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Letter to "ER" sponsors March 3, 2005

Dear Mr. Brad Iversen (H & R Block), Mr. Peter Sterling (McDonald's), Mr. Nick Sweers (Sprint) and Pepsi Board of Directors:

I am writing to request that you take a leading role in resolving the global nursing shortage. How? By urging the popular NBC/Warner drama "ER" to improve its portrayal of nursing, and by refraining from placing further advertising on the show's airings worldwide until that happens. I make this request now because lack of public understanding is a fundamental factor in the nursing crisis, "ER" is the world's most influential purveyor of the damaging handmaiden image of nursing, and the show has refused for several years to address nurses' concerns.

Unfortunately, most people still believe that nurses are unskilled physician subordinates, rather than professionals with critical thinking skills honed by years of college-level training. In fact, nurses play a central role in modern care. They assess patients' conditions and autonomously intervene, coordinate work by the health care team, use cutting-edge technology to protect patients, and teach patients to manage their conditions. Nurses save countless lives and improve patient outcomes every day.

That's why the nursing shortage is one of the biggest threats to public health, especially in developing nations. And it is projected to get far worse. Resources are allocated in accord with the public's misunderstanding of the profession. While vast sums are lavished on medical training and research, nurses struggle with short-staffing that has already killed thousands of patients. The nursing workforce is aging and burning out, and a nursing faculty shortage limits efforts to train new recruits. As a result, developed nations are now draining poorer nations of their most skilled nurses, leaving fragile health systems in chaos. Recent reports by the International Council of Nurses and others show that nurse migration, along with health system restructuring and HIV/AIDS, threaten nursing care and imperil efforts to improve global health.

What's wrong with "ER," a compelling drama seen by tens of millions worldwide? "ER" nurses are competent and caring, and the show has actually made a serious effort to improve in some episodes of thhe 2005-2006 season, but the show still consistently falls prey to the myth of the peripheral, subordinate handmaiden. Consider a few key differences between "ER" and reality:

"ER": Has about 8 major physician characters but only one nurse.
Reality: Level one ED's like that on "ER" have as many nurses as physicians.

"ER": Physicians provide virtually all significant care and receive virtually all credit for outcomes.
Reality: Nurses autonomously save lives and greatly improve patient outcomes.

"ER": Physician training is a huge focus; nurse training barely exists.
Reality: Highly skilled nursing requires years of training, which is a critical function of hospitals.

"ER": Nurses pursue graduate education only in medicine; advanced practice nurses barely exist.
Reality: U.S. nurses are more than 50 times more likely to pursue graduate education in nursing, and 200,000 U.S. advanced practice nurses are critical to the future of health care.

"ER" clearly affects nursing. Public health research shows that--just like the advertising we're asking you to shift elsewhere--entertainment media products have a significant effect on public views and actions. Indeed, this recognized effect is the basis for entertainment education, or "edutainment," a major public health pursuit in Hollywood, and one in which "ER"'s creators have themselves been deeply involved. One recent study showed that "ER" had the most striking influence on U.S. youngsters' views of nursing. Consistent with the show's physician-centric distortions, the youngsters wrongly saw nursing as a technical job for girls and one too lowly for private school students. "ER" itself has claimed credit for positively affecting social and health-related conduct, such as raising interest in emergency medicine. But the show has persistently denied the obvious corollary: that its grossly inaccurate portrayal of nursing has an equally strong--but negative--effect.

Sadly, I must also urge you to withhold advertising from other Hollywood prime time health care shows, including Fox's "House," ABC's "Grey's Anatomy," NBC's "Scrubs," and Lifetime's "Strong Medicine." Their depictions of nursing are generally even worse than "ER." In some of these shows, especially "House" and to a great extent "Grey's Anatomy," nurses essentially do not exist; the physician characters spend half their time nursing.

I do not make this request lightly. The Center for Nursing Advocacy, along with nursing leaders and many supporters, has tried for four years to influence "ER" through informal persuasion and letter-writing and media campaigns. But the show has refused to consult expert nurses in the development of scripts, or to make other changes required to improve its performance. The show's persistent refusal to address our concerns has made this step necessary. The show has never really been able to argue that it portrays nursing accurately. Instead, it claims that it must be allowed "dramatic license." But since its dramatic license has always glorified medicine and marginalized nursing, the show's position resembles a claim that a tossed coin is fair even though it always comes up heads.

"ER"'s handmaiden vision subtly undermines our efforts to address the crisis in our profession.

I hope that, in addition to pulling your advertising, you will telephone "ER" Executive Producers Mr. John Wells at 818-954-5682 and Mr. David Zabel at 818-954-3900 to ask them to address nurses' concerns.

Thank you for joining us in helping nurses resolve the nursing crisis and improve global health. Please contact me if I can provide any further information.




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