What is it about a nurse's hair that can provoke the most irrational and febrile disciplinary outrage from some nurse managers and health service executives? There seems no limit to the ways in which organisations try to exclude and persecute nurses for their chosen hairstyles. Many people ‘wonder what the fuss is all about’ as they believe that ‘it is only hair’, but for others, their hair is of important spiritual significance and deeply linked to culture and identity (Erasmus, 1997).
Black hairstyles are not some transient fashion fad. Many of these styles can trace their roots back as far as early African civilizations (Horne, 2019). They do not exist to be policed or prohibited by health services or managers. Nurses of white and Asian backgrounds come to work with their hair as part of their authentic selves without experiencing targeted harassment from managers or colleagues. Nurses of African Caribbean hair heritage should be afforded the same consideration (Jongman-Sereno and Leary, 2019).
For nurses in practice, the only meaningful requirements for their hair, and the only legitimate concerns for any nurse manager, are that hair should be clean, away from the face, up off the collar and not in the way of any procedures being undertaken. Every nurse will agree that hair has no place obscuring vision, needing minute-by-minute attention or spilling across wound sites or central venous pressure lines. Any other ‘requirements’ that hair should not be kept in locs, braids, puffs or any other style of natural black hair are simply racism cloaked in regulatory rhetoric (NHS Race & Health Observatory, 2021). Such arbitrary and capricious prohibitions have no place in today's nursing profession or among any other group of health professionals.
The authors have written previously about the demonstrable, systemic racism underlying so many current ‘dress codes’ and ‘hair policies' that specifically target black nurses’ hairstyles (Cox et al, 2021a; 2021b). Historically, black women have been raised to accept European norms of hair acceptability, having been warned that their careers will suffer and that they will be labelled as ‘unprofessional’ if they wear a natural black hairstyle (Sini, 2016).
Nurses have been told that their hair is the wrong colour, that it looks ‘frightening’, that they will have to ‘tone it down’ to be acceptable in clinical areas, that ‘patients won't like it’, that all hair must be ‘neatly combed’, that dreadlocks look ‘dirty and matted’, that black hairstyles cannot be ‘tidy’ and that black hairstyles ‘look unprofessional’. Taken individually, each of these insults could seem merely ignorant and irritating but, cumulatively, such racist microaggressions form a considerable pattern of violence against black nurses. It is also likely that many nurses with black hairstyles will have been subject to such ‘hair harassment’ (O'Brien-Richardson, 2019) throughout their childhoods (Joseph-Salisbury and Connelly, 2018; Dabiri, 2020). The message that such policies and dress codes send to black nurses could not be clearer or more blatant: ‘You, as you present today, are unacceptable and unwanted in our place. If you want to enter our place and be even remotely “accepted” here, then you must adhere to all of our established norms of appearance and presentation.’
Black nurses have already been interviewed and accepted for the roles they work in, but now face another unevidenced, micromanaging obstacle, focused, unmistakably, on their racial characteristics. Precedent and policy are thus set as objective, immutable, ‘Trust requirements’, that black hair in its natural and culturally established forms is unacceptable or ‘unprofessional’ in a predominantly white-governed health service. What is said to every black nursing colleague by such policies is that, ‘You must fit into our world of whiteness and we will not acknowledge anything you can contribute to creating a diverse and inclusive culture in our service.’
Nurses in any organisational leadership positions, whether these be clinical, executive or educational, have an ethical, social and professional responsibility not only to question, challenge and root out such racism wherever it is found, but to ensure that their organisations, schools and units are not guilty of perpetrating such hair discrimination. Nurse leaders and managers have no place to hide here. ‘I was only following policy’ or ‘I think that pink hair or dreadlocks are unprofessional’ is no defence.
The case against hair discrimination is so compelling (Lynch, 2020; Cox et al, 2021a; 2021b) that we need not restate it again here. The focus of this article is rather to help and support nurses who may find themselves victims of such hair racism and dress code discrimination.
What can nurses do?
What can clinical nurses or students do if they are told that their hairstyle is ‘unacceptable’, that it ‘doesn't comply with policy’ and that they must alter it if they want to continue to work as a nurse in this area? First, the authors recognise that this is a very difficult situation for any ‘new’ nurse in a clinical setting. There are marked power differentials that can be extremely intimidating, where a student or new clinician, especially a black nurse, is being told this by a senior nurse manager, Trust executive member or even an experienced senior clinician.
Professional organisations and the Nursing and Midwifery Council (NMC) offer advice to nurses regarding how to challenge discrimination (NMC, 2020).
Here are some additional suggestions for how nurses can respond to such edicts:
- Always confront discrimination early. It is more difficult to challenge microaggressions and racist policies if you have been seen to previously ‘go along with them’ without complaint
- Do not respond angrily with ‘all guns blazing’. This can be difficult, especially for nurses who have experienced such hair racism for almost all of their lives. This is an important strategy, however, as it confounds the ‘angry black man or woman’ stereotype that is so prevalent (Walley-Jean, 2009). Your aim here is an eloquent, evidence-informed, overturning of injustice, not a momentary emotional victory
- Listen carefully to what is being said and note the main points before responding. Explain why this policy is discriminatory. Make it clear that you will not be cutting off your hair or removing your braids or locs, but that you will always ensure that your hair is clean and neat and that it will not interfere in any way with nursing procedures
- Offer to share copies of the latest evidence and thinking from both clinical nursing (Cox et al, 2021b) and nursing management (Cox et al, 2021a), showing that hair discrimination has no place in nursing. Your stance is that evidence is important in all aspects of nursing, including practice and policy, and that you are willing to help review and ensure that any Trust policies are grounded in evidence, rather than uninformed prejudices that could leave the Trust vulnerable to accusations of racism and harassment or, worse, litigation
- Emphasise that this is not about blame or personal fault but a systemic issue. Perhaps offer to work with anyone responsible for the Trust's ‘dress code’ to ensure that hair racism or discrimination is not part of such a policy
- Do not try to ‘fight this battle’ on your own. Contact your professional body or staff representative to enlist their support for removing any such racist microaggressions from all Trust policies and documentation
- Seek ‘inclusive mediation’ (Harmon-Darrow et al, 2020) with the goal of finding support in difficult conversations and problem solving using listening, reflecting and summarising techniques
- Focus on your strengths and use the positive traits that enable you to perform at your best. Remember that such discrimination can be traumatic (Kirkinis et al, 2021) so be sure to look after yourself
- All NHS employees need to learn to understand, identify and stop racist microaggressions and subtle acts of exclusion or patronisation such as patting or touching black hair without the permission of the person (Jana and Baran, 2020). Campaign locally to make sure that your Trust policies reflect this understanding.
Some scenarios are presented in Box 1 for reflection.
Box 1.Scenarios for reflection
- You are a senior nurse or manager. A member of the Trust executive tells you that they have seen some nurses with ‘scary’ and ‘extreme’ hairstyles recently that don't ‘comply with Trust policies’. They tell you that this is one of your responsibilities and that they expect to see these codes enforced and adhered to. How do you respond?
- You are a black nurse on a new ward. Your hair is in braids or locs, perfectly clean and tied up neatly. The senior nurse on the ward pats your hair and shakes her head, saying that ‘patients don't like weird hair’ and tells you that patient preferences are more important than your hair preferences and to ‘fix your hair’ before your next shift. What do you say and do?
- A nurse manager challenges you about your natural, black hairstyle and tells you that this does not comply with the Trust dress code for nurses and has to be ‘fixed’. You listen, then begin to explain why you cannot comply with this order. The manager seethes with anger, telling you that they have 20 years' experience in nursing and will not be lectured to by a new RN and that if you want to challenge their authority, then ‘Bring it on, missy!’. What do you do?
- You and another nurse colleague both have a natural, black hairstyle. Yours is shorter and more tightly woven, theirs is longer and styled in larger puffs. A nurse manager speaks to you both about your hair, saying that yours is OK ‘because it's shorter and neater’, but your colleague's hair is ‘too big’ and ‘looks unprofessional’. How do you react?
- You witness a colleague and friend chastising a new nurse about their hair and how it is ‘unacceptable’ in the ward. What do you say or do to help achieve the best result?
Sending a clear message
It is unconscionable that nursing today attempts to dictate hairstyles to its students and practitioners, while singling out black students and nurses for particularly egregious authoritarian discrimination.
These nurses will be valuable and valued peers and colleagues. They will be standing with new families whose child is starting their fearful journey into chemotherapy. They will be soothing, comforting and bearing witness as patients slip away from this life, while helping create memories for their loved ones of a death that was as ‘good’ as a ‘good death’ could be. They will be steeped in trauma and carnage in the emergency department while still managing to help people hang on to life by the thinnest of threads. They will be dressing and addressing some of the most gaping wounds, both literal and psychological, and showing that ‘I'm a nurse, I can help here’. They will be supporting and treating society's most disadvantaged and damaged people while showing them by their every nursing and human gesture that these people's humanity still matters and that they are loved and valued.
This is what nurses do, not as momentary acts of heroism, nor because their hair is judged to be ‘professional’, but because it is their job, every day, week and year. These are the nurses who some managers and executives deem unfit and untrustworthy to manage their own hair or to choose their own colour of socks without written orders. There could be no greater display of organisational and professional contempt and distrust. Yet still nursing tolerates and is complicit in this embarrassment while we wring our collective hands wondering why so many nurses leave nursing during their education or within three years of qualifying.
The only mystery here is that some people imagine there to be one. If nursing and health care are serious about dismantling structural racism and discrimination from our systems and workplaces, there could be no better starting place than eradicating the codes and policies that deliberately target nurses' and other health professionals' hair. Let nursing send the clearest of messages to all of our profession, that we are interested in what is inside a nurse's head, not what sits on top of it.