Nurses say NBC's "ER" contributes to nursing shortage

November 10, 2003 -- Baltimore, MD -- The Center for Nursing Advocacy has kicked off a major campaign to convince NBC's popular television drama "ER" to portray the nursing profession accurately, in response to long-standing misrepresentations that the Center believes are contributing to the nursing shortage, one of the nation's most critical public health problems.

The Center began its campaign with an October 12 letter to "ER" producers, along with top executives at NBC and AOL-Time-Warner, parent of Warner Bros. Television, which produces the show. The Center has also encouraged nurses to write their own letters of protest. Already, scores of nurses in the United States and abroad, including many nursing leaders, have written powerful and unique letters explaining how the show's presentation of nursing does a disservice to their profession. Excerpts from many of these letters are available on the Center's web site.

During its highly successful nine year run, "ER" has shaped Americans' perceptions of nurses and physicians engaged in some of the most highly stressful, heroic work their professions have to offer. "Unfortunately, 'ER' has sent the profoundly misleading message that nurses are peripheral workers who report to physicians," said Sandy Summers, MSN, MPH, RN, the Center's Executive Director. "The show has worked hard to portray medical diagnosis and treatment accurately. Why does it misrepresent nursing, year after year? It focuses on every stage of physicians' education and training. Why has it ignored nursing education and training?"

Apparently in response to the Center's current campaign, Warner Bros. has just changed language on its web site stating that the show's one major nurse character had been "demoted to nurse" after being forced to abandon medical school for financial reasons--two years after the Center first let the producers know how inaccurate and harmful that description was. "We appreciate that small, belated step," Summers noted, "but obviously, much remains to be done."

"'ER' often depicts physicians performing critical tasks that nurses generally do in real life, such as defibrillation, triage and patient education," said Summers, "while anonymous nurses serve as dramatic wallpaper." And though Summers notes that "ER" has shown nurses to be competent and caring, and has avoided some of the worst nursing stereotypes, she believes that it pushes a sophisticated version of the "handmaiden" myth, which reflects the gender-based "master and servant" roles that have dominated popular perceptions of medicine and nursing. She argues that "the show seems to subvert traditional gender roles on the surface--with female physicians, and male nurses in minor roles--but it still embodies regressive views just below the surface, in its portrayal of the professional roles those characters play."

The Center also points out that "ER" has consistently presented only one major nurse character alongside about 10 major physician characters, even though in real Level One trauma centers in the U.S. the ratio is roughly 1:1. Changing major characters might present significant issues for some shows, but given "ER"'s fast-paced multiple character environment and its frequent introduction of new characters, Summers notes, "it's obvious that more nurses could be among the 10-12 major characters, enhancing both drama and realism."

Few would dispute that "ER" is the most influential health care series of the last decade, if not since the 1970's heyday of "M*A*S*H." Summers notes that last year's short-lived dramas "MDs" (ABC) and "Presidio Med" (CBS)--the latter created by "ER" veterans--took similar approaches in presenting ostensibly realistic scenes of health care in which physicians were shown to provide virtually all significant care, while nurses were assigned marginal, subordinate roles. <www.nursingadvocacy.org/media>

The "ER" episode "Dear Abby," first aired on October 9, 2003, was the last straw for the Center. In that episode, seen by over 20 million viewers in the U.S., physicians were shown firing a number of nurses for staging a walk-out mid-shift to protest hospital plans to replace senior staff nurses with new nursing graduates willing to work for "minimum wage." "That would almost be funny if the shortage weren't a matter of life and death," said Summers. "Hospitals today are desperate for nurses, because the short-staffing is literally killing patients. Nurses report to nurse managers, not physicians. And as educated professionals who hold lives in their hands, nurses don't work for minimum wage."

The Center was further incensed by the October 30 "ER" episode, "Out of Africa" in which the show's lone major nurse character abandoned nursing for medical school. A new character was immediately introduced, filling the show's one-major-nurse-character quota. But nursing, not medicine, is the overwhelming choice of nurses who seek graduate education. Recent data suggest that nurses are at least 50 times more likely to pursue graduate education in nursing than in medicine, and there are currently over 200,000 Advanced Practice Nurses in the U.S. Summers says the show has virtually ignored these nurses, and argues that "showing nurses advance only through medicine suggests--wrongly--that nursing is a subset of medicine, and that you can't really make a difference in health care unless you become a physician."

Studies have shown that "ER"'s apparent realism has a strong impact on how viewers see health care, and Summers argues that this lends dangerous credibility to the show's distortions of nursing. "Negative media images of nurses have been a key factor in the nursing shortage," she said, "because what people see affects what they think and do, in everything from decisions about what career to choose to how to allocate health care funding. We can't wait any longer for this influential show to stop misrepresenting our profession. We believe the show must have nursing advisors review its scripts--in addition to the physicians who do now--to avoid further damage."

The Center for Nursing Advocacy, founded in 2001, is a Baltimore-based non-profit that seeks to increase public understanding of the central, front-line role nurses play in modern health care. The focus of the Center is to promote more accurate, balanced and frequent media portrayals of nurses and increase the media's use of nurses as expert sources. The Center's ultimate goal is to foster growth in the size and diversity of the nursing profession at a time of critical shortage, strengthen nursing practice, teaching and research, and improve the health care system.

The following are among those who sit on the Center's Board of Directors or Advisory Panel:

Diana J. Mason, Ph.D., RN, FAAN, Editor-in-Chief of the American Journal of Nursing;

Beatrice Kalisch, Ph.D., RN, FAAN, Titus Distinguished Professor of Nursing, Division Director, Nursing Business and Health Systems, University of Michigan School of Nursing;

Jacquelyn Campbell, Ph.D., RN, FAAN, Anna D. Wolf Endowed Professor of Nursing, Johns Hopkins University School of Nursing;

Maryann Fralic, DrPH, RN, Professor of Nursing, Director Corporate Relations, Johns Hopkins University School of Nursing;

Linda C. Pugh, Ph.D., R.N.C., Associate Professor, Director, Baccalaureate Program, Johns Hopkins University School of Nursing;

Ruth E. Malone, Ph.D., RN, Associate Professor, Director, Masters Specialty in Health Policy Program, Department of Social and Behavioral Sciences, School of Nursing and Center for Tobacco Control Research & Education, University of California, San Francisco;

Margaret S. Soderstrom, Ph.D., RN, CS-P, Assistant Professor, Johns Hopkins University School of Nursing;

Keith O. Plowden, Ph.D., RN, Assistant Professor, University of Maryland School of Nursing;

Nancy Dickenson-Hazard, MSN, RN, Chief Executive Officer, Sigma Theta Tau Honor Society of Nursing;

Colonel Dena A. Norton (Ret.), MSN, RN, Administrator, Cenla Nursing Workforce Coalition, The Rapides Foundation; Retired Colonel and Former Director of Health Care Recruiting, HQ, US Army Recruiting Command;

Journalists Bernice Buresh and Suzanne Gordon--co-authors of From Silence to Voice: What Nurses Know and Must Communicate to the Public.

For more information on the "ER" campaign, contact:

Sandy Summers, MSN, MPH, RN
Executive Director
The Center for Nursing Advocacy
203 Churchwardens Rd.
Baltimore, MD 21212-2937
410-323-1100
ssummers@nursingadvocacy.org
www.nursingadvocacy.org

© 2003-2008 The Center for Nursing Advocacy, Inc. All Rights Reserved.