What Happened to the Cap?

[DutchgirlRN]

Don't worry. No one is trying to bring back the cap. Whether we wear it or not, however, the cap is a universal symbol of nursing and always will be.
But why did nurses stop wearing caps in the first place? Asking this question does not imply that nurses should not have discarded their caps; rather, it expresses a desire to know what it was about the cap that nurses felt they no longer needed. Why did something that at one time symbolized the dignity, dedication, and educational attainment of a profession become superfluous?

Back to Caps: An Experiment
Even nurses who have never worn caps are aware that many patients, particularly the elderly, have a strong attachment to the nurse's cap. Older patients find it comforting, and believe, however subconsciously, that like the white dress and shoes, it represents professional skill and knowledge.
At the John F. Kennedy Medical Center, in the spring of 2010. Nurses in the hospital's cardiovascular step-down unit were brainstorming ways to raise patient satisfaction scores, and their nurse manager, Cheryl Farrell, proposed returning (temporarily) to caps along with white uniforms and shoes. The staff were thrilled with the idea.

The day that the cardiovascular step-down unit nurses came to work in white uniforms and caps was a memorable one (Figure 1). "It really created a buzz in the hospital.

Figure 1.The 8-week experiment was so positive and successful that the hospital decided to change their nurse's dress code to require white scrubs or uniforms, but not caps.

Why a Nurse's Cap?
In 1940, an anonymous nurse historian pondered the purpose of the nurse's cap:

Why a cap? For keeping the hair in place? As an identifying mark? Or was it merely to serve some other non-utilitarian purpose? The answer is buried in the deep shadows of the past. No one has ever discovered the true origin of the cap.

Around the time that nursing became an honorable calling for which one was formally trained, rather than a loathsome occupation suitable only for unsavory and fallen women, it was perfectly natural for nurses to wear caps. In fact, all women wore head coverings indoors and when going out; no respectable women would go hatless.

Nurses continued to wear caps after it was no longer customary for women in general to do so. Florence Nightingale required the women to wear a uniform and special nurse's cap, to the consternation of some recruits.

Florence never worked as a nurse at the hospital. Popular images of Miss Nightingale suggest that she always wore a head covering, but not a nurse's cap.

Figure 2. Florence Nightingale wearing her customary cap.

Figure 3. Florence Nightingale's cap on display.

Figure 4. Florence Nightingale (center) in her later years, surrounded by the probationers of St. Thomas' Hospital wearing their mandatory caps.

Nurse's Cap: Function and Fashion
The cap soon became an inseparable part of a nurse's uniform. Initially the rationale for wearing a cap was sanitary: It contained and covered the long hair that women still wore at the turn of the century. The earliest "mob caps" or "dust caps" large enough to cover the hair.

Figure 5. Anna Palmberg wears the earliest "mob" style of cap in 1888, designed to completely cover the hair.

Figure 6. Belle McLaughlin and Miss Bell wear the smaller, stylish caps of the Virginia Hospital Training School for Nurses in 1901.

Figure 7. Milwaukee Hospital nursing students in 1914 wearing the school's peaked caps. Image courtesy of the University of Wisconsin, Milwaukee Nursing History Center.

As time went on, hairstyles changed and nurses' caps changed with them. Rather than covering most of the hair, the newer, stylized caps were designed to perch on the back of the head. Hairstyles for women were becoming shorter, and the modern "bobbed" hairstyle didn't need to be tied up in a bun, so caps became smaller as well. Many nurses began fashioning their own caps out of men's handkerchiefs or purchasing a cap that they found attractive.

Caps of Distinction
What started out as a head covering gradually became a hallmark of a profession. Because a nurse's cap had to be earned, it was highly coveted and bestowed upon its wearer the status of an educated, self-supporting woman outside of the hospital and a well-trained, respected, and dedicated professional within. Early schools of nursing quickly realized that the nurse's cap could become a "brand" for their institutions, and it became desirable to design a unique cap to represent their school and the image they wished to convey. As more schools of nursing opened, the diversity of cap styles grew, and some became as famous as the institutions they represented.

Figure 8. Display of caps at the Luckey Hospital Museum in Wolf Lake, Indiana. www.luckeyhospitalmuseum.org.

Some of these earliest caps were designed by the founders or superintendents of the first training schools in the United States. These caps became widely recognized -- and often copied -- by subsequent training schools.

Bellevue Training School for Nurses: The Fluff
Everyone recognized the Bellevue "fluff" or "cupcake," a rounded, pleated cap of organdy with a ruffled edge, a symbol of the highly regarded Bellevue Training School for Nurses.

Figure 9. The Bellevue fluff.

Philadelphia General Hospital: The Double Frill
The frill was the cap worn by graduates of Philadelphia General Hospital School of Nursing . The double frill was made of linen with 2 rows of fluting joined at the back; it was described by its proud wearers as a "square of linen, fluted and shaped so gracefully" that it was often copied by other training schools.

Figure 11. The double-frill cap of the Philadelphia General Hospital School of Nursing. Image courtesy of the Museum of Nursing History.

Figure 12. A nurse wearing the double-frill cap.

Undergraduates wore a simpler single-frill cap. This cap could be purchased for 13 cents and it lasted for 2 weeks before having to be replaced, unless the cap was pressed carefully between the pages of a book every night, which might make it last for a month. Later, a more practical Dutch-style cap of muslin, which could also be folded flat into a book, was introduced for students and worn until 1961 when the single frill was resurrected.

University of Maryland: The Flossie
The cap of the University of Maryland School of Nursing, known as the "Flossie," was designed in 1892 by the school's first superintendent, Louisa Parsons, who modeled it after one of Florence Nightingale's own caps and named it after the great lady (Flossie is a nickname for Florence). Miss Nightingale gave her a pattern for a cap and some point d'esprit lace, as well as the privilege of bestowing it upon the nurses at the school of nursing she planned to establish.

However, the original lace Flossie proved difficult to maintain. Convinced that too much time and effort went into making and laundering it, in 1900, the Superintendent of Nurses simplified the design and designated it as the graduate cap. Students wore a different, probationer's cap. Senior nursing students at the school would be taught how to string their Flossie caps at graduation, and a "fluting ceremony" was held for probationers to teach them how to flute their caps.

Figure 13. The lacy Flossie, named for Florence Nightingale.

Figure 14. University of Maryland graduate nurse wearing the Flossie.

Massachusetts General Hospital: The Ether Cap or Flat Top
Credited with being the first hospital training school to mandate wearing of a standard cap style, a cap was designed in 1878 for the Massachusetts General Hospital Training School for Nurses. MGH's first cap is believed to have been modeled after the ether cone, a device used to administer ether before surgery. In fact, the first public demonstration of the use of ether was conducted at MGH in 1846. This early nurse's cap was sometimes referred to as the "ether cap" or "ether cone."

Figure 15. MGH class of 1886 wearing the school's original nurse's cap, sometimes called the "ether cap."
Caps were first introduced at MGH against the wishes of some of the nurses, but after the nurses had adopted caps, the maids of the hospital also requested them. Probationers were given a piece of crinoline and they made their own caps. Initially a tall cap large enough to cover the nurse's hair, the cap became smaller over the years, and in 1951 a new, smaller and flatter cap was introduced which became known (along with the nurses who wore them) as "flat tops".

Figure 16. The original MGH nurse's cap (top) and the MGH flat top (bottom).

Figure 17. A student and a graduate nurse wearing their MGH flat tops in the 1960s.

Johns Hopkins
The Johns Hopkins cap did not have a nickname, but its unique style was widely recognized and coveted. A Johns Hopkins nursing cap was immediately identifiable. It was a mark of prestige, indicating that you worked with the nation's nursing leaders and knew doctors with names like Welch or Osler
Miss Susan Read introduced the fragile, almost transparent organdy pouf cap, originally large enough to contain the hair for cleanliness. The cap was subsequently reduced in size, but the shape remained constant. The cap was worn by both students and graduates until the 1940s when a new, Dutch-style winged cap with the initials JHH emblazoned on the front was introduced for students.

Figure 18(a). The renowned Johns Hopkins graduate cap. (b) The trademark Johns Hopkins student nurse cap. Image courtesy of Johns Hopkins University School of Nursing.

Figure 19. Head nurses writing reports while wearing Johns Hopkins graduate caps. Image courtesy of Johns Hopkins University School of Nursing.
In the hospital, a nurse's cap could identify her alma mater to colleagues, patients, and physicians. In a letter to the American Journal of Nursing in 1931, nurse Julia Gardner wrote, "When entering a strange hospital, as an affiliating student or visitor, it is almost like seeing a familiar face to see the cap of one's own school on a nurse there."

Caps, along with crisp white aprons or uniforms, had a pronounced effect on the public. No doubt many young girls were influenced to pursue a nursing career after seeing, and yearning for, one of those caps.

Rite of Passage: The Capping Ceremony
The capping ceremony was often the highlight of a student's experience, a "memorable and happy occasion for the students as they donned the cap and pledged to wear it with pride and dignity and in such a manner that it would always bring honor and distinction to their alma mater."

Figure 20. Capping ceremony in 1955 at Villanova University College of Nursing.
Early capping ceremonies were held after 12 months of training (the "probationary period") when student nurses would receive their student's cap.

After students received their "probationer's" caps, the goal became the black band of the graduate nurse or, later, the registered nurse.

Figure 21. Students at Johns Hopkins eagerly receive their probationer's caps in 1943.

Being "capped" was of great significance to the young student nurse. It meant the achievement of a goal, a stepping stone to other goals. It meant recognition by other members of the health team and a readiness to assume additional responsibilities.

The nurse's cap means to you what the soldier's uniform means to him. When this cap is pinned on your head, it means you have become a member of one of the noblest professions and have subscribed to its ideals of service. You are no longer merely an individual responsible for her own acts, you are part of the nursing profession.

Capping ceremonies were widely recognized as an event to celebrate

Figure 22. Capping was so common that greeting cards to mark the occasion could be purchased, such as this card from 1966.

Wearing the Nurse's Cap
In 1923, instructions for wearing the organdy cap of the Johns Hopkins Training School for Nurses read as follows: "The cap must be pinned on both sides with white beaded pearl pins, and the hair must be worn up and under the cap."Another directive: "The cap must be firmly secured and at exactly the right angle on the head."

Figure 23. Student nurse Susan Petty relaxes after a day on the wards by playing ping-pong with her cap on!
It turns out that nurses had a number of tricks they used to keep their caps securely on their heads. The first is the long, white bobby pin, sold specifically for nurses' caps. The second was a home-made contrivance known as the "brain patch" or "angel patch." These patches varied widely in their construction but had the same essential function: The patch was fastened to the hair and the cap was fastened to the patch. Here is how one nurse described the process:

You attached [your cap] to a little knitted thing that you put on your head. We called it a brain patch. You put a long bobby pin through the cap and attached it to the brain patch that you had in your hair. My big Sister knitted me my first brain patch.

Other brain patches were made of wads of tissue, gauze, Telfa pads, or multiple bobby pins, and some nurses used long hat pins or safety pins instead of bobby pins to fasten the brain patch to the cap. Another secret was that as caps became smaller and no longer contained the hair, some nurses wore an invisible hair net to "keep those unruly hairs from getting into trouble."

Figure 24. A 1950s student tries to keep her cap in place.
As early as 1898, nurses began to worry that wearing a cap would contribute to baldness:

The time has come when a cap on the head indoors is suggestive of baldness. There is a very stiff nurses cap which is accused of making rings of baldness right around the head. If nurses continue to wear caps from choice, the time may come when it will be a necessity. Maybe it is so now with the oldest of us. How I should like to lift up a few caps and peep!

Cap Maintenance
Caps were notoriously difficult to keep looking clean and tidy. The Philadelphia Hospital's double-frilled cap was so difficult to clean that all laundering was done by several generations of the same local family using a special starch.
Starch was used to "stiffen 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."
Caps that were formed from flat pieces of linen were dipped in copious amounts of blue liquid starch and pressed, wrinkle-free, onto a flat surface. Nurses used various surfaces for cap-drying, such as a refrigerator door, a mirror, or a marble shower wall, from which the caps were easy to peel when dry, and then ironed and folded them into the proper shape.

What Did the Cap Symbolize?
Ask 10 nurses what their caps meant to them and you'll get 10 different answers. Some would say the cap represents their service to humankind, and others that it symbolized all the hard work that it took to earn it.
In recollecting the feelings precipitated by getting one's first cap, a nurse said, "It was a big thrill, because when you first walked down the ward with your cap on, the patients would call you nurse." In those days, the wearer of a graduate cap, with its velvet band of black, was accorded special respect by those still coming up through the ranks. "You knew who was getting off the elevator first" if a graduate nurse was around.
The cap unquestionably represented knowledge and skill. The wearer of a cap was well taught and highly capable. As a symbol of this training, the cap might have been perceived as a threat by physicians who were concerned about permitting nurses to learn too much and become too capable. In the late nineteenth century, some physicians objected to the education of nurses, worrying that:

nurses would be 'over taught,' that they would soon think they knew full as much as or more than the doctors, that they would form too decided opinions of their own. It was objected that they would try to study medicine while disguised in nurses' caps!

Figure 25. Cap-wearing students observing surgery through a glass ceiling dome in 1942.
The cap has been called many things, but possibly the most revealing attitude about the cap is the custom of referring to the cap as one's "dignity."

To the plainest woman, the traditional nurse's cap lends an aura of dignity and beauty, of service given generously when needed most.

The dignity of the cap was taken very seriously. Another nurse, in 1906, wrote:

Why do you wear a uniform dress and cap? Its neat appearance, pleasing to the eye, distinguishes the nurse from others? All these are true, but what it really is, and what it should mean to you is, the badge of your profession. I urge you to live up to it, be worthy of all it stands for. Think of your own high ideal of a nurse, and remember that the cap is an outward sign of all this. Never think of it as an ornament, or to be worn jauntily, but to add dignity and grace to your interpretation of your profession. Remember that your every act as you wear it, reflects, for good or bad, not only on you but on the whole school.

The cap was such an important symbol of the nurse's professionalism and standing within the hospital that taking it away to discipline the nurse was the height of public humiliation. Wearing the cap was a privilege, and a nurse in training could have her cap revoked if she transgressed school rules. For example, when a student nurse at Vancouver General Hospital was caught smoking in her room, she lost her cap for 6 months. In 1919, student nurses were told they would lose their caps if they "bobbed their hair." The entire class cut their hair anyway -- and surrendered their caps the next day.

The Cap Lives On...for a Time
The "heyday of the cap" lasted well into the 1960s or later. Part 2 of this article will explore the societal events and pressures that eventually led to the demise of the nurse's cap.
Editor’s Note: Don’t miss our slideshow on this topic -- What Happened to the Cap? Part 1: Dignity and Dedication

http://www.medscape.com/viewarticle/741581?src=top10

[DutchgirlRN]

My capping ceremony was a "big big deal". My school chose the Tennessee State Cap. To me it looked like a soup bowl. We used a 4x4 for a brain patch. Folded paper towel in a pinch. A total of 3 long white bobby pins. I wore a cap every day at work from 1976 through the late 90's. The all white uniform went by the wayside with the cap. First we had solid colored scrubs. We could not wear tennis shoes to work and had to wear white nurses shoes. I wore clinic shoes.

I did get cards congratulating me on earning my cap. Wish I had kept them now.

Who else has a story about their cap?

Do any schools still have a capping ceremony? I'm assuming it's just ceremonial now?

[Diary]

I too received a cap at a traditional nursing program.

They give me a huge headache before a few hours is up. I am glad we do not have to wear them.

[SVL]

My school doesn't do caps. I wish they did, I think they are cute. LOL

[JennaRN1006]

I would like the cap for the school symbolism as i would for the candle too. My school did neither. I got a pin thrown at me.

I would like a cap for nogstaliga....but for practicality at the bedside. heck no. Nor would I be in favor of ALL white scrubs. Its bad enough trying to get excremients off my non white scrubs....lol.

The day my boss says Jen you need to wear a dress, stockings, and a cap is the day I leave bedside. No lie. I dont think the uniform gave the impression of respect and brains and smarts, etc. I think what has happened is that society has become that disrespectful and plain old selfish/rude. If we say that a uniform (which in MOST professions gets respect-- I dont think nursing now a days ever will), is what gives us the respect we deserve, then so should people giving up their seats on a bus for the elderly and pregnant women, etc. It doesnt happen (except I do it cause I was raised right). I think we as nurses need to demand respect from society and really educate what our job is and does. Ok off my soap box.... lol

[Poliopioneer]

Since I graduated in 1993, there was no capping ceremony. Our class didn't even bother with a pinning ceremony. Caps were still for sale in the bookstore, and I bought one because I grew up believing that the uniform (cap included) symbolized the profession of nursing. It's a good thing I did, because my first job required the traditional uniform (Nursing Home). Sad to say, it was the only time that I really felt like a nurse. I do believe that, when the cap symbolized something earned by hard work, there was more respect. Nowadays, when you can't tell a nurse from housekeeping, it must be extremely frustrating for the families of patients to ask questions of the wrong people and get shoulder shrugs for their trouble. Jenna, ITA that the rudeness in today's society has diminished respect for everybody.

[Kylee]

I love the caps. I love the history, symbolism, and traditionalism of the cap. I know white is traditional, but it is not practical. With all of the junk we can get on us, it doesn't make sense to wear white, unless we all own stock in Clorox.

I remember my grandmother drying her cap on the refrigerator. Hers had two black bands on it. I wish I had one of hers, but I don't. I think Mom threw them away when she was cleaning out her house.

I would love to have a capping ceremony, but we do a pinning ceremony that is separate from our commencement ceremony.

[SVL]

I have my own plan with a cap and white scrubs; since my school doesn't do it, I'm having my own graduation photos taken with a cap on. hehehe.

[Melinurse]

No cap with my LPN graduation and no cap with my RN graduation either.

[crunch]

I didn't attend my graduation. They had ended the cap thing the year before.

Hey PP - we graduated the same year!