And the first shall be first

April 26, 2007 -- Today Regis Philbin returned to the "LIVE with Regis and Kelly" TV show following his cardiac bypass surgery at New York's Weill Cornell Medical Center. Just before Regis left in mid-March, co-host Kelly Ripa had repeatedly joked that she would act as his "sponge bath nurse" in a "little nursey costume," presenting an obvious "naughty nurse" image that infuriated nurses in the United States and Canada. The show has still not responded directly to the more than 700 nurses who have written to object, or acknowledged the damage Ripa's remarks did. But today's show did include a small apparent effort to make amends that, at least in its basic form, seemed to follow the advice of the Center and many nurses. The show brought five of Regis's nurses on and offered them generic expressions of gratitude, including Ripa's comment that the "doctors can't do it without" them--actually a damaging suggestion that the nurses' role is merely assistive. The seven-minute segment was utterly dominated by three physicians, particularly the two surgeons. The physicians did all the talking. They were praised as "brilliant" (by Regis) and among the best in the world (by guest David Letterman). Ripa even joked that Regis was scared to stand next to one surgeon because he was "God." The nurses did not have the chance to say even one word. So the segment powerfully reinforced the idea that nurses are noble but low-skilled physician handmaidens, a stereotype that is even more damaging, because it is so persuasive and prevalent. Sadly, the segment's effort to thank the nurses was so flawed that we believe nursing would have been better off without it.

The show marked Regis's first day back by having on his friend David Letterman, who of course had a cardiac bypass himself some years ago, performed by the same surgeons. At one point in one of the show's earlier segments, Letterman gave his appraisal of the surgeons: "There may be people in the world as good as these guys, but there is absolutely nobody better than these guys. They are just tremendous." (See the Quicktime clip in broadband or dialup. You can get a free download of Quicktime for Macs or Windows.)

The segment in which Regis's health care team from Weill Cornell actually appeared occupied about seven minutes near the end of the hour. It began with Regis introducing the two guests, who he said have "touched Dave and me in places no one else has gone." He urged the audience to welcome the "talented and brilliant surgeons Dr. Wayne Isom and Dr. Karl Krieger." About four minutes of Letterman-fueled banter ensued, interspersed with the surgeons seriously explaining aspects of the bypass procedure.

After a break, the show returned to provide more details about the surgery. The hosts and guests stood near a table with a plastic model of a heart. Letterman and Ripa encouraged Regis to stand next to the surgeons. Regis demurred, and Kelly quipped, "he's afraid to get close to God"--presumably meaning Isom. Isom then led a discussion of the bypass using a slide show. At one point, Isom got to a slide showing more of the health care team in the OR, which was clearly a pre-arranged vehicle to bring that team on.

Isom: "This takes a lot of people. It's very, very important for the whole team, here's cardiac anesthesia, that's where Butch Thomas was--"

Kelly: "Let's meet the rest of--let's bring them out, because we owe them a great deal of gratitude around here, for sure."

The team came out, in a straight line, dressed in business clothes. In the lead was a man, and he was followed by five women. All six were introduced by name, but the cheering made it difficult and at times impossible to hear their names, except for the man in the lead--an anesthesiologist who was introduced twice--and the last, a nurse practitioner. Regis seemed to struggle with some of the nurses' names.

Kelly:   "Cardiac anesthesiologist Dr. Butch Thomas."

Regis: "Here he is, Dr. Butch Thomas. Nurse Marie Racito [unclear], hi Marie. [Inaudible name.] Mindy Benchley. Gil Magnimie [semi-audible]. And the nurse practitioner, Donna Reilly, right there, nice to have all of you here. Thank you so much for all your help."

Kelly: "We owe you a great deal of gratitude. I know that so much work and preparation goes into this procedure. I know that doctors can't do it without all of you. And take us through what your jobs are, and how you performed your jobs in the room."

Thomas: "I just put him to sleep and kept him alive while these guys [gesturing at the surgeons] saved him."

Regis: "What was the last thing I said, Dr. Butch?"

Thomas: "You said, 'Why I am I here? This wasn't my idea, nobody forced me to do it.' Then you said, 'just put me to sleep.'"

The crowd applauded, and continued to cheer as Regis seemed to begin wrapping up the segment.

Regis: "And there are these wonderful nurses, thank you very, very much. You guys are really the best, I appreciate it so much. Dr. Isom, Dr. Krieger, Dr. Butch--all of you. Thank you very much."

After this brief banter, the show cuts to commercial. The nurses are given no chance to describe what they did, or indeed, to say anything at all.

(See the Quicktime clip in broadband or dialup.)

We appreciate that the show at least tried to follow the Center's suggestion that it have the nurses on to discuss what they did for Regis. Ripa's invitation that the group tell what it did for Regis suggests that show actually intended that to happen, but simply ran out of time. It's likely that the show would not have bothered to have anyone but the surgeons on stage had nurses not responded so forcefully to Ripa's comments. In addition, the show did at least make an effort to introduce the nurses individually by first and last name--not just as "Marie"--although the way it was done, through a loud round of applause, ensured that few of the names would be well understood. It's also clear that Ripa and Regis were trying to express as much appreciation for the nurses as they could, at least within the limits of their apparent understanding of nurses' work. And of course, we appreciate that Ripa refrained from further suggestions that nurses are frivolous bimbos.

Unfortunately, what actually happened on the show failed so completely to convey anything about what nurses do, and so strongly reinforced other damaging nursing stereotypes, that we believe its overall effect actually left nurses worse off. Virtually every element of the segment aggressively pushed the idea that the physicians are the brilliant providers of all significant care, and that the nurses are their noble but largely unskilled helpers. Of course, the show also included no apology or expression of regret for the damage Ripa's earlier comments caused, which does not surprise us given that the show has failed even to respond to the hundreds of nurses who have written to protest.

The most obvious problem is that the show did not allow any nurse to say even one word, whatever its original intentions (as reflected in Ripa's request that the nurses describe their work). By contrast, the three physicians bantered with and educated the hosts and the audience for a solid seven minutes. This scenario clearly presents the physicians as the intelligent health experts and leaders, the nurses as nice helpers with little knowledge. We realize that the semi-scripted talk show format can't be precisely controlled, and presumably the show was running out of time. But the show runners could have made time for the nurses if it was really important to them. Even if Dr. Butch had not jumped in and (with Regis's help) eaten up the 20 remaining seconds, there still would not have been time for the nurses to convey anything significant. There was no slide show planned for the nurses.

Another structural factor was that the segment presented Regis's cardiac health as solely a function of what happened in the OR. All three of the physicians who actually got to speak were OR professionals, and there was no indication that in fact what happened in the OR was just a small part of the overall time Regis spent in the hospital. Of course, we don't actually know what the specific roles of any of the nurses were, since we learned only the physician specialties. Were these nurses from the OR, the ICU, the surgical floor? This all reflects the common misconception that everything important happens in what is at least perceived to be the physician-dominated OR environment. In fact, Regis spent days in the hospital after the surgery, monitored and cared for every minute by skilled nurses who held his life in their hands. A dozen or more other types of professionals also played key roles in Regis's hospital care. But the social esteem for surgeons is so great that the show felt no need to mention any of that. The show did not even bring on Regis's cardiology practitioner, who presumably had determined that he needed the surgery in the first place. The fact that even Regis seemed convinced that only the surgeons really mattered casts doubt on the faith some have that people just need to experience nursing care to appreciate it. In fact, people tend to see what they expect to see, and what they expect to see does not typically include nursing expertise.

Then there were the things that Regis, Ripa, and Letterman actually said about the physicians and the nurses, most of which strongly reinforced prevailing stereotypes. The nurses received a great deal of generic gratitude from Kelly and Regis, but this of course tells people nothing about what they actually do. We don't have a nursing crisis because the public forgot that nurses are, in Regis's word, "wonderful." In fact, that kind of praise, without any specifics, tends to reinforce the stereotype that nurses are unskilled angels. Ripa perhaps got closest to doing something helpful with her reference to "all the work and preparation that goes into this procedure," though the comment was still fairly generic and strongly suggested that only the cutting mattered. And she ruined any positive effect with her next remark: "I know that doctors can't do it without all of you." Yes, that sounds like a compliment to most non-nurses, but it is an insidiously persuasive example of the handmaiden stereotype. It suggests that nurses are not autonomous, life-saving professionals with their own scope of practice, but faithful assistants who only help the physicians who provide all the important care.

By contrast, the segment's praise for the physicians stressed their intellectual qualities, presenting them as clinical leaders, and indeed, global leaders in their field. Beyond the obvious fact that only the physicians were permitted to speak, Letterman and the hosts showered them with meaningful superlatives. Letterman said that there is "nobody better" in the world, a tribute to their skills that we have trouble imagining being applied to the nurses. Regis said the surgeons were "talented and brilliant," and he made a point of repeatedly referring to them as "Dr."--at the end, for instance, each of the three received a personal mention, whereas the nurses were thanked as an undifferentiated group.

Ripa seemed to hold back from this kind of specific physician-glorification, as if she was trying to conserve her comment time to make amends to the nurses. Unfortunately, perhaps the most revealing single comment in the segment was her joke that Regis was afraid to stand so close to "God"--the surgeon Isom. (See the Quicktime clip in broadband or dialup.)

Yes, Ripa wasn't necessarily saying she sees Isom as God, she was joking that Regis sees him that way. And if we had any reason to think that Ripa had actually thought about social attitudes toward health professionals, we might even think she was mocking the excessive esteem surgeons receive, sometimes to the detriment of patient care. But we don't have a reason to think the joke extended to Isom, and in fact, the entire segment supports the vision of surgeons as godlike, so Ripa's comment actually serves as a perfect capsule summary. And of course, if the surgeons are God, the nurses are their little angelic helpers.

We had no particular problem with most of what the physicians said--we don't expect them to credit nurses. But we do have a problem with Dr. Butch's quip that he "just put [Regis] to sleep and kept him alive while [the surgeons] saved him," which is less self-deprecating than it may seem. In fact, Dr. Butch did not keep Regis alive in the OR by himself. The OR nurses were instrumental in that effort. Likewise, the surgeons did not "save" Regis by themselves. The whole team did that, in the OR and for days afterward. Moreover, the fact that Dr. Butch chose to walk on the show ahead of all five nurses, and then to jump in first and consume the remaining air time in response to Ripa's question, belies whatever modesty might be found in his quip. We're glad he feels comfortable giving credit to others, but we'd appreciate if he would stick to minimizing his own role, rather than pushing damaging distortions that are feeding a global crisis for nursing.

We appreciate that the show evidently tried to make amends for Ripa's "sponge bath" / "nursey-poo" remarks. But what it actually did strongly reinforced the handmaiden stereotype that, in our view, is even more pernicious than the naughty nurse.

Take Action!

Since mid-March, we have called "LIVE with Regis and Kelly" many times and sent all of your letters by fax and snailmail (the show never made an email address available). The show has still offered no apology, and no direct acknowledgement of the letters from nurses, nursing students and supporters. Despite the generic gratitude expressed to Regis's nurses on April 26, the show has done nothing to remedy the damage Ripa's remarks did--it has not told viewers anything about what nurses really do. On the contrary, the April 26 segment powerfully reinforced the stereotype of nurses as silent handmaidens.

We are continuing to ask the show to allow Regis's nurses, or any nurses, to tell the public in detail what nurses actually do to help save the lives of patients like Regis.

Please click here to send our letter or write one of your own.

Even better, call the show at 212-456-0417 and ask it to tell viewers what nurses do. Thank you for continuing to put pressure on the show and let it know that amends have yet to be made.