Snake eyes

October 15, 2004 -- If only it had stayed in Vegas. Unfortunately, tonight's episode of CBS' "Dr. Vegas," entitled "Dead Man Live Bet" and written by Jack Orman and Jill Goldsmith, was seen by over eight million viewers nationwide. It presented those viewers with the state-of-the-art Hollywood nursing stereotype: the nurse as a skilled, romantically available physician assistant without autonomous responsibility for patients.

We were initially encouraged to learn that "Dr. Vegas" would include as a recurring (if not major) character nurse practitioner Amy Adams (Alice Doherty). And the show's premiere episode last month suggested that Adams would at least demonstrate skill, initiative and some willingness to challenge her colleague, lead character and physician Billy Grant (Rob Lowe), though we were not surprised that she appeared to have no patients of her own, as a real NP would.

However, in last night's third episode, the show conformed closely to the standard nursing stereotypes of modern Hollywood shows. Such shows do not typically suggest that nurses are simple sex objects or unskilled angels; they are far more sophisticated and powerful than that. Here are some examples of what they do:

1. Show a nurse as a skilled assistant to the physicians who direct and receive credit for all meaningful care, but do not suggest that the nurse has any autonomous scope of practice or independent responsibility for patients. In this episode, Grant consistently took the lead in health care interactions. Adams helped Grant, calling out vital signs and other information to him, supplying equipment and so on. But she did not do anything on her own, and no viewer would imagine that she had any autonomous responsibilities or scope of practice. The show appears to have abandoned any pretense that Adams is a nurse practitioner; she now conforms closely to the "ER" staff nurse model of a skilled but deferential physician assistant. It's not clear if the show actually knows what a nurse practitioner is; maybe that just sounded good in early press materials. The responsibility for patient outcomes typically seals the deal for physician-centric portrayals, and here Grant received all the credit for having saved the life of a drowning child, from the child's mother and even Adams, though she had worked on the child as well. (Grant magnanimously allowed that Adams too had done a great job.)

2. Frequently use your nurse characters as convenient physician love interests, which also tends to advance the view that the physicians are the stars of health care, and the nurses merely some of the planets who revolve around them. In this third episode, viewers were given to understand that Adams had a major crush on Grant, and at the end of the show, she essentially initiated a seduction and slept with him. Of course, the show would have done the same thing had both characters been physicians, but the cursory way in which the plotline developed and the clear implication that the nurse was initiating it played into the time-honored and highly damaging stereotype that nurses' main interest in the workplace is not professional, but to become romantically involved with male physicians, the ultimate "catch" for any woman. Of course this does happen, and the show does not really suggest that Adams is promiscuous by any current standard, but a responsible depiction would not partake so freely and easily of the stereotype.

3. Have your nurse character argue for a myopic adherence to procedure, so that a wise physician character can explain the enlightened big picture view, such as that some patients may rationally refuse treatment in their own best interests, or that a given procedure is actually harmful in the situation at issue. This episode presents a dying cancer patient who does not want radical interventions or to die in a hospital; he wants to spend his short remaining time enjoying life at a casino, even if that may hasten the end. Grant respects this wish, but has to explain it forcefully to the rule-bound Adams, who is slow to understand the holistic wisdom of the patient's thinking. This is a device that has also been employed repeatedly by "ER," of which Orman is a former showrunner (in fact, a January 2004 "ER" episode where an oppressively rule-bound nurse appears in a NICU setting is scheduled to be rebroadcast on October 28, 2004). This kind of plotline suggests that physicians are holistic thinkers with a keen sense of perspective and a concern for patients' broader well-being, whereas nurses are the reverse, small-minded bureaucrats who do not (or cannot) see that big picture. This view is, to say the least, largely unsupported. No doubt there are physicians and nurses who may been seen as falling into these categories. But it is nursing that places a marked emphasis on holistic thinking and advocating for patients' interests, such as through the enforcement of DNR orders, pain management, avoiding painful but needless tests, and so on. Nurses fight for patients every day, often against "the rules" and for a broader approach to patients' wellbeing than some other professionals may be taking. To put nurses in the bureaucrat box is of course ironic, but it's also highly damaging, since it works against one of the major attractive aspects of the profession--its focus on patient advocacy--at a time when nursing needs all the positive interest it can get.

This episode of "Dr. Vegas" also indulges in a plot device that many respected Hollywood shows have been reluctant to in recent years: the suggestion that nurses are romantically available to patients, and that this may even be a component of patients' therapeutic program. Both serious and trivial visual works have suggested this in past decades, but it has not been a major theme in recent dramas such as "ER" or even sitcoms such as "Scrubs." Here, the dying patient flirts immediately with Adams, suggesting that a date with her would help him cross an item off his to-do-before-dying list. Grant speculates, without sufficient irony, that the patient must have a thing for nurses; specifically, he refers to "my nurse," as if he owned Adams. But the patient notes that it is actually that Adams is a redhead, whereupon Grant helpfully notes that the nurse thing would just be a bonus. This could probably be salvaged were Adams to firmly decline the patient's offer, either politely or even with wise crack, such as by noting that she isn't a natural redhead. But no. We soon learn that they have actually had a dinner date, which is followed by unresolved innuendo from Grant about how far Adams might have gone with the patient. The nurse-as-patient-escort theme is enhanced by the fact that the hacking, emaciated patient could not be considered especially physically attractive by Hollywood standards. Adams has not been swept off her feet by a....well, a Rob Lowe; she is providing escort services because that's what a good nurse does for a dying patient.

It is not clear if "Dr. Vegas" will survive much longer, as it is apparently struggling in its Friday time slot against ABC's "20/20" and NBC's "Medical Investigation," a show that handles the nursing issue in another time-honored way: ignoring nurses completely. But while "Dr. Vegas" is on the air, we can only hope for better luck.

Please call in your comments or send the producers a letter:

Dr. Vegas
CBS Productions
7800 Beverly Blvd.
Los Angeles, CA 90036

telephone 818-977-6820