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"Scrubs" defines nursing: it's all about shutting up and following physician "orders"

November 20, 2003 -- Tonight's episode of NBC's "Scrubs," which purports to teach nurse Carla Espinosa that nursing is all about doing what physicians tell you, is one of the most virulently anti-nurse prime time television episodes the Center has ever seen.

In the episode "My Fifteen Seconds," written by "Scrubs"' story editor Mark Stegemann, Carla advised resident physician Elliot to give an elderly patient a benzodiazepine instead of haloperidol to help her sleep, noting that in her experience it was more effective. Elliot hesitated because, as she noted, some patients have a "bad reaction," but Carla reassured her and Elliot followed her advice. After the patient in fact developed a paradoxical reaction, Elliot was furious. Her view was that Carla should never have spoken up in the first place, and that Elliott's job was to ignore her and do whatever she, the physician, thought was right.

Carla went to her fiancé, surgical resident Turk. He said that recently, a surgical nurse with 20 years experience had tried to tell him what kind of suture knot to tie. He said he had kicked the nurse out of the OR and made her cry, because in the hospital, physicians are in charge. He stated that the job of nurses is to defer to physicians and follow their "orders," because ultimately the physicians are responsible for the patients. Thus, Carla had no business giving Elliott advice. Turk assured Carla that she, Carla, was in charge of him and indeed, everyone, outside the hospital. But inside, physicians were in charge. Carla accepted this, evidently satisfied as long as she was in charge on the outside.

The final scene of the plotline found Elliott and Carla at a patient's bedside. The voiceover, as usual done by resident physician J.D., was noting that sometimes friendships can be preserved simply by listening. Elliot asked for a certain treatment, and Carla meekly obeyed. She was smiling, clearly relieved to have reached an understanding of her proper, subservient role as physician helpmate.

We searched in vain for any sign of irony in this plotline. Sorry. Unlike many "Scrubs" plotlines, this one was clearly straight up.

This episode's megalomaniacal fantasy is so inaccurate, irresponsible, and just plain evil that we're not sure where to begin. In fact, physicians are not in charge of nurses. Nurses are autonomous professionals who are educated by and managed by other nurses, not physicians. Nurses and physicians do work together, and nursing and medicine overlap to a significant extent. But nursing has its own distinct scope of practice and is in no way a sub-specialty of medicine. Nor are physicians in charge of other professional members of the health care team, such as social workers and pharmacists. A junior resident is in no position to kick a veteran nurse out of an OR, nor to make one cry--an especially offensive inaccuracy, since it implies that even senior nurses are weak and unduly emotional.

A key part of nursing is protecting patients from anything that threatens their health. In doing this, nurses regularly question physician care plans they believe are not in the best interests of patients, a practice that often saves lives. For instance, and ironically given the plotline above, nurses catch countless potentially fatal medication errors before they reach patients. And nurses--like physicians--have an independent professional responsibility to patients. Nurses who fail to meet the standard of care are subject to loss of their licenses and malpractice liability. We are not saying nurses don't make mistakes, and we would not demand that nurses never be shown making errors. But no nurse can nod along mindlessly to anything a physician wants without endangering her patient and risking her license. And having Carla embrace the master-servant fantasy and sadistic humiliation the episode serves up is akin to having her say thank you for a physical assault.

"Scrubs" has never had an especially evolved view of nurses. But it has at least shown some awareness of nursing, taking relatively serious looks at current nursing issues that are rarely addressed on serial television, such as bias against men in nursing and the decision to become a nurse practitioner. To say we are disappointed in the show would be a severe understatement.

Based on prior ratings data, about 15 million people probably saw this episode of "Scrubs" on November 20. Few have much reason to question what the show told them about the roles of nurses and physicians. We doubt anything short of an onscreen explanation of each of the above inaccuracies could even begin to undo the damage the show has done to public understanding of nursing at this time of critical shortage, when the need to tell people what nurses really do is urgent. We urge anyone who cares about how nursing is portrayed in the media to let the show's producers know about the damage they have done and what must be done to repair it.

Take Action!

Write to Executive Producer Bill Lawrence at Scrubs@NBC.com to encourage him to make amends for Scrubs' abominable treatment of nurses. Please blind carbon copy the Center so that we can monitor the effectiveness of this campaign and follow the nature of your concerns. We will post your letters on our bulletin board with your name, credentials, workplace, title, city, state and country if they are included. If you do not wish to have any of this information published on our web site, please email us at letters@truthaboutnursing.org to inform us how you would like your letter to read.

Recommended bullet points for a letter to Scrubs:

  • Nurses are autonomous professionals who report to other nurses, not
    physicians. Physicians are not in charge of nurses. Nursing and
    medical practice overlap, but nursing is a distinct field with its own
    educational system, scientific knowledge base and scope of practice--all
    of which is managed by nurses, not physicians.
  • A key part of nursing is patient advocacy--questioning anything the
    nurse believes is not in a patient's best interests and negotiating for
    something better. This includes physician care plans, such as
    prescribed medications, and in fact nurses catch countless potentially
    fatal medication errors before they reach patients.
  • Nurses have independent ethical and legal responsibilities to their
    patients that preclude them from simply nodding along to anything
    physicians want to do. Like physicians, nurses are subject to loss of
    their licenses and malpractice liability if they fail to meet the
    required standard of care. A nurse will not give a medication or other
    care he believes is not in a patient's interest.

Take Action!
Click here to write Bill Lawrence a letter!

Read our "Scrubs" review.

See write-ups of other "Scrubs" episodes.

 

 

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