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Can any idiot be a nurse? Don't forget the sponge baths and happy endings!

Scrubs photoFebruary 8, 2005 -- Tonight's episode of NBC's "Scrubs," entitled "My Quarantine" and written by Tad Quill, is a good example of the "just trying to help" school of inaccurate and harmful television nursing depictions, a school epitomized by an October 2003 "ER" episode. Such shows often involve nurse characters confronting difficult situations or negative attitudes in a way that show creators may think is promoting respect for nursing, but which in fact sends even more powerful damaging messages because of the sympathetic intent. In this "Scrubs" episode, the most striking example is a surgeon character's affirmation that "any idiot can be a nurse." We see that the nurse to whom this surgeon is married strongly disagrees--but we never see why. The obvious conclusion: he's rude, but maybe he's right.

"My Quarantine" focuses on what happens to the show's hospital staff during a quarantine imposed because of a suspected case of SARS. At one point, Carla, the show's major nurse character, drags her husband Turk, a surgical resident, into a patient's room. Turks notes that he's bored because he can't perform surgery during the quarantine. Carla says that "we're short-handed" and asks him to redress the patient's bedsores. Turk notes that "that's nurse stuff" and he doesn't "have the expertise." Carla responds that "any idiot can be a nurse." Turk says, "I know." Carla shoves him, saying "I knew you thought that. I knew it." Turk realizes she has tricked him. In a later scene, attending physician Perry Cox prepares to give Turk, who is bald, some nursing tasks. Cox's lines are worth quoting in full:

So, nurse Ghandarella, I need you to suction this guy, do a wet to dry dressing change and oh, what the hell, top him off with one of your special, special sponge baths. Happy ending optional. His choice, not yours.

After this speech, the tone of which is typical of the Cox character, Cox's sister-in-law Danni enters. Cox tells Danni that "this bald, sad clown [Turk] is not much of a nurse. So could you go ahead and keep an eye on him for me?" Danni agrees, though we have no reason to think she's a nurse.

In both of these two scenes, it seems likely that the show was trying to show some support for nursing. Carla's scene clearly reveals that nurses do not appreciate being called idiots (imagine). And in fact, Cox's scene could be read to suggest that not just any idiot can be a nurse, since it describes patient care procedures that viewers will presumably understand require some training or ability, and Cox is suggesting that Turk does not know how to do them well. However, most people probably have no idea what level of expertise may be required for suctioning or dressing changes, and given everything else going on in the scene, this mildly positive implication is like a candle in a rainstorm.

Turk's "idiot" comment may be the most obvious potential problem. Of course, the show immediately has Carla express her disagreement, and the way that she has tricked Turk into revealing how he really feels suggests that at least she is not an idiot. However, that doesn't disprove what Turk has said. And the fact that the episode never does--that it never demonstrates that nursing is in fact a highly demanding profession requiring years of college-level education, critical thinking skills, courage and patience--suggests that while Turk may be insensitive, he may be right about nurses. He just needs to be careful what he says. This is reminiscent of the last couple years of "ER," which has repeatedly featured aggressive senior physician characters belittling nursing without any real rebuttal, leading viewers to think: "That physician is sure a jerk! Even if it's true that nursing is a limited, subordinate job for people with few options, it's rude to say that right to a nurse's face."

But as troubling as the Carla scene is, the one with Cox is worse, packing an extraordinary assortment of damaging inaccuracies and distortions into just a few lines. First, the whole scene suggests that physicians direct nursing care, and that nurses need physicians to tell them to do basic things like suctioning, dressing changes and hygiene maintenance, things that nurses typically do because of their own assessments, and that they of course know far more about than physicians. Can you imagine the show having Carla recruit a fellow nurse to help her by acting as a physician? Right. The entire set-up here wrongly suggests that nursing is a limited subset of medicine. But the show doesn't stop at suggesting physicians direct and monitor nursing care. Cox assigns non-health worker Danni to "keep an eye on" Turk, as if any idiot could see whether a nurse is doing a good job.

Cox's bizarre "Ghandarella" insult suggests that all nurses are female, or at least that nursing is a feminine job; otherwise, Cox would just have called Turk Gandhi. This kind of comment is very damaging to a profession that does remain over 90% female but must attract men if it is to gain the strength it needs during the current shortage. Maybe we're supposed to be impressed with the Gandhi comparison, but Gandhi was not a nurse. (Actually, though the show's creators may not be aware of it, Gandhi was a lawyer; we're not sure we can fully work out what a physician-centric U.S. sitcom means by having a physician character refer to another physician who is acting as a nurse by the gender-reversed name of a famous Indian lawyer.) Anyway, it seems most likely that the show is just feminizing a famous bald person's name to deliver an insult to Turk, or at most, suggesting that both Gandhi and nurses have engaged in selfless humanitarian work. That would be sort of nice, but nursing doesn't need more support for its selfless angel stereotype, thanks, and whatever oblique benefit there might be here is buried under the troubling gender issues.

Of course, the most striking gender problem in Cox's little speech is the comment about sponge baths and happy endings, which for the uninitiated refers to optional sex acts at the end of a massage. Cox's comments obviously suggest that erotic baths and sexual favors are part of nursing, and in a really ugly touch, that it is the physician role to pimp those favors. All of that feeds the longstanding naughty nurse stereotype that continues to plague the profession. What's that? It was only Perry's arch way of tweaking Turk and dealing with their mutual homophobia? He doesn't really think nursing includes making yourself sexually available? What a relief. Unfortunately, many viewers may not get all this, and the scene still associates nursing with submissive female sex for, oh, maybe the 1,000,000th time? We've lost count. Once again, let's imagine Carla purporting to direct a fellow nurse's physician care to include sexual favors. Would it be funny to joke that a physician should have sex with a patient during an OB/GYN exam, or surgery? The power dynamics are a little different, aren't they? It's telling that the show makes very clear that the sex will be the patient's choice, not Turk's. We wouldn't want to suggest, even as a joke, that anyone should be sexually victimized in a clinical setting. Well, except for nurses.

We would like to believe that Hollywood is not incapable of treating nursing fairly and accurately in its massively influential serial television, and that such treatment is not confined to a few Discovery Health documentaries and HBO feature films. We would like to believe that those who produce serial television are not so obsessed with perpetuating the physician-as-dominant-hero myth that they would not even consider trying to provide a more accurate vision of what nurses do. Unfortunately, no significant fictional series of the last decade has given us much reason to hope. We honestly wonder whether it would be better if nursing were simply not represented in this particular type of media right now, or more broadly, if clinical activities that involve nurses in real life were not depicted, since such activities are so often wrongly shown to be the exclusive province of physicians. It is tempting to wish that shows like "Scrubs" (and "ER," "House," "Medical Investigation," "Strong Medicine" and others) would themselves be placed in a media quarantine, to protect global society from becoming infected with their inaccurate and damaging vision of modern health care. In the end, of course, we believe the solution is more and better speech, not less, and we still hope that positive change is possible in serial television. But because of the demonstrated effect of fictional media on the health attitudes and actions of millions of viewers, each powerful handmaiden and naughty nurse image television foists on an unsuspecting public poses a threat to an already weakened nursing profession, and therefore, a threat to global health.

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