The Showtime comedy's final seasons had flaws, occasionally suggesting that nurses report to physicians. But there was still a lot of expert care and creative advocacy from the brilliant Jackie Peyton and her protegee Zoey Barkow
June 2015 – Showtime's Nurse Jackie could have been named Addict Jackie, since that aspect of the emergency nurse character's life was probably as important as her nursing. (Yes, we know that label has been questioned, but Experiencing Addiction Jackie might be a little awkward.) Jackie Peyton still managed to save plenty of lives, even during the personal crises of the show's final three seasons. Those confirmed the show's place, along with the BBC's Call the Midwife, as arguably the best drama for nursing in television history. In particular, the show offered many examples of nursing expertise, innovation, and advocacy by Jackie and her gifted protegee Zoey Barkow. The nurse character Thor, while witty and well-meaning, remained fairly weak and never displayed much skill. But the show did have impressive male nurses in the first season's Mo-Mo de la Cruz and the third season's Kelly Slater. Jackie's relationship to Zoey generally reflected the professional mentoring model that is familiar from countless other hospital shows' portrayal of physicians. By the seventh and last season, Zoey had become a head nurse pursuing a masters degree to become a nurse practitioner. That kind of bond between nurses was rarely seen before Jackie and its less successful contemporaries Mercy and HawthoRNe appeared in 2009. Jackie even trained junior physicians, especially Fitch Cooper and, in these last seasons, Carrie Roman. By contrast, even today, other hospital shows tend to have at most one competent major nurse character, fully formed to assist the expert physician leads. Nurse Jackie's depiction of emergency care was less about blood and guts than it was about how the patients—often quirky, desperate, or sad—ended up at All Saints Hospital and how their experiences there may have changed their lives going forward. The show generally avoided stereotypes, repeatedly rejecting the angel. Autonomy was always the weakest point. The show had repeated suggestions that the nurses reported to senior physicians like Eleanor O'Hara and Ike Prentiss. Still, there were plenty of plotlines in which physicians played no significant role and the nurses were clearly the primary care givers. And despite the personal issues that put many real nurses off the Jackie character—especially her addiction--the show was a landmark in popular depictions of nursing...read the analysis on the final three seasons...
Nurse Jackie returns for final season
April 5, 2015 - A week from today on April 12, Nurse Jackie will return for its seventh and final season on Showtime. Over the years, the critically respected show has given its global audience perhaps the strongest depiction of a modern nurse in the history of series television. New York emergency department (ED) nurse Jackie Peyton is expert, fearless, savvy, sensitive, and creative, with a wide array of psychosocial skills. She has even been a great mentor to Zoey Barkow, her gifted protegee who has emerged from Jackie's shadow and may now be poised to assume Jackie's central role in the ED and/or to become a nurse practitioner. That transition may have accelerated because, as many real nurses have complained, on a personal level Jackie is a train wreck. She is a "world class liar" who has struggled with addiction since the beginning, and never more so than at the end of the sixth season. At that point she finally seemed to have alienated almost everyone in her life, and possibly blown the one key relationship she had always managed to preserve--her relationship with nursing. She even made a serious clinical error as a result of her drug use, something the show has not shown enough. Zoey saved the patient. Many real nurses were never able to get past Jackie's personal flaws, but none of those flaws were nursing stereotype, and we always felt she was a persuasively complex mix of great talents and frailties, as some humans are. Had she been perfect, we would not even be talking about a second season, much less a seventh one. We ourselves have objected to the show's occasional suggestions that hospital nurses report to physicians in the clinical setting, despite the presence of nurse Gloria Akalitus, who seems to have some administrative responsibility for the ED. In any event, we thank those responsible for what the show did well for nursing, especially producers Lix Brixius, Linda Wallem, Caryn Mandabach, Richie Jackson, and Brad Carpenter; nurse advisor Jennifer Cady, RN, BSN; and actors Edie Falco and Merritt Wever. See Nurse Jackie on the Showtime site.
April 14, 2013 -- With the fifth season of Showtime's Nurse Jackie set to begin tonight, it's time to review the last season, which aired in spring 2012 and once again highlighted the central role nurses play in patient care. Most of the season focused on Jackie's recovery from her drug addiction and other personal issues. But when there were clinical scenes, the show continued to present Jackie, at least, as essentially a peer of the physicians. She was a clinical leader providing creative technical and psychosocial care. And in the last two episodes of the season, she actually took over the emergency department in the midst of a staffing crisis, running it expertly until the malevolent hospital CEO Mike Cruz fired her. The show also featured more credible, compelling interactions among nurses, and between nurses and physicians, showing that nurses are sentient three-dimensional beings. All of that is rare in Hollywood. Jackie's quirky mentee Zoey Barkow continued to show potential as a future version of Jackie--at several points Zoey showed the kind of clinical courage and initiative that Jackie does. There is still no really strong male nurse character, though nurses Thor and Sam do seem to have settled into their roles as competent, funny Jackie acolytes. On the downside, the show continued to struggle to portray nursing autonomy. There were several more suggestions that physicians control nurse staffing, and, after Cruz demoted nurse-manager Gloria Akalitus to staff nurse, the show proceeded without any apparent nurse managers at all. Still, on the whole, Nurse Jackie remains probably the best show for nursing in U.S. primetime television history. The executive producers of the show are Linda Wallem, Liz Brixius, Richie Jackson, and Caryn Mandabach. more...
May 2012 -- As we reach Nurses Week in the United States and the fourth season of Showtime's Nurse Jackie gets underway, it's worth reviewing last year's third season, in which the show's tough, expert central character bluntly dismissed the annual appreciation week as "patronizing." The third season continued the show's run as the best dramatic U.S. television portrait of nurses in decades, perhaps ever. Sure, most of the season was not about clinical work, the show faltered badly on nursing autonomy (repeatedly suggesting that nurses report to physicians), and Jackie's ongoing drug problem remains a bit hard to reconcile with her clinical prowess. But when there were clinical scenes, Jackie remained essentially a clinical peer of the physicians, and in general, the nurse characters actually performed their own work, including triage and patient education. Jackie provided expert holistic care to emergency patients including a distraught cab driver with a pneumothorax, a gunshot victim who cared more about her dog than her wounds, and a nice man who was falling apart because of chronic hypertension. The show featured credible interactions among nurses and physicians, in clinical and social contexts, showing that nurses are sentient three-dimensional beings. The season also included nurse Kelly, a skilled, flawed younger nurse who resembled Jackie in some ways and was the strong male nurse that the show was missing in the second season. And we got periodic looks at the contempt that many people have for nursing, as well as wry commentary on the nursing image, from a patient's mockery of nurse Zoey's patterned scrubs to a more nuanced critique of Nurses Week, which went well beyond Jackie's "patronizing" comment. Yet the show repeatedly suggested that nurses "assist" physicians and that physicians control nurses' patient assignments, with emergency physician Eleanor O'Hara removing nurses from one case and putting them on another. Charge nurses or nurse managers do that in real life. Here, the closest thing to a nurse manager is Gloria Akalitus, a composite administrator who is a nurse but whose ill-defined authority seems to extend to the pharmacy and even medicine, to some extent. Despite its problems, though, Nurse Jackie shows us a world in which nurses are life-saving professionals, in stark contrast to the "yes, doctor!" model that prevails on U.S. television. more...and see the film clips!
June 7, 2010 -- The second season of Showtime's Nurse Jackie continued to offer the most thoughtful and persuasive treatment of nursing issues on U.S. television. The season also featured more of emergency nurse Jackie Peyton's drug abuse, adultery, and webs of deceit. However, as always, Jackie's issues are not nursing stereotypes, but the troubles of one complex individual. As the season approached tonight's finale, Jackie and her protégé Zoey Barkow continued to display clinical prowess. Jackie skillfully worked the system to help a despairing lymphoma patient find some relief from his debilitating nausea and to provide some expert, if unpleasant, advice to an ex-football star with early onset dementia. Meanwhile, Zoey saved a boy's life by intubating and resuscitating him, and saved another patient by picking up on a blood clot that could easily have led to a pulmonary embolism, something the arrogant but marginal physician Fitch Cooper missed. The show's final episodes also included a somewhat ambiguous take on men in nursing. Nurse Sam is shown to be a fairly cool, perceptive individual with an attractive girlfriend, but she breaks up with Sam after sleeping with Cooper, saying she is doing so because Sam is a nurse. Sam proceeds to break Cooper's nose. This could be interpreted as a frank examination or even subversion of anti-male nurse bias, a reinforcement of that bias, or all of the above. More troubling were the show's confused messages about nursing authority. Several plotlines had Cooper wrongly asserting that he was in charge of and could even fire nurses, with no direct rebuttal. Cooper did more than once end up in nurse manager Gloria Akalitus's office seeking to have her discipline nurses, with little success, which at least suggested that he could not take a significant adverse employment action on his own. But why can't some character just state that although nurses do have less power, they do not report to physicians because they practice a distinct, autonomous profession? In any case, the show still provides U.S. television's most compelling account of the value of nursing, and it does not hurt that the show's dramatic quality remains higher than that of any other hospital show. We thank those responsible for the show. more...
March 29, 2010 -- Tonight's episode of Showtime's Nurse Jackie included a cautionary tale about how easily a clinician as aggressively gifted as Jackie can slip into arrogance and corner-cutting. No one will likely suffer physical damage as a result of Jackie's error here (unwittingly giving a distressed family a few hours of false re-assurance about whether their child has cystic fibrosis) and the episode also includes examples of the veteran nurse's physiological and psychosocial skills. Jackie takes responsibility for the error, and it actually makes the overall portrayal of her expertise more balanced and realistic; it's not just brilliant physicians who can fall into the ego trap. Unfortunately, the episode also includes a brief reinforcement of the previous episode's suggestion that hospital physicians have some kind of direct authority over nurses. This week, nurse manager Gloria Akalitus tells Jackie that physician Cooper has lodged a "formal complaint" against her for "insubordination and general bitchiness." Jackie dismisses the complaint with a string of expletives, and Akalitus doesn't seem to care about it. But the episode does not clearly refute the idea that a physician might legitimately complain about a nurse's insubordination. Nor does it refute the implication nurses really do, in some sense, report to physicians. They don't, and suggestions that they do feed the handmaiden stereotype that has plagued nursing for decades. However, the episode still shows viewers that nurses are skilled clinicians with some autonomy who play a leading role in patient care. The episode, "Twitter," was written by Mark Hudis. more...
March 22, 2010 -- Tonight Showtime aired the second season premiere of Nurse Jackie, the "dark comedy" about an expert New York City emergency department nurse who's not afraid to bust a few heads, and pop a few pills, to get the job done. The episode includes more examples of Jackie's clinical virtuosity. She advocates strongly to get a plastic surgery consult for a deaf woman who has had several fingers shot off, despite resistance from junior physician Cooper, who does not seem to get how important fingers are to a person who uses sign language. Then Jackie uses her incredible range of interpersonal skills to get the woman's insurance company to cover the expensive surgery, against all odds. The episode's portrayal of nursing autonomy is mixed. It shows the nasty nurse manager Gloria Akalitus exercising authority over the nursing staff. And Jackie, apparently acting as charge nurse, protects diabetic nurse Thor from Cooper's abuse, then privately counsels Thor to manage his symptoms better. Another scene has Cooper lodging a complaint against Jackie with Akalitus, arguing that he is "at the top of the food chain" and Jackie is "at the bottom." Cooper (who has a thing for Jackie) actually cries in the meeting, and Akalitus does not take the complaint seriously. But viewers may still assume that nurses generally must do what physicians say, it's just that Cooper is unusually callow, while Akalitus and Jackie are unusually feisty. Jackie still handles some things badly, and her seemingly pathological risk-taking continues. Now that the married nurse's former boyfriend and drug supplier, pharmacist Eddie, has been replaced by an automatic pill dispenser, she steals drugs from the machine (Eddie ODs in an effort to get Jackie to return his calls). The show seems more interested in addictive behavior than in nursing. But it still seems set for another compelling season of portraying nurses as skilled professionals who play the central role in patient care. This episode, "Comfort Food," was written by series creators Liz Brixius and Linda Wallem. more...
July 13, 2009 -- Tonight's episode of Showtime's Nurse Jackie focuses on the care Jackie and the other ED nurses provide to a dying nurse who used to practice with them. The plotline offers an unusual portrayal of how the nurses manage their patient's end-of-life care, and equally rare, a serious and revealing look at the clinical interactions among very different types of nurses. The dying nurse--who makes Jackie look easygoing--asks Jackie to help her end her life, because she does not want to lie in hospice for her last couple weeks. As in past episodes, Jackie works around the system. She and the other nurses provide their old friend with the ending she wants, even though it is apparently a crime to do so in New York State. The nurses' actions raise complex and difficult issues related to our flawed end-of-life care policies, and Jackie's own consistent willingness to break rules in order to further her vision of what is right for patients. Although the plotline is more about psychosocial care and advocacy, there is also a scene in which Jackie, after minimal assessment, accurately estimates that a patient will die in 10 minutes, underlining her expertise in physical care. The episode, "Tiny Bubbles," was written by Rick Cleveland. more...
July 6, 2009 -- Tonight's episode of Showtime's Nurse Jackie is yet another powerful showcase for Jackie's clinical virtuosity. The focus in several plotlines is not so much on Jackie's care for ED patients' immediate ailments as it is her holistic focus, how she expertly manages the larger family dynamics that have such a huge impact on health. Here she negotiates hospital rules to help a precocious 10-year-old continue to manage her mother's debilitating lupus. She also finds a creative way to advocate for a stroke victim, demonstrating to his obnoxious family that he's "still in there," even though he can't speak or move much of his body. At the same time, Jackie continues to mentor nursing student Zoey and new physician Coop, teaching the former about triage and the latter how to relate to the 10-year-old girl. The show even includes a quick but telling comment on patterned scrubs and the nursing image. The episode is slightly marred by its depiction of triage--it does involve assessing serious conditions, but it's not a "very simple" task that would ever be assigned to a student. And the portrayal of nurse manager Gloria Akalitus seems to reflect the battleaxe stereotype. Akalitus is a disagreeable killjoy, obsessed with enforcing rules regardless of whether they advance the wellbeing of those around her. The show punishes her constantly, her scenes are often funny, and of course some nurse managers are bureaucratic. But Akalitus is the show's Percocet, a quick way to feel better, but with potentially serious long term costs. This kind of image may suggest that female nurses can't handle authority, and that any strong woman who chooses to be a nurse must be twisted and bitter. Of course, Jackie herself belies that suggestion, and on the whole this episode offers a persuasive depiction of her advanced nursing skills. The episode, "Daffodil," was written by Taii K. Austin. more...
June 29, 2009 -- Tonight's episode of Showtime's Nurse Jackie highlights the expert psychosocial care Jackie Peyton and her nurse colleague Mohammed (Mo-Mo) de la Cruz give to ED patients and families. No one could mistake these nurses' thoughtful, sensitive care for unskilled hand-holding. The episode also suggests that physicians are often less adept at these tasks, even though they may receive all the credit from those the nurses have helped. Once again, the show's nurses play a central role in patient care, and Jackie ably trains more junior health team members. At the same time, the episode features a remarkable scene in which a school nurse goes head to head with Jackie about whether Jackie's daughter has a potentially serious anxiety disorder that may require medication; both of them seem to have valid points. One less impressive aspect of the episode involves Jackie ordering the removal of a patient's non-disruptive mother and twin brother from a trauma room without asking if they want to stay, just like the physician characters in other hospital shows do, with no hint of the potential benefits of family presence. This fourth episode, "School Nurse," was written by Christine Zander. more...
June 22, 2009 -- Tonight's episode of Showtime's Nurse Jackie continues to present Jackie as a clinical leader with a vast skill set, and to show that nursing can be as compelling as medicine--if you actually let nurse characters do the nursing, as no other major show has done on a regular basis. Here, Jackie provides skilled care to a dying heart patient and a young woman who has become addicted to Vicodin. She also joins her best friend, physician Eleanor, in an amusing but deceptively important effort to teach nursing student Zoey not to be intimidated by physicians. One of the most impressive aspects of Nurse Jackie is that it goes out of its way to show not only that Jackie is clinically expert and a strong patient advocate, but also how patients and their families benefit from her advanced psychosocial skills. These are all the more amazing given her somewhat raw approach to colleagues and the addiction to painkillers that seems to haunt her. Small parts of the episode do reflect what may be the show's most significant ongoing problem, its iffy portrayal of nursing autonomy and authority. Jackie's interactions with physician Coop suggest she has little idea about what the hospital's upper management structure is--it seems to consist of the physicians. And the episode's depiction of Jackie's boss Gloria Akalitus tells viewers that nurse managers are not really nurses. On the whole, though, the episode offers another engaging look at what a strong, skilled nurse can do for patients. The episode, "Chicken Soup," was written by Mark Hudis. more...
Below is our review of the first episode of Showtime's new television show Nurse Jackie. Please consider that what Nurse Jackie says about nursing is far different from what it is saying about its main character. We urge you to keep an open mind and watch the show in full. We know not all readers will agree with our review. Even so, we are hoping that nurses will use the show as a vehicle to teach friends, family and society what nursing is, what nursing is not and what nursing could and should be. A powerful, critically-acclaimed nurse-centered television show has been a long time coming. Let's use what we can from it to change how the world thinks about nursing. Thanks for tuning in.
Sandy Summers, Executive Director, The Truth About Nursing
Make me good, God. But not yet.
St. Augustine; Nurse Jackie
June 8, 2009 -- Tonight's series premiere of Showtime's "dark comedy" Nurse Jackie is a brutal subversion of the unskilled angel stereotype. The first significant nurse-focused show to emerge from Hollywood in more than 15 years, Nurse Jackie may be the strongest--though not most positive--fictional TV portrayal of a modern nurse that we have ever seen. Jackie Peyton is a New York City ED nurse. Like esteemed TV physicians Greg House (Fox's House) and John Carter (NBC's ER), Jackie is a high-functioning drug addict. But she is also a tough, life-saving nurse who works at the center of patient care, and the show is unusually alert to what nurses experience. Jackie displays formidable clinical expertise, advocates forcefully to save a patient from an arrogant young physician (though she does not save that patient), and provides adroit psychosocial care to patients and families, as well as tough love mentoring to an innocent nursing student--and the physician. Also, she is a major wit. Jackie is not a role model in some respects. To treat a bad back, she takes powerful painkillers that she gets illegally from her pharmacist boyfriend. She has sex with him in the hospital pharmacy. She forges an organ donor card after a young patient dies. She flushes a diplomat's severed ear down the toilet upon learning that he will not be prosecuted for a vicious assault on a prostitute. She steals a wad of the diplomat's money and gives it to the organ donor's impoverished, pregnant girlfriend. And viewers may not get that it was her job as a nurse (not just as Jackie) to protect her patient from the physician; they might wrongly assume that physicians are ultimately in charge of patient care, and Jackie is just unusually assertive. But nothing else here reinforces the stereotypes that have led the public to undervalue nursing. Jackie is deeply flawed, like real people, but she is not a brainless physician helper, a naughty nurse, or an angel, though the nursing student calls her a "saint." Since Jackie seems to leave few Commandments unbroken, "God's rogue henchman" might be closer to the mark. She is like a Jack Bauer (24) of the ED (Jackie Bauer!), an extraordinary operative doing things she has no real right to do so she can achieve her vision of social welfare. Still, there is more intelligent life in this pilot than in a whole season of some hospital shows, and Jackie may well end up as one of the most important fictional nurses in history. The episode was written by series creators Liz Brixius & Linda Wallem and Evan Dunsky. more...
May 24, 2009 -- From our summer 2009 TV preview...
Showtime's half-hour "dark comedy" Nurse Jackie is probably the most prominent of the new shows, not least because it stars highly respected Sopranos actress Falco as "veteran ED nurse Jackie Peyton," who, in the pilot, "bends the rules to create something good from a patient's senseless death, while concealing her addiction to a pain killer she gets from her secret boyfriend, hospital pharmacist Eddie." The Showtime site explains that Jackie "navigates the rough waters of a crumbling healthcare system," "lighting into a smug doctor for failing to heed her advice," "stealing a fat money clip from a man who stabbed a prostitute," and "forging the organ donor card of a man who just died." Uh-huh. We're guessing the show might have some trouble getting the endorsement of major nursing groups, and of some individual nurses, what with all the drug abuse, stealing, and forgery. But none of those things are nursing stereotypes--they are not reasons the public undervalues nursing--and we won't necessarily hold them against the show if it conveys that Jackie is a real professional who saves lives. Among other things, Nurse Jackie may cause those who are interested in the nursing image to consider which qualities they deem most important in a nurse, among them clinical skill, toughness, initiative, patient advocacy, social action, compliance with ethical and other rules, personal morality, interpersonal skill, and a sense of perspective. Jackie brings all of these into question, and Showtime's promotion of the show seems designed to provoke: one of the images shows Jackie holding a syringe and needle with the tag line: "Life is full of little pricks."
The other major characters appear to be Eleanor O'Hara, a snarky British physician who is apparently Jackie's best friend; Fitch Cooper, one of the "smug, Ivy League doctors who have trolled the hospital halls for decades on their way to the golf course, leaving the nurses to deal with the repercussions of their drive-by diagnoses"; Eddie Walzer, the pharmacist boyfriend who "showers Jackie with love and the painkiller Percocet," which she apparently uses to ease poorly treated back pain; Mohammed "Mo-mo" de la Cruz, another veteran nurse and close confidant of Jackie, with a "biting sense of 'gallows' humor"; and Zoey Barkow, who the Showtime site says is a first year nursing student, but who the pilot suggests may actually be a first year nurse, and in any case is an "impressionable, exuberant" neophyte who is not sure she has what it takes to be a nurse.
The pilot is a deliciously brutal subversion of the unskilled angel stereotype and possibly the strongest fictional TV portrayal of the experience of a modern nurse that we have ever seen, certainly in the same league as the character Belize (right) from Mike Nichols' 2003 film version of Tony Kushner's Angels in America. Over time we may have reservations about elements of the show's focus and certain things its stylized approach may not make clear enough, for instance some aspects of nurses' real working conditions like short-staffing (how can Jackie spend so much time away from her patients during her shift?). But it's too soon to say based only on a half-hour pilot. What we can say is that Jackie displays formidable clinical expertise, advocates fiercely for a patient with the arrogant young physician Fitch, provides adroit psychosocial care to patients and family and tough love mentoring to Barkow (and Fitch, though he may not know it). She is thoughtful, witty, and a good friend to Eleanor and Mo-mo. On the other hand, she seems to know that she did not do enough to protect one patient, with tragic results. The writing is incisive and funny, and Falco's portrayal is powerful and nuanced.
But the show almost seems like it's trying to push the buttons of those who have a strict definition of what it means to be a good nurse. We can't tell you everything that falls into this category without spoiling parts of the pilot before it airs. But suffice it to say that Jackie takes powerful painkillers at work that she gets from her pharmacist boyfriend (it does not seem to affect her competence); has sex with him in the hospital pharmacy (though her sexual indiscretions have nothing to do with the naughty nurse stereotype); engages in the stealing and forging mentioned on the Showtime site; works dangerously long hours; is relentlessly profane; and commits at least three serious ethical breaches in an effort to achieve substantial justice where otherwise there may be none. The innocent Barkow calls her a "saint," but since Jackie does not seem to leave many Commandments unbroken, some will likely question that view.
Perhaps because the show is so compelling, Showtime has done considerable promotion, including (in addition to making the pilot available online) scheduling advance screenings of the first two episodes in Landmark Theatres in 10 major cities on June 3. The Showtime site also includes, in addition to the standard downloads and other paraphernalia, a section for "nurse stories," though what little is there now is very much about colorful patients, rather than things that would illustrate nursing skill.
See the first episode of Nurse Jackie online now ("shift happens" is the password). Click here to see it now. The first episode airs on Showtime June 8 at 10:30 pm ET/PT.
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