The Soft Bigotry of Low Expectations
January 25, 2007 -- Tonight's episode of ABC's "Grey's Anatomy" includes a short scene in which attending physician Mark Sloane praises nurses as "helpful," "smart," and "already good at their jobs." We give the show credit for trying. But the scene presents Sloane as inflicting seemingly grotesque, trivial nursing tasks on interns Meredith Grey and Alex Karev as a punishment, with no hint that the tasks might be important to patient outcomes--a "Grey's" scenario that is sadly familiar (see examples 1, 2, 3, 4). So the scene suggests that physicians do nursing work, that nurses are helpful physician helpers, that nursing tasks are unpleasant and insignificant, and that nurses are all already good at their jobs because there isn't much to their jobs, in contrast to real professions like medicine, in which people must practice for years to achieve proficiency. The "smart" comment will have little effect given these problems, and given that "Grey's" has spent the last two years telling the world that nurses are disagreeable twits. Indeed, that comment may be the biggest insult of all, because it suggests the show thinks nurses can be mollified with such an unpersuasive pat on the head. The episode, Eric Buchman's "Great Expectations," was seen by 21.5 million viewers in its initial U.S. airing.
In the episode, plastic surgeon Sloane (a.k.a. McSteamy) is annoyed with Meredith and Alex because they won't do his personal errands. At this point, Sloane is also about to leave Seattle Grace and return to New York, as his lover Addison Montgomery has dumped him. (See the clip in Quicktime--choose broadband or dialup speed.) We see Sloane introduce the "annoying interns" (as he calls them) to his patient "Jim." Sloane says Jim is "semi-comatose, and has stage 3 decubitus ulcers." Alex looks incredulous: "Bedsores?" Sloane smiles, and says that Jim will "need to be debrided, have his dressings changed, and be repositioned every two hours." Meredith notes that by the time they finish, they'll "just have to start again." Sloane assures her he's "crying on the inside." Alex wonders: "Can't the nurses help?" Sloane:
They could but...I like nurses...they're helpful, and smart, and already good at their jobs. So as a going-away gift to them, I'm gonna let you hang with Jim.
Later, we see intern Cristina Yang enter Jim's room where Meredith and Alex are working. She sees what they're doing and asks: "Who'd you piss off?" Meredith notes, in a resigned voice, that it was Sloane.
Some may view this as a laudable effort by "Grey's" to show nurses some respect. And the record will reflect that the episode presents the show's tens of millions of viewers worldwide with a respected attending telling two other physicians that he likes nurses because they're smart and good at their jobs. Sloane is making the nurse comments mainly to draw a contrast with his worthless interns, rather than because of a keen desire to credit nurses. But the show still probably means for us to take the comments more or less at face value. Some might also thank the show for the implication that the work nurses do is difficult. And maybe we should be grateful that the interns did not respond by saying, "Are you kidding? You're dumping this trivial nursing scut work on us?"--or, as Meredith herself once memorably said to Alex, "Did you just call me a nurse?"
Sadly, it's easy to see this isolated half-minute scene as a token effort to appease nurses after the show's many hours of damaging disinformation, especially since the scene is itself dominated by themes that cause the same kind of harm, messages that dwarf any benefit the Sloane character's compliments might have had. And the compliments themselves reflect not so much the "great expectations" of the episode's title as they do the soft bigotry of low expectations. Consider:
Given all of that, we really can't give the show much credit for this episode. But we do, as always, urge it to consider how it might actually show nurses being "smart" and "good at their jobs," in compelling dramatic scenes that would mean something to viewers. Perhaps nurse characters could do some of the exciting, important nursing tasks we commonly see the physicians characters do, like the 24/7 monitoring, patient education, and psychosocial care. That would be a way to start alleviating the great harm the show has been causing to public understanding of nursing for nearly two years.
Please see below for a powerful alternative idea for the scene with Dr. Sloane written by Mandy Mayling, RN, HN-BC, Director & Program Developer for Holistic Services Assisted Home Hospice, Home Health, & Private Duty, Thousand Oaks, California. Ms. Mayling's script envisions what might have happened if Seattle Grace actually had nurse managers.
INT: Hospital, patient 'Jim's' room. A woman, obviously a professional, wearing a smart suit or dress, arrives and stands in the doorway, behind the interns, a look of confidence and intent listening evident on her face, as Sloane, and the interns, have their dialogue about 'Jim's decubitus' treatments. When they have finished, Sloane walks toward the woman standing in the doorway; a pleasant curiosity expresses itself on his face. He tries to engage her with his smile, and piercing McSteamy stare.
Woman: (smiles warmly) I'd appreciate it if you'd run this by the nurses in the future. All intern activities affecting nursing care need to be documented and coordinated with the nurse case managers, or the RN floor supervisors. Dr... ?
Sloane: Sloane... And you are?
Woman: Maggie Jones.
Jones points to her nametag.
Sloane: You're a nurse? (Incredulously) Well, "Nurse Maggie" (sarcastically), I don't 'coordinate' my activities with nurses.
Jones: If you're going to call me 'nurse' Maggie, I expect you to add PhD to that title.
Sloane: Oh, so you're 'Doctor-Nurse-Maggie'? (smirks)
Jones: Doctor Jones will do just find, Dr. Sloane. (Looks him directly in the eye, holding her hand out to shake his, her confident smile still evident.) I'm the new nurse manager, and I expect a professional level of cooperation with the physicians here, and your interns. If you're personally unable to coordinate this, then I'll need you to ensure someone else does.
Sloane: Well, we'll see about that (He purrs condescendingly.)
Jones: Yes we will. (She leans into him, talking in a quiet, but serious tone) Your reputation with our nurses precedes you. Newsflash. I don't report to you, neither do the nurses. We are not at the beck-and-call of the physicians here, or the interns. We work with physicians, not for them, under them, or because of them. Your disdain, and lack of respect for nursing roles, our skills, education, expertise, and professionalism are just a few of the things you're passing onto your interns. Now, if you're looking for someone you can pat on the head, and who will acquiesce to being a 'smart, good, helper' someone you can order around, then I suggest you go and buy a dog! (Talking louder now -- smiling again, as Sloane tries to recover). I look forward to continuing this discussion in our next meeting.
Sloane: What meeting?
Sloane calls out as Jones begins walking away.
Jones: (Talking as she's walking.) The first of many meetings to discuss coordination and teamwork between nurses and physicians. Oh, and the upcoming rotation your interns will be assigned under nursing supervision.
Sloane: You can't do that!
Jones: It's already done.
Jones turns a corner and is gone.
The interns in the patient room have been looking on, listening to the interaction. Sloane turns and sees their expressions, a mixture of surprise and admiration on their faces.
Intern: Still want us to continue with the debriding and dressing changes?
Sloane: You're damn right I do (authoritatively).
Sloane walks away, and the interns shrug, turning their attention back to the patient. Suddenly Sloane appears back at the door.
Sloane: Better inform the nurse supervisor before you get going (trying to maintain his superior, authoritative demeanor).
Interns: Sure. Okay.
As Sloane leaves again, the interns turn to each other, smiling incredulously, with a 'can you believe it?' expression.