Emma Peel

August 29, 2006 -- Today a brief United Press International item reported that a California advocacy group has created a computer game called "Nurse Avenger." The game aims to build support among "20-somethings" for a state universal health care bill. Game players try to save the state billions by fighting "mobster-styled insurance company and HMO representatives trying to kill a patient in a hospital bed." For a "special attack" on the HMO reps, players click on the icon of the "Nurse Avenger," a figure the piece describes as a "superhero." We're uncomfortable with the game's central activity: shooting the evil HMO reps. But it does present nurses as fighters protecting patients from the threats of the managed care era.

"'Nurse avenger' joins Calif. health battle" explains that the bill pending before the state legislature would "replace the private insurance market with a public insurance program." So the Foundation for Taxpaper and Consumer Rights developed the game to try to build support among young adults, who have the highest rate of uninsurance. The piece notes that player weapons besides the Nurse Avenger include "the waste whacker, salary sucker, voicemail avenger and a purchasing power mega weapon." Players who "defeat[] all the HMO bosses" save the state $8 billion, the amount some believe the state would save under the bill. Gov. Arnold Schwarzenegger reportedly said he would veto the bill.

The Nurse Avenger game involves protecting a hospital patient by shooting the many big, scary HMO reps who pop out of surrounding closets. (It is shooting--the reps have targets on them, and the instructions tell you to "shoot the HMO reps.") When you've eliminated enough of the reps without your patient suffering too many "denials," you advance to the next level. Each level is introduced with a short statement about HMO evil. The "salary sucker" level intro tells you how wasteful huge HMO executive salaries are. Occasionally, the smiling "Nurse Avenger" icon appears in the lower left hand corner of your screen. The Avenger is a strong and attractive hero, professionally attired in solid blue scrubs. Click the Nurse Avenger icon before it disappears, and, with no more than a graceful wave of her cape, she rids you of the multiple HMO thugs (right) who are tormenting your patient at that moment. Of course, more soon appear. As you progress in skill, your final score indicates that you have saved taxpayers more and more money. The game is not cutting-edge, but it may be graphic enough to hold some gamers' interest--one type of patient death seems to involve decapitation.

We're not in love with shooting the HMO reps, even though the Nurse Avenger herself doesn't do any. It seems to us that nurses, who must cope with so many of the effects of gun violence, should not be too comfortable with even the fantasy idea that shooting people is fun, or a good way to solve policy problems. Indeed, some nurses actually work for insurance companies and HMOs, and no doubt some work to help patients within those systems. We're guessing they would not be particularly amused by the "Nurse Avenger" game. Comic book justice is a tricky thing in the real world.

Leaving all that aside, this game and the UPI article present nurses in a highly flattering light. And many nurses do work hard, at the bedside and in the policy arena, to protect patients from the short-sighted cost-cutting that appears to be a hallmark of the managed care era. We wonder if the game's vision of nurses as aggressive fighters against managed care has anything to do with the legislative campaigns of the California Nurses Association over the last decade. Of course, it is difficult to be an "avenger" when you yourself do not enjoy sufficient power or respect relative to surrounding forces. If only it were as easy as smiling and waving a cape! Indeed, patients suffer when nursing itself is threatened by short-staffing and other resource limits that have been linked to managed care. Despite those limits, the current U.S. health financing system appears to be more expensive than that available in other developed nations, which have some form of universal coverage. And there is no question that death can result from a lack of resources--the game is not exaggerating in that regard. The "avenger" may be one manifestation of the life-saving "patient advocate."

So, are nurses heroic "avengers"? Do they, as a group, fight effectively to protect patients in the managed care era?

See the UPI story "'Nurse avenger' joins Calif. health battle" posted on its website August 29, 2006.