Changing how the world thinks about nursing

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Q: But that television show you're complaining about just happens to be about physicians. How can you expect it to show nurses or nursing?

A: Oh yes, of course. That show just "happens" to be all about physicians. In 2005, roughly 24 of 25 major characters on the top three U.S. hospital shows (ABC's "Grey's Anatomy," Fox's "House," and NBC's "ER") just happened to be physicians. However, in all these hospital shows, the physician characters also just "happen" to spend about half their time doing key tasks that nurses do in real life. This includes crucial monitoring, life-saving procedures, psycho-social care, patient advocacy and education. And even if a show actually stuck to showing what physicians really do, at some point Hollywood would have to take responsibility for the fact that virtually every significant hospital show in recent decades just "happens" to have focused overwhelmingly on physicians and their work, clearly reinforcing the prevailing social view that they provide all important care. We can easily name a dozen significant shows of the last decade that have focused overwhelmingly on physicians, many of the shows monster hits. But try naming one U.S. show from that time that has focused on nurses--or even given them comparable treatment. At a time when nursing has been in the midst of a life-threatening global shortage for many years, it will no longer do to pretend that the health care media landscape is the result of anything but a dangerous lack of understanding and widespread social bias.

Virtually all major hospital shows of recent years have portrayed physician characters providing all health care of any significance. This includes exciting, important care that is primarily or exclusively the province of other health professionals, especially nurses. In hit Hollywood shows like "Grey's Anatomy" and "House," physicians tend to be there with patients all the time, providing all monitoring, all emotional support, all patient advocacy, and all education. If something goes wrong, the physicians often singlehandedly save the patient's life, though a silent nurse's arm may appear to hand them something. In Hollywood, physicians generally give all medications; in real life, nurses do. In Hollywood, physicians do virtually all defibrillation; in real life, nurses do the vast majority of it. In Hollywood, physicians stay with patients 24/7, providing emotional support; in real life, nurses do that. In Hollywood, only physicians generally have positions of any interest or importance. In real life, nurses play the central role in hospitals, which exist mainly to provide nursing care. In Hollywood, nurses are commonly seen as mute, deferential servants. In real life, they are highly educated, autonomous professionals who regularly save lives by making critical judgments about patients' conditions and taking actions, which may include questioning other health workers' care plans. In Hollywood, physicians usually have the time to carefully explain patients' conditions and options in plain language and answer all their questions. Well, you see our point.

It's almost as if Hollywood producers know that they cannot make a sufficiently dramatic hospital show without featuring plenty of the work of nurses. It would appear that they just don't know (or care) that they are actually showing the physician characters doing nursing work. The reasons for this are likely complex, but in general, even elite sectors of society have long believed that physicians provide all health care of any importance, in part because of historic gender bias, as well as nurses' own failure to assert themselves. At one time, fictional media creators might have felt compelled to focus to some extent on nurses and other non-physicians in order to get a balanced gender mix. But today, when women are becoming physicians in large numbers, most in the entertainment media world evidently feel they need not include any significant nurse characters at all in order to create compelling health care drama. The result: "House" and "Grey's Anatomy." And of course, once all your main characters are physicians (or CSI's, for that matter), the need to constantly sell those characters means they're going to be doing anything and everything, regardless of what happens in real life.

But let's assume that these hospital shows really did stick with the real physician role; no physician nursing. At some point, it is simply not credible to claim that every health care show the industry produces just "happens" to be all about physicians. What are we talking about, specifically? We're talking about "Grey's Anatomy" (9 physician characters, 0 nurses), "House" (6 physician characters, 0 nurses), "ER" (8-9 physician characters, 1 nurse), "Scrubs" (5 physician characters, 1 nurse), "Out of Practice (5 physician characters, 0 nurses), "Nip/Tuck" (4 physician characters, 0 nurses), and "Strong Medicine" (3-4 physician characters, 1 nurse). We're talking about "Chicago Hope," "St. Elsewhere," and "M*A*S*H." We're talking about numerous shorter-lived shows that still reached millions, like "Medical Investigation," "Presidio Med," and "Gideon's Crossing." And we're talking about the countless isolated plotlines in non-health shows that portray nurses and physicians in very similar ways. 1989's bimbo-fest "Nightingales?" Don't get us started.

There have been only a few limited exceptions to the rule of blatant physician-centrism. The central character on "China Beach" was a competent nurse. But that was a show primarily about non-health subjects, and it went off the air in 1991. The minor sitcom "Nurses" focused on nurses, and reportedly treated them with some respect, for three seasons in the early 1990's. More recently, a few popular shows have made limited efforts to show that nurses are not total handmaidens, notably "ER" and to a lesser extent "Scrubs" and "Strong Medicine," but they could never be mistaken for anything but "doctor shows."

Thus, judging from virtually all Hollywood products in recent years, we might well assume that most health care professionals are smart, life-saving (if flawed) physicians, and that nurses, at best, are marginally skilled physician assistants with little to say about care. In real life, there are four times as many registered nurses as physicians in the United States, and the nurses work at the center of the health care team. They are autonomous professionals with 3-10 years of college-level education. Their work is intensely challenging and exciting, and they use their advanced skills to save lives and improve patient outcomes every day, often with little or no involvement from physicians.

We would be eager to know what Hollywood show "happens" to be all about that. What show is devoted to the vital contributions the nation's millions of nurses make to modern health care? Hello? Is anyone there?

last updated: December 5, 2005

 

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