"ER" nurse characters are mad that everyone thinks they're just handmaidens of physicians.
February 5, 2004 -- Tonight's episode of NBC's "ER," credited to R. Scott Gemmill--who also wrote the disastrous October 9 "Dear Abby"--includes several elements that seem specifically designed to show sensitivity to nurses' concerns about the show's damaging misportrayal of their profession. We salute the effort. But sadly, the episode itself is full of damaging anti-nurse distortions, proving that there's only so much "ER" can do to overcome its overwhelmingly physician-centric approach without more major nurse characters and meaningful advice from real nurses.
In the episode, "Get Carter," the most striking apparent effort to score pro-nurse points occurs when nurse Sam Taggart explodes after frustrating interactions with physicians Luka Kovac and John Carter. Taggart storms over and tells nurse Chuny Marquez and nurse/medical student Abby Lockhart that she's sick of the physicians thinking they're in charge of the nurses. Chuny responds that the patients think so too.
Well, we're shocked. Where on earth would the public have gotten the horrifically damaging idea that nurses report to physicians? Unless...could it possibly relate to the fact that the massively popular "ER" itself shows physicians managing nurses in every episode? Like this one, in which physician manager Kerry Weaver seeks someone to replace the late chief of ED medicine and "run this damned department"--that is, the whole ED. Could the public's misunderstanding of nursing have anything to do with the fact that the most popular health care drama in history almost never shows nursing as an autonomous profession with its own scope of practice, ignoring nurse managers, advanced practice nurses, and nursing students for more than 200 powerful episodes?
The irony in the show having its nurse characters make these complaints is extreme. It is compounded by the fact that the behavior that sparks Taggart's explosion is extremely minor compared to the physician authoritarianism that the show constantly endorses--and the fact that her reaction is likely driven as much by her self-confessed sexual frustration and attraction to Kovac as any real nurse consciousness. And it's one thing to have characters say nurses don't get respect, quite another to illustrate how that actually harms patients. Putting all of this aside, which is not easy, we thank the show for at least stating one of the Center's major points about the public's understanding of nursing.
The episode also seems to go out of its way to show Taggart having interactions with the physicians on substantive and at times highly technical aspects of patient care. This display of technical knowledge seems to be the highest compliment "ER" can bestow on nurses, and it's certainly better than showing them as mindless servants.
Unfortunately, virtually all of Taggart's ideas are swatted away by the more knowledgeable physicians, and the impression is that she's more of a frustrated wannabe that anything else. Arguably even worse, Taggart often seems to be arguing for compliance with protocol, rather than what would be in the particular patient's best interest--an infuriating distortion, given that nurses are the bedside professionals whose central mission is to protect the patient's overall well-being. Of course, the more typical display of expertise by the show's nurse characters, here and on other episodes, involves reporting aspects of a patient's status to the physicians, so that the physicians, in their wisdom, can do something about it.
What viewers rarely see--apart from the occasional brief triage scene--is nurses autonomously practicing nursing. Nursing overlaps with medicine but is a separate profession with its own scope of practice, and one that is vital to patient outcomes. "ER" almost never shows what is actually the main experience of hospital patients: a care-focused interaction with a nurse.
The episode includes a few other small pro-nurse elements. For instance, ED physician John Carter, who has brought girlfriend and public health professional Kem to observe, notes that she would like to see how the "public health nurses" track communicable diseases. This is a nice little thought. Unfortunately, what Kem is actually shown doing is having extended interactions with ED and AIDS physicians.
In other respects, it's business as usual. The physicians regularly provide nursing care to the patients, having extended interactions with them and taking a holistic approach to care that in real life is the province of nurses. Taggart repeatedly has her arguments for following the rules overruled by the humane physicians, who are focused on providing the care patients really need, without unnecessary tests or procedures. In one priceless scene, Carter explains to Taggart that he sent a patient home because his extensive exploration of the patient's family situation persuaded him that was all that was needed--the patient just needed someone to listen--as if a physician would be more likely than a nurse to look at such factors.
As usual, isolated pro-physician distortions abound. Resident Pratt does a defibrillation, though ED nurses do that in real life. At one point, a grateful patient profusely thanks Pratt--"you saved my life!" Patients and families thank physicians all the time on "ER," and that's fine, but the implication is always that the physicians acted all by themselves. We can't recall the last time a patient on the show thanked a nurse for anything significant, much less saving a life. At another point, resident Greg Pratt sternly commands a nurse to cut off a patient's clothes for an assessment, as if nurses need physicians to tell them that. Once, as Pratt enters a trauma room to assist Carter, a nurse hands him a stethoscope, as if ED nurses have the time or inclination to maintain physicians' stethoscopes--a subtle but powerful handmaiden touch.
And it's full speed ahead for the show's relentlessly harmful nurse-as-physician-love-interest theme. "ER"'s physician characters have had countless relationships with non-nurses (as Weaver and Carter are now). But the nurse characters have constantly been shown having relationships with physicians--and only physicians. Presumably this is because physicians are nurses' highest aspiration, and in any case, only relationships involving physicians are worthy of the show's attention. At one point here, nurses Marquez, Lockhart and Taggart discuss everyone Kovac has dated. Both Lockhart and Marquez have dated him, and at least one other ED physician each. Taggart begins her relationship with Kovac in this episode. Original major nurse character Carol Hathaway's great love was physician Doug Ross. We could not help but be amused when, in this episode, a minor nurse character implored the reluctant Pratt to accompany her and her nurse friends to a club, noting that "nurses make people feel better all the time!" On "ER," they certainly make physicians feel better all the time.
Nevertheless, we recognize and encourage the pro-nurse efforts in this episode, and we hope they are a portent of far more to come. But we fear that the show will never get far with only one major nurse character and no nurse advisors--that is, without any real understanding of nursing--and that next week it will more of the same old physician-centric world, without even this episode's minimal nod at reality. Please prove us wrong.
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