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Physicians do the nursing, while male nurses get their pink on

October 14, 2004 -- In tonight's episode of NBC's "ER," physician characters spend significant time providing important care that nurses do in real life, but can't do on "ER" because the one major nurse character is consumed with personal issues, and every other major character is a physician. In this episode, entitled "Try Carter" and written by R. Scott Gemmill, that means that nearly 17 million impressionable viewers were told once again that nurses are marginal and physicians do everything of significance in the ED. Well, not quite everything: the only male characters we saw wearing pink patterned scrubs or breastfeeding were nurses.

In this episode, as in the past, physician characters regularly perform key nursing tasks that there are simply no nurse characters to perform. This proves once again that the show does think nursing is exciting and important enough to be worth its attention; it just doesn't fit with the program to show nurses doing it. Nurses are not alone in this; "ER" often shows physicians doing the work of social workers and respiratory therapists as well. Particularly striking is the episode's relentless depiction of new interns giving medications. Of course, nurses give most medications, and physicians--whether interns, residents or attendings--are not trained to do so and rarely do. Likewise, the episode has physicians receiving emergent patients from onrushing EMT's. In at least two cases, the EMT's actually call out the names of specific physicians as they crash through the door. So much for the triage nurse, who would take the lead in receiving and coordinating initial care for such patients in real life. Likewise, an intern who may have obsessive compulsive disorder (OCD) is shown struggling to do virtually everything connected with an intubation, when in real life nurses would do much of it, including giving medications and arranging for the required equipment.

Perhaps the most subtle distortion involves one of the main themes of the episode, the potential hazards linked to the annual arrival of the new class of interns, which some have termed the "July syndrome." In the episode, it is the senior physicians, like the attending Carter and resident Pratt, who assume complete responsibility for training these interns and trying to keep them from killing patients. No nurse is seen doing so. In real life, nurses play a critical role in protecting patients from new interns, and spend significant time in informal teaching of the interns. But not on "ER," where the nurses spend most of their time deciding how to proceed with their current physician romance, as lone major nurse character Sam Taggart did once again in this episode.

One remark by intern Abby Lockhart, who is also an experienced nurse, deserves comment. In the episode, Lockhart clashed with fellow intern Ray after she went behind his back to get a toxicity screen on one of his patients that Ray did not think was needed. After Ray complains to her and stalks off, Lockhart observes to Carter that it's easier to just fix things, presumably rather than debating them with difficult colleagues; indeed, "that's what the nurses do." This is a good example of "ER" trying to throw nurses a bone: a flippant one-liner that sounds positive, but does not bear close scrutiny. Of course at one level the comment suggests that nurses operate autonomously to protect their patients from errors by physicians and others. That is correct, and obviously it needs to be more widely understood. But that idea is a complete contradiction of the image of nursing that the show has spent over a decade pushing around the globe, which is of a deferential group of physician assistants who do virtually nothing on their own, and whose limited independence is expressed only in the very occasional argument about care with a (usually impaired) physician. This episode did not even show that kind of interaction, though the arrival of the new interns presented a golden opportunity. In addition, in context Lockhart's comment suggests that nurses are reckless swashbucklers who operate without consulting colleagues, doing whatever they think is right regardless of the consequences for workplace relations. But nurses do typically consult with colleagues, including physicians, when they see a potential problem with a care plan that involves those colleagues. They do not just "fix" things that are not exclusively within the scope of nursing practice.

Of course, we understand that Lockhart's tossed-off comment was probably not meant to be taken so seriously. It seems likely that it was intended, and may well be received, basically as an observation that those little nurses are used to making adjustments as to trivial matters on their own, but now that Lockhart has moved up to the big leagues, her decisions are far more consequential. She is going to have to learn to collaborate more effectively with her fellow physicians. It is time to put away childish things, starting with that petty RN attitude.

But a couple elements of the episode have us baffled. First, what's up with veteran minor nurse character Malik McGrath's pink patterned scrub top? We have never seen a male nurse wear such a thing. Is the show trying to send some kind of transvestite-friendly message? We believe nursing should lead the way in tolerance as to matters that do not affect work performance (patterned scrubs in general are separate issue). But we wonder how this might register in the minds of a wider public that is already disposed to see male nurses as effeminate. And we wonder what male nurses think; we know of one major nursing school that changed its pink student identification cards to green to make men more comfortable wearing them.

Adding to the curious male nurse effeminacy theme, attending Susan Lewis' nurse boyfriend Chuck appears briefly so she can reveal that he is more "maternal" than she is, and he can then be shown "breastfeeding" their new baby using a breastfeeding supplementation system in the ED locker room. The show has pushed tolerance for many novel social practices, but this is not one of them: Carter, the show's moral center and an ED veteran, clearly regards Chuck as a total freak. (In fact, there is historical precedent for male breastfeeding, and there are good reasons to consider it today where the mother is unavailable, though of course the practice remains extremely rare.) "ER," to its credit, has not really pushed the "effeminate male nurse" stereotype, and we would be the last to discourage all men from exploring their feminine sides. But the way this episode presents these elements makes us a little uneasy, and we are concerned that it could discourage men from considering the profession.

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