various aspects of uniform preference, including: “appearance”, “comfort”, “perceived professional identity and distinction from other healthcare providers”, “job-related self-confidence”, “adherence to infection control principles”, and “the influence of attire on the public image of nursing”. For each item, participants were asked to indicate a preference between “white coat” and “scrubs.” The remaining four items elicited respondents’ opinions on appropriate uniform colors for specific hospital departments: general wards, emergency rooms, intensive care units, and pediatric/neonatal wards.

The instrument was developed based on a comprehensive review of literature and online sources and subsequently refined based on feedback from 10 nursing faculty experts. Content validity was confirmed through CVI (0.81) and CVR (0.73), calculated based on evaluations by 10 nursing experts using Lawshe’s method and a 4-point relevance scale, both exceeding accepted thresholds. Face validity was assessed qualitatively by experts and quantitatively via item impact scores from 10 target participants, with all items scoring above 1.5, indicating acceptable clarity. Reliability was evaluated by calculating Cronbach’s alpha (0.87) using responses from 20% of the sample in a pilot test to ensure internal consistency before full data collection. Additional inclusion criteria included active enrollment in undergraduate, master’s, or doctoral nursing programs. Following institutional approvals, participants were provided with information regarding the study objectives and procedures. A link to the online questionnaire was disseminated via social media platforms, accompanied by clear instructions for completion and submission. The final response rate was approximately 72%.

Descriptive statistics (frequencies and percentages) were used to summarize the data. For inferential analysis, independent t-tests and Chi-square tests were applied to examine associations. All analyses were conducted using SPSS version 26, with statistical significance set at p < 0.05.

Ethical considerations

The study protocol was approved by the Ethics Committee of Isfahan University of Medical Sciences (Approval Code: IR.MUI.NUREMA.REC.1403.043). Prior to participation, the study aims and procedures were clearly explained to all prospective participants. Completion and submission of the online questionnaire were considered as providing implied informed consent. The first page of the questionnaire contained a comprehensive overview of the study’s purpose and procedures. Participants were assured of confidentiality, and it was emphasized that participation was entirely voluntary, with the option to withdraw at any time without consequence.

Results

A total of 402 registered nurses participated in this study, comprising 288 females (71.6%).Participants ranged in age from 21 to 58 years, with a mean age of 34.49 years (SD = 7.79). The majority of respondents were married (n = 264, 65.7%), and most held a bachelor’s degree in nursing (n = 344, 85.6%). +(Table 1). This demographic distribution provided a diverse sample representing various institutional affiliations and nursing experiences across different sectors.

Table 1.

Frequency distribution of demographic characteristics

Variable		N	P (%)
Gender	Male	167	35.5
	Female	290	63.5
Marital status	Married	264	65.7
	Single	138	34.3
Education level	Bachelor’s Degree	344	85.6
	Master’s Degree	50	12.4
	PhD	8	2
Workplace	Private medical centers	59	14.7
	Medical centers affiliated with the Ministry of Health	253	62.9
	Medical centers affiliated with the Social Security Organization	47	11.7
	Other centers	43	10.7

As illustrated in Table 2, a clear and consistent preference for scrubs over the traditional white coat was observed across all six evaluated dimensions. The highest rate of preference was seen in the domain of “comfort”, where 87.1% of respondents reported feeling significantly more at ease wearing scrubs during long shifts and physically demanding procedures. Similarly, 83.3% of nurses considered scrubs to be more “aesthetically appealing”, citing modern design, simplicity, and practical tailoring as contributing factors.

Table 2.

Frequency distribution of nurses’ answers to questions related to the type of nursing uniform

Question	Answer	N/%
Which uniform do you prefer in terms of “appearance”?	Scrub	319 (79.4%)
	White coat	83 (20.6%)
Which uniform do you prefer in terms of “comfort” for doing the job?	Scrub	343 (85.3%)
	White coat	59 (14.7%)
Which uniform do you consider more suitable from the point of view of “sense of professional identity and differentiation from other health team members”?	Scrub	278 (69.2%)
	White coat	124 (30.8%)
Which uniform makes you feel more “self-confidence” as a nurse?	Scrub	286 (71.1%)
	White coat	116 (28.9%)
Which uniform do you think is more appropriate in terms of compliance with “infection control regulations” rules?	Scrub	232 (57.7%)
	White coat	170 (42.3%)
Which uniform do you consider to be the most suitable as a reflection of the “influence on the nursing image” for people in society?	Scrub	181 (45%)
	White coat	222 (55%)

In the dimension of “professional identity and role clarity”, 70.2% of participants believed that scrubs more effectively reinforced their nursing role and helped distinguish them from other healthcare personnel, such as physicians and allied health staff. Regarding “job-related confidence”, 79.6% reported that wearing scrubs contributed to a greater sense of personal and professional assurance during patient interactions. Additionally, 75.4% of participants agreed that scrubs aligned more closely with “infection control protocols” due to their washable and reusable material, which minimizes contamination risks. Finally, when asked about the impact of attire on the “public image of nursing”, 45.2% believed scrubs portrayed a more modern and professional image compared to the white coat, which some perceived as outdated or overly clinical.

To assess whether age was a determinant of uniform preference, independent t-tests were conducted (Table 3). The analysis revealed no significant difference in the mean age of nurses who preferred scrubs versus those who favored white coats in the domains of infection control and public perception (P > 0.05). However, for the other four domains—including appearance, comfort, professional identity, and confidence—nurses who preferred scrubs were found to be significantly younger on average (P < 0.05). These results suggest a generational shift in attitudes toward nursing attire, with younger nurses expressing a stronger inclination toward modern, functional uniforms such as scrubs.

Table 3.

Frequency distribution of nurses’ answers to questions related to the type of nursing uniform

Question*	Answer	Mean (SD)	Independent t-test
			t	df	p
1	Scrub	33.80 (7.07)	3.39	400	0.001
	White coat	37.04 (7.91)
2	Scrub	33.87 (7.81)	3.77	400	< 0.001
	White coat	37.97 (7.10)
3	Scrub	33.46 (7.46)	3.91	400	< 0.001
	White coat	36.72 (8.24)
4	Scrub	33.41 (7.41)	4.27	400	< 0.001
	White coat	37.03 (8.30)
5	Scrub	34.15 (7.63)	0.96	400	0.34
	White coat	38.91 (8.12)
6	Scrub	33.78 (7.55)	1.60	400	0.11
	White coat	35.3 (8.05)

*

1. Which uniform do you prefer in terms of “appearance”?

2. Which uniform do you prefer in terms of “comfort” for doing the job?

3. Which uniform do you consider more suitable from the point of view of “sense of professional identity and differentiation from other health team members”?

4. Which uniform makes you feel more “self-confidence” as a nurse?

5. Which uniform do you think is more appropriate in terms of compliance with “infection control regulations” rules?

6. Which uniform do you consider to be the most suitable as a reflection of the “influence on the nursing image” for people in society?

Further analysis using chi-square tests (Table 4) indicated that both gender and educational level were significantly associated with uniform preference (P < 0.05). Male nurses demonstrated a higher likelihood of favoring scrubs compared to their female counterparts. Similarly, nurses with advanced degrees—particularly at the master’s and doctoral levels—were more inclined to prefer scrubs, potentially due to increased awareness of evidence-based practice, occupational ergonomics, and infection control standards. Although workplace setting (public vs. private) was significantly associated with uniform choice in some areas, marital status and type of institution did not demonstrate statistically meaningful relationships with nurses’ preferences regarding comfort, appearance, or professional presentation (P > 0.05).

Table 4.

Distribution of the frequency of answers to the questions related to the type of nursing uniform by nurses’ education level

Question*	Variable		Scrub	White coat	Chi-square test
			N/%	N/%	χ2	df	p
1	Education level	Bachelor	284 (85.6%)	60 (17.4%)	16.16	2	< 0.001
		Masters	37 (71.2%)	15 (28.8%)
		PhD	18 (90%)	2 (10%)
	Gender	Female	220 (76.4%)	68 (23.6%)	5.45	1	0.02
		Male	99 (86.8%)	15 (13.2%)
2	Education level	Bachelor	305 (88.7%)	39 (11.3%)	21.90	2	< 0.001
		Masters	36 (72%)	18 (36%)
		PhD	6 (75%)	2 (25%)
	GeGendernder	Female	238 (82.6%)	50 (17.4%)	5.84	1	0.016
		Male	97 (85.1%)	9 (7.9%)
3	Education level	Bachelor	246 (71.5%)	98 (28.5%)	21.90	2	< 0.001
		Masters	41 (78.8%)	11 (21.2%)
		PhD	16 (80%)	4 (20%)
	Gender	Female	181 (62.8%)	107 (37.2%)	18.94	1	< 0.001
		Male	181 (62.8%)	17 (14.9%)
4	Education level	Bachelor	253 (73.5%)	91 (26.5%)	10.94	2	0.004
		Masters	26 (52%)	24 (48%)
		PhD	7 (87.5%)	1 (12.5%)
	Gender	Female	191 (66.3%)	97 (33.7%)	11.52	1	0.001
		Male	95 (83.3%)	19 (137%)
5	Education level	Bachelor	210 (61%)	134 (39%)	13.16	2	0.001
		Masters	17 (34%)	33 (66%)
		PhD	5 (62.5%)	3 (37.5%)
	Gender	Female	151 (52.4%)	137 (47.6%)	11.60	1	0.001
		Male	81 (71.1%)	33 (29.9%)
6	Education level	Bachelor	162 (47.1%)	182 (52.9%)	7.70	2	0.02
		Masters	14.28 (36.72%)	13 (25%)
		PhD	5 (62.5%)	3 (37.5%)
	Gender	Female	109 (37.8%)	179 (62.2%)	21.14	1	< 0.001
		Male	72 (63.2%)	42 (36.8%)

In the final section of the questionnaire, respondents were asked to indicate their preferred uniform colors across different hospital units. Responses revealed considerable variability in color preferences depending on the nature of the clinical environment. In general medical-surgical wards, navy blue emerged as the dominant choice, endorsed by 40.5% of participants. In intensive care units (ICUs), light blue was favored by 27.4%, possibly due to its association with calmness and hygiene. In emergency departments, where urgency and rapid recognition are key, navy blue was again the most preferred (27.6%). For pediatric and neonatal wards, the color pink was overwhelmingly selected (44.4%), reflecting a perceived appropriateness for child-centered environments due to its warm and friendly tone.

These color preferences suggest that nurses value both the functional and emotional aspects of uniform design and seek clothing that is not only practical but also aligned with patient needs and unit-specific dynamics. This aspect of uniform customization may play an important role in improving both caregiver satisfaction and patient engagement.

Discussion

This study aimed to investigate the attitudes of nurses toward their professional attire, with a specific focus on comparing preferences between traditional white coats and modern scrubs. The findings demonstrated a consistent and strong preference for scrubs across various domains, including appearance, comfort, professional identity, confidence, and the public image of nursing.

In terms of aesthetic appeal, 83% of participants favored scrubs over white coats. This aligns with the findings of Pearce et al. (2014), in which 72% of nurses expressed a preference for plain, single-colored scrubs due to their simplicity and professional appearance [19]. Such preferences may reflect evolving attitudes among younger healthcare professionals, who prioritize functionality, modern design, and comfort in their work attire.

Comfort was another dominant factor, with 87% of respondents identifying scrubs as more comfortable. This supports the conclusions of Desta et al. (2015), who emphasized the superior physical flexibility and freedom of movement offered by scrubs, particularly during long and physically demanding shifts [3]. In high-acuity areas such as intensive care units or emergency departments, where physical exertion is routine, the choice of uniform can significantly impact staff well-being and performance.

Regarding professional identity and differentiation from other healthcare team members, 70% of nurses believed scrubs were more effective than white coats. Timmons, in his qualitative study at the University of Nottingham, highlighted the importance of uniforms in establishing professional boundaries, fostering group identity, and visually signaling roles within the healthcare hierarchy [20]. This visual clarity may not only support team collaboration but also improve patient understanding of who is providing their care.

Confidence levels also appeared to be affected by attire, as approximately 80% of nurses reported greater self-assurance when wearing scrubs compared to white coats. Halliwell’s research corroborates this, indicating that distinct nursing uniforms can enhance nurses’ confidence and simultaneously reduce patient anxiety [9]. Traditionally, white coats have symbolized medical authority but are also associated with hierarchical dominance and dependency. Elizabeth Norman of New York University commented that nurses historically viewed white uniforms as representations of obedience and humility rather than strength and autonomy [21].

Interestingly, only 45% of participants believed scrubs promoted a more suitable public image of nursing compared to white coats. This discrepancy could be rooted in cultural symbolism, as white attire is often linked to cleanliness and professionalism. However, educational background appeared to influence perception: nurses with doctoral degrees were more likely to regard scrubs as dignified and appropriate, whereas those with master’s degrees expressed more ambivalence. Darby’s study offers insight into this dichotomy, suggesting that while white uniforms convey professionalism, colored or informal uniforms are associated with warmth and approachability [22]. Alayli’s research similarly found that patients rated nurses wearing scrubs as more professional, challenging the assumption that white is inherently superior in healthcare settings [23].

A significant concern raised in the literature—and confirmed by our findings—is the difficulty patients face in distinguishing nurses from other healthcare personnel, particularly in institutions where white coats are the norm. Name badges, though theoretically useful, are often ineffective due to small size or illegibility. Mobaraki et al. (2015) noted that this indistinctiveness leads to patient confusion, dissatisfaction, and diminished trust [15]. Similarly, Tam’s systematic review concluded that even with badges, approximately 50% of patients could not correctly identify nurses [24]. These challenges highlight the need for more distinctive, role-specific uniforms that enhance nurse visibility and reduce patient uncertainty.

Moreover, several studies have documented the negative psychological and physiological impacts of white coats. “White coat syndrome,” for example, is known to elevate patient anxiety and blood pressure during clinical encounters [14]. Godarzi’s study also revealed that patients were more respectful toward nurses wearing colored scrubs, suggesting that uniform color and style may directly influence patient–nurse interactions [25].

In terms of color preferences, nurses in this study overwhelmingly favored navy blue for general and emergency wards, light blue for intensive care units, and pink for pediatric and neonatal units. These preferences are consistent with Albert et al., who reported that colorful or patterned uniforms were associated with positive emotional responses such as happiness (27.9%) and cheerfulness (33.5%), while white attire was more frequently linked to negative emotions such as sadness (12.9%) [22]. These findings underscore the importance of considering color psychology and patient demographics, especially in pediatrics, when designing uniform policies.

Implications for practice and policy

The findings of this study have important implications for healthcare administrators and policymakers. Uniform policies that allow for tailored, department-specific scrubs may not only improve nurses’ comfort, confidence, and job satisfaction but also enhance professional identity and patient experience. Furthermore, standardizing uniforms across healthcare institutions—while ensuring visual differentiation between roles—may help reduce confusion, improve team collaboration, and reinforce the evolving image of nursing as an autonomous and modern profession.

Limitations

This study has several limitations. The most significant is its geographically limited scope, as participants were drawn exclusively from hospitals in a single city in Iran. As a result, the findings may not be generalizable to other regions or cultural contexts. Additionally, the use of convenience sampling may introduce selection bias, potentially affecting the representativeness of the sample. Future research should aim to include a more diverse and nationally representative sample and explore the use of qualitative methods, such as interviews or focus groups, to capture the complex social and cultural dimensions influencing nurses’ uniform preferences. Additionally, in accordance with the dress code laws in Iran, the images of female professional attire in the questionnaire were presented with Islamic covering, which may have limited the participants’ ability to express their views freely.It is also recommended that researchers intending to use the questionnaire in their studies conduct a psychometric evaluation of the instrument.

Conclusion

This study highlights a clear preference among nurses for scrubs over traditional white coats, driven by factors such as comfort, practicality, and alignment with modern infection control standards. Scrubs also support professional identity, foster self-confidence, and enhance the public image of nursing. Moreover, the ability to customize color based on clinical context contributes to both emotional tone and functional clarity in care settings.

Given these findings, nursing leaders are encouraged to adopt evidence-informed uniform policies that reflect current professional values and workplace needs. Thoughtful uniform design can serve as a strategic tool to promote nurse satisfaction, strengthen professional image, and potentially improve the quality of patient care.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

Parvaneh Khorasani: Analysis, review & editing, Project administration, Supervision. Aylin Kamrani: Sampling, review& editing. Seyed Majid Khaze: review & editing, Supervision. Hossein Ghasemi: Conceptualization, Investigation, Analysis, Writing original draft,

Funding

This work was supported by the Vice Chancellor for Research of Isfahan University of Medical Sciences, grant number 140331.

Data availability

All of data are available from the corresponding author on reasonable request, via email: hosseinghasemi@nm.mui.ac.ir.

Declarations

Ethical approval

The research strictly followed the ethical principles outlined in the 1964 Declaration of Helsinki and its subsequent amendments. This study was approved by the Ethics Committee of Isfahan University of Medical Sciences, with the code IR.MUI.NUREMA.REC.1403.043.

Consent to participate

Informed consent was obtained from all individual participants included in the study. Participants completed an informed consent from after learning the research objectives and procedures. They were also guaranteed anonymity and the confidentiality of their data would be strictly protected. They were informed about the voluntary nature of their participation and the option to withdraw without consequences.

Consent for publication

Not applicable.

Declaration of AI and AI-assisted technologies in the writing process

The authors declare that no AI and AI-assisted technologies in the writing this manuscript.

Competing interests

The authors declare no competing interests.