Tattoos can hold a significant cultural connection for different people around the world including, but not limited to, indigenous peoples such as the Māori population. However, in the UK, there can be an associated societal stigma with having tattoos, especially for people whose tattoos are visible to others.
When surveyed, 34% of people in the UK indicated that visible tattoos for doctors or nurses were not acceptable, with this reducing to 25% for paramedics. However, the acceptability rate increased to 38% and 42% respectively if tattoos were visible, but not on a person's face or neck (YouGov, 2022).
Elements such as the location, number and design of tattoos, along with the perception of tattoos, could intersect with a person's sex, gender, ethnicity or socioeconomic background. This could possibly lead to differing levels of stigma being experienced by the person who is tattooed. Looking at this through the lens of health care, and more specifically nursing, provides a different consideration: how others, including people accessing healthcare provision, may stigmatise the nurse treating them if the nurse has visible tattoos. This could include questioning their skill and proficiency levels, empathy or their professionalism.
NHS uniform policies will often highlight that offensive tattoos should be concealed; however, what they each deem offensive can be subjective, with some referencing religious tattoos or those that indicate sports affiliations (NHS Borders, 2019; Shrewsbury and Telford Hospital NHS Trust, 2022). It is important to be aware that some tattoos could always be deemed to be offensive. However, the discussion here is about generally deemed non-contentious and non-offensive tattoos, for example, those that are not political or sexual in nature (NHS Borders, 2019).
Professional and organisational stigma
Nursing is still a predominantly female-based profession, with approximately 90% of all Nursing and Midwifery Council (NMC)-registered nurses listed as female (NMC, 2023). Although women with visible tattoos can be seen as more confident than those without, they can also attract stigma, including perceptions of being less honest, less capable and less intelligent (Broussard and Harton, 2018). These attitudes could potentially call into question their capability to be competent nurses who can practise safely while they have visible tattoos.
The Equality Act 2010 protects people from discrimination. However, although having a tattoo, visible or otherwise, is not a protected characteristic, sex and religion are and if there were to be a gender-based or religious component in play then perhaps this prejudice against a person with a tattoo could be deemed as a form of discrimination. Aligned to this, the Human Rights Act 1998 supports freedom of thought and freedom of expression.
A nurse's tattoos may or may not be visible or they may not have any tattoos at any stage in their career. In either of these situations, should there be an impact on the perceived level of care they provide or the professionalism they exhibit?
‘Is it more acceptable for a nurse working in an emergency department to be visibly tattooed than a nurse working in palliative care? If so, why?’
Where is stigma being manifested?
There is an increase in the prevalence of tattoos in society, which inherently means there is more potential for them to be visible (YouGov, 2022). Questions arising from this include:
- Is it more acceptable for a male nurse to have visible tattoos than a female nurse, because tattoos have historically been associated with men?
- Is it the public who have issues with a visibly tattooed nurse, the organisational perception that there will be stigma from the public about visible tattoos, or is there an internalised stigma becoming manifest from the nurses themselves?
Although research has been undertaken around some aspects of public perceptions of a person who is tattooed, there is a lack of specificity on perceptions of those working in different areas of nursing and the environments in which they practice.
For example, is it more acceptable for a nurse working in an emergency department to be visibly tattooed than a nurse working in palliative care? If so, why? Would it be deemed more appropriate for a registered mental health nurse to have visible tattoos compared with a children's and young people's nurse? It is worth considering whether there is an inherent perceived view of these areas and specialties of nursing.
Challenging stereotypes
If tattoos are demonstrative of a particular culture or community, does this increase stigma? In contrast, if these can be de facto protected characteristics as recognised by the Equality Act, 2010, what then for those who have tattoos without any connected significance? Are they more or less likely to encounter stigma? Does this change how they are perceived by the public?
There is already an innate level of stigma within nursing, especially concerning the portrayal of nurses within the media, including a hypersexualised view of female nurses and a stereotypical view of male nurses' sexuality (Weaver et al, 2014; Kearns and Mahon, 2021).
Nease et al (2021) found that, although there was some stigma evident regarding the perceptions of nurses with visible tattoos within acute and emergency departments, overall people accessing these services were less concerned with the tattoos themselves and more concerned with the care received. This could help support the creation of NHS uniform policy guidance that would provide appropriate levels of confidence for those with visible tattoos, supporting these nurses to demonstrate their levels of knowledge and skill with their actions rather than by appearance alone (Nease et al, 2021).
Conclusion
Further research is required to explore the perception of visibly tattooed nurses in different clinical settings and situations to understand any preconceptions and stigma that may be manifest. This could then lead to a campaign to enhance public understanding and awareness and aim to reduce stigma and for people to embrace difference and diversity. This could ultimately lead to a situation where nurses are assessed purely on the quality of the care they provide, not how they look or may present while delivering that care.
Tattoos can hold significant cultural importance, be seen as commemorating or celebrating a personal event, or as attractive body art. In contrast, they could be seen through stigma as ugly or offensive. However, a campaign on generally deemed non-offensive tattoos could allow nurses to be themselves and feel able to express their identity without fear of prejudice. This safer, more secure workforce, less concerned about societal pressures to confirm, can focus upon delivering patient care and lead to enhanced patient outcomes.