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British Medical Journal highlights "ER" campaign

November 29, 2003 -- This week's issue of the British Medical Journal has a substantial article by Jeanne Lenzer about the Center's "ER" campaign.

See the BMJ article.

See the Center's response to the article published in the online BMJ.

The piece includes quotes from Truth executive director Sandy Summers, who explains the Center's concerns that the show presents inaccurate images of nursing to impressionable viewers. Summers notes that the show has physicians doing key tasks, such as defibrillation, that nurses typically do in real life. An accompanying photo shows Noah Wyle, who plays physician character John Carter, awkwardly holding the paddles next to two apparent nurse extras, who look dubious. The caption: "Look who's doing the defibrillating."

The story also has several helpful quotes from American Journal of Nursing editor-in-chief Diana Mason. She addresses the critical nature of the shortage, compares "ER"'s portrayal of nurses as a "doctor wannabes" to the relatively strong portrayal of Margaret Houlihan in "M*A*S*H," and stresses the importance of adequate nurse staffing and nurse-physician collaboration to patient outcomes and reduced hospital costs.

The article includes opposing views from four sources. A Warner Bros. statement says the show "goes to great lengths to portray medical situations accurately." Of course, to the extent that is true as to technical medical aspects such as diagnosis and treatment, it makes the show's marginalization and distortion of nursing all the more influential.

Frank Sloan, an economics professor at Duke, suggests that working conditions and pay are at the heart of the shortage, and that "ER" is "probably 87th among the reasons--we had this problem back when television was black and white." He notes that today's women, with more professional options, no longer want nursing jobs which pay less and command less respect, "even if undeservedly so." Sloan claims that hospitals with openings are "not willing to pay what it will take" to get permanent nurses, "so they use traveling nurses and whatever else it takes."

Working conditions are the most obvious current factor in the shortage, but people should consider how they came about. In the Center's view, the economic decisions behind those working conditions reflect, at least in part, a misunderstanding of nursing heavily influenced by the mass media. Sloan virtually admits that the inaccurate popular image of nurses is a factor when he suggests that the lack of adequate respect for nursing, a partial reason for fewer women entering the profession, is undeserved. And if the persistent "handmaiden" image deters today's more empowered women, consider how it continues to hamper the recruitment of men; even today, only about 6% of nurses are male.

Sloan's comment about hospitals using travelers because they're not willing to pay what it takes to get full time nurses seems to suggest that travelers work more cheaply, and that the biggest problem today is that nurses are holding out for highly paid permanent jobs. Neither of those implications is correct, though it is possible Sloan is including staff nurse recruitment costs, which as Mason notes are substantial, in his comparison of the costs of staff nurses and travelers.

Finally, we did not have "this problem" back when TV was black and white. Hospitals began feeling the effects of the current shortage in about 1998, it is already the worst in recent memory, with a significant effect on patient mortality, and it is projected to grow far worse. Of course, contrary to one interpretation of this article's headline--"'ER' blamed for nursing shortage"--the Center has never argued that "ER" is the sole cause of the shortage. The Center does believe that popular media products like the show contribute to it by influencing how people view health care, as shown in recent studies not mentioned in this article, but which are discussed in other articles about the Center's campaign, such as the November 18 Washington Post piece.

The article quotes Oregon ED nurse Gabi Ford as saying that overall "ER" portrays nurses in "a very positive light," and also quotes a June "Nurseweek News" piece by Bree LeMaire noting that several advanced practice nurses are "involved with" the show, and that the "technical directors of 'ER' have a built-in respect and regard for nurses."

In the Center's view, the nurse characters on "ER" are generally decent and competent, and they do on occasion have serious interactions with physicians about patient care. But the show's overall portrayal of them as marginal, subordinate physician helpers and wannabes does a gross disservice to an autonomous profession in crisis.

However, no nurses are involved in the preparation of "ER" scripts, as readily admitted to us by an "ER" co-executive producer and many others working at top levels on the show, and that is where the problems occur. It means little if real nurses are on the set showing Noah Wyle how to defibrillate, or if the show's "technical directors" (all physicians) have "respect and regard" for nurses in some general sense, as long as the show that employs them misrepresents nursing to over 20 million viewers each week.

See Jeanne Lenzer's article "ER blamed for nursing shortage" in the British Medical Journal.


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