"THANK YOU NURSES!"
Free flu shots
Two plotlines in the April 25, 2011 episode ("Rat Falls" by Alison McDonald) showcase Jackie's astute patient care and her ability to relate to fellow health workers. In one, she helps a good-hearted middle-aged man who keeps falling down, and in a broader sense is falling apart, because of his hypertension. Jackie provides sensitive psychosocial care--and goes out of her way to help the patient navigate an unfriendly health care system. She gets him an immediate psychiatric consult, despite the scheduler's flat refusal, by promising to give the scheduler's family at-home flu shots. Later, Jackie goes to get the patient's broken glasses fixed, without being asked. Would a real emergency nurse have time to do that? Should a nurse have to do things like that? Regardless of the answers, viewers are likely to see Jackie as an expert, holistic caregiver.
Another patient from the April 25, 2011 episode is a girl named Natasha, who ostensibly has asthma and is a frequent emergency department visitor. We first see her at triage, which is staffed by nurses Zoey and Sam. Nurses actually doing triage, as in real life--awesome! Anyway, Natasha's mother is impatient and abusive. The mother refuses to fill out the required forms. Jackie arrives and pushes back, saying they'll get to Natasha when they can. Jackie explains to the other nurses that Natasha and her mother are not here for health care; the more hospital visits they make, the more public assistance they get.
Later, we see physician O'Hara, who is Jackie's best friend, examining Natasha in a treatment room, listening to her lungs. Jackie enters. O'Hara says Natasha seems to be in tip-top condition. The mother counters that "she's got asthma, it's chronic." O'Hara says she didn't hear any wheezing. She asks Natasha to blow into a tube as hard as she can; the mother tells Natasha not to push herself. Natasha seems to blow as hard as she can. Her mother claims Natasha can breathe out, but not in (in reality, asthmatic patients can breathe in, but not out). Outside, Jackie tells O'Hara that if patients pretend to be sick, she pretends to treat them, but O'Hara is encouraging the girl, presumably meaning encouraging her to defy her mother in a way that will cause trouble. O'Hara says she hopes she is, and tells Jackie to "please stop thinking you're one step ahead." Back in the treatment room, the mother snaps at Natasha to hurry up and get dressed. O'Hara observes that they've been to lots of hospitals, and (really speaking to Natasha now) says that must be pretty boring.
O'Hara shakes her head in disagreement. Natasha's mother seems unhappy, and maybe a bit shamed. This plotline is not about Jackie saving the day, and it may even suggest that O'Hara has the better approach to helping this very unfortunate girl. But Jackie clearly is a peer of the physician, and her approach is plausible. Jackie does share O'Hara's concern for the girl, and she plays along with O'Hara's career inquiries, pushing the idea that intellect is valuable in nursing, which is "much cooler" than medicine--not ideas we hear expressed very often on television or in any other popular medium.
"These nurses that stay in one place . . . they're off their game."
The May 2, 2011 episode ("When the Saints Go" by Liz Brixius) is notable for the introduction of Kelly, a savvy, skilled male nurse character, which the show has been missing since the departure of Mo-Mo after the first season. The episode also features an elderly patient's mockery of Zoey's patterned scrubs. But there is also a scene in which physician O'Hara throws Kelly off one case and assigns him to another.
Early on, the some-type-of-manager Akalitus tells Jackie that "everybody gripes about not enough help, so I scoured the budget and hired a temp. His name is Kelly. Don't eat him alive." This is a bit of a throwaway, but it is at least a nod toward the nurse understaffing that plagues many modern care settings but that Nurse Jackie has largely ignored. Ignored at best: You could argue that the show's leisurely clinical pace actually implies that nurses are not all that busy.
Soon afterwards, Jackie and O'Hara together receive from a paramedic a gunshot victim, an innocent bystander. This patient doesn't seem too badly off, and she appears to be concerned only about the whereabouts of her dog, who was with her at the time. Meanwhile, physician Cooper and Zoey receive another victim of this incident, a police officer who was apparently first on the scene and got "trampled," an injury he wants to be taken more seriously than it is being by his colleagues. Jackie introduces herself to the gunshot victim, but Kelly kind of reaches across her and seems to try to take over: "My name's Kelly, you're at All Saints, you're gonna be OK, just hold on for a sec, you're gonna be fine." Jackie is obviously startled at this intrusion; she's not used to anyone messing with her. O'Hara looks at Jackie, who shrugs it off.
Kelly goes. This is awful. True, Kelly was inserting himself too aggressively into Jackie's case, but O'Hara's summary dismissal suggests that physicians direct nurses' patient assignments and that nurses report to physicians generally. And no character here reacts in a way that contradicts those ideas.
Kelly arrives at the other case. The officer is claiming that he got "pummeled." Kelly notes that he sees no marks. The officer begs for pain meds, claiming that his pain is 11 on a 1-10 scale, though that does not seem likely. Cooper agrees to morphine, and Kelly goes for it. Upon his return, Cooper notes that Kelly is "a girl's name," saying that he must have gotten "sh-t" growing up. Kelly says that "they might have given it, but I never took it, that's for sure."
Meanwhile, the gunshot victim remains obsessed with her dog. Zoey's paramedic boyfriend Lenny finally calms her by reporting that he has the dog in his rig. The patient doesn't care about her pain, saying it's a 2 out of 10--though she has been shot. Jackie actually brings the dog into the hospital and takes care of it, although a passing interaction with Akalitus suggests that is not allowed. When Jackie checks back on the patient later, she continues to seem utterly unfazed by the pain, but asks Jackie to contact her sister to pick up the dog. It appears that Jackie takes care of the dog until the patient is released, or at least until the end of the episode, which certainly reflects Jackie's commitment to holistic care, if not the show's commitment to realism.
At another point, Jackie and Zoey arrive at the nurses' station as Kelly is regaling other nurses Thor and Sam with heroic tales of his time in Haiti, where he was "using a shoelace to tie off a gusher and grabbing f-cking dish soap from the rubble to wash out a wound."
He turns around, and sees Jackie and Zoey staring at him; of course, Jackie has been at All Saints for many years. Uncertain, Kelly asks if Jackie was sitting at the desk he now occupies. Zoey snaps, "It's her desk!" Kelly gets up and says it's his mistake, he did not know they had assigned desks. Jackie says they don't--and sits down right after he clears out. Kelly says he respects squatters' rights, then leans in to Jackie and speaks low:
Jackie leaves; Kelly sits back down in her chair. The other nurses are clearly impressed with Kelly for messing with the formidable Jackie.
Later, we see Kelly actually showing the injured police officer his X-rays--without a physician present! As Coop enters, Kelly says it "looks good, no fractures."
The insecure Coop loves that, and he tells Kelly that's he's got it now, pressuring Kelly (an African-American) to give him a fist bump. Kelly, grinning contemptuously, gives Coop the fist bump and leaves. Coop tells the officer he got the wind knocked out of him, "but the ribs look good, nice and clean"--confirming that Kelly was correct. The officer insists that he heard and felt a crack. Coop himself has an embarrassingly minor injury, and the two commiserate about the unfairness of what Coop calls "the whole shaking-it-off thing." Though these two dismissed Kelly, the show is clearly unimpressed with them.
Later, as Kelly is telling more heroic tales to the nurses, Jackie arrives and tells Sam to take someone to the waiting room. Kelly asks Sam if he's going to let her talk to him like that; Sam says that's just the way she talks. At the end of the episode, Kelly actually thanks Jackie for a great first day--in front of Akalitus. Clearly, he's a kindred spirit to Jackie in terms of manipulation. But our concern is with what the character says about the nursing profession, and Kelly seems to be a strong, bright, skilled nurse.
"I don't believe for a minute that you're a nurse"
Another plotline in the May 2, 2011 episode involves a dignified but ornery 95-year-old patient named "Totty" who has suffered heart palpitations and chest pain at the show Jersey Boys. We see Zoey, dressed in her usual pink-patterned scrubs, trying to take care of Totty. But Totty says: "I don't believe for a minute that you're a nurse." Totty's son is apologetic. Totty explains.
Jackie arrives, recognizes Totty, and tries to manage her. When O'Hara enters, Totty is thrilled to see "a woman who's not wearing trousers." They leave her to O'Hara, who eventually discovers that Totty is missing the cocktails she used to have with her husband; Totty's rest home seems to frown on this. O'Hara proposes "a glass of sherry a day, doctor's orders." We could do without the endorsement of the inaccurate "doctor's orders" expression, but we did appreciate another of the show's periodic critiques of patterned scrubs, which provide an unvarnished sense of the impression the uniforms actually make on many members of the public. Of course, this patient doesn't respect any woman who wears pants. But the more general point is that, if Zoey earns respect, it's in spite of her clothing, which suggests to some that she is not a serious professional--in stark contrast to O'Hara's business-oriented attire.
"We both want to marry doctors"
The May 16, 2011 episode ("The Astonishing" by Rajiv Joseph) includes more on nursing skill and on pro-physician social bias, but also another indication that O'Hara controls nursing assignments, and a suggestion from Jackie herself that the nurses are there to "assist" O'Hara.
Early on, Jackie and O'Hara receive from paramedics a restrained patient who "went nuts on the High Line." Jackie asks whether it was "sherm or dust," and the nurses and paramedics have different guesses, with Jackie eventually suggesting the guy is a sherm sticker, someone who smokes a cigarette dipped in formaldehyde. O'Hara says they can mull this over while Thor draws blood for a toxicology screen. Later, Jackie asks Sam to give the patient (who turns out to be on PCP) his Ativan. Sam hesitates because he is a recovering addict. Jackie urges him to do what his sponsor would want, which Sam says is to "be of service." Jackie says he can do that by being a "productive member of the staff": "Assist Dr. O'Hara in treating this afflicted man." Sure, any health worker might be said to "assist" another in treating a patient, but given the unfortunate history in which nurses were seen to merely "assist" physicians generally--rather than having their own autonomous profession and scope of practice--we wish the show would "assist" us more in improving understanding of the role nurses really play in hospital care.
Later we see Kelly introduce to physician Coop two teenage girls, one of whom is in an ED bed with a bashed-up face. Kelly: "Dr. Cooper is going to be taking care of you. These ladies skipped school, hit the bottle, then hit the sidewalk." The girls are still drunk and giggly. They recognize Cooper as the sexy physician guy from a prior hospital promotional campaign. Cooper, not in the mood, wants stitches and an X-ray.
Kelly smiles and says, "you know it."
Cooper says he's "going to drop some wisdom" on them. Kelly quickly assures Coop that he doesn't have to--he has already noticed that Coop is not exactly a font of wisdom--but Coop babbles on about how all his material things are "illusions." But Kelly is real, Coop says, poking him. The uninjured girl asks if Kelly is "really real." Kelly smiles and says, "100%."
Later, Jackie trips over the drunk girls' beer, and snaps at Kelly. He says he's following up with a concussion. Jackie orders him to "check on the PCP in 3--now." He says "yes, ma'am," but also leans close to the girls as if telling them something naughty, then leaves. They start laughing. Jackie notices. Kelly does check on the PCP patient and sees O'Hara unkinking an IV line. (Sure, physicians do that all the time.) Kelly warns O'Hara to keep the patient restrained, but she says he's knocked out. Kelly starts to leave, but then a monitor alarm sounds, the patient awakens and slams O'Hara against the wall. Kelly rushes back and restrains the patient, then checks on O'Hara. She claims to be fine. Later, in the women's room, Jackie pours out the girls' beer as O'Hara continues to recover. Jackie suggests O'Hara take something from the pharmacy, and offers her one of the beers--which O'Hara takes.
Still later, Jackie confronts Kelly: "You wanna try taking it easy on the jailbait?" Kelly denies it, and they soon have a confrontation; he says if she comes after him, he'll come after her.
The nurses in these scenes are by turns skilled, astute, supportive, tough, jaded, snarky, and maybe inappropriate--in other words, they are three-dimensional professionals deeply engaged in the substantive work of the ED, not timid flunkeys who are just there to "assist" and be ordered about by physicians. And the drunk teen was even willing to consider getting with a nurse, because they're healers!
"Every day is doctor day"
The June 6, 2011 episode ("F. the Lemurs" by Liz Brixius) focuses on the close relation between Jackie and O'Hara, which Zoey finds remarkable because of the traditional nurse-physician divide, but which is now tested by Jackie's drug abuse. However, the helpful suggestions that nurses and physicians can be friends and peers are overwhelmed in this episode by further autonomy problems, including yet another instance of O'Hara taking a nurse off a patient's case.
Early on, the episode offers a small, temporary reversal of the traditional power dynamics between Hollywood nurses and physicians, as Zoey seems to be enjoying speaking to a group of physicians, who seem to be in the ED for flu shots, as if they were notably slow children.
Sam explains to the arriving Jackie that it's "doctor day" for the flu shots. Jackie: "Every day is doctor day . . . she must be in Heaven." OK, so maybe this presents nurses as a bit insecure and petty, just waiting for some way to strike back at physicians who have traditionally held more power. But Zoey, despite the pink-patterned scrubs, has come a long way from the new nurse who was afraid to even speak to O'Hara during the first season.
Later, we see Jackie suggest that Coop prescribe Percocet for a patient. Akalitus shows up and tells Kelly to take over for Jackie, which at least shows that someone other than physicians can direct nursing assignments. In her office, Akalitus tells Jackie that she can't administer medications for a while, explaining that the hospital's Human Resources department thinks someone is abusing narcotics. (This stems from Jackie's earlier theft of several Fentanyl patches that were on their way from the pharmacy to oncology. HR suspects Jackie because too few patches survived the run, which also involved Kelly; HR grilled Kelly about it, and he avoided blaming Jackie directly.) In Akalitus's office, Jackie accepts this decision, but asks Akalitus not to tell anyone. Jackie thinks O'Hara told HR about her drug use, and Jackie later confronts O'Hara, who is with Zoey treating a young environmentalist who was attacked while doing street canvassing to help the lemurs. O'Hara orders Jackie out. Zoey tries to intervene.
Zoey is shocked, but we're not, because the show does not fully grasp nursing autonomy. Of course, while it might be fair to ask a disruptive colleague to leave if she has no pressing business with a patient, a physician cannot order a nurse like Zoey to "replace herself." Charge nurses and nurse managers, who don't really exist on the show apart from Akalitus, have that responsibility. Zoey leaves, barely keeping it together, and asks Kelly to go in and "assist." The writer could have structured this scene to bring out just as much of the conflict between Jackie and O'Hara without suggesting that physicians direct nurse staffing or that ER nurses are there to "assist" physicians.
O'Hara and Jackie enter Ohara's office. Jackie continues to accuse O'Hara of being behind the medication ban. O'Hara vehemently denies saying anything, noting she could have long ago, "and I've been asked." Jackie says the ban is very embarrassing to her because everyone knows what it means. O'Hara: "Stick close to me, I'll administer anything I prescribe." But actually, physicians can't do that, as a matter of authority and more generally as a matter of skill. The assumptions here are that nursing knowledge is merely a small subset of what physicians know and that the normal practice in hospitals is for physicians to delegate less important tasks to nurses. Not so. Nurses have their own distinct body of practice, and as part of it, they are responsible for giving narcotics and keeping track of what narcotics and to whom. Physicians have no access to narcotics, and they do not have the skill or authority to administer many of the medications that nurses do. Drug administration can be dangerous and complex.
Later, as O'Hara and Kelly are prying a chair off a pediatric patient's head, Jackie enters and asks Kelly to get morphine for a "kidney stone in 6." Kelly doesn't want to. Jackie looks at O'Hara, as if she were in charge. O'Hara tells Kelly to "go ahead." But Kelly is not there just to do whatever O'Hara wants. He's there to provide nursing care, independent of O'Hara, and only he and the charge nurse, who appears to be Jackie, are qualified to determine where he is needed.
The June 13, 2011 episode (Liz Flahive's "Batting Practice") includes a couple impressive displays of nursing expertise, and another suggestion that O'Hara directs nurse staffing. But the episode may be most notable for its part-mocking, part-admiring depiction of a "National Nurses Appreciation Week" celebration that seems to be initiated and entirely organized by Zoey.
In one scene, O'Hara warns ED staffers that they will be seeing patients resulting from a pedestrian vs. cab crash, and she asks Jackie to "intercept the cab driver," possibly because Jackie still can't give the narcotics the pedestrian will likely need, or possibly to remove the cab driver from a likely dramatic scene and defuse the situation. Either way, physicians do not choose which nurses work on which cases. But the cab driver, who is upset, turns out to have a serious problem. He was "unbelted," and now he can't breathe. Jackie and Kelly expertly set him up in bed and assess him, with no physicians present. Kelly reports that his pulse-ox is low and he's "unstable." Jackie throws a curtain shut to block the view of a nearby patient who is staring, saying that it's "not a show." Kelly says, "Trachial shift, pneumothorax." Jackie: "Probably on impact. He's gonna need a chest tube." Kelly says he'll get O'Hara, but Jackie tells him to stay put, explaining, "Needle decompression." Kelly reports that the patient's pressure is dropping. Jackie asks for "10 of Versed," which they'll need for afterwards. Kelly declines--he resists Jackie bossing him around, which the other nurses tolerate. (At least some of the time, Jackie may be acting as the charge nurse who does have authority over patient assignments, though the show never calls her a charge nurse or makes that clear.) In any case, Jackie tells Kelly that she can't get the drug because she's on probation. He agrees to get the versed. Jackie decompresses the patient's chest. O'Hara shows up, tells them nice work, and asks them to tell the OR there is a chest tube to do. Kelly complies. Jackie assures O'Hara she did not do anything she wasn't supposed to. Jackie comforts the patient, telling him he's OK. Despite the "O'Hara's in charge" suggestions that bookend the scene, it's mostly skilled, autonomous care by Jackie and Kelly.
Another notable clinical case in the June 13, 2011 episode involves a 30-year-old who called an ambulance because she supposedly could not stop coughing. The paramedic Lenny delivers this patient to Jackie and Coop. Lenny's not thrilled to have been bothered for something like this ("Nice day for a cabulance."). Jackie is also pretty skeptical. Later, Sam reports to Jackie that he got the cougher some codeine. Jackie tells the patient she should have just gone to the drug store for her cough. The patient says she didn't want to get sick. Jackie points casually to cases of meningitis and bacterial pneumonia nearby in the ED that could make the patient sick, and notes helpfully that "unnecessary opiates can do more harm than good." Jackie suggests the cougher try to steer clear of dairy products and get some Cloraseptic "before you go down that [opiate] road." So, Jackie asks, does the patient really want the codeine? The patient hands the drugs over and Jackie pockets them--a good illustration of her expert care dovetailing with her quest for narcotics.
"Appreciation Week is patronizing. It's for the overworked and underpaid. . . . We don't celebrate it."
But the nurses week plotline in the June 13 episode is the most striking. Early on we see Zoey, a little dressed up and not wearing scrubs, loudly inviting Jackie to a celebration she has arranged for "National Nurses Appreciation Week." Jackie, Sam, and Thor are very dubious.
Zoey explains that she appreciates the nurses and she wants them all to be together. Only Thor promises to "make an appearance."
Later, Zoey seems to be alone at her appreciation party in the hospital basement. A big lonely banner blares, "THANK YOU NURSES!" There are yellow smiley face balloons with nursing caps. Zoey's boyfriend Lenny shows up and is pleased to sample the plentiful food, but he doesn't seem to grasp what the special event is. Thor arrives and starts rehearsing "Ave Maria," which he will sing at Coop's upcoming wedding, in the big empty space; Zoe asks him to stop. For a while they remain the only ones there. Thor tries to comfort Zoey, but she is despondent, until the police officer who got "pummeled" in the earlier episode shows up with flowers for Zoey. The two nurses can't believe it, and they are suspicious, almost mad. The officer explains that his mother and sister are nurses, and someone should get them flowers, because they work hard. Zoey hesitantly takes the flowers and thanks him. He also says she looks nice. She invites him to stay for "the party," but he is on duty. Thor reminds her that she has a boyfriend. Then a group of children whom Akalitus has been leading in a fight-childhood-obesity event arrive. Zoey is thrilled, and she welcomes them to the food table. Akalitus herself arrives and is pretty dubious about all the sweets, but one of the overweight kids claims to be stopping at one cupcake, and Akalitus approves. Finally, even O'Hara shows up. But not Jackie, Kelly, or Sam.
This is a pretty nuanced treatment of Nurses Week. The show lays out the argument against it, that it is a good example of how society placates disempowered groups with special events that are cheap ways for those who hold power to look appreciative, even though the overall treatment of the groups the rest of the year--as expressed in the allocation of resources--shows they are not really appreciated at all. And as the episode suggests, for nurses these events often focus on vague, smiley, angel-oriented expressions ("THANK YOU NURSES!") and rarely on nurses' life-saving clinical skills, actually reinforcing harmful stereotypes. There is really no reasoned answer to this view, and Jackie, its most forceful proponent, neither relents nor attends the event. On the other hand, the show seems to have some sympathy for the urge to honor nurses in some way. As Zoey and her police suitor suggest, nurses work hard, they could stand more emphasis on solidarity, and it may seem churlish to begrudge them some special recognition. But the show isn't happy leaving it there, throwing in the seemingly smitten officer with flowers (is his appreciation for nursing or just Zoey?) and the overweight children (are nurses themselves a group that really needs an event encouraging them to consume a lot of sweets?).
Nurse Jackie has always been interested mainly in addiction. But nursing is a critical element in the show, and in particular, in its complex central figure, who defines herself more as a nurse than anything else. Jackie doesn't just have extraordinary health skills. She seems to have a pathological need to use her gifts to help patients no matter what lines she has to cross, and perhaps that is her strongest addiction: She must make the patients' world a little better every shift, even as she is wrecking her own life and maybe the lives of those close to her. The show continues to present Jackie and her nurse colleagues as troubled but substantial and committed clinicians who really don't need physicians to tell them what to do, despite the awful scenes in which O'Hara does that. These nurses may not be 100% real. But they are healers.
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