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Open letter #2 to Grey's Anatomy

Dear Ms. Rhimes, Mr. Gordon, Mr. Parriott, Ms. Beers, Dr. Klein, Ms. Gilmore, Ms. Liggins, Ms. Tobin and Mr. Thompson:

I am writing to express concern about the portrayal of nursing in the April 3, 2005 episode of "Grey's Anatomy," which offered 18.2 million viewers more of its surgical intern characters' explicit contempt for nursing. The episode was also notable for its relentless portrayal of physician nursing, as the physicians basically handled all meaningful patient care by themselves. I fear that the show is shaping up to be a major new force in fostering inaccurate attitudes toward nursing, at a time when the world is in the midst of a desperate nursing shortage. I urge you to improve the portrayal of nursing on the show.

The episode appeared to endorse the vicious anti-nurse bigotry in the premiere, which as you know involved the beautiful, sympathetic lead character Meredith angrily weathering insults to the effect that she was like a nurse. This week, Meredith's friend Cristina greets male intern Alex as follows: "You're the pig who called Meredith a nurse...I hate you on principle." I can't see how Cristina's comment would have been any different if Alex, instead of calling Meredith a nurse, had called her a "stupid bitch." The show does not seem concerned with the nurses who are the objects of its characters' scorn, but only with showing how hard it is to be a female physician who has the misfortune to share her gender with most of the nursing profession.

Just like last week, this appears to be "dress for success" feminism, an expression of contempt for a traditionally female profession by bright, ambitious women who think they have left all that lowly "women's work" behind in pursuing high-status, traditionally male professions like surgery. In fact, real interns learn a tremendous amount from experienced nurses. Moreover, the kind of comments the show is endorsing are based on the same misogynist stereotyping that has long made women second class citizens across the board.

Most of the episode consists of physicians handling all aspects of patient care, with little or no involvement by nurses or anyone else. For instance, the pediatric intern and Meredith are pretty much the only caregivers we ever see in the crowded nursery, though a surgical attending and pediatric resident do stop by for a brief showdown. The inaccurate message: physicians provide all significant direct care to newborns 24/7. They may as well call it the "doctory."

The denursification is also notable in what is perhaps the main subplot, which involves the critically injured rape victim who gets emergency surgery. The show presents the victim's care as directed entirely by physicians. The apparent ED attending hands her off to the surgical physicians, who spend the remainder of the show watching over her, especially since she has no family present. For an entire night, the surgical attending Derek sits by the side of the rape victim, but no ICU nurse ever appears. That would not occur in real life, to say the least. In these scenes and those involving the perpetrator, the physicians dominate all aspects of the action. Nurses are absent, apart from the usual fleeting, peripheral appearances in the OR.

In reality, rape victims at major urban teaching hospitals like this one are typically under the care of Sexual Assault Forensic Examiners. These are highly skilled forensic nurses adept at providing the physical and psycho-social care victims require, and at the complex, sensitive task of collecting usable physical evidence for prosecution of the crime. In the OR, the surgical attending mentions that the rape kit was negative, but we never see the forensic nurse who undoubtedly did the rape exam in the ED. Of course, psycho-social care might not initially have been seen as a huge priority for this unconscious victim, but the show does portray the physicians worrying over her lack of supportive family or friends, suggesting that they are trying to manage such things while she is unconscious. And she does finally wake up--apparently with only the surgical attending present. Nursing would also be central to the victim's physical care, in the emergency, surgery and post-op contexts. Moreover, forensic issues remain vital throughout this episode. Yet Meredith is assigned the job of protecting key physical evidence, instead of the forensic nurse, who has the expertise. Forensic nurses are not even mentioned. Because no nurse plays any significant role, the impression is that only physicians matter, and physicians get credit for work that nurses do in real life.

In the smaller subplot in which intern Izzie helps the Chinese patients in the hospital and the parking lot, from the older woman's arrival in the emergency department until the patients' waterlogged discharge, there is no sign of any nurse involvement. In real life, nurses would have provided much of the care for these two. They would have taken a leading role in negotiating the language and cultural barriers, advocating to have skilled plastic surgeons suture the young woman's face (rather than a brand new intern with marginal skills), ensuring that the patient's care would remain confidential from law enforcement, reassuring the patient of that confidentiality, and providing discharge planning. All of these roles call for clinical skills that ED nurses have, and that, it's safe to say, new surgical interns typically do not have. And the chances that a physician, rather than a nurse, would be the one to leave the ED in the pouring rain to see a patient in the parking lot are very low. I mean low.

Watching "Grey's Anatomy," we can imagine young females all over America thinking: "Wow, maybe I could be a surgeon." But we can't imagine a single self-respecting viewer thinking: "Wow, maybe I could be a nurse." If roles were accurately assigned on the show and nurse characters were allowed to do all the nursing work the physician characters are doing, we can imagine viewers making either of the above statements.

Please be aware that smart, tough, attractive women DO become nurses. Given the media's proven influence on the public, it is important that "Grey's Anatomy" do its part to help resolve--instead of exacerbate--the nursing crisis that is taking lives worldwide. Please consider hiring and heeding the advice of a well-qualified nursing consultant, and by crafting future scripts to present nurses (not physicians) doing the work real nurses do. Help us improve public understanding of nursing at this critical time.

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