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July, August, September 2009 News on Nursing in the Media

   

 

In the thick of it

Veronica Callahan MercySeptember 30, 2009 -- Tonight's episode of NBC's Mercy included two plotlines that highlighted strong, innovative patient advocacy by lead character Veronica Callahan and novice nurse Chloe Payne. In one plotline, Veronica fights through abuse from an injured patient who is furious that his leg, shredded in an accident, has been amputated without his knowledge. Veronica brings the patient some closure by retrieving the leg from the hospital's bio-waste department and bringing it to him so he can say goodbye. Meanwhile, Chloe helps a patient who seems like no more than a manipulative drug addict, despite mockery from other nurses and skepticism from physician Dan Harris. This patient claims that a pounding in the ears has driven him to his OxyContin addiction. Chloe determines that the pounding is real, and caused by a blood vessel about to burst, simply by applying her stethoscope to his external ear, which evidently no one else thought to do. These plotlines have some silly elements, but they both show the episode's 7.4 million U.S. viewers that nurses' job is, as Veronica actually tells Chloe, to advocate for their patients. The episode is show creator Liz Heldens's "I Believe You Conrad." more...

 

"We do try to keep the doctors from killing you"

4 nurses from MercySeptember 23, 2009 -- The series premiere of NBC's drama Mercy presents a group of attractive young Jersey City hospital nurses as downtrodden working girls, failing to get the respect they deserve from physicians or patients. Lead character Veronica Callahan displays advanced psychosocial and life-saving skills, though the show attributes the latter to her tour of duty in Iraq, rather than nursing education and experience. Like the lead characters on Showtime's Nurse Jackie and TNT's HawthoRNe, Veronica is a fighter, telling physicians off and doing what she thinks best to protect patients. Unfortunately, the show seems to think she reports to the physicians, a major flaw. As in the premiere of Jackie, Veronica warns a young physician that a patient may have a critical problem; he ignores it, the patient dies, and the nurse tears into him. As on HawthoRNe, Veronica's disregard for protocol repeatedly gets her in trouble with superiors, in her case the apparent chief of medicine. Like Jackie, Veronica is self-medicating, in her case with alcohol and "delicious Paxil" for what seems like PTSD from the war. As on Jackie, Veronica's nurse sidekicks include a smart but clueless novice who favors mockable patterned scrubs, as well as a wisecracking gay man. Veronica is separated from her pugnacious contractor husband, who persuades her not to divorce him, though she still has a strong thing for a hot surgeon she hooked up with in Iraq--and who has pursued her to her new hospital. So like Jackie, Veronica looks set for a love triangle involving her working class husband and a colleague with more education. Her nurse friend Sonia connects with a nice, funny police officer, but she is desperate to escape what the show sees as the violence and unpaid bills of the working class; she wants a wealthy Manhattan lawyer. In any case, like the two summer shows, Mercy is raising important nursing issues other hospital shows rarely have. The premiere ("Can We Get That Drink Now?"), written by show creator Liz Heldens, drew 8.2 million viewers. more...

 

Traffic is backed up in the tunnel heading into respect

Cast of nurses from MercySeptember 23, 2009 -- The series premiere of NBC's drama Mercy presents a group of attractive young New Jersey hospital nurses as downtrodden working girls, failing to get the respect they deserve from physicians or patients. Lead character Veronica Callahan displays advanced psychosocial and life-saving skills, though the show attributes the latter to her tour of duty in Iraq, rather than nursing education and experience. Like the leads on Showtime's Nurse Jackie and TNT's HawthoRNe, Veronica is a fighter, telling physicians off and doing what she thinks best to protect patients. As on both other nurse shows, this lead nurse character "treats the patient," while the physicians merely "treat the disease" (here characters actually say that). Unfortunately, the show seems to think she reports to the physicians, a major flaw. As in the premiere of Jackie, Veronica warns a young physician that a patient may have a critical problem; he ignores it, the patient dies, and the nurse tears into him. As on HawthoRNe, Veronica's disregard for protocol repeatedly gets her in trouble with superiors, in her case the apparent chief of medicine. Like Jackie, Veronica is self-medicating, in her case with alcohol and "delicious Paxil" for what seems like PTSD from the war. As on Jackie, Veronica's nurse sidekicks include a smart but clueless novice who favors mockable patterned scrubs, as well as an apparently gay, wisecracking man. So two of the three significant male nurse characters on the new nurse shows seem to be gay, which is not representative of the profession as a whole. Veronica is separated from her pugnacious contractor husband, who persuades her not to divorce him, though she still has a strong thing for a hot physician she hooked up with in Iraq--and who has pursued her to the hospital. So as on Jackie, Veronica looks set for a love triangle involving her working class husband and a colleague with more education; unlike on Jackie, the colleague here seems a lot more promising than hubby. Her nurse friend Sonia connects with a nice, funny police officer, but she is desperate to escape what the show sees as the violence and unpaid bills of the working class; she wants a wealthy Manhattan lawyer. Mercy has some problems, but like the two summer nurse shows, it raises important nursing issues other hospital shows rarely have. And the premiere ("Can We Get That Drink Now?"), written by show creator Liz Heldens, drew 8.2 million viewers--millions more than the other two shows combined. Are these shows the product of an Obama-era interest in underdogs? Are recession-weary viewers responding to the shows' criticism of the flawed U.S. health system? Whatever it is, we urge nurses to watch Mercy (the premiere is at the NBC site and free on iTunes), and use the show to help people think about nursing. see the rest of our interim analysis...full analysis to follow soon...and please post your comments on the show on our discussion board. Thank you!

 

Staying awake and alert

Garrison KeillorSeptember 16, 2009 -- Today the Salon web site ran a piece by regular contributor and Prairie Home Companion radio host Garrison Keillor about the four days he recently spent at the Mayo Clinic following a minor stroke. Keillor offers a wry and insightful account of his "brush with mortality," and closes with a simple plea for reform of the broken U.S. health financing system. Keillor's comments about his nursing care, though all very positive, range from the perceptive to the blatantly stereotypical. Evidently Keillor's nurses were "fabulous," "smart," "brisk," "utterly capable," and possessed of the humor and psychosocial skills needed to get patients through painful and dehumanizing experiences. But the female nurses also "have the caring gene most men don't," and Keillor senses "some human tenderness ... as if she thought, I could be the last woman to hold that dude's hand." Keillor begins his comments about the nurses by referring to an ED physician's note that Keillor presented as "awake, alert, and appropriate," then admitting that he is "even more awake and alert around attractive young women (though I try to be appropriate)." Keillor refers particularly to a "dark-haired beauty named Sarah" who not only "coaches him on self-administered shots of heparin," but also inspires him to plunge the needle in without hesitation, since "no man is a coward in the presence of women." We appreciate Keillor's kind thoughts, and we don't begrudge him his honest observations. But we have to note that he seems to be responding to the nurses' gender and physical attractiveness at least as much as their skills, and that his specific examples of care do not exactly overemphasize the nurses' advanced skills and health care knowledge. We hear about Keillor's physicians too, but nothing about their appearance. In any case, nurses of both genders improve patient outcomes because of their education, experience, and skills, not because they are nice, attractive women. more...

 

"Nurses: Pain affects everything else"

Gayle Page and Sharon KozachikSeptember 14, 2009 -- Today United Press International (UPI) issued a short item about the pain management research of Johns Hopkins nurse scholars Gayle Page and Sharon Kozachik. The main idea is that the nurses have "determined through research that pain management is not only a matter of compassion, but a medical necessity for patients to heal"--a statement that could as easily be made about the profession of nursing, which many decision-makers see as being more about compassion than life-saving. The piece includes short quotes by both scholars. Page says pain is an "exquisite stressor" because it affects so many components of wellbeing, from sleep to the ability to heal. Kozachik describes the challenge of finding the point at which pain is adequately managed--a line that is vital to clinical care. The piece notes that the research relies on animal studies; it does not explore the ethical issues involved. The item might have described more of the specific effects of this research on patient outcomes and costs, and told readers that Page and Kozachik are leading scholars with doctorates. But on the whole, the piece is a good example of press coverage of nursing research, coverage that remains rare. Indeed, though the UPI item (presumably the result of a September 11 Hopkins press release) was noted on a few health-oriented web sites, we saw no other mainstream press coverage. We commend UPI and Hopkins for their efforts to inform the public about the value of nursing research. more...

 

Messing with Texas

Mess with TexasSeptember 11, 2009 -- Recently veteran Texas nurses have published powerful op-eds advocating legislative changes to improve nurses' practice environments--and public health. On August 22, the Houston Chronicle ran an op-ed by Linda Record Srungaram arguing that the recent indictment of two West Texas nurses after they filed a complaint about a physician with the state medical board showed the need for better whistle-blower protections for nurses, who must be able to engage in such advocacy to protect patients. And today, the Austin Statesman published Toni Inglis's piece arguing that primary care shortages require the removal of legislative barriers that still inhibit the work of advanced practice nurses. These op-eds show the importance of nurses speaking up to protect patients and to show the public that nurses are critical thinkers with thoughtful perspectives on health policy. We thank those responsible for the op-eds. more...

 

Love and Commerce

September 11, 2009 -- Today NBC's Today Show aired a segment with the title "The Perils of Midwifery," though it later changed the title of the online version to "The Perils of Home Births." The "Today Investigates" segment, introduced by Matt Lauer, was mainly a pre-recorded report by NBC's Peter Alexander. The unbalanced piece used the tragic experience of one couple whose baby died in a home birth setting, including emotional footage from interviews with the grieving parents, to question the safety of home births and midwives generally. Would NBC find one sad obstetrician outcome and run a report titled "The Perils of Obstetricians?" The report also suggested that the apparent trend toward home births is a "hedonistic" one driven by a misplaced desire to emulate celebrities like Ricki Lake, who produced the documentary The Business of Being Born. NBC did include elements that ran counter to its main theme, briefly describing the arguments of home birth advocates and offering a short look at the good home birth experience of another couple. But the report also featured a series of unanswered attacks on home births and midwives, and the ostensible effort at balance just made the attacks all the more persuasive. Perhaps most glaring, the report did not offer a single quote by any midwife expert or midwifery association to defend midwife care, but instead relied heavily on the American College of Obstetricians and Gynecologists, as if physicians were the only real health experts, even about the care of other health professionals with whom they compete. The report ignored the data showing that other developed nations achieve better outcomes at lower costs with less interventionist, midwife-centered birth models. It ignored the research showing that the care of nurse midwives is at least as good as that of physicians. And it ignored the overall safety record of the veteran nurse midwife involved, Cara Muhlhahn. Unsurprisingly, the month after the Today report aired, the couple whose baby died, Catherine and Ricardo McKenzie, filed a malpractice lawsuit against Muhlhahn. The suit itself earned a lot of press coverage, featuring multiple quotes from the couple's malpractice attorney. We urge the Today Show to provide fair and balanced reporting on advanced practice nursing. more...

 

"Reform Won't Work Without Strengthening Nursing"

September 3, 2009 -- Today Kaiser Health News published an op-ed by Truth About Nursing executive director Sandy Summers arguing that the role of nursing in the success of U.S. health reform must not be overlooked. Summers explains that nurses are critical both to expanding access to care and containing costs, which are key elements of the reform proposals now under consideration. Although nurses' holistic, preventative focus is vital to reform, harnessing the power of nursing will require more resources for nurses' clinical practice, education, and research. And long-term change, Summers notes, will in turn require that we improve our understanding of the value of nursing, and overcome the female stereotypes that continue to plague the profession. see the full op-ed...

 

Crucial, but not consulted

Nurse vaccinating childSeptember 2, 2009 -- Today the New York Daily News published a very good report by Juan Gonzalez about the reaction of New York City school nurses to the city's plan to vaccinate elementary students for H1N1 flu in the fall and winter. The article includes substantial comment from local nursing union leader Judith Arroyo. She reportedly liked much of the plan but urged the city to consider having special traveling teams perform the vaccinations, in order to avoid overwhelming school nurses who already have their hands full with their usual case load. The piece might have noted that the critical shortage of school nurses will likely make the situation even harder. But the piece does give a good sense of the role school nurses will play in the city's flu plans. And perhaps the best part of the report is Gonzalez's pointed statement that "the front-line nurses--who were not consulted by the city--will be crucial this fall and winter to containing the epidemic and keeping schools open." We thank Gonzalez and the Daily News. more...

 

"It made me realize...what heroes doctors are"

Fall 2009 TV Preview

Veronica, Sonia and Chloe from Mercy September 2009 -- The fall 2009 U.S. television season includes an unusually high number of health-related shows, and although one new show actually focuses on nurses and another on paramedics, overall the landscape seems likely to remain dominated by programs that reinforce the notion that physicians provide all important health care. Of the nine health-related prime time shows (including four new dramas) that are slated to start seasons in the fall or mid-season, regular physician characters appear to outnumber nurse characters by roughly 50 to 7. And four of those seven nurses are on NBC's new Mercy (premiering Sept. 23), which follows several nurses at a New Jersey hospital. Mercy will be the first nurse-focused regular season show to appear in more than 15 years. Previews suggest that it may actually show some nursing expertise and nurse-physician conflict, as on this summer's new shows Nurse Jackie and HawthoRNe, though Mercy seems to be more about the romance. The other new shows are adrenaline-fueled dramas that seem to want to be the new ER, which ended its 15-year run on NBC earlier this year. The new shows are Three Rivers (CBS, Oct. 4), which follows elite Pittsburgh transplant surgeons; Trauma (NBC, Sept. 28), a show about San Francisco paramedics and EMTs that manages to limit itself to just one physician and a paramedic with an MD; and a Jerry Bruckheimer project about an elite team of trauma surgeons that was called Miami Trauma (CBS, mid-season), but is apparently being reworked. Both Three Rivers and Miami Trauma have one nurse, but neither character seems likely to play an important role. The returning shows are the surgeon soap Grey's Anatomy (ABC, Sept. 24), with its unmatched line-up of 12 physicians and no nurses; the diagnosis-is-everything House (Fox, Sept. 21), with eight physicians and no nurses; the Grey's spin-off Private Practice (ABC, Oct. 1), with seven physicians and the novice nurse-midwifery student Dell Parker; the nasty plastic surgery drama nip/tuck (FX, Oct. 14), returning for a final nurse-free season; and the Lazarus-like Scrubs (ABC, mid-season), which will move to a medical school setting, with only two of its previous physician characters remaining as professors and a new crop of medical student characters, but apparently no nurses. more...and please learn how you can help us in monitoring these television shows.

August 2009 News on Nursing in the Media

Boys don't nurse

naggingAugust 20, 2009 -- Today the Times of India briefly reported that a court in Madras had upheld the Tamil Nadu government's decision to bar male candidates from a "diploma course in nursing," apparently indefinitely, on the grounds that the course syllabus had been changed to include midwifery, and anyway, government hospitals will have enough "male nurses" till 2045. An applicant denied admission had challenged the new policy on the grounds that it violated the constitutional right to be free of gender discrimination. The jurist responsible for the court decision was Justice K Suguna, who is female. The government's action appears to reflect damaging gender assumptions, including that no one wants men to provide pre- or post-natal care (does that apply to male physicians?), and that male nurses are "needed" only in practice settings that presumably are seen to require their special physical attributes, like jails and orthopedics. Sadly, any action that reduces the presence of men in nursing is likely to weaken and isolate the profession even further, exacerbating the global nursing crisis. The Times of India might have raised some of these issues or at least sought comment from nursing experts, but we thank the paper for its report on this important subject. more...

 

"Nurse clinics are 'supermarket medicine'"

Australian Medical AssociationAugust 13, 2009 -- Today the Western Australia news site Watoday.com ran a story by Julian Drape about the Australian Medical Association's (AMA) criticism of one company's plan to open more than 180 pharmacy-based clinics staffed by nurse practitioners, who would treat "common medical conditions" like infections and the flu. Predictably, the AMA does not think the NPs are qualified, branding the clinics "supermarket medicine" and claiming that NPs can't diagnose more serious conditions, despite countless studies showing that NP care is at least as good as that provided by physicians. Less predictably, AMA president Andrew Pesce (right) is quoted as saying this: "Nurse practitioners tend to be highly trained in a narrow area of health care and are not skilled or experienced in providing holistic care." That statement is false, since NPs are nurses who are trained in a care model whose core focus is holistic, but it's also pretty ironic coming from a physician, trained in a care model that often seems a bit less holistic, and, well, more focused on intense technical training in one area of health care. Watoday.com should have provided NPs or their professional associations a chance to respond to the AMA's baseless claims. Instead, all it included was an inadequate response from Health Minister Nicola Roxon who (like many retail clinic CEOs) made no defense of NP skill, but emphasized that the NPs would be required to practice under collaborative agreements with physicians. Sadly, readers of this article will likely come away with the false impression that NP care is pretty marginal. more...

 

Christina Hawthorne"Nurses don't need credit for saving lives! It's just what we do!"

August 11, 2009 -- Tonight's episode of TNT's HawthoRNe included several generally helpful plotlines exploring nursing autonomy, advocacy, and skill. The episode focuses on the intersection between the hospital CEO's efforts to get CNO Christina Hawthorne to cut her staff in order to reduce the hospital budget, on the one hand, and the tragic events that ensue after a woman brings her mother to the ED for treatment of a stroke, on the other. New nurse Kelly Epson manages, despite resistance from physician Brenda Marshall, to stop dangerous treatment of the stroke victim. But Kelly's advocacy also puts her job in peril. Nurse Ray Stein actually saves the life of his nemesis, Larry the accountant, who is choking on a donut. The plotlines have some problems, like nurse Candy's odd chastising of Ray for wanting it understood that the donut did not dislodge itself (as Larry claimed), and Ray's even more bizarre hookup with the awful Marshall after he confronts her for abusing Kelly. But on the whole the episode presents nurses as serious professionals saving or trying to save patients with advanced skills and tenacious advocacy. And the show's portrayal of the CNO as a clinical leader fighting for her staff? Some nurses may be skeptical, but we think there is room for at least one positive Hollywood vision of a nurse executive. After all, Hollywood has offered countless positive portrayals of senior physicians. The episode, "Mother's Day," was written by Glen Mazzara. more...

 

I like getting to prevent things

NP taking blood pressureAugust 9, 2009 -- Nurse practitioners have not received the attention they deserve in connection with the ongoing U.S. health reform debates. But two recent press articles do a generally good job of highlighting the key role NPs play in providing excellent, cost-effective primary care. And the stories suggest that NPs might well play a much bigger role in a health system reformed to increase access to care yet cut costs. Kelly Brewington's lengthy story "Nurse practitioners pick up the slack in providing primary care," which ran in today's Baltimore Sun, gives readers a sense of what NPs already do at a time when fewer physicians are choosing family practice, and suggests that NPs' work might expand if more people had health insurance. And in a July 26 report on National Public Radio's (NPR) Morning Edition, Joseph Shapiro explained the work of transitional care nurses, many of whom are NPs, to help patients navigate the health care system after hospital stays, preventing needless readmissions--and thereby saving a money. Commendably, both pieces rely on expert comment from the nurses, and to a lesser extent several physicians, who actually know about NPs' work, which is not something you can take for granted in media reports about health care areas that overlap with the work of physicians. The Sun does quote a Maryland physician who says NPs are "paraprofessionals" who will actually cost more money through overtreatment. Those comments reflect no understanding of what NPs do or the research showing that their care is at least as effective as that of physicians--a point that the Sun, sadly, did not include. In any case, we commend those responsible for these stories. more...

 

Not to get beat up

beaten up nurseAugust 4, 2009 -- Today USA Today ran a very good report by Erin Thompson about a new study detailing the high level of abuse emergency nurses suffer. The article, "More than half of ER nurses have been assaulted on job," describes the results of an online survey of more than 3,000 ED nurses by the Emergency Nurses Association (ENA). The study was published in the Journal of Nursing Administration. The USA Today piece relies heavily on comments from ENA president Bill Briggs about the causes of and potential solutions to the problem. The report might have included comment from hospital representatives as to how they are addressing the abuse. And it might have been more explicit about whether the problem has been exacerbated by the widespread belief that abuse is just part of an ED nurse's job. But on the whole, the article is a helpful look at the dangerous conditions many nurses confront and a commendable example of mainstream coverage of nursing research. We thank Ms. Thompson and USA Today. more...

July 2009 News on Nursing in the Media

From rock stars to activity logs

Christina HawthorneJuly 21, 2009 -- TNT's Hawthorne has some issues, but it deserves more credit for its efforts to show nurses as skilled patient advocates. The show often explores the limits of its lead character's authority as chief nursing officer of a Richmond, VA hospital. In the July 14 episode, Christina Hawthorne goes around a powerful surgeon to give a patient the option to get treatment from a more experienced surgeon at a different hospital. In doing so, Hawthorne violates rules related to the transfer of health records and gets in major trouble with the hospital CEO. In tonight's episode, Hawthorne tangles with the CEO over nurse under-staffing, though only in the context of a somewhat absurd plotline in which the hospital absorbs the entire emergency department patient load of a nearby hospital after its ED closes. Hawthorne also uncovers the cause of a teen's Adderall overdose: a prescription from his own physician father. These plotlines feature strong patient advocacy, though Hawthorne also tends to overstep and have her ultimately subordinate position made clear. Meanwhile, plotlines about the staff nurses--the real ones, though Hawthorne herself often plays that role--show that they too try hard to protect patients. In one, nurse Candy shows an ED patient's contemptuous father that she actually does have expertise by catching his own hypertensive crisis. Another plotline conveys sympathy for the staff nurses who must log all of their daily activities for the benefit of hospital "efficiency experts." This task seems pointless and bad for patient care, until timid nurse Kelly's log shows a patient's litigious wife that Kelly was actually nursing, rather than having sex in the closet, when the patient had an allergic reaction. Sadly, another plotline follows nurse Ray Stein on a deeply embarrassing ego trip as he plays source for a reporter who is supposedly going to expose the ED's overwhelmed condition--until the "reporter" turns out to be a delusional psychiatric patient. Ray is not a bad nurse, but he is also a hapless, self-absorbed physician wannabe--an unfortunate choice for the show's sole male nurse character. Tonight's episode was writer Jeff Rake's "Trust Me"; the July 14 episode was Anna C. Miller's "The Sense of Belonging." more...

 

It's time for us to buck up

President Obama with nurses in the Rose GardenJuly 15, 2009 -- Today U.S. President Barack Obama gave a short speech at the White House surrounded by nursing leaders, in order to promote his health care reform policies. The event was notable not only in that it reflected Obama's continuing use of nurses (the "most trusted" workers) to promote his reform efforts, but also because the speech reflected an understanding of nursing that is unusual in a political figure at the highest level. The President's speech suggested that he understood some of the basic elements of nurses' clinical work, including patient advocacy and the teaching of new physicians, as well as the centrality of nursing care in underserved communities, in EDs and obstetrics. Even Obama's introductions of and remarks about the nurses who were present show the public that nurses can be health care leaders. Unfortunately, the speech did focus on nurses' caring, virtue, and hard work, rather than their life-saving skills, which are probably the most important aspects of nursing that the public must understand in order for us to resolve the nursing crisis. And it is not clear from the speech whether Obama believes not just that nurses are supporters and potential beneficiaries of reform, but also that a greater investment in nursing education and clinical practice is critical to the success of reform and the future of health care generally. On the whole, though, the speech sent very helpful messages about nursing, so we commend the President and others who played a role in the speech for advancing understanding of the profession. more...

 

We are offering free breasts

Breast implant surgeonJuly 14, 2009 -- Two recent press articles reflect some of the complex issues nursing faces in Europe during the current shortage, though the specific subjects of the stories could hardly be more different. Today, the Denver Post ran an Associated Press story by Daniel Woolls reporting that the infant son of the first person to die of H1N1 flu in Spain had himself died because of what appeared to be a tragic nursing error. The piece says that a nurse working her first shift in the NICU had apparently fed the baby formula intravenously, rather than through a naso-gastric tube. The main Spanish nursing union urged caution pending an investigation, stressing that the nation's hospitals do not have enough nurses, and those who are working may not have the specialized experience needed on their units. On May 24, the New York Times published a piece by Dan Bilefsky focusing on the inducements desperate employers are offering to lure nurses to jobs in Prague, the capital of the Czech Republic. These include free plastic surgery. Reactions to this not only underline the severity of the shortage in a nation that has lost many of its nurses to better-paying jobs abroad, but also reveal public attitudes toward the underpowered profession, which is still associated with female subservience and sexual attractiveness. Taken together, these generally good pieces suggest (though neither actually says) that nurses remain caught in a dangerous disconnect between their image as disposable female helpers and their actual life-and-death responsibilities to patients. more...

 

Who must do the hard things?

Nurse Jackie PeytonJuly 13, 2009 -- Tonight's episode of Showtime's Nurse Jackie focuses on the care Jackie and the other ED nurses provide to a dying nurse who used to practice with them. The plotline offers an unusual portrayal of how the nurses manage their patient's end-of-life care, and equally rare, a serious and revealing look at the clinical interactions among very different types of nurses. The dying nurse--who makes Jackie look easygoing--asks Jackie to help her end her life, because she does not want to lie in hospice for her last couple weeks. As in past episodes, Jackie works around the system. She and the other nurses provide their old friend with the ending she wants, even though it is apparently a crime to do so in New York State. The nurses' actions raise complex and difficult issues related to our flawed end-of-life care policies, and Jackie's own consistent willingness to break rules in order to further her vision of what is right for patients. Although the plotline is more about psychosocial care and advocacy, there is also a scene in which Jackie, after minimal assessment, accurately estimates that a patient will die in 10 minutes, underlining her expertise in physical care. The episode, "Tiny Bubbles," was written by Rick Cleveland. more...

 

Take Action!

Post-Its and other priorities

Hank LawsonJuly 9, 2009 -- In the June 4, 2009 premiere of USA Network's new hit summer drama Royal Pains, the brilliant and heroic physician character Hank Lawson was fired and blackballed by a New York City hospital for treating all patients equally. Afterwards, Hank lamented that he could not even find a job as a school nurse! (See the Quicktime clips at broadband or dialup speed.) The message for the episode's 5.6 million viewers was that there could not be a more trivial and unskilled job for a health worker than that of school nurses, who presumably spend their days placing band-aids on scraped knees. But in fact Hank could not get a job as a school nurse because he has not spent years in nursing school, has no nursing license, and knows little about nursing. While the contempt in this episode continues to infect the mass media, it's no surprise that real school nurses struggle for the resources they need to save lives and improve student health. Ryan Blackburn's May 8, 2009 story in the Athens Banner-Herald (GA) explained that school nurses manage chronic health issues like allergies, diabetes, and seizures so students can continue learning. Anemona Hartocollis's April 28 New York Times article described the work of New York City school nurse Mary Pappas. She became "a sort of folk hero to nurses" for setting in motion the governmental response to the recent swine flu outbreak, identifying and managing hundreds of students' symptoms in a way that might even impress Hank Lawson out in the Hamptons! And today the Associated Press ran an excellent item by Lauran Neergaard about Pappas's "riveting" performance at the Obama Administration's swine flu summit. school nurseThere the nurse explained how she handled the huge triage challenge in April, and her plans for the coming flu season, offering this pointed advice to the government: "Every school needs a nurse." Kris Sherman's March 8 article in the News Tribune (Tacoma, WA) offered a tragic example of what happened in October 2008 at a local school with no nurse:   A fifth-grader died from a massive asthma attack, even though she was taken to a school health room where materials were reserved specifically to save her life. No one with significant health training was there to use them. These recent press pieces paint a picture of a vital professional specialty worthy of more than the undervaluation that has strained its members beyond the breaking point--and that continues to take our children's lives. We urge everyone to help change that situation. Join the National Association of School Nurses in the effort to pass the student to school ratio improvement act and ask your organization to join their list of supporters. more...and take action to support school nurses!

 

Take the blue pill

Jackie PeytonJuly 6, 2009 -- Tonight's episode of Showtime's Nurse Jackie is yet another powerful showcase for Jackie's clinical virtuosity. The focus in several plotlines is not so much on Jackie's care for ED patients' immediate ailments as it is her holistic focus, how she expertly manages the larger family dynamics that have such a huge impact on health. Here she negotiates hospital rules to help a precocious 10-year-old continue to manage her mother's debilitating lupus. She also finds a creative way to advocate for a stroke victim, demonstrating to his obnoxious family that he's "still in there," even though he can't speak or move much of his body. At the same time, Jackie continues to mentor nursing student Zoey and new physician Coop, teaching the former about triage and the latter how to relate to the 10-year-old girl. The show even includes a quick but telling comment on patterned scrubs and the nursing image. The episode is slightly marred by its depiction of triage--it does involve assessing serious conditions, but it's not a "very simple" task that would ever be assigned to a student. And the portrayal of nurse manager Gloria Akalitus seems to reflect the battleaxe stereotype. Akalitus is a disagreeable killjoy, obsessed with enforcing rules regardless of whether they advance the wellbeing of those around her. The show punishes her constantly, her scenes are often funny, and of course some nurse managers are bureaucratic. But Akalitus is the show's Percocet, a quick way to feel better, but with potentially serious long term costs. This kind of image may suggest that female nurses can't handle authority, and that any strong woman who chooses to be a nurse must be twisted and bitter. Of course, Jackie herself belies that suggestion, and on the whole this episode offers a persuasive depiction of her advanced nursing skills. The episode, "Daffodil," was written by Taii K. Austin. more...

 

"Helpers?" The New York Times on Saving Lives

July 1, 2009 -- Today Tara Parker-Pope's "Well" blog at the New York Times posted a very good piece by regular contributor Theresa Brown, RN, about the key issues raised by the book Saving Lives: Why the Media's Portrayal of Nurses Puts Us All at Risk, written by the leaders of the Truth About Nursing. Brown framed her well-written discussion of the book by suggesting that even her beloved New York Times crossword had reinforced "outdated nursing stereotypes" by referring to nurses as "white-cap wearers" and "I.C.U. helpers." The Times deserves credit for publishing a piece framed by a critique of one of the paper's own prominent features. Brown explained that the book argues that the media's heavy reliance on nursing stereotypes, particularly in Hollywood television shows, can undermine nursing care by reducing the attention we pay to vital issues like short-staffing.

Saving Lives is an important book because it so clearly delineates how ubiquitous negative portrayals of nursing are in today’s media... [The authors] argue that these images of nursing degrade the profession by portraying nurses as either vixens, saints or harridans, not college-educated health care workers with life and death responsibilities. The problem with how nurses are portrayed in the media is that it has the potential to devalue the way we view nurses in the real world.

We thank Theresa Brown, Tara Parker-Pope, and the New York Times.

See the full article, "Why Nurse Stereotypes Are Bad for Health," and take a look at the numerous and varied comments that follow at the "Well" blog. Please weigh in on this interesting discussion! Some of the comments so far suggest a need for further education about nursing autonomy and the value of nursing (e.g., #44).

 

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