Lifeline: Nursing Diaries (2004)
Created by Richard Kahn
Part One: Richard Kahn, Linda Martin
Part Two: Linda Martin
Part Three: Jenette Restivo
Executive Producers: Brett Alexander, Alon Ornstein
CBS News Productions and Discovery Health Channel
Part I: "The Rookies"
"Lifeline: The Nursing Diaries" is a three-part documentary that follows the work of nurses at two prominent hospitals, Boston's Massachusetts General and New York City's New York-Presbyterian. On the whole, it's a valuable but frustratingly uneven work. The first part, set in Boston, is possibly the best single hour of a nursing documentary that we've seen. It is an engaging work that deftly shows autonomous nursing actions that the media often ignores or assigns to physicians, including life-saving interventions, patient education and family support.
But when the program moves to New York for its second and third parts, it starts to veer off track. It still gives a fairly good sense of some key aspects of nursing. But it also tends more toward the "reality show" category of health care documentaries, and indulges in some of the same handmaiden and maternal stereotypes of nursing that the first part carefully avoided.
The first part, "The Rookies," gives an unusually good sense of the value of highly skilled nursing. It shows nurses working in three intensive care units at Mass. General: the cardiac surgical intensive care unit (CSICU), the neonatal ICU (NICU), and the surgical ICU (SICU). The filmmakers focus on only one patient in each unit, which allows them to show a broader range of things that nurses do for patients, and more of the relationships that nurses develop with patients and families. The episode is compelling and moving but does not resort to the cheesy directorial tricks or heroic hyperbole that some health care documentaries use to try to pump up the action. Consistent with this serious approach, we are not invited into the nurses' personal lives.
The episode shows nurses doing so many critical health tasks that the media commonly has physicians doing that it almost seems like it must have been a conscious goal of the filmmakers. However, it may simply be the natural result of taking a comprehensive look at what nurses really do.
We see nurses autonomously managing patient care, detecting critical problems, formulating key interventions, explaining things to patients, families, and the viewer, and generally managing recoveries with little physician involvement.
The show does minimize the physician role, but its explicitly stated goal is to explain what nurses do. By contrast, the usual approach of today's fictional and nonfictional media is to focus almost exclusively on physicians, and tell the public they are hearing about health care as a whole. Moreover, "The Rookies" does not pretend physicians are irrelevant, noting at times that they have made a given diagnosis, or that they have "decided" a patient needs a certain procedure (which seems questionable, since we would hope that patients and the rest of the health care team would also be involved in such "decisions.")However, the physicians seem somewhat awkward, talking past patients and families or over their heads--despite obviously being aware of the cameras trained on them. It is left to the nurses to manage the emotional aspects of the patients' care, and to make sure the patients' complex health situations are explained in a way they can understand.
This is a critical depiction of nurses' patient advocacy and education roles.
"The Rookies" also counters other common media myths. For instance, it shows the intensive training a new nurse must receive from an experienced nurse in order to handle the sickest SICU patients, even after the new nurse has received her "Bachelor of Science in Nursing" (a phrase that almost never appears in the mainstream media). And the episode closely examines the development of the new nurse's skills, and her concerns about measuring up. On other shows, extraordinary attention is lavished on the training of physicians, whose awesome skills are seen to flow from careful mentoring by wise senior physicians, but nurses are presented as fungible assistants who exist to call out vitals and hand things to physicians.Likewise, the episode illustrates the crucial family support a skilled nurse can provide. A team of cardiac ICU nurses helps an angry patient recover and move forward despite the amputation of his leg. And a veteran NICU nurse expertly helps a frightened young couple bond with their very ill premature baby, aiding the recovery of the entire family. Again, on television dramas and even most documentaries, there is virtually no chance that these critical real-life nursing tasks would have been performed by nurses; physicians or physician characters would have done it all.
But "The Rookies" is the real thing.
Part II: "Pediatrics"
Part III: "In the O.R."
Sadly, the second and third episodes of "Nursing Diaries" show such a clear decline that we can't help but wonder if it has anything to do with the absence of series creator Richard Kahn as a producer. Whatever the reason, the series' initial close focus on showing the nature of high quality nursing seems to slip somewhat, and the stereotypes that were absent start to appear.In fairness, the second and third episodes still focus on the nurses, giving a fairly good account of some of their work in the NICU and Operating Room settings at New York-Presbyterian. The nurses explain aspects of their work that clearly require significant skill. And we see them engaged in some important patient monitoring, advocacy and education.
For instance, one pediatric nurse manages the pain and the emotional wellbeing of her young patients. She tries to protect one from what she regards as an excessively upsetting recitation by a young resident of the risks of a pending operation to correct scoliosis. Another nurse has an admirably tough, streetwise approach to helping her patients recover following surgery. She tangles lightheartedly with a somewhat uncooperative post-op patient who plays a firefighter on NBC's "Third Watch" (and who is a nurse himself). All the nurses speak persuasively of the satisfactions of their work. And these episodes include profiles of ethnic minority nurses, which the first episode did not.
But other elements of the second and third episodes undermine these good features. At a number of points, the show comes uncomfortably close to giving the impression that important care really revolves around the physicians, especially in segments involving a fairly inexperienced OR nurse. This nurse is shown telling us how much she learns from the surgeons (fair enough, but how about noting how much young physicians learn from senior nurses?). When this nurse attends an after-work party, the narrator informs us that this is a good chance for the nurses to get together without the surgeons "ordering" them around. At another point, the narrator refers to letting "the surgeons do their work," as if nurses were not really very important. And on another occasion, the narrator refers to a time when "doctors" will think a patient is well enough to leave the hospital, as if nurses were not involved in such key decisions.
The later episodes also indulge in some of the maternal and emotional stereotyping that the first avoided. Now we are drawn into the nurses' personal lives, and we hear about their romantic affairs (one is about to get married; another is looking), as well as their children, or desire for children. More distressing, on two separate occasions the narrator describes one of the nurses as "mothering" her pediatric patients, a highly inaccurate and damaging way to describe a modern scientific profession. In addition, both episodes refer to the need of these caring nurses for someone to take care of them, which forms an uncomfortable link between the nurses' professional roles, which require college-level science training to perform, and the roles of their potential mates, which presumably do not.
The focus on personal issues and tired stereotypes breaks up the compelling narrative flow seen in the first episode, and with it the sense that we are seeing something vital and unusual. What's the big deal about another cable documentary that, at least in parts, trots out familiar health care reality show cliches, and suggests that nurses are maternal figures who defer to physicians? Given these elements, even the show's overall lack of male or advanced practice nurses, and its female-associated title--all easy to overlook in the first episode--become more troubling.
"Lifeline: The Nursing Diaries" remains an engaging and informative look at part of the real world of nursing. But only the first episode is truly impressive.
Review by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed December 16, 2004
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.