Open letter #1 to Grey's Anatomy

Dear Ms. Rhimes, Mr. Gordon, Mr. Parriott, Ms. Beers, Dr. Klein, Ms. Gilmore, Ms. Liggins, Ms. Tobin and Mr. Thompson:

I am writing to express grave concern about the portrayal of the nursing profession in the March 27, 2005 premiere of "Grey's Anatomy." In my view, the episode exhibited contempt for nursing, stressing that smart, tough, attractive women do NOT become nurses. Given the media's proven influence on the public--an influence Ms. Rhimes acknowledged in her recent NPR interview--the show's regressive attack on nursing will likely do its part to exacerbate the nursing crisis that is taking lives worldwide. However, even within the extraordinarily physician-centric structure of the show, it is possible for it to do less damage, and I urge you to listen to nurses' ideas as to how that can happen.

"A Hard Day's Night" seems to go out of its way to endorse the surgeon characters' contemptuous views of nurses, and to reinforce a vision of nurses as unattractive, marginally skilled subordinates. Though nurses do occasionally appear, and even make a few care-related comments at the margins, the show is really a series of intense interactions among its nine physician characters. No nurse is ever named. Only surgeons play significant roles in care discussions, and only their actions matter in patient care. The nurses never interact with patients, and thus they provide no patient support. In stark contrast to real life, nurses provide no informal education to the interns, not once proposing a care option.

In "Grey's Anatomy," nurses are generally absent or peripheral, reinforcing the common but completely wrong impression that physicians provide all meaningful care. We believe two nurse-related themes merit special attention. First, the show carefully defines and endorses the surgeons' contemptuous views of nurses. Consider the scene in which Meredith wheels the teenage seizure patient around the hospital. When the patient recalls her prior hospital visit--in which she "didn't get stuck with someone this clueless, and that was, like, a NURSE"--Meredith looks miffed but has no reply. She DOES feel as clueless as a nurse! This patient is not a positive character, but without any rebuttal, this will still reinforce prevailing stereotypes. It's not like the patient is saying something most people no longer believe. The key is in Meredith's reaction to the slur, which effectively endorses the teenager's ignorant view of nurses.

But the episode's most striking example of physician contempt is the post-op interactions involving Meredith, Alex, and the older, far less attractive nurse who briefly and annoyingly questions Alex's diagnosis. As you know, Alex trashes the nurse, and calls Meredith a nurse when she also questions the diagnosis. Meredith takes great offense at being called a nurse. And of course, her judgment is ultimately vindicated. Taken together, these interactions powerfully illustrate what Suzanne Gordon has termed "dress for success" feminism, in which women who pursue traditionally male professions like medicine disdain those in traditionally female ones like nursing. In the "I hate nurses" scene, it looked for a second like the show was going to hold intern Alex accountable for his abuse of and refusal to listen to the nurse. But no. The real problem was that he did not know enough medicine, and was, as Meredith suggested, "too busy to do the tests." It would never occur to Meredith to say anything in defense of nurses. What she cares most about is that she not be regarded as one of them. The show is not directly adopting Alex's "hatred" for nurses, and the nurse did identify the patient's continuing symptom and raise it with Alex, in a kind of weak, nagging patient advocacy. But that nod toward reality just makes the nurse's essential irrelevance more persuasive. It was the chief of surgery who pushed the issue of the continuing symptoms; without him, it's not clear anything would have happened. The nurse looked as if she could have had decades of post-op experience, but presenting no further assessment, she left the impression that she was more of a bitter peasant than a professional with clinical judgment. This would have been a great opportunity to show how nurses teach new physicians, and more broadly, that experienced nurses have a great deal of health knowledge.

In essence, the nurse is an anonymous vehicle for Meredith's vindication. But it's not just that Meredith has the right answer. It's that Alex has had the effrontery to call her a nurse. The episode is very interested in Meredith's bruised feelings. But the nurse has been eviscerated for doing her job as a patient advocate, and the show could not care less. She is merely an annoying old plot device who serves to tell us something about the pretty, powerful characters who matter. We also note the specific take-down of nursing education: nurses have not been to medical school, therefore pretty much all they can do is mechanically identify symptoms. Viewers will not get that nurses are college-educated critical thinkers, nor that physician abuse is a major factor in nurse burnout and a real threat to patients.

The other troubling nurse-related theme is the show's vision of nurses as dependent, marginally skilled subordinates in care settings. During the seizure patient's code scene, when Meredith does her kind of spaced-out freeze, these words of the nurse echo loudly in her head: "You need to tell us what you want to do!" Eventually Meredith recovers, initiates and performs defibrillation, saving the patient. Here, the nurses are working hard, they have some technical knowledge, and they are impatient with Meredith's hesitation. But they have no suggestions for her. All they can do is await her command, and for her to take decisive action to save the patient. Of course, among five nurses, there would be plenty of experience to guide Meredith through the usual response to grand mal seizures, and probably for the nurses to simply do it themselves, and assume physician concurrence in the absence of an objection. Nurses are the ones who defibrillate the vast majority of the time. But the take-away message here is that five nurses with many years of combined experience have no ideas to offer a physician on her first day on the job.

On March 25, 2005 NPR broadcast an interview with Shonda Rhimes and Isaiah Washington. In the interview, Ms. Rhimes stressed that she hoped to be able to change perceptions of persons of color with the show. She observed that "the way people look at people on television is the way they perceive the world," and that "we can change the assumptions that people have simply by the images they see in the background of the show."

We could not have explained better why "Grey's Anatomy" will likely have a negative effect on public health, at a time when most of the world confronts huge nursing shortages. In fact, substantial research confirms Ms. Rhimes' view that entertainment television is a powerful force in shaping public views and actions, including in the health care context. Indeed, even in its current form, the show could tell viewers that nurses are highly skilled, autonomous professionals who save lives and improve outcomes every day, and do it without asking physicians what to do.

Please be a part of the solution to the nursing shortage by hiring a nursing consultant for your show and improving the portrayal of nursing on "Grey's Anatomy." Help us improve public understanding of nursing at this critical time.

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