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Letter to "ER" from Beatrice Kalisch

I write regarding the portrayal of nurses on "ER." It is of deep concern to the profession of nursing and ultimately to the American public that nurses on this very popular and influential television program are presented in such a negative light.

Particularly damaging is the recent portrayal of Abby Lockhart as leaving nursing to become a physician. You did this several years ago with another nurse character and we attempted to let you know then how damaging these types of portrayal are to the profession of nursing. Unfortunately the message that comes across to the viewing public is that it is "better" to be a doctor than a nurse. This feeds into a major stereotype that we in nursing have been fighting for decades: "Nursing is the lower half of medicine" and "people only become nurses because they can't make it in medical school."

Nothing could be further from the truth. In actuality, the vast majority of nurses choose nursing over medicine or other careers because they want to function as a nurse. Physicians focus on curing the patient, providing disease management using various medical technologies such as medications, surgery etc. Nursing on the other hand has as its goal the overall well-being of the patient and his/her family. While the nurse like the physician has as part of their goals to "save" or cure the patient, the nurse also is concerned about the patients' emotional reactions, spiritual concerns, knowledge of their illness, how to provide care to self once they have left the care of clinicians, setting, the adequacy of the home environment etc.

One of the least understood aspects of nursing by the general public is that the nurse monitors the patient in the hospital setting 24 hours a day while the physician checks the patient for just a few minutes during the day. It is the nurse that is observing the vital signs, physiological signs, the emotional status, interactions with friends and relatives, and intervening in a timely manner.

Thus to make a long story short, there is a distinct difference between those individuals who wish to do medicine and those that wish to do nursing. Both are needed, both are valuable and both deserve appropriate depictions in the media. The reasons nursing needs a vastly more realistic and positive image on "ER" is that millions of young people in the position of deciding "what they want to be" are receiving messages that nursing is secondary and lower than medicine and that nurses are largely powerless.

As you know, there is and will continue to be a very serious shortage of nurses in our country. If we are not successful in recruiting more people into nursing, the impact on society will be disastrous. If all the physicians in the world took tomorrow off, the consequences would be very bad but I assure you if all the nurses in the world took tomorrow off, the consequences would be far more devastating.

I have personally studied the media image of the nurse and worked to improve the image of the nurse for 30 years. Aaron Spelling called me during the television program "Nightingales." He had somehow gotten a hold of one of the books we had written on the portrayal of nurse in the media and said it had stayed up reading it. We discussed the program and I attempted (unfortunately to no avail) to convince him to include not just the sexual image of nurses dressing and undressing in their locker room but also nurses saving lives and making a difference in the outcome of patients. I asked him if he had heard from nurses and he said "The Civil Rights Movement should have been so well orchestrated." He had received over 5,000 letters he said. The program was removed from the air but for us in nursing the better outcome would have been to improve the quality of the image so that individuals considering nursing as a career and the general public that depends on our services would get a glimpse of "real nursing."

We know we will receive our fair share of negative images but we ask that this is balanced with positive images. For instance, since Abby is leaving nursing to become a physician why not have one of the medical students or residents leave medicine to become a nurse? This happens in real life as often as a nurse leaves nursing to become a physician.

I hope you will consider revamping the image of the nurse on your excellent and important healthcare drama. The future of healthcare in this country is dependent on it.


Beatrice J. Kalisch, PhD, RN, FAAN
Division Director, Nursing Business and Health Systems and
Titus Distinguished Professor of Nursing
University of Michigan
Ann Arbor, Michigan



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