The League of Extra Ordinary People
2006 Fall TV preview
September 2006 -- This fall's U.S. television season has less health-related serial programming than last year, but the top hospital dramas--Fox's "House" (premieres Sept. 5) and ABC's "Grey's Anatomy" (Sept. 21)--will soon resume spreading their misportrayals of nursing to tens of millions each week. These dramas depict physicians providing all key care, and the few nurses who appear are insignificant handmaidens. NBC's long-running "ER" (Sept. 21) returns with a slowly shrinking audience and major nurse character Sam Taggart. The show remains physician-centric, but last season its vision of nurses as skilled sidekicks who are at least capable of challenging physicians presented a sharp contrast to the other hospital dramas. In general, shows with nurse characters often emphasize their ordinariness, using them to set off the more interesting characters around them, and they also focus on the nurses' personal lives, presumably because producers don't know that nursing itself is interesting. NBC's sitcom "Scrubs," with relatively normal nurse character Carla Espinosa, will again return in mid-season. It had a few good episodes for nursing last year, though its overall depiction remained fairly poor. One character in NBC's new drama "Heroes" (Sept. 25) is hospice nurse Peter Petrelli, one of the "ordinary" people who discover they have an extraordinary power (in Peter's case, it's flying). The show web site says Peter has always lived in the shadow of his high-achieving politician brother, but he feels "destined for something bigger" than lowly hospice nursing. Imagine our excitement. HBO's raw sitcom "Lucky Louie" includes major nurse character Kim, who is essentially Alice Kramden's granddaughter. Like Carla, the tough Kim is the fairly normal one in a crew of misfits, though the show is not really about her work life. "Lucky Louie" was a summer show, but HBO is re-broadcasting episodes into the fall. FX's plastic surgery drama "Nip/Tuck" (Sept. 5) kicks off its fourth season, still with no recurring nurse character. And staffing agency Access Nurses may produce another season of its web-based "13 Weeks," an inadequate reality series about travel nurses.
The basic story of nurses on U.S. prime time television can still be summed up with a bottom-line statistic about the top three hospital dramas, all of which are now popular around the world, as of the end of the 2005-2006 season. Here it is: although hospitals exist mainly to provide nursing care, and hospital nurses far outnumber physicians, 23 of 24 major characters on these shows are physicians, and one--one--is a nurse.
That one, of course, was "ER"'s Sam Taggart. Since Taggart's arrival in late 2003, she and her "ER" nurse colleagues have had some good plotlines, though the show remains physician-centric, with an overwhelming focus on physician care, physicians doing key tasks that nurses do in real life, and suggestions that nurses report to physicians. Most Taggart plotlines have explored her romance with physician Luka Kovac, and her struggle to raise her son despite the less-than-helpful involvement of her ex-husband, a criminal. But the Eve Peyton episodes, for all their faults, presented a nurse as a health expert and aggressive clinical leader--a small milestone given the way Hollywood has treated nursing. Even some non-Peyton episodes last year seemed to make a greater effort to show Taggart and the minor nurse characters making tangible contributions to care. In 2005-2006, "ER"'s depiction of nursing rose to the level of fair--and so it was probably the best season for nursing of any major network prime time show in more than a decade
Of course, "Grey's Anatomy" and "House" are now the 600-pound gorillas for television depictions of health care, with late season episodes drawing over 20 million U.S. viewers each. Sadly, they are also by far the worst shows for nursing, ignoring nurses except when showing them as disagreeable clerks, mute underlings, and objects of contempt. Every major character on "House" and "Grey's Anatomy" is a physician. Perhaps because it would be difficult to sustain a prime time drama based solely on the real physician role, physician nursing is rampant on both shows.
Last year, "Grey's Anatomy" for the most part avoided the explicit anti-nurse slurs of its first season. It even ran a couple episodes about a nursing strike, and one in which a veteran nurse responded to an intern's disrespect by paging her frequently to perform grotesque care tasks. But those episodes were deeply flawed, and given the essentially nurse-free episodes that dominated the season, they seem to have been token efforts to counter nurses' objections. The vast majority of the show still consists of pretty, smart physician characters providing all important care to surgical patients, including monitoring, emotional support, advocacy and other important work that nurses do in real life. Nurse characters remain bitter or pathetic losers, no more than disposable foils to the hot physicians.
"House" pretty much ignores nursing completely. Its dream team of diagnostic experts provides all meaningful care, while the nurses are nameless, uneducated servants whose main role is to fetch physicians and do what they say. The final episodes of the last season prompted the Center to compare the show's rare nurse characters to the golems of Jewish folklore: mute, brainless creations whose godlike masters--in this case physicians--use them for menial tasks. But the show's physicians generally don't need any nurses to provide comprehensive care to their patients. If "Grey's Anatomy" has often treated nurses with contempt, "House" seems to regard them as beneath contempt. While no all-physician show could provide a remotely fair or realistic vision of what happens in hospitals, "Grey's Anatomy" remains a bit more likely to present nurses at least as sentient beings.
"Scrubs" will return for its sixth season with character Carla Espinosa, the only major nurse character we know of in a U.S. broadcast network sitcom. The fifth season did have a few surprisingly good nursing plotlines for Carla; one highlighted her prodigious knowledge of the conditions of various patients. But for the most part the show has continued to focus on her marriage to surgeon Turk, and in particular the impending arrival of their baby. Dramatically, Carla is the most sensible of the major characters, yet in a sitcom, this may signal mostly that the show considers nurses good "straight men" to set off the kookier, more interesting physicians (see "Becker"). Moreover, in clinical settings, "Scrubs" continues to promote the standard Hollywood vision of nurses as peripheral subordinates to the all-important physicians. The show's mid-season status suggests that it's on its way out--but we said that last year too.
"Heroes" is a new show about "ordinary people discovering extraordinary abilities." These people include a cheerleader, a "low ranking" L.A. beat cop, a web-cam stripper, a Japanese "cubicle jockey," a junkie artist...and nurse Peter. The "dreamy" Peter has "always stood in his brother's shadow. A hospice nurse, Peter feels destined for something bigger in life." His "over-achieving" "golden boy" brother is afraid Peter's delusions of flying will mess up his run for Congress. We get it--nurses are low-achieving losers, especially the male ones, but they can too be special, darn it, if they happen to be blessed with superpowers unrelated to nursing. On the plus side, Peter appears to be the only major recurring nurse character who is a man to appear on a U.S. broadcast network show in the last decade. But it's hard to see how the show could give viewers much sense of the skills of hospice nurses, or why they're so important, since that would probably require that the show actually believe they're important in the first place. Can you imagine a network show suggesting that a physician character who devotes his career to helping patients and families confront death "feels destined for something bigger in life?"
The new "Lucky Louie" is a sitcom in form but HBO in style--raw, obscene, and cynical, though not above sneaking in a nervous hug. It centers on a dysfunctional working class married couple, part-time mechanic Louie and "full-time nurse" Kim, the "real breadwinner of the family." They raise their young daughter in an urban apartment building full of oddballs, with whom Louie engages in a range of irresponsible conduct. The tough, sensible Kim is yet another long-suffering, relatively "normal" nurse character. One episode featured her efforts to push the out-of-shape Louie to start eating better (she even made him some tempeh and kale!), which gave her a chance to display some expertise and autonomy, though there were a couple troubling lines. Of course, the show is almost entirely about the couple's home life, and it is less likely to focus on Kim's nursing than on things like the 37-year-old nurse's first orgasm, or her reaction to Louie's DUI. One of our correspondents felt that the very presence of a nurse character on this was show degrading. The show does surround Kim with people without much education or sense of purpose, and we admit that marrying the hapless Louie did not exactly say "I am an empowered professional." But we found Kim closer to heroic than anything we're likely to see on "Heroes." The first season of "Lucky Louie" ended in August, but episodes remain available on demand through late September, and HBO will start broadcasting season 1 again in October.
The physician-dominated "Nip/Tuck" has never paid much attention to nursing, and it has no significant nurse character. The plastic surgery drama's two principal surgeon characters work with anesthesiologist Liz Cruz, a "strong lesbian" who appears to play a role that a nurse might in real life, providing the "voice of reason" in the "chaotic, superficial" plastic surgery world, and "challeng[ing] the surgeons' views on women and how best to help their patients heal." A patient advocate! As we explained last year, many viewers have actually mistaken Liz for a nurse, but we probably can't count that as a good portrayal of nursing. Should we be happy because some people see a smart, assertive nurse, or sad because she isn't actually a nurse?
Finally, from late 2005 to early 2006 California staffing agency Access Nurses posted episodes of its web-based reality show about travel nurses, "13 Weeks." The show was ostensibly designed to promote nursing in the midst of the current shortage, though it probably did more to promote Access and its travel nursing business. The first season had some positive aspects, notably a clear focus on the diverse nurse participants. But it dealt primarily with extracurricular activities (the nurses go kayaking!), and the clinical scenes were generally inadequate at best, with little indication of the real difference nurses can make in patient outcomes. The show's overall implication that the rapid growth in travel nursing is a solution to the shortage--rather than a dangerous symptom--also troubled us. The Access site has a few suggestions that there will be a second season of this show, though there is no indication when that might appear.
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