"Is this all nurses do?"
November 21, 2006 -- Fox's "House" generally ignores nursing or shows physicians doing it, but recent episodes have included troubling comments on nurses' autonomy and skill. In Thomas L. Moran's November 7 "Que Sera Sera," (16 million viewers), a police officer pursues lead character Greg House for possible crimes related to his prescription drug abuse. In response to one taunt from House, the officer notes: "I think working around a bunch of nurses has given you a false sense of your ability to intimidate." Tonight, in Pamela Davis's "Whac-a-Mole," (15.2 million viewers), physician Eric Foreman prepares to take a sample of spinal fluid from a patient. When the patient's 11-year-old sister offers to help, Foreman agrees, noting that it's "quicker than calling a nurse." When Foreman instructs her to hold her brother's legs still, the girl asks: "Is this all nurses do?" Foreman responds, with a wry smile: "My boss [House] doesn't trust 'em to do anything else." The show is not explicitly endorsing these comments. But they are a fair summation of its portrayal of nursing, and it has never done a thing to rebut the attitudes they reflect. Viewers are likely to conclude that the vision the comments present of nurses as timid, unskilled physician subordinates is harsh, but essentially correct.
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In recent episodes, police officer Michael Tritter has been pursuing House because the physician treated the officer with disrespect as a clinic patient (the situation involved a rectal thermometer). House is vulnerable because he may not have proper prescriptions for all of the Vicodin he uses to ease his chronic leg pain. Tritter arrests House after a traffic stop, and House spends the night in jail, as we see in the November 7 episode. The next day, Tritter shows up at the hospital. House suggests that Tritter quit while he's ahead--before he ends up as a security guard. Tritter responds: "I think working around a bunch of nurses has given you a false sense of your ability to intimidate." As Tritter says this, we see that a woman who seems to be a nurse is seated next to House, at what looks like a nurses' station. This nurse peers at Tritter. She doesn't look especially intimidated, but neither does she or anyone else say anything to challenge Tritter's remark.
It seems to us that too many nurses can be intimidated by abusive physicians, and the show has every right to have a character suggest as much. But "House" has never showed that there is even one nurse who would not be intimidated by House, or countered the assumption underlying Tritter's taunt: that nurses are inconsequential mice. Many nurses would at least work around House's abuse (of health workers and patients alike) in order to save the patients a physician of his arrogance would likely threaten. And we'd like to think that some nurses would discuss House's abusive behavior with him directly, and if necessary with his superiors.
A larger problem is that the kind of disruptive conduct in which the House character engages can lead to hostile work environments that have negative effects on health workers and patient outcomes. Verbal abuse is a factor in nursing burnout. We can't recall the show illustrating this kind of negative effect, perhaps by having a patient die because a nurse was too "intimidated" by House to alert him to an apparently deteriorating condition, or to discuss how a treatment was not working. Instead, the show seems to suggest that House's abuse is the price we have to pay for his brilliance; at most, he might consider laying off targets with real power, like Tritter.
In tonight's episode, we see Foreman preparing to take some spinal fluid from a young man with a devastated immune system, in order to perform a diagnostic test. The patient's precocious, wisecracking 11-year-old sister watches with concern. Foreman asks why she is not in school. She makes an unconvincing excuse. Then she asks if she can help Foreman. Foreman responds: "Well, I guess it's quicker than calling a nurse--and a truant officer." He asks her to grab her brother's shins, push his knees up towards his chest, and hold them there tight while he takes the fluid. The child asks: "Is this all nurses do?" Foreman replies with a small, conspiratorial smile: "My boss doesn't trust 'em to do anything else."
Of course Foreman and the show itself are not explicitly endorsing this view. And the comment is vague enough that, in and of itself, it does not necessarily mean that House controls what the nurses do. Perhaps they do far more and, although House does not control it, he doesn't trust them. But given what viewers have seen on the show, most will likely assume physicians are in charge of the nurses. "House" has never presented a nurse as anything but a disposable physician helper. On those rare occasions when nurse characters have briefly expressed doubt about what a physician wants, the nurses have conveyed nothing more than the instinctive fear of petty bureaucrats.
And aside from the autonomy issue, there's the little matter of the physicians' contempt for nursing skill. Consider Foreman's suggestion that the girl can help because it will be quicker than calling a nurse. This will suggest to many viewers that nurses could be replaced by lay persons--even children--who can follow simple directions. Can this untrained middle schooler monitor various aspects of the patient's condition for subtle changes during the procedure and, if necessary, expertly use high-tech equipment to save his life? It doesn't matter, because physicians alone do that sort of thing on "House."
As for House, yes, he's a jerk who mocks everyone's abilities. But he's also a prominent physician whose bottom-line clinical judgments are almost always shown to be correct. House makes fun of the physicians who surround him, but viewers are constantly shown that those physicians are in fact extremely bright, caring, and attractive--not quite as smart as House, of course, but worthy of great respect nonetheless. The contrast with the show's anonymous nurse flunkies could hardly be more stark. Consider Foreman's little smile, which says that House is sure a character for thinking of nurses that way, but it's not like we're talking about anything important when we talk about undervaluing their work. After all, it's not a matter of life and death.
On the whole, the statements in these episodes fairly represent the way the show portrays nurses. There has never been any suggestion that nursing is an autonomous profession. No nurse has ever played a significant clinical role on the show. And to our knowledge, no nurse has ever had the slightest impact on the diagnostic mysteries the show presents as the ultimate health care challenge. Instead, the show's six physician characters roam the hospital doing everything themselves, and having no meaningful interaction with the mute nurse-bots who occasionally pop up to hand them instruments or push wheelchairs.
So yes, child, on "House," that is all nurses do. We suppose the job wouldn't be much of a challenge to a capable 11-year-old like you. So if you want a real career instead, you better not skip any more school!