The Star-Ledger: "Nurses urge TV dramas: Get real"

 
January 28, 2007 -- On January 11, the New Jersey Star-Ledger published an excellent piece by Carol Ann Campbell on Hollywood's treatment of nursing. The article is headlined "Nurses urge TV dramas: Get real; Portrayals deceive public, groups say." The substantial piece features extensive comment from nurses (including Center executive director Sandy Summers) who explain how popular U.S. television dramas regularly show physicians doing important work that nurses really do, while nurses are shown as peripheral subordinates, when they appear at all. As the piece notes, this widespread undervaluation is a factor in the critical nursing shortage. We thank Ms. Campbell and the Star-Ledger for this piece, which stands in stark contrast to a slew of recent articles in the major print media that explore Hollywood's "medical accuracy" but completely ignore nursing.

The Star-Ledger piece begins with examples of physician nursing that Summers draws from each of the three current major Hollywood hospital dramas ("Grey's Anatomy," "House," and "ER"). These examples range from skilled 24/7 NICU monitoring to helping patients to the bathroom. The article notes that episodes from all three shows appeared on the Center's list of the worst 2006 media products for nurses (The Golden Lamp Awards). The piece ably summarizes nurses' concerns:

On TV, nurses complain, hospitals seem to run without nurses. And they almost never are portrayed as educated professionals making decisions that save lives. Instead, they see themselves portrayed as technicians subservient to the real stars -- the doctors.

The piece suggests that nurses "long for" the days of "China Beach," which featured a U.S. military nurse in the Vietnam War (Colleen McMurphy) who was "tough and smart, saved lives, and never went to medical school." That's all true, and "China Beach" was clearly better for nursing than any current network show. Of course, it's important not to romanticize the program. The show did not generally convey nurses' full expertise. And its vision of how McMurphy operated in a war zone some 40 years ago, with many episodes spending little or no time on clinical care, could hardly counter the influence of the cutting-edge, physician-centric portrayals in the popular hospital dramas that have dominated network television since the mid-1990's.

The article also relies on quotes from nurses at University Hospital in Newark. The piece notes that, unlike on TV, SICU nurse Kathy Sullivan delivers the majority of bedside care for her patients, and does not just stand by while physicians save lives--she saves them herself. Sullivan observes that physicians don't know how to operate some of the machines she uses. Trauma nurse Olivia Nicastro notes that trauma work is a team effort in which nurses make their own assessments and discuss them with others. The piece notes that "smart" television nurses, such as "ER"'s Abby Lockhart, tend to advance by going to medical school. But Phyllis Shanley Hansell, dean of the College of Nursing at Seton Hall in South Orange, notes that graduates of her school's masters program can earn $200,000 per year as executive vice presidents (presumably of hospitals). We might add that nurses with graduate degrees can also become clinical and research leaders who use their expertise to develop important new treatments and care systems.

The piece explains that popular television programming can have real effects "in the midst of a nursing shortage." American Nurses Association president Rebecca Patton notes that the negative media image is a factor in young people choosing other professions. Some might respond that nursing schools are getting more qualified applicants than they can accept, but we would argue that the faculty shortage and the flight of nurses from the bedside--key drivers of the shortage--are both linked to the social undervaluation of nursing that the mass media reinforces. Darrell Luzzo, senior vice president of education for JA Worldwide (Junior Achievement), confirms that the media affects career choices, and that the popularity of careers wanes if they are portrayed as not being meaningful or important.

Ms. Campbell rightly sought comment from the three major current hospital shows. The shows argue that their mission is to create entertainment, not documentaries. Of course, that does nothing to change the demonstrated effects of the programming. To his credit, "House" creator David Shore--whose mother is a nurse--at least spoke with Ms. Campbell. (The producers of "Grey's Anatomy" and "ER" declined.) Shore admits that "House" "ignores nurses," but argues that the House character is "dismissive of everyone." However, the problem is not so much that House himself is dismissive of nurses, but that the entire show is. Viewers are constantly shown that the physicians House holds in contempt are in fact smart and critical to patient care. But the show's overall vision of nursing is quite consistent with that of House himself--the nurses who do appear from time to time are mute servants with nothing important to contribute. To our knowledge, no nurse character on "House" has ever countered the show's own "dismissive" vision of the profession.

"House" creator Shore says that his mother, the nurse, "loves" the show.

Ms. Campbell's piece is especially remarkable because its focus on the effect of U.S. television shows on nursing is so unusual. In recent months, there have been a spate of long pieces in the major print media about the "medical" accuracy of Hollywood programming. On October 8, 2006, the Orange County Register ran an extensive piece by Lisa Liddane, "Paging Dr. Nielsen: TV medical shows." The piece examines the extent to which highly popular hospital dramas like "Grey's Anatomy" both reflect and shape real life health matters. On November 13, 2006, the Los Angeles Times ran a lengthy and similar piece by Susan Brink headlined: "Prime time to learn: In law dramas, medical shows and comedies, science is invading TV story lines. Good thing they try to get it right." This article also explores the growing role of realistic-seeming health themes and issues in major television shows. On January 9, 2007, The Washington Post ran Christopher J. Gearon's "Getting Into the Act: When Federal Health Experts Troubleshoot TV Medical Dramas, They Expect a Payback." This long piece pursues similar "medical accuracy" themes, with a special focus on the involvement of federal agencies like the Centers for Disease Control in Hollywood dramas. And today, the Parade magazine inserted in millions of newspapers nationwide ran Dr. Ranit Mishori's cover story "How TV Docs Can Keep You Well," a somewhat shorter, glitzier version of the basic "medical accuracy" story, with emphasis on the physician's perspective.

Despite some variations, all of these other pieces on Hollywood's "medical accuracy" ignore nursing and the arguments of advocates that the overall depiction of the profession has been highly inaccurate, despite the presence of physician writers and advisors. Not a single nurse is quoted in these pieces. Moreover, though dramatic license and inevitable inaccuracies are mentioned, no one quoted argues that the products under discussion could not really have any effect on the real world because they're fiction. On the contrary, the pieces stress just how influential serial TV depictions can be on the public's health-related conduct, and the need to be as accurate as drama allows. However, the overwhelming focus here is on technical information about particular diseases and conditions, rather than professional roles. It would appear that much depends on longstanding assumptions about the nature and importance of the subject in question, and, of course, who is being consulted. These other articles, which purport to be comprehensive looks at hospital show accuracy, clearly assume that only the work and opinions of physicians matter.

See the article by Carol Ann Campbell "Nurses urge TV dramas: Get real; Portrayals deceive public, groups say" from the January 11, 2007 issue of the New Jersey Star-Ledger.