The world crashes in, into my living room

September 2005 -- The fall 2005 U.S. television season promises a lot of influential health-related serial programming. But since nearly every major character is a physician--literally dozens--it seems unlikely that nurses will receive their due. At the top of the list are the three hugely successful returning prime time hospital dramas: NBC's "ER" (premieres Sept. 22), Fox's "House" (Sept. 13), and ABC's "Grey's Anatomy" (Sept. 25). Of the 25 major characters in these three shows, 24 are physicians, and only one--"ER"'s Sam Taggart--is a nurse. "ER" will reportedly add another nurse character--someone TV Guide refers to as a "take-charge nurse manager" who "mentor[s]" Taggart and, oh, is also a "bitch"--but it is not clear if she will be a major character. NBC's new fertility clinic drama "Inconceivable" (Sept. 23) focuses on two physicians and a therapist; it also includes one nurse character, but her only role in the extended preview now on the NBC web site seems to be seducing a physician. On the reality show front, ABC's new "Miracle Workers" (mid-season) will reportedly feature an "elite team of physicians" who help people with "revolutionary medical treatments." Ohio family nurse practitioner Margaret Bobonich is one of the 16 contestants on CBS' "Survivor: Guatemala" (Sept. 15), and as of this writing, Las Vegas ED nurse Maggie is one of only three guests left on CBS' "Big Brother 6." NBC's fading sitcom "Scrubs," which includes several major physician characters and nurse Carla Espinosa, returns in mid-season. On CBS' new sitcom "Out of Practice" (Sept. 19), four major physician characters look down on a family member for being "'just' a psychologist." Lifetime's "Strong Medicine," now in its sixth season, focuses on two physicians but occasionally features nurse midwife Peter Riggs, as it will in the Sept. 18 episode. The WB's small-town drama "Everwood" (Sept. 29), which has a physician lead character and includes "nurse and office manager" Edna Harper, returns for a fourth season. FX's nasty drama "Nip/Tuck" (Sept. 20), starting its third season, focuses on two plastic surgeons and has no recurring nurse character, but many viewers mistake its assertive, pro-women anesthesiologist Liz Cruz for a nurse, if that's any consolation. And staffing agency Access Nurses has selected the six cast members for its web-based "13 Weeks" (November), a reality series about travel nurses.

At the end of the 2004-2005 season, the combined U.S. viewership of new episodes of the three prime time hospital dramas was well over 50 million. If ER's new "take-charge nurse manager" does turn out to be a major character, and Sam Taggart remains, it will be the first time since the NBC juggernaut's 1994 debut that the show has had two major nurse characters. Of course, that would still make just two of 10 major "ER" characters, and two of 25 in the top three dramas. We're not necessarily concerned about the new character being a "bitch" if she is in the mode of the show's other management "bitches," physicians Kerry Weaver and Robert Romano, or even Margaret Houlihan in the later years of CBS' "M*A*S*H," troubled but three-dimensional characters with clinical prowess and some actual concern for patients. On the other hand, we could probably live without an Establishment sociopath like Mildred Ratched ("One Flew Over the Cuckoo's Nest") or a pathetic managed care enforcer like Nurse "Doctor" Poole of ABC's ill-fated 2002 "MD's." In any case, the new character's reported role as a "mentor" to Taggart is a hopeful sign. Taggart herself, since her first appearance in late 2003, has at least been given a few good nursing plotlines, though they remain drops in the show's bucket of physician-centrism, which regularly includes nurses reporting to physicians and physicians doing key tasks that nurses do in real life. Most Taggart plotlines focus on her romance with physician Luka Kovac and her struggle to raise her son. Even so, we have to admit that compared to the new hospital shows, "ER"s fairly poor portrayal of nursing can start to look pretty good.

Indeed, while "ER" may depict nurses as skilled handmaidens to the physicians who really matter, the new hits rarely show nurses at all, and when they do, it's likely to be as clerks, mute underlings, or even objects of contempt. Every major character on Fox's "House" and ABC's "Grey's Anatomy" is a physician, and there is no indication that will change. Debuting in late March 2005, "Grey's Anatomy" was perhaps the biggest hit of the latter half of last season. The show immediately distinguished itself with vicious anti-nurse slurs from the young female surgical interns that are its main focus. Nurses did occasionally emerge from the show's wallpaper later in the short first season. A dying, no-nonsense veteran surgical nurse figured in one episode, and in another episode a senior nurse actually guided an intern through a life-saving procedure, though the nurse got no credit. But the vast majority of the show consisted of physician characters providing all important care to surgical patients, including monitoring, emotional support, advocacy and other important work that nurses do in real life.

Of course, "House" pretty much ignores nursing completely, as its dream team of diagnostic experts provides all meaningful care, while the nurses are nameless, uneducated servants whose main role is to fetch physicians and do what they say. The show's physician characters generally don't need any nurses to provide comprehensive care to their critical patients. On the rare occasions when nurses do appear, they bear little resemblance to the autonomous, educated professionals who save lives in real hospitals. If "Grey's Anatomy" has often treated nurses with contempt, "House" seems to regard them as beneath contempt. While no all-physician show could provide a fair or realistic vision of what happens in hospitals--which exist mainly to provide nursing--at this point "Grey's Anatomy" seems a bit more likely to present nurses at least as sentient beings.

NBC's new drama "Inconceivable" focuses on a fertility clinic. According to the NBC site,
"[t]he doctors of the Family Options Fertility Clinic are on a noble quest to help desperate couples give birth. Except these doctors are often distracted by their personal quests involving sex, deception and secrets." If you were wondering where a nurse might come in, the "preview video" on the site suggests that it's pretty much in the "sex" and "secrets" area, and not so much in the "noble quest" part. In that video, lone nurse character Patrice Lo Cicero seems to be engaged primarily in seducing the reluctant lead physician character Malcolm Bower. The preview also includes much heated discussion among the lead characters about substantive issues in the clinic's work, but we're not sure how much the young, attractive Patrice will be involved in that, as opposed to fulfilling tired stereotypes about snaring a hot, gifted physician.

The "Miracle Workers" of ABC's new reality show of that name are, according to the network's site, "an elite team of physicians who embrace revolutionary medical treatments many never knew existed. Each week, the show will focus on a single patient with a serious medical condition and follow as this dream team of medical professionals changes his or her life forever through treatment." The team, composed of "some of the world's most renowned medical experts," will focus its "extraordinary expertise in cutting edge medical technology" to restore health and hope to "individuals who otherwise would never have access to elite medical specialists or the ability to afford costly procedures." The show's own site has a list of specific procedures for which it is seeking candidates. The procedures, not surprisingly, are primarily complex surgeries. We understand that nurses will be involved in the show, though shows about flashy high-tech interventions by prominent physicians rarely give significant recognition to nursing.

NBC's "Scrubs" will return for its fifth season with character Carla Espinosa, who is now perhaps the only major nurse character in a US network sitcom. Despite a few decent work-related plotlines in the show's early years, recently Carla has been all about her marriage to surgeon Turk, falling into a physician-love-interest arc that has been a central theme for many nurse characters in US television (see "ER," "Inconceivable"). Dramatically, Carla is the most sensible of the major characters, yet in a sitcom, this may signal mostly that the show considers nurses good "straight men" to set off the kookier, more interesting physicians (see "Becker"). Moreover, in clinical settings, "Scrubs" continues to promote the standard Hollywood vision of nurses as peripheral subordinates to the all-important physicians. In any case, the show's mid-season status suggests that it may be on its way out.

Like "Scrubs," CBS' new sitcom "Out of Practice" features a handful of physician characters set off by one non-physician. Series lead Benjamin Barnes is a psychologist who is (as TV Guide explains) "often patronized" by his brother, sister, and divorced parents "for being a mere couples counselor." Of course, the characters are all very much in need of his professional skills, from the "strident cardiologist mother" and "mild-mannered gastroenterologist" dad to the "womanizing plastic surgeon" brother and the "can't keep a girlfriend" ED physician sister. Physician attitudes toward non-physicians will obviously be a theme--even the CBS site synopsis hammers away at the idea that Ben's family has never considered him to be a "real doctor"--and we assume the show will suggest that this view is misguided. Of course, physician arrogance may be presented as simply a funny little issue, a foible with no serious clinical consequences. It appears that the show's focus will be on domestic interactions, but to the extent there are clinical scenes, or the characters become involved with nurses, how will the show's treatment of them compare to that of its psychologist hero? Do they also have vital expertise that the physician characters should recognize? Or will their role be limited to the casual, low-grade stereotyping we see in the extended trailer, in which cardiologist mom complains that following the breakup of her older physician friends' marriage, the ex-husband is "shacking up with his 25-year-old nurse."

Lifetime's "Strong Medicine" is now in the middle of its sixth season of providing hospital drama for women. It has continued to focus on a team of two physicians: the primary care physician Lu Delgado, who leads with her heart, and a hotshot surgeon partner, a character now in its third incarnation in this season's Dylan West, played by Rick Schroder. Hunky alternative nurse midwife Peter Riggs has been with the show since the beginning, and despite his clear subordinate status, he has gotten a few interesting plotlines, including one in which nurses actually struck the hospital over short-staffing, a subject that to our knowledge has never been seriously addressed by a primetime network hospital drama. Unfortunately, Riggs only appears occasionally, and the show tends to portray bedside nurses as deferential, often mute servants. It also includes a huge amount of physician nursing, as the physicians seem to provide all monitoring, emotional support, patient advocacy and education. But we will be watching the Sept. 18 episode, "It Takes a Clinic," which reportedly has Riggs supporting Delgado in her own pregnancy, and, "[t]ired of seeing overwrought teen moms, []begin[ning] a boot camp for teenage fathers."

The WB's family drama "Everwood" focuses on lead character physician Andrew Brown, a big city hotshot who moved to a small Colorado town in the wake of his wife's sudden death. Recurring character Edna Harper is Andy's "nurse and office manager," and she is also the mother of the town's only other physician--so you get a sense of how important she is. But to our knowledge the show really does little with Edna as a nurse.

FX's physician-dominated "Nip/Tuck" has evidently never paid much attention to nursing, and it has no significant nurse character. However, the cutting plastic surgery drama's two principal surgeon characters work with anesthesiologist Liz Cruz, a "strong lesbian" who appears to play a role that a nurse might in real life, providing the "voice of reason" in the "chaotic, superficial" plastic surgery world, and "challeng[ing] the surgeons' views on women and how best to help their patients heal." Indeed, web searches suggest that a number of viewers and even some members of the press have taken the Liz character to be a nurse (see examples 1, 2), presumably because the show presents her in an assistive or sidekick role. So--is Liz the strongest nurse character on television? Should we be happy because some people see a smart, assertive nurse, or sad because she isn't actually a nurse?

Finally, an unusual feature of the fall TV season is the appearance of a web-based reality show about travel nurses called "13 Weeks," which is being produced by California staffing agency Access Nurses. The show's producers state that the show is intended to promote not just their company, but travel nursing and nursing in general in the midst of the current shortage. The show has gotten significant coverage in the mainstream press as a business-and-media story, including a May NPR piece and a recent story in the San Diego Union-Tribune. The producers will reportedly begin webcasting in November on their "nursetv" site, and they hope to find a home for the show in the future on cable television. The show's web site has details about the six nurses it has chosen to participate. There seems to be a focus on ED, ICU and (of course) travel nurses. We can at least commend their demographic diversity; two are men, two are minorities, and not all are in their twenties. We hope the show gives the public a sense of the impact nurses actually have on patient outcomes, which strikes us as a critical part of the long-term solution to the crisis, and does not simply suggest that nursing is about traveling and learning to surf. We understand that the show's producers do plan to include some portrayal of nursing work. Of course, the role of temporary staffing in the nursing crisis is a complex one; some may be ambivalent about an industry whose recent growth appears to be a symptom of that crisis. In any case, we urge everyone to check out the show.

Don't Just Yell at Your TV!

Because television probably remains the most influential mass medium in modern society, we hope all supporters will watch nurse-related shows in which they have an interest, and let those responsible know what they think. If you want to help the Center monitor any of the above shows, please let us know at info@nursingadvocacy.org. We need several monitors for each show discussed above. Monitors record each show and watch it. If a monitor believes the portrayal of nursing is notable, the monitor alerts us and, if the Center did not record the show, the monitor sends us the recording so we can view it (the Center will reimburse). If you routinely watch any of these shows, please sign up to be a media monitor! Thank you.

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