13 Weeks (November 2005 until March 2006)
What a tangled webisode we weave
January 2007 -- From November 2005 until March 2006, California travel nurse company Access Nurses posted on a company web site 18 brief "webisodes" of what is apparently the first Internet-based reality show, "13 Weeks." The webisodes spotlight six nurses living in a posh Orange County mansion while working at local community hospitals. The show was ostensibly designed to address the nursing shortage by highlighting how exciting travel nursing can be. Of course, it is clearly a vehicle to promote Access Nurses as well. "13 Weeks" gets points for diversity, for avoiding most nursing stereotypes, and for giving career seekers some sense of what nurses do. However, the show's focus is mainly on the "fun in the sun" aspects of travel nursing. Eight webisodes follow the nurses on outings, including wine tasting, kayaking, and visiting an amusement park, and most of the other episodes include significant non-clinical elements. The work portrayals are cursory and at times troubling--it's not a serious documentary. In the end, viewers are likely to get that some nurses are articulate and committed (and fun-loving!), but not so much that they are clinical experts whose work saves lives every day. And the full-bore endorsement of travel nursing as a solution to the shortage is problematic, given that many feel its rapid growth is more a dangerous symptom of the crisis than a cure.
The stated mission of "13 Weeks" is to "[e]ncourage more people to enter the nursing profession by highlighting the tremendous skill, compassion and dedication of nurses and the adventure and excitement of the travel nurse lifestyle." The webisodes are mostly about 3-4 minutes long. They follow the six nurses over the course of their 13-week assignments at four hospitals: Western Medical Center (Santa Ana and Anaheim), Coastal Communities Hospital, and Chapman Medical Center. The group is admirably diverse. Two of the six nurses are men, a proportion that is something like five times the percentage of actual male nurses, and one of the men is of Mexican and Filipino ancestry. The show also seems to make a point of showing us that one of the men is straight. Of the four women, one is African-American. The nurses' ages range from twenties to late forties. The show avoids the naughty nurse stereotype completely (something we can't say for all reality shows), and it generally avoids the handmaiden. And there are no hosts or other reality show trappings to distract from the nurses. Even in the hospital segments, the focus remains on them, rather than patients or physicians.
Fun in the Sun
Most of the series shows us what the nurses do away from the hospital, as they are taken on a series of jaunts, mainly around Orange County. Eight of the 18 webisodes focus exclusively on these activities, specifically hot air ballooning, wine tasting, skydiving, kayaking, and visiting an aquarium, the zoo, an amusement park, and an orphanage. In addition, the six initial webisodes, each of which introduces one of the nurses, also spend significant time on their non-work hobbies and pursuits, such as learning to surf, dance, or speak Spanish. In at least one, it's the clear majority of the webisode.
This all allows viewers to get a better sense of who the nurses are, though it also captures a fair amount of trivial misadventure and chatter ("this is fun!"; "the wild animal park was amazing!"; "he's such a cutie!"). Of course, that is the nature of most reality shows, but when one is so aggressively billed as being about nurses, it is worth noting. Many of the "fun on our days off" webisodes rely on veteran ED nurse Ron Coronado. The producers evidently felt that Ron--articulate, engaging, and not excessively burdened by modesty--would be a good general narrator and commentator. The amusement park excursion finds the nurses playing a game of "laser tag" (i.e., laser war), shooting each other with laser guns in an urban war game environment, an interesting choice for a group in which half of the members are ED nurses. Another segment finds the nurses at a Tijuana orphanage at Christmas, reading to the kids, face painting and so on. This is admirable, though like an early segment in which Ron describes his work at a summer camp for kids with heart disease, it's not really something nursing needs. Nurses don't need to persuade people that they're public-spirited, as opposed to health experts who make huge contributions by being nurses.
The last webisode (XVIII), which follows the nurses skydiving, ends with a twist designed to keep viewers eager for further travel nurse adventures. Veteran ED nurse Angelena Johnson is apprehensive about jumping from the plane. This is nothing new, as "Angel" also had trouble with the kayaking and hot air ballooning. The kayaking episode included description of her capsizing and being rescued. In the last webisode, we see footage of Angel reluctantly jumping, but there seems to be a problem. The screen goes black. On the ground, a stretcher is loaded into an ambulance, and the ambulance pulling away. The screen reads: "Find out what happens...Stay tuned for information about full-length episodes of...13 Weeks." We see nothing else about this on the nursetv site (as of January 2007), but this suggests that Access Nurses hopes to be back with expanded episodes. We assume Angel is fine, or the company would not be using the incident in this way.
The Coolest Job
"13 Weeks" does manage to show some of the actual work the nurses do in the four hospitals, albeit in segments of just a few minutes long, which is a significant constraint. To its credit, the show generally manages to avoid handmaiden stereotyping, and it does give the nurses some space to show what they know and what they can do. Some acquit themselves better than others. Indeed, as with documentaries, it's difficult to fully analyze the clinical scenes without commenting on the quality of the "real" nursing. Some of the nurses exude authority, expertise, and a practiced sensitivity with patients. Others seem less articulate, unsure how to relate to patients, and perhaps a bit lost. And when they discuss nursing, some of the nurses do tend to describe it mainly in emotional terms.
The work-related footage of Ron Coronado is pretty good. There's not much to his introductory segment, but he does explain his choice of a nursing career:
Patients know that they can ask me  questions, or confide in me things that have happened to them and that they need help with. Those are the characteristics that make nursing different, and much more desirable to me in my own heart than medicine or engineering or whatever else is out there. Even though I went to college wanting to be a biology teacher, this is a much better fit.
Having said that Ron, allows: "My passion and I think my true talents, even though I'm an excellent nurse, I think that my true talents lie in performing and entertaining and telling stories." We wish Ron's explanation of his choice of nursing gave a better sense of nurses' life-saving skills--they aren't just people you can confide in--but this does at least suggest that nurses are in a unique position to answer questions and provide psychosocial care, to have close interactions with patients. It also suggests that it would be rational to choose nursing over medicine, engineering, and teaching, at least implying that nursing is comparable to respected professions requiring significant university training.
A later webisode (XVII--"Ron at work") features a fairly good display of Ron's clinical work, particularly patient education and advocacy, in the ED. The three-minute webisode focuses on Ron's care for a Spanish-speaking patient with a serious infection in his leg. As we see Ron care for the patient, he explains to us that there is "suspicious" staph going around in the community. He notes that physicians diagnose this kind of thing, while nurses "treat the infection, treat the pain." He explains to the patient and an apparent family member in plain terms that there is too much pressure in the leg, probably "a big ball of pus," and that a physician will probably cut and drain it. As he works, Ron explains to us that the physician "ordered some blood tests and some medication therapy." He elaborates: "I just started the IV and drew blood to test for the white count. Then I started the antibiotics, and also gave him a tetanus shot." Ron also explains that an X-ray was done to ensure that there is no abnormality, and that the infection hasn't "traveled to the bone and it's not osteomyelitis."
Ron comes off as fairly down to earth, someone who can and does actually explain things to patients, but also as a clinical expert. As if to make sure we haven't missed this, Ron later makes a point of politely pushing the physician who comes to drain the cellulitis about the nature of the infection. The physician examines and puts Betadine on the infection site.
Ron: "You don't think this is MRSA?"
The physician, noncommittally: "It might be..."
Ron: "It looks like it to me..."
Physician: "Yup, you're probably right..."
We never learn if Ron is correct, and of course it's possible that the physician may have disagreed but was acting polite so as not to spoil Ron's nursing show. But viewers will likely take away that nurses can and do discuss diagnoses with physicians, and that they are not afraid to speak up to ensure that all possibilities are considered. Providing informed input on the various aspects of patient care, including the actions of other providers, is a key part of nurses' patient advocacy. It might have been nice if someone had explained what MRSA is (a dangerous staph infection that resists some antibiotics), so that viewers would know how potentially serious the condition could be. After the physician finishes draining the patient's leg, Ron bandages it and walks out with the patient. We could have used some wrap-up here, perhaps some discharge discussion, or some sense of what was next for the patient.
Whatever Angel's problems with skydiving and kayaking, her fairly brief work segments present her as an authoritative, experienced ED professional with a positive attitude. It's true that her segments are somewhat short on the specifics of what she does. We see her interact briefly with patients and colleagues, asking about pain levels, using a bit of technical jargon. She stresses that patient education is important to her, and to that end, her goal is to learn Spanish, which we see her practicing at work. Angel also talks about her experience caring for victims of the Oklahoma City bombing. She says she was the "first and only hired nurse" to be the "nurse case manager" at the ED where she worked after the tragedy. She notes that she also went with an ambulance to help victims at the bombing site, and that they were able to help many people, though the experience was terrible. It might have been helpful to get a more specific description of what Angel did, or at least what injuries she handled, to give viewers a better sense of her expertise.
Amy Morrison (I and XI--Labor & Delivery) comes off as personable and competent, though her clinically-focused segments both show Caesarian sections in which she has little interaction with the patient, the family, or colleagues. Moreover, they give viewers only a vague idea of what Amy really does to help her patients. In her introductory webisode, she notes that it's her job to "make sure the patient's ready," to make sure everyone who needs to be there is there, and to stay with the patient. She does explain a few things, like that the patient receives "medication" and that a "vacuum" is used to help bring babies out. But she tends to use general terms that do not convey the range or depth of nurses' knowledge or skill. When a physician arrives to perform the C-section, he remarks: "Here comes the star!"--a good way to disparage nursing's role in L&D care while seeming only to make light of the filming. It seems to us that Amy's response, that "we have our whole star crew here," is not adequate to counter the ignorance/arrogance embedded in this "joke." She also offers emotional description of how it feels to help people when they're so vulnerable, and to give her heart and soul to patients. The segment closes with Amy lightheartedly noting that "that's nursing, it's 2:30 and I still have not had lunch...to pee, I need to pee too."
In Amy's second C-section webisode (XI), we get vague descriptions of her job being to "make sure everything runs smoothly." Meanwhile, we see the baby being pulled out and cared for, but there is really no explanation of what Amy is doing. Indeed, for most of the segment she seems to be watching rather than playing an active role. Of course clinical assessment includes observing, but viewers don't know that if you don't tell them. Amy makes a real effort to sell nursing in a general way ("people are just so intrigued by what I do," and it's nice to be "appreciated"). But these webisodes do little to show that nurses can be authoritative clinical leaders and make a tangible difference in patient outcomes.
The clinical webisodes (V and XVI) with the voluble Emily Seay (Post-Partum) at least feature some patient interactions and convey a sense of autonomy, with a few suggestions of technical expertise. Emily interacts with moms and babies, doing assessments with her stethoscope and spirometer, talking briefly with mom about what she's doing and why, taking babies for tests. We see her bathing, weighing, holding and soothing a newborn. Unfortunately, she feeds the babies formula with a syringe without ever noting the adverse health effects from formula use. Nor do we see her educating the family about the benefits of breastfeeding. At one point she notes that she's going to do the "PKU," the "standard metabolic screening." Emily went to Asia to help victims of the 2005 tsunami, and we get a brief clip of her caring for a child there, though as with Angel and Oklahoma City, we don't get a strong sense of what Amy actually did for the victims.
Emily makes perhaps the most spirited and extensive efforts to sell nursing. She hopes the show motivates people to become nurses, because it's "the coolest" job. She "love[s] helping people" and wishes everyone could have the same sense that you don't have to work "in a cubicle." Indeed, she thinks "nursing is the noblest profession, where you actually go to work and get paid to do something that you would do for free. I would." This sounds great at first, but a lot of it--especially the "for free" part--plays into the sense that nursing is more of a noble vocation than a real profession that needs serious educational and clinical resources. There's also nothing specific about what nurses do and why they're essential; instead, it's full of emotional "helping" imagery.
Young ICU nurse Nick Shields presents a contrast to his colleague Ron Coronado. Unlike the animated, camera-loving Ron, Nick is quiet. However, the director makes sure to show him weightlifting, riding a motorcycle, going on a date with a woman, and getting advice from Emily ("I'm telling you, chicks dig bikes"). We do get some idea that Nick has skill and knowledge, but he seems a bit self-conscious about the super-serious hospital setting, as if he doesn't want us to think he's uncool just because he's called upon to say things like "bilateral lung reduction surgery" or "COPD emphysema." At one point, an apparent physician prods Nick into performing for his own show: "Nick, why don't you tell me about how [the emphysema patient's] doing." All a grinning Nick can manage is: "He's doing great." We do see Nick interact with his patient and briefly describe the patient's condition. Nick also uses the spirometer. He does not identify this device, but explains: "That machine, it helps you see what good of volume you're getting whenever you take in a deep breath, and how well your lungs are expanding, and it also helps you expand your lungs better, because it forces you to take a big deep breath." At another point, a physician shows us what emphysema looks like using scans of the patient's lung. Then we see gee-whiz shots of his surgery, in which Nick is not directly involved.
A later webisode shows Nick interacting a little more with other nurses and patients, but the vast majority of this one is actually recycled from the earlier webisode described above. Did the producers think viewers wouldn't notice, or wouldn't care? Near the end, after the patient's surgery, we see Nick changing the dressing at the incision site. He notes that it's "amazing what they can do though these little holes." But it's not clear from these scenes that nurses can do anything amazing.
The Bottom Line
The nursetv site also includes promotional videos about each of the four participating hospitals, featuring infomercial-type discussion by nurse managers and satisfied staff nurses. Low-key and tour-oriented, these seem directed at nurse recruiting, and in particular in promoting travel nursing, making clearer the symbiotic relation between Access Nurses and the hospitals. At a few points, the videos suggest that a lot of the travel nurses stay indefinitely at the hospital in question. At one point, a speaker notes that the travelers actually bring new ideas and new perspectives to the host hospitals.
That's a good point, and it brings us to the larger concerns about "13 Weeks"' suggestion that travel nursing is a solution to the nursing shortage. Most recent press pieces about travel nursing (including those about "13 Weeks") have given a very positive account of the sharp growth in travel nursing that has accompanied the nursing shortage, and included no significant analysis of what the trend really means for nurses' work environments. One recent Baltimore Sun piece went so far as to suggest that travel nurses actually provide better care than staff nurses.
Travel nursing offers some real benefits to some nurses and some hospitals, as "13 Weeks" suggests. However, as Suzanne Gordon explained in Nursing Against the Odds, the growth in travel and temporary nursing is cause for concern as well. It may create resentment in regular staff nurses, who are often making less money; it can undermine unions, and decrease nurses' power and inclination to challenge unsafe conditions that result from short-staffing; it costs money that could be spent on adequate full time staffing; and it may present inherent safety issues, since even the most qualified travelers will have difficulty instantly getting up to speed with site-specific and increasingly complex hospital systems. At the same time, Gordon argues, the tempting perks of travel nursing--short contracts, nice housing, sign-on bonuses--may do little to keep nurses in the profession long term. Travelers don't have to like their hospitals, and they may have little incentive to improve them; they can be gone in, well, 13 weeks. The hospital promotional videos on the nursetv site seem to make an effort to respond to some of these concerns, but they obviously do not present a balanced view of current clinical settings.
"13 Weeks" might cause some viewers to take a look at nursing, and maybe some will even find something to like about the profession itself. The extracurricular activities that occupy most of the show do matter to career seekers. And many nurses can arrange their schedules to allow for a range of activities not available in most jobs. But it's hard to believe that a focus on what can be done off duty will really attract many people who will be motivated to stay and push the profession forward. As for the clinical scenes and general testimonials in the show, these too may persuade some to give nursing a look. But the show could have done far more, even in its brief webisodes, to show viewers how important nursing really is to patient outcomes. Too much of the show plays on the same emotional imagery that was well-established in the public mind well before the current crisis began. And even the nurses who seem inclined to convey specifics about their expertise and real value to patients get too little chance to do so here.
"13 Weeks" may help to spread some helpful knowledge about nursing. But the vision it presents is so limited that the show will likely help Access Nurses more than it will nursing.
See our previous analysis of 13 Weeks from May 2005.