Take care of yourself!

November 23, 2004 -- Tonight's episode of "Law and Order: Special Victims Unit," Marjorie David's "Doubt," featured a "sexual assault nurse" character conducting an examination of a rape victim in its first few scenes. We have to commend "SVU" for at least showing that forensic nurses exist, and showing a little of their work. Unfortunately, though the episode resisted the urge to show a physician directing the action, it instead gave the impression that one of its two main detective characters was doing so. In real life, the forensic nurse would have directed and provided all the critical care and forensic work, and the police probably would not even have been present. But here, the nurse character came off as an awkward and insensitive assistant, as the detective explained what was going on, took photos, and provided what little emotional support the patient received.

This episode focused on an alleged acquaintance rape of a graduate art student by one of her professors. Roughly the first 10 minutes of the episode traced the immediate aftermath of the alleged crime, including the examinations of the victim and the suspect at a Manhattan hospital. The show's female lead, Det. Olivia Benson, accompanied the victim from the scene, riding with her in the ambulance, and basically guiding her through the hospital process and out the door of the hospital. Benson was portrayed as essentially in charge of the victim throughout, playing the role that we might expect a paramedic to play in the ambulance, and at the hospital, guiding the victim through the care and forensic process. The nurse character was introduced--by Benson--as "Louise," a "sexual assault nurse." She was very briefly shown performing several forensic procedures, including searching for bodily fluids and conducting a vaginal exam that seemed brutally abrupt and insensitive. During this process, the nurse had only a few perfunctory lines, including brief responses to patient questions. By contrast, Benson had control, not only questioning the victim about the rape, but explaining what was going on in the forensic exam in more detail than the nurse, and providing emotional support to the victim. The nurse circled the victim like an indifferent technician, making no connection with her. Meanwhile, the suspect was examined separately by a physician as Benson's partner questioned him, even though in real life _______. This physician was introduced as "Dr. Warner." As the victim left the hospital with Benson, Louise appeared and breezily advised her: "take care of yourself!" During the trial scenes that occupy the latter part of "Law and Order" episodes, the nurse did not appear to present forensic evidence, and there was no reference to that key forensic nurse role. But she was there in spirit, as the prosecutor, eager to stress the victim's ordeal, emphasized in her closing how the victim had been poked and prodded at the hospital, in a kind of new sexual assault--which, of course, meant the work of the "sexual assault nurse." So that's what the job title means!

Though the Benson character's dominant role in the hospital scenes was inaccurate and damaging to the image of forensic nurses, we're not really surprised. It is consistent with current Hollywood practice, which follows what might be called the major character imperative. In most dramas, the main recurring characters will spend as much time as possible on screen, because of time constraints and the need to build the audience's identification with them, even if that means they will do jobs that their characters would never do in real life. Thus, the CSI's on the "CSI" shows do the jobs of about four different criminal justice professionals, the physicians on "ER" and "House" do the work of nurses and other health professionals, and in this case, Det. Benson did the work of paramedics and nurses. This obviously underlines the importance of the identities of the major characters in Hollywood shows. We can't expect much from shows like "SVU," which are about police and lawyers, but for shows about health care, it is critical that nurses be adequately represented in the major characters, or we'll get more of what we're getting now. In this episode of "SVU," nursing has effectively exchanged one master for another: rather than wrongly presenting physicians as the directors of significant care, the show has a detective play the role. Of course, a key reason that forensic nurses are trained to play so many different care and forensic roles is to minimize a victim's sense that she is being physically or mentally poked and prodded right after the crime by a long line of different people. You know, like police detectives.

The specific portrayal of the forensic nurse was especially disappointing. "Louise" never did get a surname, as the physician did. And with only a few relatively trivial lines for the nurse character, the actress and director made the least of them. The actress' delivery was halting and unsure when confidence was required; abrupt or inappropriately light when sensitivity was needed. And the portrayal of the care given the rape victim was not really inconsistent with the vision the prosecutor left with the jurors (and millions of viewers): the victim was treated more like a crime scene than a patient, given little explanation, shown little sensitivity. She had only a few seconds notice of the vaginal exam, which made her jump and grimace with pain. The show gave no indication that this nurse was unusually inept, nor that the victim's experience was unusual. At least they avoiding the compassionate nurse stereotype.

In sum, the episode presented the nurse as a tentative technician who was peripheral to the important action. Now millions of viewers have a reason to know that nurses are involved in the care of rape victims, with no physician present. But they have little reason to think that forensic nurses are highly skilled, autonomous professionals who play a critical role in helping patients recover physically and mentally from violent crimes, as well as in assembling and presenting the evidence needed to prosecute the crimes. That is especially sad because the Center understands that two highly skilled forensic nurses worked hard to improve the accuracy of the episode's portrayal of the work of the forensic nurse. The result is no reflection on them.