Changing how the world thinks about nursing

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Open letter #11 to Grey's Anatomy

Dear "Grey's Anatomy" Producers:

I am writing to encourage you to improve the portrayal of nursing on "Grey's Anatomy." The November 9, 2006 episode, like all prior episodes, told viewers that physicians deliver all health care that matters--including patient monitoring, patient emotional support, family relations, patient advocacy, and supportive and therapeutic care that nurses do in real life. As you know, since all major show characters are physicians, there were no nurse characters to deliver this key care. In the midst of a global nursing shortage that is based largely on a lack of understanding of the nursing profession, the continuation of this unrealistic portrayal of nursing is irresponsible.

The November 9, 2006 episode, "Where the Boys Are," included a plotline in which the "nurse's job" of "dig[ging] through crap" was used relentlessly as a symbol of professional disaster for the show's smart, ambitious surgical interns. Intern Cristina Yang spends most of the episode sifting through the stool of a boy who has swallowed Monopoly pieces. This is presented as a brutal punishment from Cristina's chief resident. Intern Izzie Stevens joins Cristina, in a desperate effort to avoid her own mandatory peer counseling. The plotline equates nursing with disgusting, trivial work that no educated person would ever want to do (ewww!).

Later, nurse Moe pages Cristina when the boy starts vomiting. Cristina quickly diagnoses a perforated bowel and directs the clueless Moe to page the chief resident. Thus, nurses do alert physicians to obvious changes in patient conditions, so the physicians can give life-saving care. Physicians also provide all other important care on the show, though nurses may be present at the edge of the main action, silently doing some little nurse thing.

My concerns about the show's portrayal of nursing extend to every episode that has been broadcast. Ten of ten major show characters are physicians, despite the central role nurses play in hospitals, which exist primarily to provide nursing care. Physician characters often perform key tasks that are generally the province of nurses, including various treatments, patient monitoring and psycho-social support. The show seems to reflect the view that now that women can become physicians, nursing work no longer matters (if it ever did). Nurses are typically presented as marginally skilled physician subordinates, usually faceless and mute--like wallpaper. And earlier episodes have offered a vision of nurses as fawning or vindictive losers (or even sluts, e.g. "skanky syph nurse") whose lives revolve around the physician characters. I do commend the show for decreasing the frequency with which its physician heroes express contempt for nurses.

However, simply decreasing the characters' express contempt is not enough. The undervaluation of nursing, including media depictions of nurses as peripheral physician subordinates, erodes financial support for nursing clinical practice, education and research, driving the global shortage. Underfunding nursing also increases patient mortality, increases errors and poor outcomes like infections, and adds millions of patient hospital days, all of which fuel rising health care costs. For the nursing shortage to end, society must learn what nurses do to save lives and improve outcomes, which also means unlearning the common misconception that physicians do important work that nurses really do. And unlearning--whether done by the general public or Hollywood producers--is clearly very difficult.

I know the entertainment media resists the idea that its products can cause real-world harm (real-word good is another matter, as the industry's embrace of media public service awards shows). But research shows that entertainment television like "Grey's Anatomy" has a real effect on health care views and actions. That's why public health groups like Hollywood, Health and Society work to improve public understanding of key health information through shows and public service announcements.

I urge you to minimize the damage done by "Grey's Anatomy" by consulting a nurse expert in creating your scripts. Having a nurse on the set to teach actors playing physicians how to convincingly do the work that real nurses do is not helping nursing--it is harming nursing. I also urge you to consider dramatic changes that would allow the show to provide a vision of modern health care that gives viewers at least some basic sense of the role of skilled nurses in modern care.

Even if there is no room for even one major nurse character, or a recurring one who does more than act as a pathetic foil to the physicians, more could be done in virtually every clinical scene to avoid the suggestion that nurses are silent handmaidens. For example, a nurse character might be shown actually having a meaningful care interaction with a patient, or doing defibrillation or other key tasks nurses do in real life.

Real nurses are skilled, autonomous professionals who play a central role in health care--if they can persuade decision-makers and the public to provide the resources needed. It is no exaggeration to say that the future of global health depends in significant part on better understanding of nursing. We hope that "Grey's Anatomy" will move toward being part of the solution.

Thank you for your consideration.

Sandy Summers, RN, MSN, MPH
Executive Director
Center for Nursing Advocacy
203 Churchwardens Rd.
Baltimore MD 21212