HawthoRNe reviews

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"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...

From rock stars to activity logs

July 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...

Trouble handling this nurse

June 30, 2009 -- Tonight's episode of TNT's HawthoRNe again presented the lead character as an authoritative chief nursing officer who fights for patients and families. Hawthorne tries to solve problems in creative ways, notably in using hospital systems to give a grieving man time to say goodbye to his brain-dead mother before her life support is disconnected. The new nurse Kelly, who is very meek, does manage to show some skills and to solve an important health care mystery, determining the surprising cause of an infant patient's ingestion of a toxic substance. And nurse Ray forcefully explains to a patient that he is a trained professional, though not until he has spent an entire shift letting her treat him like a servant. And his speech about nursing does show that he is still a wannabe physician. Indeed, the show seems to focus on nursing weakness, and what nurses lack the authority to do. Perhaps the most striking problem is that the episode finally makes clear that Hawthorne reports to the chief of surgery. This plays out in a horrific scene in which the hospital CEO criticizes the chief surgeon for failing to control "this nurse," i.e., Hawthorne, who stands by, essentially silent. This wrongly suggests that nurses, no matter how senior, automatically report to physicians, and by extension, that nursing is merely a subset of medicine. The episode, "Yielding," was written by Sarah Thorp. more...and please speak to the producers.

Chief Nursing Officer

June 16, 2009 -- Tonight's series premiere of TNT's hospital drama HawthoRNe makes a serious effort to tell stories from a nursing perspective and to focus on nursing care, particularly the exploits of the dedicated, expert, and strong chief nursing officer Christina Hawthorne (Jada Pinkett Smith). Remarkably, the show has four diverse major nurse characters--including the black female lead and a man--with just one major physician character. This is an unheard-of TV ratio, though a good approximation of hospital reality. Indeed, the very fact that HawthoRNe shows that chief nursing officers exist is helpful. Nurses are not interchangeable widgets, and some here are clearly more skilled than others; to some extent they provide autonomous care. In several cases the pilot gives viewers a sense of the lack of respect nurses often receive from patients and physicians. And it suggests that nurses have the skill and perhaps even some obligation to resist physician "orders" in order to protect patients. One nurse questions but still gives an erroneous physician insulin prescription, then gets in trouble when the patient crashes. But sadly, the overall portrayal does not convey enough of nurses' real skill or autonomy, and elements of the episode reinforce harmful stereotypes. The nurse-physician conflicts do not really make clear that nurses are legally and ethically obligated to resist dangerous physician care plans. Many scenes suggest that the direct care nurses are, well, weak, and very much in need of rescuing by Hawthorne. As on other shows, the blistering contempt of some physician characters is not adequately refuted, except to some extent by Hawthorne herself. And surely nursing does not need an image of a frustrated nurse who really, really wants to be a physician but was unable to get into medical school, and so harbors a huge inferiority complex. Surely we don't need an image of a beautiful young nurse named Candy who thinks it's part of her job to grant sexual favors to Iraq War veterans as a "thank you" for their service, and who we see cheerfully provide manual sex to a soldier in the pilot. And at times, the show suggests that staff nurses tend to be frivolous physician helpers--physicians still do both defibrillations we see. HawthoRNe may not inspire a lot of critical respect, but its main character and basic structure could help nursing a great deal, so we hope future episodes will avoid stereotypes, and do more to convey what nurses do to save lives. The pilot was written by series creator John Masius. The first episode was seen by 3.8 million viewers. more...

Summer 2009 TV Preview

The other nurse-focused summer show is TNT's full hour drama HawthoRNe, a spelling which is, as another observer noted, not easy to type out--not exactly the way to win critics over. Fortunately, the character Hawthorne herself does not seem to spell it that way. The TNT site explains that the show focuses on "Christina Hawthorne (right), a compassionate and headstrong Chief Nursing Officer heading up a group of dedicated nurses at Richmond Trinity Hospital who spend long days and nights on the hospital's front lines." The site and the video clips available present her as "the kind of nurse who fights for her patients and doesn't let them slip through the cracks," and who even "takes on doctors and administrators who are overworked, distracted or just unable to see the human being behind the hospital chart." Indeed, the clips suggest that the show will address nurse-physician power relations and overlapping responsibilities. Although the basic cable show seems far more conventional in dramatic terms than Nurse Jackie, with a clear focus on tugging heartstrings, the TNT site makes clear that Hawthorne will not "hesitateto violate protocol" to help patients (nothing about Percocet, however). And all this commitment has not earned Hawthorne a perfect life. Her husband recently died of cancer, leaving her to raise a "smart, rebellious teenage daughter on her own."

One promising thing about HawthoRNe is that it appears to have an amazing four major nurse characters to one physician, reversing the ratio of most other hospital shows (when they have nurses at all). But of course, HawthoRNe's character ratio simply approximates the actual ratio of physicians to nurses in U.S. hospitals and in the nation generally. The one physician is Tom Wakefield, the "oncologist who treated Christina's husband and [] Chief of Surgery for the hospital." Wakefield is "strong" and "competent," but he "bristles when his judgment is called into question, especially when he's second-guessed by subordinates." He also "relies on [Hawthorne] to serve as a buffer between himself and the staff," which seems a little odd since a chief of nursing and a chief of surgery would not generally supervise any staff in common.

The other HawthoRNe nurse characters seem like a mixed bag. Nurse Bobbie Jackson is a close friend of Christina's who is "smart, honest, caring and funny, yet she also fights personal insecurities." Ray Stein is frustrated because, as a man, he does not get the respect from "patients and staff" that other nurses do. Unfortunately, the TNT site also reports that Ray "has always wanted to be a doctor and hopes one day to go to medical school." That does occasionally happen in real life, but Hollywood's suggestions (notably in the first two thirds of ER's long run) that smart nurses aspire to medical school reinforce the wannabe physician stereotype. In fact, nurses are 100 times more likely to pursue graduate education in nursing than medicine.

And HawthoRNe nurse Candy Sullivan (right) "has a reputation for giving 'special attention' to soldiers injured in the [Iraq] war, something she sees as her way of supporting the troops." Really? A nurse named "Candy" who thinks it's part of her job to provide what sound like sexual favors to soldiers? We guess that does draw on the battlefield roots of modern nursing, but it also seems to reinforce a pernicious stereotype:   the naughty nurse. In fact, early nursing leaders emphasized nurses' purity precisely to assure society that women could do this vital professional work without raising questions of sexual immorality. The TNT site assures us that Candy is also "very competent," but regardless, we hope the show avoids the nurse-as-sex-worker image, which undermines real nurses' claims to adequate resources--especially since the show's apparently serious dramatic portrayal could be even more damaging than the standard pornographic nurse image, which people presumably know is just a model playing dress-up (or down).

TNT has promoted the show through a "nurse hero sweepstakes," which includes tributes to real nurses posted on the TNT site by members of the public. Those posted so far reveal much of the nature of public understanding of nursing in 2009. They are heartfelt salutes to nurses as caring, dedicated maternal figures and physician helpers, but despite a few general references to "skill" and "knowledge," there is virtually nothing in these well-meaning tributes to suggest that nurses are educated health science professionals who save lives. And one writer offered this revealing tribute to her own (real) mother: "My dream [is for her] to become my surgical nurse when I become a surgeon." These are just the unskilled angel images that Nurse Jackie subverts so effectively, and that we hope HawthoRNe will do its best to avoid.

See preview clips from HawthoRNe: clip 1 and clip 2. Tune in to TNT June 16th at 9pm to catch the first episode.
 

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