Changing how the world thinks about nursing

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SVU photoNovember 23, 2004 -- Tonight's episode of NBC's "Law and Order: Special Victims Unit," Marjorie David's "Doubt," featured a "sexual assault nurse" character examining a rape victim in its first few scenes. We commend "SVU" for recognizing that forensic nurses exist and showing a little of their work. Sadly, though the episode resisted the urge to show a physician directing the action, it instead gave the impression that one of its two main detective characters was doing so. In real life, the forensic nurse would have directed and provided all the critical care and forensic work, and the police probably would not even have been present. But here, the nurse character came off as an awkward and insensitive assistant, as the detective explained what was going on, took photos, and provided the only real emotional support the patient received.

This episode focused on an alleged acquaintance rape of a graduate art student by one of her professors. Roughly the first 10 minutes of the episode traced the immediate aftermath of the alleged crime, including the examinations of the victim and the suspect at a Manhattan hospital. The show's female lead, Det. Olivia Benson, accompanied the victim from the scene, riding with her in the ambulance and guiding her through the hospital process. Benson was portrayed as essentially in charge of the victim throughout.

The nurse character was introduced as "Louise," a "sexual assault nurse." She was very briefly shown performing several forensic procedures. These included searching for bodily fluids and conducting a vaginal exam with only a few seconds notice, an exam that made the victim jump and grimace with pain. During this process, the nurse had only a few perfunctory lines. By contrast, Benson had control, not only questioning the victim about the rape, but providing emotional support and explaining what was going on in the forensic exam in more detail than the nurse. The nurse circled the victim like an indifferent technician, making no connection with her, and explaining what she was doing only when the patient recoiled. Meanwhile, the suspect was examined separately by the physician medical examiner as Benson's partner questioned him, even though in real life this exam would almost certainly have been performed by another forensic nurse. The physician who did this exam was introduced as "Dr. Warner," and she had more lines and a far more commanding presence than "Louise." As the victim left the hospital, Louise gave her only a perfunctory farewell at the door ("Take care of yourself!"), not unlike what we might receive from a clerk at the dentist's office.

During the trial scenes that occupy the latter part of "Law and Order" episodes, the nurse did not appear to present forensic evidence, and there was no reference to that key forensic nurse role. But the nurse was there in spirit: the prosecutor, eager to stress the victim's ordeal, claimed in her closing statement that the victim's hospital experience was only one of three "sexual humiliations" she had to endure, along with the trial and the rape itself. Specifically, the prosecutor noted that the victim "had to strip naked, she was photographed, poked, prodded and then scraped so the police could gather evidence"--which, of course, meant the work of the "sexual assault nurse." Needless to say, it is quite a compliment to the forensic nurses who care for sexual assault victims to have their work compared to rape by one of the prosecutors who typically provide the perspective of the show itself.

Though the Benson character's dominant role in the hospital scenes was inaccurate and damaging to the image of forensic nurses, we're not really surprised. It is consistent with current Hollywood practice, which follows what might be called the major character imperative. In most dramas, the main recurring characters seem to spend as much time as possible on screen, presumably because of time constraints and the need to build the audience's identification with them, even if that means they will do jobs that their characters would never do in real life. Thus, the CSI's on the "CSI" shows do the jobs of about four different criminal justice professionals, the physicians on "ER" and "House" do the work of nurses and other health professionals, and in this case, Det. Benson did the work of paramedics and nurses. This obviously underlines the importance of the identities of the major characters in Hollywood shows. We can't expect much from shows like "SVU," which is really about police and lawyers. But for shows that are mainly about health care, it is critical that nurses be adequately represented among the major characters. In this episode of "SVU," nursing has to some extent exchanged one master for another: rather than wrongly presenting physicians as the directors of significant care, the show has a detective play the role. (The show apparently couldn't resist inaccurately giving the suspect's forensic exam to a physician character.) In fact, a key reason that forensic nurses are trained to play so many different roles is to minimize a victim's sense that she is being physically or mentally "poked" and "prodded" right after the crime by a long line of different people. You know, like police detectives.

The specific portrayal of the forensic nurse was especially disappointing. "Louise" never did get a surname, as the physician did. And with only a few relatively trivial lines for the nurse character, the actress and director seemed to make the least of them. The actress' delivery was halting and unsure when confidence was required, abrupt or inappropriately light when sensitivity was needed. And the nurse's care of the rape victim was not really inconsistent with the prosecutor's description: the victim was treated more like a crime scene than a patient, given little explanation, shown little sensitivity. The show gave no indication that this nurse was unusually inept, nor that the victim's experience was unusual. It did, however, do a nice job of avoiding the compassionate nurse stereotype.

In sum, the episode presented the nurse as a tentative technician who was peripheral to the important action. Now the episode's 15 million viewers have a reason to know that nurses are involved in the care of rape victims. But they have little reason to think that forensic nurses are highly skilled, autonomous professionals who play a critical role in helping patients recover physically and mentally from violent crimes, as well as in assembling and presenting the evidence needed to prosecute those crimes.