Starring Zach Braff, Sarah Chalke, Donald Faison, John C. McGinley, Judy Reyes, Ken Jenkins, Neil Flynn
Executive Producer/Creator: Bill Lawrence
Produced by Touchstone Television
"Scrubs" remains one of the better sitcoms on television, though it has lost some steam in recent seasons. An irreverent, at times hilarious show with gifted actors, it poses the question: what if a hospital was staffed by insult comics? "Scrubs" has trained its lacerating wit mainly on the professional and personal lives of several young physicians. Perhaps as a counterpoint to the put-downs, the show relies heavily on fantasy sequences and sentimental musings on life by its goofy, insecure lead character J.D. This may seem a little too much like "Ally McBeal," but somehow "Scrubs" usually manages not to be cloying. And despite the nasty and surreal elements, its characters are not above learning or growing, as they try to cope with the very real stresses of life and death at the hospital.
The show's portrayal of nursing has been less impressive. It does have one major nurse character in the tough Carla Espinosa. Carla has, on occasion, briefly displayed nursing expertise. And a few plotlines have had surprisingly thoughtful takes on nursing issues. These include the decision to become a nurse practitioner, bigotry towards male nurses, nurses' informal teaching of residents, and nurse-physician tension. But on the whole the show reflects the prevailing Hollywood vision of nurses as peripheral health workers with limited skills who report to physicians. Indeed, the nurses' lives seem to revolve around those of physicians, who are seen as the providers of virtually all meaningful health care.
"Scrubs" follows the work and personal lives of three young physicians at Sacred Heart Hospital. They are John Dorian ("J.D.") (Zach Braff), the earnest but klutzy lead character who narrates most of the shows in voiceover; J.D.'s long-time best friend Chris Turk (Donald Faison), a competitive, self-assured surgeon; and the insecure, odd Elliot Reid (Sarah Chalke). Another main character is experienced, relatively normal registered nurse Carla Espinosa (Judy Reyes), the subject of Turk's romantic attention from the start. Carla's testy relationship with Elliot, at least initially, seemed to reflect a female nurse-female physician tension. However, they have become close friends. The final major character is the attending-cum-drill sergeant Perry Cox (John C. McGinley), a gruff mentor to J.D. Cox's vicious insults seem designed to hide his crumpled idealism--a tactic that the show itself seems to employ.
Other important regular characters include chief of medicine Bob Kelso (Ken Jenkins), a charmless despot who regularly does battle with Cox. Neil Flynn plays a predatory hospital janitor (known only as "The Janitor") who often takes offense at J.D.'s insensitivity and exacerbates his neuroses. The Janitor has increasingly spent time playing juvenile power games with the male physicians. Minor recurring characters include the obese, disagreeable Nurse Roberts (Aloma Wright), whose work at times seems to consist of sitting around and fulfilling stereotypes, and the comically arrogant, crudely sexual surgeon Todd (Robert Maschio).
A good example of the show's not-for-everyone comic sense was J.D.'s romance with Jamie (Amy Smart). Jamie was the attractive wife of a patient who spent years in a coma before he died. She was delicately known to the hospital staff as "TCW"--Tasty Coma Wife.
During "Scrubs"' first five seasons, the lives of its characters have developed considerably, especially in view of the show's irreverent, surreal themes. In the second season, the main characters finished their internships and became residents. Carla belatedly accepted Turk's marriage proposal, and at the end of the third season they finally married. J.D. and Elliot, who had flirted from the beginning, spent some time as "sex buddies" until Elliot pulled back. J.D. then became convinced that Elliot was the woman for him. But after finally working up the courage to tell her at the end of the third season, causing her to dump her then-boyfriend, J.D. realized that she wasn't the one after all. His mishandling of this poisoned his relations with Elliot for some time. Cox got back together, tentatively, with ex-wife Jordan (Christa Miller Lawrence), whose ultra-nastiness matches his own. Her new baby turned out, unexpectedly, to be fathered by Cox himself.
At the end of the fourth season, the main characters finished their residencies. Turk and Carla's marriage seemed to have survived serious early difficulties, including adjustments to Turk's recently diagnosed diabetes, and uncertainty as to whether their romance was really strong enough. One result of these marital struggles was that J.D. finally moved out of the apartment they had all still shared. Elliot, having gained some professional confidence, accepted a position at another hospital.
But she soon rejoined the other new attendings at Sacred Heart, and the fifth season found all three main characters confronting the challenges of training the new physicians they had only recently been themselves. Despite the show's light overall tone, a sense of aging and transition haunted the major characters. Plotlines focused on Turk and Carla's efforts to conceive a child, and then to cope with her pregnancy. Cox struggled to reconcile his machismo with modern fatherhood, and to manage his still-testy relations with Jordan. Elliot had an extended, dysfunctional affair with her intern Keith. And J.D. drifted in and out of relationships, though the season ended with his new girlfriend pregnant.
The show has made frequent use of guest stars, though they appear far more commonly as physicians than nurses. Rick Schroder appeared in several early 2003 episodes as confident, witty and sensitive nurse Paul Flowers (yes, a male nurse named Flowers). Elliot had a romance with Paul, who faced anti-male nurse bigotry from the show's emotional wrecking crew, including Kelso and Todd, who called him a "murse" who did "women's work." Elliot herself struggled with her self-esteem when she belatedly learned that Paul was a nurse, not a physician. Paul easily rose above the slurs, casually dismissing Kelso and upstaging the jealous J.D. by offering a superior toast to the newly engaged Turk and Carla.
"Scrubs" has been better for nurses than most current serial television, though it remains fairly poor overall. The show features a major nurse character in Carla. She is often portrayed as strong and competent, and she is probably the most prominent Latina nurse character in modern US television history. She is the only major character on the show who could really be described as normal and caring. Of course, in the "Scrubs" universe this could actually be a mark of disrespect, in the sense that maybe the show feels nurses aren't interesting enough to be truly screwed up.
The show has at times recognized nursing skill, and touched on some real nursing issues. These include the decision to become a nurse practitioner, bigotry towards male nurses, and nurses' informal teaching of residents. One early episode was called "My Nightingale" (most of the episodes are entitled "My _____", with the pronoun referring to J.D.). In this episode, the young residents relied on Carla's health care knowledge on a night when there was no attending on duty.
Likewise, one early 2006 episode showed Carla helping interns (including Elliot) learn key aspects of clinical practice, catching their errors, taking decisive action to rectify them, and teaching the residents how to avoid the errors in the future. Viewers saw Carla leading efforts to manage a seizing patient, and telling Elliot that she would protect her from Cox if she promised to practice repositioning swan-ganz catheters. This episode even made a point of showing how Elliot had overlooked Carla's contributions to her professional development, until someone else--Cox, no less--pointed it out to her.
And on occasion the show has even highlighted nursing expertise. Another early 2006 episode had Carla display an encyclopedic knowledge of patient conditions and care plans, and even some independent problem-solving ability. This episode suggested that the physicians were heavily dependent on charting, but Carla had what the Janitor termed "crazy nurse memory"--she was able to instantly tell the physicians about a variety of patients, and explain what was being done for them and why.
Rick Schroder's portrayal of nurse Paul Flowers was a notable network television examination of men in nursing. The abuse directed at Paul and Elliot by the physician characters caught the attention of many real life nurses. Some were offended at the comic mileage the show got out of these slurs, noting that men were unlikely to want to become nurses in the face of such abuse.
But not every depiction of nurses can be a recruiting ad, and the series clearly showed its contempt for those who made the negative comments. The anti-male nurse bigots were portrayed as childish idiots, while Paul was witty, secure, and fearless. He calmly dismissed the slurs and went on, outclassing his critics. Even his breakup with Elliot did not seem to stem from any questionable factor, such as some stereotypical aspect of Paul, but from his too-aggressive efforts to improve Elliot. If anything, that made him seem more like a real person, rather than Mr. Perfect. On the whole, the Flowers character seemed to be an admirable effort to explode stereotypes about male nurses.
That is not to say that the Flowers character's understated reaction to the slurs is one we would recommend for nursing as a whole. The show's creators worked hard to convey that Flowers was a formidable guy and his critics were idiots to give him a hard time. Real nurses do not enjoy those advantages. And in the real world, failing to counter bigotry can breed or at least allow more of it. The average week of U.S. television includes hours of persuasive programming telling millions of viewers that nurses don't matter, with no comparable rebuttal. Indeed, nursing has generally taken the "just say nothing and rise above it" approach, yet the profession faces an ongoing staffing crisis and a lack of adequate resources. And even today, less than 10% of U.S. nurses are men.
Unfortunately, on the whole "Scrubs" suffers from "Marcus Welby Syndrome," in which physicians are shown directing if not providing all meaningful health care. The show's vision of physicians as flawed but still dominant heroes is underlined by its theme song, whose lyrics are: "I can't do this all on my own / No, I'm no superman." This associates the young physicians with a teamwork message, as if their development involved learning that however wonderful they are, they still need some help. This is the same message often addressed to preschool children, as in, for example, "Rescue Heroes" products. But "Scrubs" viewers are unlikely to see it as a subtle dig at physicians. Instead, most will likely see the issue as the extent to which physicians are "supermen," which reinforces the notion of physician primacy in health care. Moreover, based on the show's content, the help the song envisions would probably come mainly from other physicians.
Despite the occasional Carla-focused plotline like those described above, the show generally seems to regard nursing as a fairly low-skilled and peripheral job. It gives little sense of the range of nursing practice, or nurses' central place in hospital care. We rarely see Carla actually give or discuss nursing care, in contrast to the physicians, who do often manage to treat and discuss patients despite the constant hijinks. While the professional development of the physicians is often the show's main topic, the development of nurses is almost never mentioned. And the show has on occasion indulged in the naughty nurse stereotype, in fantasy sequences based on the characters' overworked imaginations.
As on other television series, "Scrubs" physicians are shown supervising nurses, and nurse managers generally don't exist. Even the relatively impressive early 2006 episodes discussed above suggest that Carla reports to the physicians.
One late 2003 episode purports to teach Carla that nursing is all about doing what physicians tell you, and it is one of the most virulently anti-nurse TV episodes we have seen. In the episode, a patient has an adverse reaction to a medication Carla recommended to Elliot. Elliot and Turk then persuade Carla that physicians are in charge of nurses, that the nursing role is to follow physician "orders" without question, and that nurses should be happy to accept their role as brainless physician helpmates. Another episode shows Kelso firing the nurse who had made Cox's favorite cup of coffee, suggesting not only that Kelso could actually do that at will, but that nursing involves making coffee for physicians.
Early 2005 episodes offered somewhat more nuanced visions of physicians directing nursing care. One featured code scenes in which omniscient physicians issued flurries of commands to nurses, who then leapt to carry them out, displaying little autonomy or expertise. The scenes suggested that nurses have some technical knowledge, but that they are heavily reliant on physician direction--they report vitals and await orders. J.D. at first struggled with this superman role, but there was no indication that experienced nurses would be able to help him make decisions in codes, as is actually the case.
Another troubling 2005 episode actually had Cox assign nursing tasks to Turk as a result of short-staffing caused by a SARS quarantine. In doing so, Cox impugned Turk's masculinity, and joked that he should give his "special sponge baths" and a "happy ending" if the patient so desired. Beyond the association of nursing with submissive female sexuality, this suggests that physicians manage nursing care. In that same episode, Carla tries to get Turk to help her. When Turk says he doesn't "have the expertise" to redress bedsores, Carla assures him that "any idiot can be a nurse." When he agrees, she shoves him, and he sees that she has trapped him. We get that she disagrees with his view, but not why. And the episode does nothing to disprove what Turk has said, leaving viewers to conclude that Turk is not very tactful, but he may be right about his wife's job.
In accord with prevailing Hollywood practice, the focus is generally on Carla's personal life, and a major theme has often been her romance with a physician. One episode did involve Turk signing Carla up for a nurse practitioner program as a surprise gift--one of the few times serial television has acknowledged that the nation's 200,000 advanced practice nurses even exist. The show made clear that Carla was well qualified for the program, but she chose not to pursue it so she could spend more time with Turk. No one should be quick to judge someone else's decision on such a difficult matter. But Carla did not say that she had no desire to be a nurse practitioner. And no one on the show really argued that perhaps her career was as important as her then-boyfriend. It seems doubtful that the show would have had a physician making that kind of sacrifice for a nurse (or a man for a woman) without further comment.
As if to balance Carla's positive persona, the show's other recurring nurse character, the African-American Nurse Roberts, often seems to be a mix of stereotypes. Lazy, disagreeable, and rarely engaged in anything but gossip, Nurse Roberts is one of the most consistently negative nursing characters on television, though she is a very minor one."Scrubs" is actually one of the better shows on television for nursing. But it's far from being superman.
Reviewed by Harry Jacobs Summers
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.
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