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ER (1994-present)
Starring Noah Wyle, Maura Tierney, Laura Innes, Anthony Edwards, George Clooney, Julianna Margulies, Eriq La Salle, Sherry Stringfield, Alex Kingston, Goran Visnjic, Ming-Na, Sharif Atkins, Mekhi Phifer, Paul McCrane
Executive Producers: John Wells, Christopher Chulack, Michael Crichton, Jack Orman, Lydia Woodward, Dee Johnson
Constant C Productions and Amblin Television/Warner Bros. Television
NBC
PG-14
Most Recent Season (2002-03) Ratings and Review
Review and Synopsis (2002-03 season)
Portrayal of Nursing (2003-03 season)
| Nursing rating |  |
Rating guide: |
| Artistic rating |  |
"ER" is arguably the best major health care-related television series since "M*A*S*H," and it is one of the most medically realistic dramatic series ever. When "ER" leaves prime time, probably after more than a decade on the air, it will also have been one of the most popular shows in history, and it will likely continue for years in syndication. Accordingly, it will have a tremendous influence on how the public views health care, including nursing. "ER" has generally portrayed nurses as competent, caring professionals and avoided the worst nursing stereotypes. But the show's physician-centric world view has led to a continuing failure to give viewers an accurate or complete picture of the vital role the nursing profession actually plays in modern health care. The few nurses who emerge from the "ER" wallpaper are skilled but essentially fungible, serving mainly as subordinates and romantic foils for the heroic physicians.
Since its inception in 1994, "ER" has focused on the professional development and personal lives of a shifting cast of about 10 emergency department (ED) and surgical physicians and one ED nurse at "County General," the main public hospital in Chicago. Keys to the show's success have been its adrenaline-happy depiction of emergency procedures, complete with whirling camera work and faster-than-the-speed-of-light technical dialogue, and an addictive soap opera approach to the intersecting lives of the main characters. "ER" has also featured some inventive plotting, strong characters, effective direction and fine acting. In recent years it has slowed down creatively, certain plot lines have not worked well, and some digressions into the characters' non-work lives have grown tiresome. But "ER" is still capable of fine work, and it remains very popular as it enters its 10th season.
In its early years, "ER" introduced the model that would prove so effective: dedicated, intelligent physicians staggering under the volume and complexity of cases seen in a Level One Trauma Center, and trying to cope with the effects on their professional and personal lives. The show's plot is too intricate to summarize here, but major characters in the early years included John Carter (Noah Wyle), a wide-eyed medical student from a wealthy family who would ultimately become chief ED resident, and who will likely end up as the most important character in the show's history; Mark Greene (Anthony Edwards), a sensitive, decent ED chief resident whose marriage to an attorney ultimately fell apart and who became, as an attending, the show's moral center; Kerry Weaver (Laura Innes), an insensitive, physically disabled ED senior resident who consistently put herself before her colleagues, and became chief of emergency medicine; Carol Hathaway (Juliana Margulies), a troubled but tough and competent ED nurse who became a nurse manager; Doug Ross (George Clooney), a hunky pediatric ED resident whose maverick ways would eventually lead to his departure from the hospital and the show, followed by long-time flame Hathaway; Peter Benton (Eriq La Salle), a coldly intense surgery resident who seemed to have a maximum allotment of one smile per season, which he didn't always use; Jeanie Boulet (Gloria Reuben), an earnest, HIV-positive physician's assistant; Susan Lewis (Sherry Stringfield), a down-to-earth ED resident who would leave the show for several seasons; Elizabeth Corday (Alex Kingston), a skilled English surgeon who would marry Greene; and the great Robert Romano (Paul McCrane), an acid-tongued, highly skilled surgical attending who would become the chief of medicine and who served, along with Weaver, as the show's enduring character-you-love-to-hate.
By the early part of this decade, some of these characters were on their way out, and a new crew was moving in. Ross and later Hathaway departed for the Northwest to raise their twins, Benton left for a job that would allow him to care for his young son, and perhaps most significantly, Greene succumbed to brain cancer, leaving Corday to raise their young daughter alone. Romano lost his arm to a helicopter rotor and his job as chief of staff to the relentlessly ambitious Weaver. Lewis returned, for some reason. Most importantly, the show formally anointed Carter, now ED chief resident, to be Greene's successor as its moral and professional heart. Important new characters included Abby Lockhart (Maura Tierney), an alcoholic former OB nurse who started on the show as a medical student before settling in as the post-Hathaway major ED nurse character and love interest to Carter; Jing-Mei Chen (Ming-Na), a resourceful senior resident and contemporary of Carter's who had briefly appeared on the show near its beginning; Luka Kovak (Goran Visnjic), a Croatian ED attending who replaced Ross as the show's designated hunk, but who has had difficulty overcoming the death of his wife and children in the Balkans war; Michael Gallant (Sharif Atkins), a bright, decent medical student whose education is funded by his commitment to the U.S. Army; and Gregory Pratt (Mekhi Phifer), an often arrogant intern struggling to care for his mentally disabled brother.
"ER" has generally depicted nurses as competent, caring professionals with technical training who contribute to patient outcomes. Unlike many shows, it has resisted showing them as Nurse Ratcheds or sex objects. It has shown some nurses to be men and members of minority groups, though both of the major nurse characters have been straight white females. The Carol Hathaway and Abby Lockhart characters are, along with "M*A*S*H"'s Margaret Houlihan and "China Beach"'s Colleen McMurphy, among the most influential portrayals of nurses in television history. They are capable, nuanced and generally positive. Hathaway in particular was a strong character and a nurse manager. Although Abby was fairly weak early on, in recent seasons she has begun to show signs of an actual nursing identity, explaining why she chose to remain a nurse rather than continue with medical school even though she was doing well there, teaching Gallant the ropes, rising above anti-nurse slurs from Pratt, questioning physician treatment decisions (though still generally only when the physicians were impaired in some way), and recently becoming a nurse manager. The minor nurse characters likewise have been shown as caring professionals with skills, and recently their skills seem to be getting a little more attention. In the show's early years, it even focused some attention on nursing issues, for example during the labor dispute in the third season.
However, on the whole "ER"'s treatment of nurses as peripheral has failed to reflect nursing's vital role in clinical health care delivery. The show has consistently and inaccurately portrayed nurses as subordinate to the physicians who dominate it, rather than as members of an autonomous profession--as exemplified most recently by its late 2002 depiction of Weaver promoting Abby to nurse manager. For all its medical realism, "ER" remains a victim of what Kalisch and Kalisch have called "Marcus Welby syndrome": the inaccurate depiction of all significant health care being provided by physicians. As a result, it has frequently shown physicians performing critical nursing tasks, such as triage, patient teaching, and preventative care such as vaccinations. Perhaps the ultimate example of this marginalizing of nurses is having only one of the roughly 10 major characters be a nurse, when in a real life ED the nurse-physician ratio would likely be about 5:5. The show gives viewers little sense of the independent, science-based assessment and intervention that is central to the nursing process. Nor has it often depicted nurses in their patient advocacy role, which can entail questioning physicians' care plans and catching their mistakes. "ER" has rarely shown a nurse acting as a primary force in a patient's outcome. Instead, physicians receive the credit or blame for the results.
The show pays little attention to nurse managers or the professional development of nurses generally, such as through advanced nursing degrees, research or scholarship. Nurse characters have limited opportunities to display their special knowledge and skills, especially since nursing students are never shown. This stands in stark contrast to the show's obsessive focus on each stage and feature of the physicians' professional development, from medical students through the chief of medicine. Tellingly, both of the major nurse characters flirted with medical careers, as if to prove that they were worthy of the show's attention despite only being nurses. Hathaway and Abby have also spent most of their time in romances with physicians, and in many episodes, the main role of the nurses has been to comment idly on the lives of the physicians.
Finally, though the show prides itself on being on the cutting edge and often refers to the budget crisis in public hospitals, it has still has paid no serious attention to the current nursing shortage, a shortage that now constitutes a major threat to global health--but which "ER"'s generally inadequate portrayal of nursing has done little to address.
In sum, "ER" has some appreciation for the role nurses play in modern emergency care, but that recognition almost invariably gives way to its obsessive focus on physicians. In real life, nurses, physicians and other health care professionals have complementary and interdependent work relationships. But on "ER," the bottom line has usually been that the physicians' role is unrealistically large and robust, and the nurses' role correspondingly small and flat. In dramatic terms, the physicians are the tragic heroes, while the nurses are essentially members of the chorus.
Most Recent (2002-03) Season Ratings and Review
| Nursing rating | |
Rating guide: |
| Artistic rating |  |
Review and Synopsis (2002-03 season)
The ninth season of "ER" was touted as one of revitalization, with edgier themes and new characters breathing some fresh life into its formula. The series was a little stronger than it had been in the last couple years, with some fairly diverting ideas and less time spent on soapy subplots that had little to do with the ED.
Still, the soap content was fairly high. Gothic playboy Luka teetered on the edge, though he may have found some solace in helping an old friend from Croatia and his work overseas with a Doctors Without Borders-esque NGO. Carter got excruciatingly close to asking Abby to marry him, then pulled back; he may have been reconsidering by season's end, following a harrowing stint in the Congo with Luka's NGO. Abby herself continued to flirt with alcohol, and the show could not resist still more tiresome forays into the bipolar disorder in her family. Elizabeth decided to return to County rather than stay in England following Mark Greene's death. Romano lost his arm to a helicopter rotor, and in the process nearly lost everything else, engendering even more ill will than usual as he spiraled downwards. Weaver, capitalizing on Romano's injury and some unethical but savvy health care assistance to a city alderman, became County's chief of medicine (or as the show persists in calling it, "chief of staff"). But she suffered a miscarriage of the baby she planned to raise with her partner. Newcomers Gallant and Pratt continued their good attitude-bad attitude display, with a much bigger focus on Pratt's struggle to protect his mentally disabled brother and his romance with Jing-Mei. The most compelling plot line may have been the ongoing mystery of why the whining, uninteresting Susan Lewis continued to play such a major role in the show.
The writing quality varied greatly. And the show was not above gimmicks, such as the episode told in reverse chronological order, the gratuitously can-they-say-that-on-prime-time-broadcast-TV sexual patter, and Romano's injury, which suggests that the show feels compelled to physically disable its nastiest characters. But on the whole, "ER" stuck more closely to the work than in recent times, and the results were fairly positive.
Portrayal of Nursing (2002-03 season)
"ER"'s approach to nursing improved slightly. Abby remained the only major nursing character, but she did grow stronger, acting with more confidence in patient care and advocacy. On occasion she questioned physician actions, though usually some kind of physician impairment was still required, such as when she tried to get a hungover Luka to take a closer look at a patient who ultimately died because of medical errors.
The show also seemed to pay a little more attention to the work of the minor nurse characters, giving them a few more substantive lines. At one point the show appeared to admit that nurses do triage, only to suggest at another time that a physician was "stuck at triage." A veteran physician in the Congo episode told a Canadian nurse not to let the newcomer Carter kill anyone, which suggested that she knew enough to prevent a physician from harming a patient (as always on “ER,” this was only because the physician was impaired, in this case by inexperience).
But the series still has not overcome its mistaken belief that physicians supervise nurses. Perhaps the most egregious recent example of this occurred early in the season, when Kerry forcible promoted Abby to ED nurse manager, which of course would be the decision of a nursing executive, and which wrongly suggested that nurse manager is a job no one would want. As nurse manager, Abby did handle a complaint by fellow nurse Chunie against the increasingly troubled Luka, even attending a brief meeting with the Director of Nursing (!). However, consistent with the show’s longstanding reluctance to show nurses in leadership roles, this was the last we heard of the Director of Nursing, and Abby’s supposed management duties were barely mentioned for the rest of the season.
Other misrepresentations include Kerry directing Carter to choose three senior nurses to fire in order to save funds, which again would not be a physician decision (and would not save much money anyway, since senior nurses do not earn much more than junior ones), and Abby's request that Kerry approve her timecard for her time in quarantine at the start of the season (this task would fall to the nurse manager, not the chief of emergency medicine). "ER" continues to show physicians doing clinical nursing tasks that they would almost never do in real life, such as meeting ambulances and doing defibrillation. Likewise, it was almost amusing to see Kerry make a public error giving flu shots, an error that might be more likely than the show knows, given how rarely physicians would actually be involved in such a task. The final episode showed Carter and Luka giving vaccinations in the Congo, then congratulating themselves on saving hundreds of lives; of course, giving vaccinations is typically a nursing task. The show still lacks any portrayal of nurse practitioners or other graduate-prepared nurses, and it has yet to realize that nurses gain skills with experience or to even show nursing students, despite its obsession with the training of physicians.
Thus, though commendable efforts seem to have been made to improve the depiction of nursing on "ER," there remains much room for improvement. Each week, tens of millions of viewers continue to see an ostensibly realistic presentation of cutting edge care in which the few nurses who receive any attention serve mainly as subordinates and romantic foils for the physicians who dominate the show.
Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed July 27, 2003
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Center for Nursing Advocacy.
© 2003-2004 The Center for Nursing Advocacy, Inc. All Rights Reserved.