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Open Letter #4 to Grey's Anatomy

Dear Ms. Gilmore:

Thank you for your April 14, 2005 letter responding to the Center for Nursing Advocacy and the hundreds of nurses who have written to protest the damaging portrayal of nursing on ABC's "Grey's Anatomy." We appreciate your taking the time to draft a letter which acknowledges the life-saving contributions of nurses and which appears, at least in part, to have been written directly in response to our concerns.

We want to assure you that we are well aware of the dramatic considerations that guide "Grey's Anatomy" and similar Hollywood products. We often hear the argument that damaging misportrayals of nursing are unavoidable in "fictional" shows subject to the demands of "dramatic license." However, no dramatic consideration requires that nine out of nine major characters in a drama about the practice surrounding surgery be physicians. To the extent that drama seems to require those characters to spend a lot of time doing things that nurses do in real life, that is obviously not something we can ignore or excuse, particularly in the midst of a global nursing crisis driven in significant part by the lack of public understanding of the real nature of nursing. Indeed, the term "dramatic license" suggests something driven by objective plot demands, but what we see is that shows like this virtually always inaccurately deify physicians and disparage or ignore the real work of nurses. What would you think if a tossed coin always came up heads?

We note that you do not dispute any of our specific points about the portrayal of nursing on "Grey's Anatomy," including the anti-nurse slurs that have been effectively endorsed by the attractive lead characters. And we commend you for not questioning the powerful influence that popular television dramas like this one have on the public's health care views and actions. As you know, this is the basis for the edutainment efforts in which we understand that you yourself have played a role. We note that in a June 2004 Broadcasting & Cable piece, you were quoted as stressing that public-service messaging "that plays naturally to the storyline and is complementary to the content of the show can have great impact." We agree. And the "great impact" that the explicit and implicit messages that "Grey's Anatomy" has sent so far about health care roles and nursing in particular have been strikingly negative.

We are glad to hear that an experienced registered nurse is a member of your team of "medical advisors." However, we're afraid that alone does nothing to alleviate the problems we have identified. Viewers see what is on screen. At the most basic level, there is only so much that can be done with a show that tries to portray the full range of surgical patients' experiences with a recurring cast consisting entirely of physicians. The show could confine itself to what surgeons really do, but if it wishes to portray all the aspects of patient care that it seems to, it would need to add several major nurse characters. We suspect that the show's producers have rarely heard this kind of advice from their advisors. Of course, as we have noted, even within the show's physician-centric structure, it could do less damage to the nursing image. But that would require that it have a nursing advisor who was willing and able not just to confirm whether a specific symptom was being presented correctly, or whether a patient was being bagged correctly, but to let the producers know exactly what physicians do and what nurses do. It does no good for a nursing advisor to show the actors playing physicians how to do things that nurses generally do in real life, such as defibrillation. And in addition to having a forceful, media savvy nursing expert, it is essential that the producers actually heed his or her advice. This is why we have urged you to employ such an advisor in the preparation of your scripts, where most of the critical dramatic decisions that will affect the portrayal of nursing are made. Physicians, of course, generally know little about nursing theory or practice.

You also point to the diversity of those playing nurses on each episode. Of course we salute such diversity. But the fact remains that these are no more than anonymous, peripheral figures who serve to frame the actions of the main characters who matter, who are without exception physicians. Such "wallpaper nurses" rarely have lines and tend to appear only fleetingly at the edge of the frame or in the deep background. Obviously, whether they are real nurses or not will mean nothing to viewers. If we are not mistaken, no nurse character in the first three episodes has even been named.

We assume at least that will change with the episode scheduled to air on April 17, which as you note will feature a patient who was, as some of the promotional materials have put it, Meredith's mother's "long-time scrub nurse." We always have hope that such a future portrayal will be fair and accurate, though we might note that OR nurses do not belong to particular surgeons, as the above phrase implies, any more than we might speak of an OR nurse's "long-time surgeon." Perioperative nurses are not surgeon appendages, but autonomous professionals with a distinct scientific knowledge base and scope of practice who work together with surgeons, anesthesia professionals (often advanced practice nurses) and others to provide the complete range of care that surgical patients need. Of course, once a show actually has a major nurse character, a host of other considerations come into play, including that he or she not be portrayed stereotypically as a physician handmaiden, bitter battleaxe, Mrs. Welby wannabe, silly sex object, or brainless angel.

Thank you again for your considered reply, which appears to reflect some concern that such influential dramatic programming be consistent with the public interest. We have been unable to reach the show's producers as of yet, so we urge you to help us arrange a conference call to discuss these issues in more detail. We hope the call would at least include Ms. Rhimes, one or two prominent nursing experts, and you.

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