Bullet point guidelines to help write "ER" a letter

Identify the episode(s) by name or date.

Say something positive about "ER" if you can.

State your problems with this episode or the show in general and explain why the portrayals are inaccurate. Here are some suggested problems with "ER" that you may wish to write about in your own words:

• The global nursing shortage is severe. It has already led to thousands of deaths and is only predicted to get far worse over the next two decades;
   
• Nursing is an autonomous scientific profession that is central to the work of hospitals and the survival of patients. It is not peripheral work assisting physicians;
   
• Physicians do not supervise, hire or fire nurses. Nurses do;
• Nurses advance professionally through higher education in nursing, not medicine, as shown by the United States' 200,000 advanced practice nurses, virtually all of whom have at least a master's degree;
   
• Nurses are about 100 times more likely to pursue graduate education in nursing rather than of medicine.
   
• Nursing involves constant, technical communication with patients and colleagues and cannot be performed in US hospitals without absolute fluency in English.
   
• Nurses have an independent professional responsibility to their patients, so they advocate to protect patients when they believe care plans are not in the patients' best interest;
   
• ER has a ratio of 10 major physician characters to 1 major nurse character. A real level one trauma center would have a ratio of 1 physician to 1 nurse.

Tell "ER" that the effect is that their show is making the nursing shortage worse--because the images of nurses they broadcast strongly and negatively influences the way children view nursing.

In 2000, JWT Communications did focus group studies on 1800 students in grades 2-10 in 10 U.S. cities, and found that the youngsters got their most striking visualization of nursing from "ER." Under "ER"'s influence, the youngsters considered nursing a technical career "like shop"--not a profession. They did not consider nursing a career suitable for private school students, because "more" is expected of them. In their view, nursing was "a girl's job."

In a 2002 Kaiser Family Foundation study, more than half of regular "ER" viewers studied reported that they learned about health issues on "ER" and discussed them with their friends and family. A third used "ER" to help them make choices about their or a family member's health care. The study concluded that it was worth the effort to make entertainment television like "ER" as accurate as possible because of its potential influence on the public. On the other hand, the authors stressed, "fictional depictions could lead to viewers' obtaining inaccurate information or taking away critical misperceptions about health topics."

The JWT and Kaiser research studies above show that many people, especially youngsters, take very seriously what they learn from popular media products like "ER." Yet the show regularly misrepresents nurses as peripheral subordinates to over 20 million U.S. households, at a time when their profession is in crisis.

Ask "ER" to stop misportraying nurses and make amends to the nursing profession by taking steps such as:

• Hiring a nurse to provide advice on each script before production to prevent the kind of serious inaccuracies and distortions that dominated the October 9 episode;
   
• Just as the show has long focused on all stages of medical training and authority, it should depict all levels of nurse training and authority--including nursing students, clinical nurse specialists, nurse practitioners, nurse midwives, nurse anesthetists, nurse researchers, nursing managers, and a director or vice president of nursing;
   
• Portray the autonomous nature of nursing and do not distort or minimize nurses' key roles in patient care, such as at triage and in patient education;
   
• Have nurses do all of the defibrillating--as they do in real ED's;
   
• How characters address each other matters: have nurse characters call the physicians by their given names, as they do in real teaching hospitals, and as physicians now do with each other on the show;
   
• Portray cutting edge nursing problems and issues, not just medical problems and issues;
   
• Revise the blatantly offensive and inaccurate language on the Warner Bros. web site suggesting that nursing care is based on "orders written by doctors." (The Center has provided them with alternate language already);
   
• Use their power to help us resolve the nursing shortage by portraying some positive aspects of being a nurse;

Thank them for their time or attention. Please stand behind your letter and sign your full name, full address, email address and telephone number. They will not take you (or the nursing profession) seriously if you fail to include these details.

Click here to send emails to those responsible for "ER"

When we receive a copy of your email, we will also post your letter to our discussion board, along with the other letters that we have received. We are referring NBC and "ER" to these discussion boards--just in case some of them get deleted without being read. It is important to build up an impressive arsenal of letters in one easy-to-reference place. We will post your name, credentials, title, city, state and country. So please include all of this information in your letter. Your email address will not be posted. If you do not wish to have your letter posted, please email us at letters@truthaboutnursing.org . Thank you!

Thank you for advocating for the nursing profession!