Reality Alert! "Lifeline: The Nursing Diaries" shows actual work of nurses

November 7, 2004 -- Today the Discovery Health Channel premiered the first of three one-hour episodes of "Lifeline: The Nursing Diaries," a new documentary that follows the work of nurses at two prominent hospitals,

Massachusetts General and New York-Presbyterian. Based on the first episode, this is an engaging documentary that shows autonomous nursing actions that the media (e.g. NBC's "ER") commonly ignores or assigns to physicians, including life-saving interventions, patient education and family support. We urge all members of the reality-based community to watch the show over the next two weeks.

"Lifeline: The Nursing Diaries," a production of Discovery Health and CBS News Productions, gives an unusually good sense of the real value of skilled nursing, but avoids fostering stereotypes of nurses as handmaidens or angels. The description on the Channel's web site suggests this might be so, as it stresses the nurses' communication skills and their role as "patient advocates in a complex technical medical environment," and notes that studies have shown nursing care directly affects patient outcomes. On the other hand, the description page also offers "Inspirational Desktops" for nurses' computers so "you can be reminded every day of how special you are!" The title of the show also gave us some pause, as "diaries" are now more closely associated with women, and such a title might not appeal to men.

The first episode, "The Rookies," shows nurses working in three intensive care units at Mass. General, the cardiac surgical intensive care unit (ICU) and the neonatal ICU (NICU). The filmmakers focus on only one patient in each unit, which allows them to show a broader range of things that nurses do for patients, and more of the relationships that nurses develop with critically ill patients and their families. The episode is compelling and moving without resort to the cheesy directorial tricks or heroic hyperbole that some health care documentaries use to pump up the action. Consistent with this serious, dignified approach, we are not invited into the nurses' personal relationships.

The episode shows nurses doing so many critical health tasks that the media commonly has physicians doing that it almost seems like it must have been a conscious goal of the filmmakers. However, it may simply be the natural result of taking a comprehensive look at what nurses do. We see nurses autonomously managing patient care, detecting critical problems, formulating key interventions, explaining things to patients and families, and generally managing recoveries with little physician involvement. The show does not pretend physicians are irrelevant, noting at times that they have made a given diagnosis, or that they have "decided" a patient needs a certain procedure (which seems questionable, since we would hope that patients and the rest of the health care team would at least be involved in such "decisions.") However, the physicians seem somewhat awkward, talking past patients and families or over their heads--despite obviously being aware of the cameras trained on them. It is left to the nurses to manage the emotional aspects of the patients' situations, and to make sure the patients' complex health situations are explained in a way they can understand. This is a critical depiction of nurses' patient advocacy and education roles.

The show does minimize the physician role, but its explicitly stated goal is to explain what nurses do. The usual approach of today's fictional and nonfictional media is to focus almost exclusively on physicians and tell the public they are hearing about health care as a whole. For instance, the massively popular NBC drama is not called "ER Physicians," though that would at least be a step in the direction of accuracy. Discovery Health is not innocent of this. It did show the excellent five-part documentary "Nurses," which focuses on Johns Hopkins Hospital, in 2002. But it and other cable channels have devoted far more time to shows like Discovery Health's 12-part "The Critical Hour," which gives viewers the impression that the only care that really matters at the University of Maryland's Shock Trauma Center is provided by physicians--and which (ironically) continues to premiere new episodes in the time slot just before "The Nursing Diaries" does.

"The Rookies" counters other myths perpetuated by much of the media. For instance, it shows the intensive training a new nurse must receive from an experienced nurse in order to handle the sickest ICU patients--even after the new nurse has received her "Bachelor of Science in Nursing"--and focuses closely on her development of skills and her concerns about measuring up. (We were thrilled to see the educational preparation of nurses mentioned on television--so often the media make it appear as if nurses have no formal education). On other shows, extraordinary attention is lavished on the training of physicians, whose skills are seen to flow from careful mentoring by wise senior physicians; nurses are presented as fungible assistants, and who cares how they get trained to call out vitals and hand things to physicians. Likewise, the show illustrates the crucial family support a skilled nurse can provide. A team of cardiac ICU nurses help an angry patient recover and move forward despite the amputation of his leg. And a veteran NICU nurse helps a frightened young couple bond with their desperately ill premature baby, aiding the recovery of the entire family. On shows like Lifetime's "Strong Medicine," there is virtually no chance that these critical nursing tasks would have been performed by nurses; physicians would have done it all. But this is the real thing, and we can only hope that as many people watch as possible.

See our full review of all three episodes here.

The current schedule: "The Rookies" (Nov. 13 @ 5:00 p.m.); "Pediatrics" (Nov. 14 @ 10:00 p.m., Nov. 15 @ 1:00 a.m., Nov. 20 @ 5:00 p.m.); "In the O.R." (Nov. 21 @ 10:00 p.m., Nov. 22 @ 1:00 a.m., Nov. 27 @ 5:00 p.m.)

See the show's website and the times the show will be aired the weeks of November 7, 14 and 21.