Changing how the world thinks about nursing

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"Yes, doctor."  
"Right away."
"I was just trying to get a urine sample, and he went crazy!"

September 7, 2007 -- Above is the complete dialogue of nurse characters in the May 15 episode of Fox's "House," an episode that will be rebroadcast on September 11. These few lines reflect the hospital drama's portrayal of nurses in bedside care, a vision of physician handmaidens with little technical knowledge who perform menial assistive tasks but panic in an emergency, relying on physicians to supply all thinking, expertise, and courage. The episode reinforces this vision with a few of the House character's typical expressions of contempt for nurses and nursing, as always delivered without challenge from the other characters or the show as a whole. One priceless moment finds House informing two nurses, without irony, that a patient the nurses can see is having a pronounced full-body seizure is in fact "having a seizure." The episode, Leonard Dick's "The Jerk," drew 21.6 million U.S. viewers on May 15.

The episode's main patient character is super-obnoxious teen chess prodigy Nate. He spends most of the episode in hospital beds, insulting everyone around him as House's team tries to figure out what would explain his symptoms, which include rage, head pain, hypogonadism, and organ failure. Nate ultimately turns out to have hemochromatosis related to his recent decision to start eating meat, following a lifelong vegetarian diet.

A big theme in the episode is the impending departure of Foreman, the physician on House's team who has perhaps the most troubled relation with House. The main characters spend the episode debating which of them sabotaged an interview Foreman had with a New York hospital, in order to get Foreman to stay (or leave). Foreman suspects House, but House denies it.

Then House goes to accuse chief of medicine Cuddy of sabotaging Foreman. As House enters Cuddy's office, she sits at her desk with some paperwork, with someone we later learn is "Nurse Unger" standing beside her. House: "You girls can gossip later." A moment later, when the nurse has not left, House addresses her:   "When I said you girls can gossip later, I was throwing you out in a polite way." Rather than responding directly, Cuddy hands some paperwork to the nurse, and makes a face suggesting, "You know how he is, we'll come back to it later, no big deal." The nurse leaves without a word. After Cuddy denies sabotaging Foreman, and she and House banter a while, Cuddy sends House away: "Send in Nurse Unger on your way out."

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We can hear the "House" fans now: "But House treats everyone with contempt! We're supposed to think he's mean! And he was calling Cuddy a gossiping girl too!" The answer is that the physician characters deal it back to House in spades, as Cuddy does here. It's obvious to viewers, if not to House, that the other physicians are in fact very smart and highly skilled. But find us an example where the show has revealed any such thing about a nurse character. Here, Nurse Unger speaks not a word. Incidentally, it's not clear why a nurse would be in Cuddy's office, but it's pretty evident she's no nurse manager, a job category that does not exist in the "House" universe. The idea seems to be that nurses are among Cuddy's administrative minions.

But enough of the show's view of the nurse as clerk. Let's look at how the episode presents the nursing role at the bedside.

1.   When the troublesome Nate refuses to consume the meat that physician Chase wants him to eat in order to test for a certain condition, Chase threatens to force feed him. Chase speaks into a nearby intercom: "Nurse, full set of body restraints." A nurse's voice responds: "Yes, doctor." Nate gives in, and we never see the nurse.

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2.   At another point, physicians arrive at Nate's room to find him out of bed and swinging a lamp. A nearby nurse is, of course, helpless. Physician Cameron:   "What happened?" Nurse: "I was just trying to get a urine sample, and he went crazy!" Chase and Foreman talk to Nate until his symptoms overcome him. The implication is that no nurse could handle this situation; physicians handle unruly patients. We also loved the impressive nursing assessment ("he went crazy!").

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3.  During one diagnostic discussion among the physicians, Foreman suggests that Nate may have a genetic disorder. House asks Foreman to get the "sequencing primers." Foreman says he can draw some blood, but then must leave. House asks if he has a job interview. Foreman evades the question. House tells him to do "the nurse stuff," and Chase and Cameron will "do the doctor stuff." Later, we see Foreman get the blood sample. Of course you might argue this at least suggests this "nurse stuff" matters to the diagnosis, but that tiny benefit is overwhelmed by the negative messages. House is mocking Foreman, suggesting he only has the time and/or skill to do the less important "nurse stuff."   In addition, the scene suggests that physicians would just swoop in at will and "do nurse stuff," that nursing is included within the scope of physician practice, that any physician could easily do what nurses do. That is all false.

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4.   Late in the episode, House decides to test Nate by causing him stress. House challenges Nate to a chess match, during which they trade barbs, jerk to jerk. After a while, Nate starts to have pronounced full-body tonic-clonic seizures. A monitor starts beeping, and a couple nurses approach, though as usual we don't get a good look at them.

            House: He's having a seizure. [Give] 4 mg. IV lorazepam.

            Nurse: Right away.

There is no irony in House's voice. The clear implication is that nurses are so ignorant they would not recognize such obvious seizures. Their expertise seems to be limited to saying things like "right away," to indicate that they will automatically comply with physician commands; the nurses almost never actually react to the patient or each other. They have no autonomous relation to the patient; only a subservient one to the physician. In the real world, the nurses would have recognized the seizures and known how to handle them; they probably would have simply given the lorazepam if no physician was present.

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5.   Near the end, after House figures out that Nate has hemochromatosis, House enters the patient's room. House stabs Nate's radial (wrist) artery with something, causing a little blood to spurt from Nate's wrist area and continue a slow drip (presumably to drain blood from the patient--a necessary part of treatment). House, who has been making a show of having fun causing Nate pain, casually calls out: "Oh, nurse..." Then he hits the intercom: "This patient is bleeding for some reason." A nurse enters, but we see only her back. The nurse does not question what House has been doing. Indeed, she has no lines, but busies herself preparing something in the background, as we continue to focus on House, the star. The nurse doesn't even approach the patient till House departs some time later, after he has finished explaining Nate's condition to his mother and discussing the chess match. The "House" nurse's obligation is to be obedient busy hands for the physician, not to think or speak for the patient. This also explains why the nurses, who are near the patients 24/7, are still far less familiar with the patients' conditions than the physicians are, and why "House" nurses (unlike real nurses) never detect non-obvious symptoms. The nurses just work there.

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6.   At the beginning of one scene, we (but probably few others) caught a fleeting glimpse of an anonymous nurse in the background, seeming to take Nate's pulse with one hand and feel his forehead with the other. In the foreground, Chase explains to the mother that Nate has amyloidosis (their current theory) and what that entails. Of course, on "House," nurses never talk to patients or families at all, much less explain conditions. As the episode shows over and over, nurses aren't too good with those word thingees; best to leave that to Doctor.

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Can we find anything good? Sort of. The episode actually has nurses, unlike many "House" episodes. We learn that nurses get blood and urine samples, and that they can give IV drugs (though viewers have no basis to know how much skill that takes). At one point, a nurse even finds a coin that House is searching for on the floor and hands it to him. House actually thanks her, very softly. Of course, note the apparent underlying joke:   House is the life-saving genius, but some anonymous nurse has to find his coin for him. Ha ha.

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In any event, these tiny bits are a drop in a huge bucket of contempt. Every aspect of the episode's portrayal of nursing that will make any impression on viewers tells them clearly that nurses are witless physician lackeys who do basic manual tasks, that they are very limited in knowledge and skills, and that they play no significant role in patient care. They have nothing worthwhile to say to the physicians, the patients, or other nurses. They have no ability to perform independently in a crisis, whether that means a code, an abusive patient, or an abusive physician.

One curious thing is that, although Nate spends the episode savaging nearly every human who gets near him, he never says anything about the nurses. Sure, it could be because, as we've said, nurses on "House" really don't interact with patients. But the nurses don't talk to physicians much either, and that doesn't stop House from trashing them (e.g., the scene in Cuddy's office).

The more likely reason is that the nurses are just beneath Nate's notice. With so many other tempting targets to engage, why waste the character's limited screen time with people who couldn't make a snappy response, or maybe any response? Nate doesn't mock the walls either.

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