During the autumn of 1917, a series of 'stripes' were introduced for VADs to wear on the sleeve of their dresses. They were worn on each sleeve of their work dress, four inches below the shoulder:
White stripe: the VAD had served continuously for at least thirteen months
Scarlet efficiency stripe: the VAD had been employed solely in military hospitals under War Office control since November 1915. If their service continued unbroken they received their second stripe twelve months after the first. This stripe was only awarded if the VAD had been certificated as 'efficient' by their Matron and Commanding Officer.
In March 1918 it was decided to create a new grade, the ‘VAD Assistant Nurse,’ as set out in Army Council Instructions:
- It has been decided that special military probationers and nursing members of Voluntary Aid Detachments who have completed two years' continuous service in Military, Territorial, or War Hospitals, shall be eligible for the grade of V.A.D. Assistant Nurse.
- It should be clearly understood that promotion of special military probationers and V.A.D. nursing members to this grade is to be recommended for efficiency only, and not for length of service, and candidates selected must have been already awarded the red efficiency stripe authorized by W.O. letters 83/7924(A.M.D.4) of 6th may, 1917, and 83/9885(A.M.D.4) of 22nd December, 1917, copies of which are printed below.
- Recommendations should be made by the matron of the hospital in which the candidates are serving, on a special form to be circulated. These will be counter-signed by the C.O., and, in the case of the T.F. Nursing Service, by the Principal Matron also, and forwarded for final approval through the official channels to the Secretary, War Office.
- Special military probationers and V.A.D. nursing members appointed to the grade of V.A.D. assistant nurse will wear the letters A.N. in metal on the right strap of their aprons in indoor uniform, and on the shoulder straps of their outdoor uniform coats.
- Promotion under this A.C.I. will not carry any increase of pay, which will remain as for V.A.D. members