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"Scrubs," lift us up where we belong

February 1, 2007 -- Tonight NBC's "Scrubs" told millions of viewers that nurses are handmaidens with low-skilled jobs, that physicians supervise nurses and can become nurse managers at will, that nursing is for women so men who do it should be mocked, and that physicians take the lead in skilled patient monitoring, though nurses actually do that. The episode does suggest vaguely that "head nurse" Carla Espinosa is needed. And nurse Laverne Roberts, who has often been presented as a lazy, disagreeable stereotype, takes a more active and realistic role here. But on the whole, Mike Schwartz's "His Story IV" is one of the worst "Scrubs" episodes ever for nursing.

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The episode focuses on the hospital's tyrannical "chief of medicine," Bob Kelso, who narrates most of it. The show has always suggested that Kelso manages every aspect of hospital operations, including the nursing staff. But in this episode, we're told that Kelso has become lazy and removed from the day-to-day workings of the hospital. Thus, attending Perry Cox suggests that Kelso does not realize "head nurse" Carla Espinosa (the show's lone major nurse character) has been on maternity leave for six weeks, and not just the six days that Kelso has actually worked that month.

Despite that gibe, we see Kelso walking happily down the hall, until he is confronted by Nurse Roberts (or as he dubs her in voiceover, "Nurse Buzzkill"). Roberts says crossly: "Carla's gone another week. We need a substitute head nurse." Kelso: "Laverne, from now on if you need something, just take care of it yourself." Obviously, the idea is that the chief of medicine supervises nursing management. Of course, that is false; the chief of nursing does that, and no nurse would ever come to the chief of medicine with this problem. Scenes like this tell viewers that nurses are physician helpers, not members of an autonomous profession with its own vital scope of practice. See the clip in broadband or dialup speed.

Later, Kelso interacts with a wounded veteran of the Iraq war, one Private Dancer who has hydrocephalus (excess fluid in the brain) and short term memory loss. Kelso worries that this patient's association with the "controversial" war could set the hospital staff at odds, and it does. The characters spend much of the rest of the episode taking polarized positions on the war, with plenty of red state / blue state name-calling about hot button political issues. Meanwhile, an intern is the only person doing any actual patient monitoring, and she tells Kelso that Private Dancer's temperature has elevated. Of course, monitoring patients and detecting changes in their conditions is a nursing function, not a medical one. See the clip in broadband or dialup speed.

Laverne takes part in the political discussions and does not really come off worse than anyone else. She supports the war her nephew Lance is fighting in Iraq (we later learn that her nephew is a corporal--Corporal Lance! Lance Corporal! Get it? Ha!). On the other hand, the conservative attending Elliot mocks Laverne for being concerned about global warming, spraying aerosol hairspray with abandon as she does so. So Laverne is not drawn as necessarily liberal or conservative. She tends to express sincere beliefs, in her usual crabby way. Her comments do not seem to reflect as much knowledge as the comments of most others, but attending physician and central character J.D. comes off far worse. Even after J.D. has read a long book called "The Iraq War for Dummies," he's baffled by a simple comment from the Janitor about Osama Bin Laden's whereabouts.

Meanwhile, Kelso continues to try to bond with Private Dancer. Telling the wounded veteran about his own Navy service long ago, Kelso imagines what might have happened if he had stayed in the service. We see Kelso enter what appears to be a South East Asian garment factory in full dress uniform, sweeping a woman named Ling off her feet to the tune of "Love Lift Us Up Where We Belong," a take-off on the climactic scene from the Richard Gere / Debra Winger movie "An Officer and a Gentleman." See the clip in broadband or dialup speed.

Kelso notes, in voiceover, that the extent of the staff's division on the Iraq issue could interfere with patient care, and we see him proved right. He approaches Private Dancer's bedside, sees that the patient is feverish and unresponsive, then barks: "Get respiratory for a blood gas and set up for a lumbar puncture!" A three-second scene without dialogue shows three nurses doing things with the patient (busy hands!). Then, after we understand that intense activity has occurred, we see Laverne report to Kelso, Cox, Elliot, and Turk: "He's stable." Kelso snaps at the physicians: "Whose fault is this?" The physicians start bickering. Kelso tries to restore order, but Cox says Kelso can't expect to be "an absentee chief of medicine." Cox and the other physicians go talk it out, leaving Kelso to see that they don't need him. Neither Laverne nor any other nurse is involved. See the clip in broadband or dialup speed.

Perhaps the show thought it was doing nurses a favor by involving them in some care tasks, but apparently absolving them of responsibility for what happened here. It wasn't. We do see Laverne report that the patient is stable, which at least suggests that she knows how to tell. But the scene is absurd, since it's the nurses' job to monitor patients 24/7, using nursing skills. Thus, it is the nurses' role to note changes in patient conditions (including far more subtle ones than this) and to act accordingly to save patients, calling in colleagues if necessary. Such close monitoring is not normally associated with physicians, least of all the chief of medicine. The failure-to-rescue scene also suggests that physicians would be the only ones involved in the analysis of what went wrong, when nurses would be key participants. The scene wrongly sends the message that physicians do important nursing work, and that nurses merely carry out physician commands.

Kelso concludes that he has to "get back in the game." However, no one seems to need his help, until Laverne returns to her "where is Carla?" theme. Kelso sees Laverne approach Carla's husband, the surgeon Turk, with an armful of paperwork: "When is your wife coming back to work? I'm drowning here without a head nurse." See the clip in broadband or dialup speed.

Kelso dons solid purple scrubs and white bucks. He will take over as "head nurse" until Carla returns. Kelso addresses six female nurses, including Laverne: "OK, ladies. I've posted your new room assignments on the board and we'll pass out the new weekly schedules before your shifts are over." All the nurses but Laverne leave. Kelso notes: "Being a nurse isn't so bad..." Laverne responds: "What did you think it would be like?"

In response, Kelso visualizes Cox and Laverne in a code, with Cox doing chest compressions and saying: "We're losing him." Laverne: "BP's falling." Cox: "Nurse Kelso, I need one milligram of epi stat! Now, nurse, now!" We see that Kelso stands on the other side of the patient hanging an IV bag, but he seems frozen. Then he turns away, and another "Officer and a Gentleman" scenario plays out in his head. But this time it seems to be Ling who enters the room in a U.S. Navy uniform, picks nurse Kelso up, and staggers out of the room with him in her arms, to the same "Love Lift Us Up..." theme song, apparently sung in Vietnamese. Cox, far from yelling about the epi or the abandoned patient, leads the room in applause and cheering for Kelso. Back in "reality," Kelso turns to Laverne: "I'm sorry, what was the question?" Laverne leaves in disgust.

The idea that Kelso could step directly into any nurse's job, much less a nurse manager job, is more absurd and damaging than merely suggesting that nursing managers report to him in some vague administrative way. A physician who was not a nurse could not manage a nursing staff in this way, and to pretend otherwise sends the message that nursing is just a minor subset of medicine that any physician could handle, more or less. Laverne's general disgust is not enough to convey to viewers that Kelso can't do this because he's not a nurse and lacks nursing skill. Many if not most viewers probably do think physicians could easily do nurses' jobs. And the idea that it would be OK to respond to nurses' complaints about lack of staff by having some unqualified dilettante assume the role may strike some short-staffed nurses as less than funny.

As for Kelso's fantasy about Ling, we can't quite tag the show with that, since Kelso is usually presented as a twisted jerk. But we have to note that the scenario compares nursing to undesirable factory work that people long to be rescued from. Even if some dissatisfied nurses today might see themselves in this way, it's not a fair comparison in terms of the years of college-level training nursing requires. And this show's viewers are unlikely to register any of that anyway. They are likely to get that nurses are underlings with what viewers will see as limited skills that don't require much independent thought.

A little later, we see nurse manager Kelso with four female nurses, including Laverne. The scene is worth a close look:

Kelso: OK, Janice, I'm going to need you to make sure Mr. Jeffords gets his meds...and FYI, don't lean over him, he's handsy. And Bernice, could you do me a major large and cover Jessica's shift this weekend?

Jessica (confiding): I have to have a pap smear.

Kelso: Have you seen Georgina lately? She looks like she's been eating for two.

Bernice (grinning): Oh stop!

Kelso: You stop!

Cox arrives at a nearby nurses' station. His clothes are stained with coffee because of a prank related to the Iraq war arguments. Cox addresses Kelso, who still wears purple scrubs:

Ooh...purple's not your color. Could you go down to housekeeping and maybe send up some fresh scrubs for me? And psst...come here...please put on a bra, you're distracting some of the other doctors.

Cox leaves. Kelso thinks to himself: "Let him joke. You look spiffy and you're doing great." But then Kelso overhears Janice ask Laverne: "Why'd he tell me to give meds to Mr. Jeffords? I did that 5 minutes ago." Laverne: "Girl, just humor him. He'll be out of here eventually." (Oh, so a member of a dispossessed group says the best strategy is to just wait until an arrogant interloper who's trying to control the group gives up and leaves, all in an episode about the Iraq war?   Hmm...) In any case, Laverne's words, along with leadership lessons from the wounded veteran, soon have Kelso back in his chief of medicine clothes, acting like a jerk again, ostensibly to give the staff something to take their minds of the war arguments. J.D. notes that sometimes being a good leader means "[u]niting giving them someone to hate." See the clip in broadband or dialup speed.

Let's play count the stereotypes. First, there's the physician handmaiden, underlined by Cox's remarks about Kelso getting him new scrubs from housekeeping. And the "girl talk" angle (e.g., the "handsy" remark, the giddy overweight talk, the pap smear comment) suggests that nurses hang around and gossip. The actual nursing here--scheduling and giving a patient "meds"--will strike most viewers as pretty trivial. The suggestion that Kelso is not doing well is linked more to his being out of touch generally than to a lack of nursing skill and knowledge. Then there are Cox's remarks about Kelso needing a bra because he's "distracting" the physicians, a variation of the "nurse as physician sex toy" idea, and another suggestion that physicians have to monitor nurses' personal conduct. You know how nurses tend to flaunt it for those hot physicians! Of course, the only male "nurse" in the episode--Kelso--is an object of relentless mockery.

Sure, this is all part of the usual "Scrubs" silliness, and you could argue that the show isn't endorsing any of these stereotypes, just using them to mock a male character by feminizing him, which is always riotously funny. But few viewers will separate these stereotypes from the way nursing really is. No one is likely to think, the show knows nurses are not really a bunch of frivolous, gossiping physician handmaidens who hand patients pills and call out a few vitals, it's just playing with outdated stereotypes. Viewers are unlikely to see the show as questioning the idea that male nurses should be mocked for doing something that society has traditionally regarded as feminine. They are likely to think how funny it would be if Kelso took a job meant for servile females. They are more likely to have their stereotypes reinforced.

There is one bright spot in the plotline. Until recently, Nurse Roberts was presented mainly as a tired stereotype: a lazy, disagreeable, overweight African-American woman. She's still pretty disagreeable, but this episode finds her actually participating in substantive discussions and pranks, calling vitals, and complaining about the lack of a nurse manager, as if she actually cares about the work getting done. Since she seems to be the closest thing to a backup to Carla, the show could have made her acting nurse manager. If she was unsuited to the role, that could have led to some comic situations and underlined how skilled Carla is.

Of course, the idea that the hospital needs Carla in some general way is also of some value. In the past, the show has occasionally seemed to present Carla as a manager, but her role has not been clearly defined. Unfortunately, this episode does not make very clear why she's needed. Laverne's stack of paperwork doesn't do it, and the show never links the absence of a nurse manager to any problem with patient care. The veteran's failure-to-rescue problem was ascribed to the staff's arguments over the war, and presented as something for which the physicians were responsible.

This "Scrubs" episode is an unfortunate step backward from several the show ran last season that included relatively helpful visions of nursing.

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