Dispatch July 2009

Prime Time Nurse

A pair of new TV shows—HawthoRNe and Nurse Jackie—finally puts nurses front and center. One contributes to longstanding misconceptions about the profession, the other nails real-life nursing like never before
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It’s been several decades since prime time TV featured a nurse as anything more than a background prop for doctors. Back in the 1980s, RNs and the crucial work they do had a brief star turn in a show called Nurse. The main character was RN Mary Benjamin, who cared for patients in a fictitious New York City hospital. The series, which was critically well-received, offered a refreshingly sympathetic portrayal of the field, but it only lasted two seasons before Benjamin and her colleagues disappeared from view.

Between now and then, the nation’s largest health care profession (now 2.5 million members strong) has remained invisible or, at best, laughable, on the home screen. In typical TV treatment, the nurses on Chicago Hope spent more time charting doctors’ love lives than the recovery of their patients. On a short-lived Aaron Spelling series called Nightingales, student nurses were similarly depicted as bimbos too busy with exercise class to spend any time studying. (The show was so insultingly bad that a well-orchestrated protest by thousands of RNs quickly led to its cancellation.) In the post-Nightingales era, the medical profession continued to dominate—in The Practice, Grey’s Anatomy, and House—while the message of ER seemed to be that any really good nurse was just wasting her life in a subordinate role and should become a physician instead (as the leading RN character in the series eventually did).

In real life, of course, hospitals would grind to a halt and patients would be in serious jeopardy without the presence of nurses, who provide the bulk of bedside care. Their contribution to live-saving and healing takes training, skill, and experience—not just the kind, sweet, and caring nature long attributed to women alone. But now—better late than never—Hollywood is finally acknowledging such truths, in the form of two new shows (with one more on the way this fall) in which nurses finally take center stage. TNT’s HawthoRNe, starring Jada Pinkett-Smith, and Showtime’s Nurse Jackie, featuring Edie Falco, each premiered in June, with much media fanfare. Both have provoked vigorous debate among nurses about their relative accuracy, while the spotlight that Nurse Jackie puts on the gritty underside of hospital life is making some RNs or their organizations particularly uncomfortable.

Professional quibbles about HawthoRNe are quite understandable. Jada Pinkett Smith plays Christina Hawthorne, in a series high in saccharine content but low in verisimilitude. As chief nursing officer of “Trinity Hospital” in Richmond, Virginia, Christina is no typical nurse manager. Real nurse managers spend their days closeted in offices, poring over spread sheets, preparing budgets, and attending administrative staff meetings. In big city hospitals, many staff nurses wouldn’t recognize their CNO if she (or he) walked by in the corridor. Pinkett-Smith’s character is, by contrast, a hands-on super-nurse—feisty, indefatigable, and seemingly everywhere. She talks psych ward patients off the roof (or tries to), personally wheels accident victims into the ER, grabs the paddles from doctors when they give up on a man in cardiac arrest (the guy is, in fact, a lost cause), and, in one episode, even rescues a newborn infant from the neighborhood bag lady, who has unwittingly become a mother while living on the street. Christina’s long list of heroic interventions puts past TV-healers to shame—and the season is far from over. Unfortunately, the show’s acting is poor, its dialogue silly, its syrupy soundtrack absolutely dreadful, and its contrived dramatic situations straight out of—you guessed it—Hollywood. What’s worse, from the perspective of the nursing profession, is that it reproduces the fundamental problem of TV doctor shows, which perennially distort who really does what. In those, the doctors do all the bedside nursing. In this one, the chief nurse does the nursing. Why worry about a nursing shortage? Christina will do it for you.

The painful realism and dark comedy of Nurse Jackie is the flip side of Pinkett-Smith’s fairytale version of nursing. Just check out Showtime’s edgy promotional ads for Falco’s outer-borough alter-ego—a shot of Jackie holding up a latex gloved hand, with syringe ready to go—in the position of an extended middle finger—with the ever-so-true caption: “Life is full of little pricks.” The ex-Sopranos star takes it from there. In wry, witty, often hilarious fashion, she nails real-life nursing like no one has ever done before, amid the chaotic war zone of big city health care. In Manhattan’s “All Saints” hospital, Falco gets plenty of help from a great ensemble cast that includes Anna Deavere Smith as a far more believable hospital administrator than Hawthorne; Haiz Sleiman as a gay male nurse (the best in this genre since Jeffrey’s Wright’s unforgettable role in the HBO production of Angels in America); and Merrit Wever as a student nurse, who captures all the touching enthusiasm, on-the-job nervousness, and short-lived naiveté of the legion of young women and men now apprenticing to become RNs.

I’m a longtime journalistic observer of nursing, a nursing school adjunct professor, and a frequent critic of hospital dysfunction. So I managed to get Showtime to send me the whole first season’s worth of Nurse Jackie episodes. As more regular viewers will hopefully discover, week by week this summer and fall, the show just keeps getting better. With the unblinking eye of a good documentary, Nurse Jackie finds a way to catalogue every major problem afflicting nurses, while skillfully illuminating common ethical dilemmas and public policy questions involving end-of-life care, assisted suicide, and organ transplant donation. The series depicts workplace violence against nurses, disrespect from doctors, the breakdown of MD-RN communication that puts patients at risk, plus the forced overtime, understaffing, job stress and occupational hazards that drive so many RNs to burn-out, drop out, gain weight, or even self-medicate. Like the best nurses I know, Falco’s Jackie displays deep compassion for her patients, but without a shred of sentimentality. Unlike most doctors (apart from those on TV), she spends a lot of time talking with patients and their families—just as real-life nurses do when they’re providing the patient with the kind of education and emotional support that’s so hard to find anywhere else in modern hospitals.

Unfortunately, Jackie breaks a few rules—not just to get the job done, but to make it through her arduous work days. Her not unheard of reliance on pain-killers and uppers (plus a related affair with the hospital pharmacist) has made some actual nurses and their professional organizations a bit nervous about the show. One state nurses’ association has even demanded that Showtime inform viewers that Jackie’s behavior represents a violation of the RN code of ethics; the American Medical Association has yet to register a similar demand about the main character in House, a pill-popping, problem-solving doctor—and still active drinker—who makes Jackie, a recovering alcoholic, look rather tame in comparison.

Critics in the nursing field are, I fear, looking a gift horse in the mouth. A series like Nurse Jackie is a rare gem because it manages to entertain, instruct, and debunk traditional stereotypes about nursing all at the same time—quite a hat-trick for TV. Furthermore, Nurse Jackie calls attention to many of the conditions of nursing work that cry out for reform. It dramatically illustrates why we need legally-determined staffing ratios, protections against mandatory overtime, or even simple lifting equipment—widely available in European hospitals—to reduce the current epidemic of RN back injuries, which result from handling a patient population that is increasingly overweight and infirm). The all-too-real and dysfunctional nurse-doctor interactions on the show demonstrate why teamwork needs to be at the core of “patient-focused care.” And the important mentoring relationship that develops between Jackie, as an older nurse, and Zoey, her young nursing student, illustrates the way essential nursing knowledge is passed along when veteran nurses have the time and institutional support to play this crucial role.

In short, Nurse Jackie makes a real contribution—to public understanding of nursing, to nurses themselves, and to those now in training to become RNs. Let’s hope that it survives on air longer than Nurse did back in the ‘80s, because there’s no better popular depiction of hospital life and work available today.

Suzanne Gordon is the author of Nursing Against the Odds: How Media Stereotypes, Medical Hubris and Hospital Cost-Cutting Undermine Nurses and Patient Care. She is editor of the Culture and Politics of Health Care Work Series at Cornell University Press.
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