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14 Hours (2005)

Starring JoBeth Williams, Rick Schroder, Kris Kristofferson

Directed by Gregg Champion

Screenplay by Danilo Bach

Cosmic Entertainment

TNT


Nursing rating

Rating guide:
excellent = 4 stars; good = 3 stars;
fair = 2 stars, poor = 1 star

Artistic rating

"14 Hours" is a fact-based cable drama about Memorial Herrman Hospital's efforts to protect patients from the deluge that Tropical Storm Allison dumped on Houston in June 2001. The main character is warm, supportive nursing supervisor Jeannette Makins (JoBeth Williams), who joins arrogant surgeon Tom Foster (Rick Schroder) to coordinate the hospital's response to massive flooding, which ultimately involves an amazing logistical feat. Despite generally adequate work by the cast and crew, this is a mostly bland and at times gooey disaster story. But the movie deserves credit for placing skilled (if only marginally assertive) nurses at the center of patient care and the hospital's response to a life-threatening emergency.

The film follows Jeannette on one very long night shift. As the storm gradually floods the hospital, the facility loses primary and then backup power, which begins to threaten the lives of the more critical patients, whose care is dependent on electricity. Meanwhile, the movie's stock and simulated footage of the storm's effects on the city is often more compelling than the staged scenes. This kind of footage could have been the basis for a gripping documentary. But the specific stories and interactions we see are not all that engaging, and the screenplay is pretty flat.

On this shift Jeannette is the charge nurse for the trauma and emergency units, but she ultimately plays a leadership role in the whole hospital's disaster response. She leads her staff in resolving specific problems, such as getting the blood out of the rapidly flooding basement blood bank. Jeannette warily builds a working relationship with surgeon Foster, who is more or less her co-leader in the overall response. Some scenes present Foster as the more aggressive and decisive facility-wide patient advocate. While Jeannette in the early scenes displays a hesitant, "wait and see" attitude about the evacuation decision, Foster argues for it early and often, and it is he who reaches out to the city's disaster chief (Kris Kristofferson) for critical assistance.

The evolving relationship of Jeannette and Foster seems to reflect a view of the complementary care giving roles of nurses and physicians. Two of the main patient characters, a mother and daughter, have had an auto accident. Foster operates on the critically injured mother, fighting through the loss of power, while Jeannette addresses the psycho-social needs of the daughter, whose injuries are far less serious, but who is scared and deeply worried about her mother. The patients clearly appreciate both of these roles. But it's hard not to see it in terms of the classic stereotype of the physician as the strong, clinically brilliant father figure, and the nurse as the sensitive, nurturing mother figure. To counter this, the film could have done more to underline Jeannette's clinical skills in caring for the daughter. At one point, she does give the daughter a flashlight to calm her after the power loss. But it may not be clear to most viewers that this is part of her nursing care, rather than just a nice gesture that anyone might make.

That is not the only time that the film includes good nursing interventions whose serious clinical dimensions may not be clear to viewers without more explanation. In one scene, a veteran NICU nurse helps the mother of a premature newborn hold her daughter, advising the mother to place the infant in a skin-to-skin position, though the movie inexplicably shows them both clothed (right). The nurse even notes that this has immediately improved the fragile infant's heart rate. However, without explanation, this may strike viewers as just a happy accident, when in fact the clear physiological benefits of kangaroo care have been identified in nursing research. And here it is actually the distraught mother, not the nurse, who initiates the contact in the first place.

At several points, Jeannette and her fellow nurses do clearly display clinical knowledge. They get report from paramedics, stabilize the preemie in the NICU, and effectively rebuff Foster when he questions their medication double-checking and ability to keep patients going without electricity. Foster does slowly come to appreciate the value of the nurses in keeping his post-op patients alive. He even thanks one. At another point, Jeannette effectively overrules a physician's myopic desire to see a "slow-code" patient be given priority in the overall response plan. Nursing comes off better in trauma and the NICU than in surgery, where we hear too many obsequious "yes doctors" in response to Foster's gung-ho patter. Even in the NICU, the film more than once presents the NICU attending issuing stern orders to the assembled nurses, as if she was their commanding officer.

Away from the bedside, the portrayal of nursing has a number of positive features. Jeannette is presented as one of the right-hand people of the hospital administrator. Well into the film, when Foster urges the administrator to evacuate the hospital, the executive turns immediately to ask Jeannette's opinion. She gives a measured, credible concurrence with Foster's view, though the film has not effectively conveyed whether her thought process was the result of careful deliberation, or--as it appeared earlier--difficulty in making radical but necessary decisions. One good element of the movie is that it presents the nurses interacting with each other about care. This may not seem like much, but in most television drama, everything revolves around the physicians, and nurses only interact with each other to gossip or pursue personal issues. And the nurses in the film are not all white women; one of the emergency nurses is a black man who gets a significant number of lines.

One early scene symbolizes the film's combination of a fairly good awareness of nursing issues with somewhat shaky execution. Jeannette arrives for her shift with an inscribed homemade cake for a farewell party for her friend, the veteran NICU nurse, who is working her last shift at the hospital. Within seconds of Jeannette's placing this cake in her unit's refrigerator, Foster swoops in, cuts out a huge piece that includes part of the inscription, and stuffs much of it into his mouth. Most nurses will recognize this scenario. Jeannette turns and sees this, and can barely speak. Foster keeps eating, offering mockingly to perform a "surgical repair." Finally, Jeannette manages to sputter that he "had no right." This makes the point, but I have to admit I was hoping for a little more from Jeannette. Such as? "Well, from what I hear, you do need the cutting practice." Or, "I hope you like our special laxative cake, honey." (Having Jeannette take the knife and cut off the surgeon's cake-filled hand would probably be going too far.)

"14 Hours"' portrayal of nursing isn't perfect. But it is a story of nursing leadership and grit, and it presents a welcome contrast to the prevailing media model, in which physicians provide all significant health care.

Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed March 31, 2005

The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.

Also see Wendy Bonifazi's review of "14 Hours" in Nursing Spectrum.

See more information on the movie on the TNT site. The movie will air:

Sunday, April 3, 8:00PM ET

Sunday, April 3, 10:00PM ET

Monday, April 4, 12:00AM ET

Wednesday, April 6, 10:00PM ET

Thursday, April 7, 12:00AM ET

Saturday, April 9, 1:00PM ET

Sunday, April 10, 9:00AM ET

Tuesday, April 12, 11:00PM ET

If you go to this TNT page, they can send you a reminder to watch the movie at one of the above times.

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