Bare below the elbows: the rules for sleeves, rings and nails

Short answer

• Bare below the elbows means forearms uncovered during patient care so hands and wrists can be washed properly.
• NHS England guidance rules out wrist watches and hand or wrist jewelry in direct care, though local policy may allow a plain ring.
• False nails and nail varnish are not allowed in the NHS policies we checked.
• For religious reasons, many trusts allow disposable elasticated over-sleeves, used and discarded like gloves.
• Each trust writes its own dress code, so check yours before your first shift.

In this guide (9 sections)

1. What does bare below the elbows mean?
2. When do you need to be bare below the elbows?
3. Bare below the elbows rules side by side
4. Can I wear long sleeves for religious reasons?
5. Can nurses wear a watch or fitness tracker?
6. Is bare below the elbows required in the US?
7. Does bare below the elbows reduce infections?
8. What this means when you buy scrubs
9. What to check before you act

"Bare below the elbows" means your forearms are uncovered during patient care, so you can wash your hands and wrists properly. In practice that means short or rolled-up sleeves, no wrist watch, no jewelry on the hands or wrists except usually one plain band, and short nails with no varnish or false nails. NHS England's 2020 guidance sets out the principle, but each trust writes its own rules, and some go further.

If you are a student or new starter, this is often the first dress code question you meet. Here is what the national guidance and two trust policies actually say.

What does bare below the elbows mean?

NHS England's "Uniforms and workwear: guidance for NHS employers" (2 April 2020) asks staff in direct patient care to:

• Keep forearms bare for hand hygiene. Local codes can allow covering at other times.
• Wear short-sleeved tops and no white coats during patient care.
• Wear no jewelry or watches on the hands or wrists. Local policy may allow a plain ring, such as a wedding ring.
• Keep nails clean, short and unvarnished, with no false nails.
• Tie long hair back off the collar.
• Not wear neckties or lanyards during direct care (bow ties are acceptable).
• Keep pens and scissors out of outside breast pockets.

NHS Scotland's national uniform policy, DL(2018)4, says much the same: short sleeves in patient care, no false nails, and no hand or wrist jewelry except a plain wedding ring or one other plain band.

When do you need to be bare below the elbows?

The national guidance ties it to direct patient care. Trust policies define it more precisely, and they don't all draw the line in the same place.

• Leeds Teaching Hospitals (dress policy v7.0, approved October 2022) applies it whenever staff work in or enter a clinical area. That includes ward rounds and contact with patients, their notes or the clinical environment. Staff only passing through should do so quickly and uncover their forearms if they stop.
• Rotherham Doncaster and South Humber (RDaSH) lists ward-based staff, food handlers, and staff doing hands-on care in clinics or patients' homes. Its page (reviewed March 2024) says staff who wear a uniform should always be bare below the elbows.

So a rule that applies "in patient care" at one trust may apply "whenever you are in uniform" at another.

Bare below the elbows rules side by side

Rule	NHS England (2020)	NHS Scotland (2018)	Leeds Teaching Hospitals (2022)	RDaSH (2024)
Sleeves	Short sleeves in patient care; longer sleeves must be secured	Short sleeves in patient care; full sleeves OK outside it	Rolled up or short enough to fully uncover forearms	Must be pushed up for hands-on care
Wrist watch	Not on wrists in direct care	Not stated separately; no wrist jewelry	Not allowed, nor other wrist coverings	Not addressed
Rings	Local policy may allow a plain ring	Plain wedding ring or one other plain band	One plain wedding or civil partnership band	One plain band on wrist or hand
Nails	Short, unvarnished, no false nails	No false nails, short and clean	No varnish, gel, false nails, extensions or nail jewelry	No false or painted nails
Religious sleeves	Over-sleeves or secured 3/4 sleeves	Over-sleeves with gloves, or secured 3/4 sleeves	Elasticated disposable over-sleeves	Over-sleeves for the care episode
Religious bangle	Bracelets pushed up and secured	Not stated	Kara pushed up and taped	Non-fabric bangle pushed up and secured
Cardigans	Not stated	Not stated	Navy uniform cardigans outside clinical areas only	Push up sleeves and remove for hands-on care

Policies are reviewed regularly. The Leeds policy we read had a review date of October 2024, and the RDaSH page had a next-review date of March 2025, so newer versions may exist.

Can I wear long sleeves for religious reasons?

Yes, in the policies we read, with conditions.

NHS England's guidance allows full-length or three-quarter sleeves as long as they don't hang loose and can be secured during hand washing and patient care. It also allows disposable over-sleeves, elasticated at the wrist and elbow, which are put on and thrown away like gloves, with hand and wrist washing still required. Leeds and RDaSH both allow over-sleeves. NHS Scotland mentions over-sleeves worn with gloves and three-quarter sleeves that can be rolled and secured.

On other faith items:

• Kara or religious bangles: Leeds allows them worn discreetly, pushed up the arm and taped in clinical areas. RDaSH asks for a non-fabric bangle, pushed up and secured.
• Headwear: NHS England allows religious headwear if it doesn't compromise patient care, safety, infection control or security.
• Hand gel: NHS England's guidance notes that alcohol hand gels use synthetic alcohol and do not conflict with the Muslim prohibition on natural alcohol.

If you need an adjustment, raise it with your manager or placement lead before your first shift so the right items are ready.

Can nurses wear a watch or fitness tracker?

Not on the wrist during direct care in the NHS policies we read. NHS England's guidance rules out watches on the hands or wrists in direct care. Leeds bans wrist watches and "other wrist coverings", which would include a fitness band, though its policy doesn't name trackers. Ask your trust what alternative it allows.

Is bare below the elbows required in the US?

We found no national US rule. In 2014, the Society for Healthcare Epidemiology of America (SHEA) published expert guidance on healthcare attire in Infection Control and Hospital Epidemiology. It said facilities may consider bare below the elbows for inpatient care, meaning short sleeves and no watch, jewelry or ties, as a voluntary policy. The authors said their recommendations rested on limited evidence and that clothing's role in spreading pathogens to patients was not well established.

That guidance is now over 12 years old. US students and staff should follow their school's or hospital's dress code, which may include similar rules on nails and jewelry.

Does bare below the elbows reduce infections?

The NHS guidance frames it as making effective hand and wrist hygiene possible. The 2014 SHEA paper said the role of clothing in transmission was not well established. We have not found a study that settles the question, so we don't claim a size of effect either way.

What this means when you buy scrubs

• Short-sleeved tops are the default in UK patient care. A long-sleeve undershirt is only usable where your policy lets you push it up and secure it.
• Check your trust's color rules too. Our guide to NHS uniform colours lists the national roles.
• Students should read the program and placement dress code before buying. See what color scrubs nursing students wear.
• Washing rules come with the uniform. See how to wash scrubs.

What to check before you act

• Get your trust's or hospital's current dress code, not an old copy.
• Check whether the rule applies only in patient care or whenever you are in uniform.
• Ask what is allowed for rings, watches and medical alert jewelry.
• Arrange religious or medical adjustments, such as over-sleeves, before your first shift.
• For a skin condition affecting hand washing, talk to occupational health or a clinician.

Questions people ask

General information only, not medical, legal or employment advice. Your employer's uniform and laundry policy comes first, and brand specs and prices change. Spotted something out of date? Tell us.

Sources

1. Uniforms and workwear: guidance for NHS employers (NHS England, 2 Apr 2020)checked October 23, 2026
2. DL(2018)4: NHSScotland national uniform and dress code (Scottish Government)checked October 23, 2026
3. LTHT Dress Policy v7.0 (Leeds Teaching Hospitals NHS Trust, approved 17 Oct 2022)checked October 23, 2026
4. Do you need to be bare below the elbows (BBE)? (Rotherham Doncaster and South Humber NHS FT, reviewed 12 Mar 2024)checked October 23, 2026
5. Infectious diseases experts issue guidance on healthcare personnel attire (Infection Control Today, 20 Jan 2014)checked October 23, 2026