The beginning of a new age?
Summer 2009 TV Preview
May 24, 2009 -- This summer Hollywood will unveil four new fictional health care television shows, an unusually high number. But what's even more striking is that two of the shows--Showtime's Nurse Jackie (premieres June 8) and TNT's HawthoRNe (June 16)--will be the first significant nurse-focused shows to emerge from Hollywood in more than 15 years. These two shows appear to feature strong central nurse characters: Jackie (right) is a New York City ED nurse played by Edie Falco, and Hawthorne is a chief nursing officer played by Jada Pinkett Smith. And although we can foresee some issues with the two shows, there is cause for hope that they--along with NBC's Mercy, a nurse-focused regular season drama that will reportedly air in mid-season (est. January 2010)--may do what we have been urging Hollywood to do since 2001: convey more of what nurses really do to save lives and improve outcomes. The pilot episode of Nurse Jackie is one of the best (though not most positive) fictional TV portrayals of a nurse that we have seen. The other two new summer shows, Fox's Mental (May 26) and USA's Royal Pains (June 4), are in the traditional physician-centric mold. Mental, about a maverick LA psychiatrist, has one recurring nurse character to support the five physicians who will likely dominate. And Royal Pains is about a brilliant, hunky, good-hearted "concierge doctor" in the Hamptons; it appears to include no nurse characters. Of course, even if the new nurse-focused shows do offer better portrayals of nursing, Nurse Jackie and HawthoRNe are summer cable shows, which reach a far more limited audience than regular season broadcast shows and run only half as many episodes. As with any new show, there is no guarantee they will last long. And it would take a lot to counter the hundreds of hours of persuasive disinformation about nursing conveyed to millions around the world by popular hospital shows like House and Grey's Anatomy, to say nothing of the many damaging portrayals in non-health care shows like Law and Order: SVU and Desperate Housewives. In fact, even with the perhaps unprecedented event of two "nurse shows" premiering within a week of each other, there are still more major physician characters than nurse characters in the four summer health shows. Still, there is always hope. Tune in and see what happens.
Read more below on each of the coming shows:
Showtime's half-hour "dark comedy" Nurse Jackie is probably the most prominent of the new shows, not least because it stars highly respected Sopranos actress Falco as "veteran ED nurse Jackie Peyton," who, in the pilot, "bends the rules to create something good from a patient's senseless death, while concealing her addiction to a pain killer she gets from her secret boyfriend, hospital pharmacist Eddie." The Showtime site explains that Jackie "navigates the rough waters of a crumbling healthcare system," "lighting into a smug doctor for failing to heed her advice," "stealing a fat money clip from a man who stabbed a prostitute," and "forging the organ donor card of a man who just died." Uh-huh. We're guessing the show might have some trouble getting the endorsement of major nursing groups, and of some individual nurses, what with all the drug abuse, stealing, and forgery. But none of those things are nursing stereotypes--they are not reasons the public undervalues nursing--and we won't necessarily hold them against the show if it conveys that Jackie is a real professional who saves lives. Among other things, Nurse Jackie may cause those who are interested in the nursing image to consider which qualities they deem most important in a nurse, among them clinical skill, toughness, initiative, patient advocacy, social action, compliance with ethical and other rules, personal morality, interpersonal skill, and a sense of perspective. Jackie brings all of these into question, and Showtime's promotion of the show seems designed to provoke: one of the images shows Jackie holding a syringe and needle with the tag line: "Life is full of little pricks."
The other major characters appear to be Eleanor O'Hara, a snarky British physician who is apparently Jackie's best friend; Fitch Cooper, one of the "smug, Ivy League doctors who have trolled the hospital halls for decades on their way to the golf course, leaving the nurses to deal with the repercussions of their drive-by diagnoses"; Eddie Walzer, the pharmacist boyfriend who "showers Jackie with love and the painkiller Percocet," which she apparently uses to ease poorly treated back pain; Mohammed "Mo-mo" de la Cruz, another veteran nurse and close confidant of Jackie, with a "biting sense of 'gallows' humor"; and Zoey Barkow, who the Showtime site says is a first year nursing student, but who the pilot suggests may actually be a first year nurse, and in any case is an "impressionable, exuberant" neophyte who is not sure she has what it takes to be a nurse.
The pilot is a deliciously brutal subversion of the unskilled angel stereotype and possibly the strongest fictional TV portrayal of the experience of a modern nurse that we have ever seen, certainly in the same league as the character Belize (right) from Mike Nichols' 2003 film version of Tony Kushner's Angels in America. Over time we may have reservations about elements of the show's focus and certain things its stylized approach may not make clear enough, for instance some aspects of nurses' real working conditions like short-staffing (how can Jackie spend so much time away from her patients during her shift?). But it's too soon to say based only on a half-hour pilot. What we can say is that Jackie displays formidable clinical expertise, advocates fiercely for a patient with the arrogant young physician Fitch, provides adroit psychosocial care to patients and family and tough love mentoring to Barkow (and Fitch, though he may not know it). She is thoughtful, witty, and a good friend to Eleanor and Mo-mo. On the other hand, she seems to know that she did not do enough to protect one patient, with tragic results. The writing is incisive and funny, and Falco's portrayal is powerful and nuanced.
But the show almost seems like it's trying to push the buttons of those who have a strict definition of what it means to be a good nurse. We can't tell you everything that falls into this category without spoiling parts of the pilot before it airs. But suffice it to say that Jackie takes powerful painkillers at work that she gets from her pharmacist boyfriend (it does not seem to affect her competence); has sex with him in the hospital pharmacy (though her sexual indiscretions have nothing to do with the naughty nurse stereotype); engages in the stealing and forging mentioned on the Showtime site; works dangerously long hours; is relentlessly profane; and commits at least three serious ethical breaches in an effort to achieve substantial justice where otherwise there may be none. The innocent Barkow calls her a "saint," but since Jackie does not seem to leave many Commandments unbroken, some will likely question that view.
Perhaps because the show is so compelling, Showtime has done considerable promotion, including (in addition to making the pilot available online) scheduling advance screenings of the first two episodes in Landmark Theatres in 10 major cities on June 3. The Showtime site also includes, in addition to the standard downloads and other paraphernalia, a section for "nurse stories," though what little is there now is very much about colorful patients, rather than things that would illustrate nursing skill.
See the first episode of Nurse Jackie online now ("shift happens" is the password). Click here to see it now. The first episode airs on Showtime June 8 at 10:30 pm ET/PT.
We will post a full review of the first episode after it airs June 8th.
The other nurse-focused summer show is TNT's full hour drama HawthoRNe, a spelling which is, as another observer noted, not easy to type out--not exactly the way to win critics over. Fortunately, the character Hawthorne herself does not seem to spell it that way. The TNT site explains that the show focuses on "Christina Hawthorne (right), a compassionate and headstrong Chief Nursing Officer heading up a group of dedicated nurses at Richmond Trinity Hospital who spend long days and nights on the hospital's front lines." The site and the video clips available present her as "the kind of nurse who fights for her patients and doesn't let them slip through the cracks," and who even "takes on doctors and administrators who are overworked, distracted or just unable to see the human being behind the hospital chart." Indeed, the clips suggest that the show will address nurse-physician power relations and overlapping responsibilities. Although the basic cable show seems far more conventional in dramatic terms than Nurse Jackie, with a clear focus on tugging heartstrings, the TNT site makes clear that Hawthorne will not "hesitateto violate protocol" to help patients (nothing about Percocet, however). And all this commitment has not earned Hawthorne a perfect life. Her husband recently died of cancer, leaving her to raise a "smart, rebellious teenage daughter on her own."
One promising thing about HawthoRNe is that it appears to have an amazing four major nurse characters to one physician, reversing the ratio of most other hospital shows (when they have nurses at all). But of course, HawthoRNe's character ratio simply approximates the actual ratio of physicians to nurses in U.S. hospitals and in the nation generally. The one physician is Tom Wakefield, the "oncologist who treated Christina's husband and  Chief of Surgery for the hospital." Wakefield is "strong" and "competent," but he "bristles when his judgment is called into question, especially when he's second-guessed by subordinates." He also "relies on [Hawthorne] to serve as a buffer between himself and the staff," which seems a little odd since a chief of nursing and a chief of surgery would not generally supervise any staff in common.
The other HawthoRNe nurse characters seem like a mixed bag. Nurse Bobbie Jackson is a close friend of Christina's who is "smart, honest, caring and funny, yet she also fights personal insecurities." Ray Stein is frustrated because, as a man, he does not get the respect from "patients and staff" that other nurses do. Unfortunately, the TNT site also reports that Ray "has always wanted to be a doctor and hopes one day to go to medical school." That does occasionally happen in real life, but Hollywood's suggestions (notably in the first two thirds of ER's long run) that smart nurses aspire to medical school reinforce the wannabe physician stereotype. In fact, nurses are 100 times more likely to pursue graduate education in nursing than medicine.
And HawthoRNe nurse Candy Sullivan (right) "has a reputation for giving 'special attention' to soldiers injured in the [Iraq] war, something she sees as her way of supporting the troops." Really? A nurse named "Candy" who thinks it's part of her job to provide what sound like sexual favors to soldiers? We guess that does draw on the battlefield roots of modern nursing, but it also seems to reinforce a pernicious stereotype: the naughty nurse. In fact, early nursing leaders emphasized nurses' purity precisely to assure society that women could do this vital professional work without raising questions of sexual immorality. The TNT site assures us that Candy is also "very competent," but regardless, we hope the show avoids the nurse-as-sex-worker image, which undermines real nurses' claims to adequate resources--especially since the show's apparently serious dramatic portrayal could be even more damaging than the standard pornographic nurse image, which people presumably know is just a model playing dress-up (or down).
TNT has promoted the show through a "nurse hero sweepstakes," which includes tributes to real nurses posted on the TNT site by members of the public. Those posted so far reveal much of the nature of public understanding of nursing in 2009. They are heartfelt salutes to nurses as caring, dedicated maternal figures and physician helpers, but despite a few general references to "skill" and "knowledge," there is virtually nothing in these well-meaning tributes to suggest that nurses are educated health science professionals who save lives. And one writer offered this revealing tribute to her own (real) mother: "My dream [is for her] to become my surgical nurse when I become a surgeon." These are just the unskilled angel images that Nurse Jackie subverts so effectively, and that we hope HawthoRNe will do its best to avoid.
Fox's Mental, as the only one of these summer shows on a broadcast network, is likely to attract many more viewers than the others. Perhaps not surprisingly, it appears to be the most conventional in structure, with five strong physician characters, an administrator, and last and apparently least, Malcolm Darius Washington (right), "a nurse who pulled himself out of the impoverished neighborhood he grew up in to pursue his career."
The Fox site explains the show's basic concept:
MENTAL is a medical mystery drama featuring Dr. Jack Gallagher, a radically unorthodox psychiatrist who becomes Director of Mental Health Services at a Los Angeles hospital where he takes on patients battling unknown, misunderstood and often misdiagnosed psychiatric conditions. Gallagher delves inside their minds to gain a true understanding of who his patients are, allowing him to uncover what might be the key to their long-term recovery. As seen through the eyes of doctors and patients who, as Jack points out, have more in common then they're willing to admit, MENTAL also tracks the romantic and personal relationships of the team of doctors and hospital staff who work closely together as they delve into the mysteries, oddities and wonders of the human brain.
The clips available suggest that whereas Fox's House often sends viewers into patients' bodies to explore what is going on there, Mental will show us what patients with delusions are actually seeing or experiencing. The other characters are Dr. Carl Belle, "a master politician with a polished exterior who is dedicated to Jack's downfall"; Nora Skoff, a "hospital administrator" who "shares a romantic past" with Gallagher but whose "conservative style" clashes with his unorthodox approaches; Dr. Veronica Hayden-Jones, a "dedicated psychiatrist who is upset she wasn't promoted to Jack's position"; and Dr. Chloe Artis, who is "drop dead gorgeous with an attitude" and "is passing time in a residency she feels is beneath her until Jack opens her mind to the inspirational benefits of psychiatry." All of these characters play active roles in the video clips online, reacting with outrage, bafflement, or dawning enlightenment to Dr. Jack's "unorthodox" ways--all except nurse Washington, who we could not find in any of the clips.
The show seems like a mix of House and some older neurologically focused hospital shows that did not survive long (e.g., CBS's weak 3 Lbs. ( 2006) and ABC's extraordinarily promising Wonderland (2000)). But in any case, we would be very surprised if Mental's familiar "eccentric genius" focus and heavily physician-centric structure included a good portrayal of nursing.
Finally, USA Network will introduce Royal Pains, a show about a "concierge doctor" in the Hamptons. Dr. Hank Lawson is a "handsome, smart, talented and innovative doctor in his mid-30s who thinks fast on his feet, solving even the most unexpected problems like a 'Medical MacGyver,'" but who "falls from grace when he is blamed for the death of a hospital trustee [and] inadvertently stumbles into the world of private medical service for the elite denizens of the Hamptons." Hank's younger brother, an accountant and "savvy businessman," encourages him to pursue the "concierge" business and sets it up for him. Hank soon teams up with an ambitious "physician assistant"--we assume the show means "physician's assistant"--who regards working for Hank as a dream job that will help her escape the expectations of her wealthy family. There is also a "beautiful administrator" at the local hospital whose mission is to provide care to the "ordinary folk" in the Hamptons. The show appears to have no nurse characters. And although public health nurses actually provide visiting health services for "ordinary folk" in New York State and elsewhere, it seems unlikely that there will be any indication of that in what seems to be a summer festival of physician glorification and wealth porn. See a preview to the first episode.
Farther off on the horizon, NBC has reportedly scheduled a new regular season drama called Mercy to begin airing in mid-season, which probably means around January 2010. The show appears to be focused on several hospital nurses, including one who ostensibly has mad skills (more than the interns!) because she did a tour in Iraq. Although that premise is problematic--nurses have skills because of their education and clinical experience, not only if they happened to spend time in a war zone--available clips do suggest the show will address some of the same nursing issues that Nurse Jackie and HawthoRNe will, including highlighting the fact that nurses actually think and the complexities of nurse-physician relations. See a preview of Mercy.
Why are these nurse shows, which all seem to involve some element of questioning physician power, suddenly making an appearance after all these years? Has Hollywood abruptly realized that there really is some dramatic potential in nursing, after many years of advocates persistently making that argument? Or has the industry finally played out most of the permutations of the physician-driven hospital drama? Of course, that has not deterred the networks from introducing new physician shows like Mental and Royal Pains with minor variations on familiar themes, nor from continuing with the popular House, Grey's Anatomy, and Private Practice. Perhaps the new nurse shows somehow reflect a shift in the public mindset, as the reliance on traditional "heroes" broadens in the Age of Obama. Maybe we are willing to consider the perspectives of the traditionally disempowered. It may be the economic crisis and Wall Street meltdown are causing some to question established heirarchies and systems. Or is it a more basic aspect of the public view of nursing--the new shows may feature surprisingly empowered nurses, but is their appearance now still more due to a perceived need to be comforted and cared for in a time of great uncertainty? Post-9/11, it may have made sense to rely on brilliant physicians who offered quick, bold insights (House) or actions (Grey's) to save us from sudden threats. Now, perhaps months after losing our jobs and homes, maybe we need what is perceived as the less flashy, more enduring help associated with nursing.Whatever the underlying reasons, only time will tell whether any of the new nurse shows will make a significant contribution to public understanding of nursing. In the meantime, we urge everyone who cares about the nursing image to watch the shows and let others know what they think. If nothing else, the shows--however long they last, and however accurate they may be about nursing--can be an important vehicle for public discussion of the value of the profession in the midst of the global nursing crisis.
We are sending copies of our book Saving Lives: Why the Media's Portrayal of Nurses Put Us All at Risk to the many producers of these shows. Please help support our program where for every copy of Saving Lives you buy from us for $40, that will allow us to send an additional copy of our book to one of the producers. Please help us provide the producers of these shows with the in-depth analyses on nursing in the media that will help them avoid pitfalls and produce quality portrayals of nursing. Please click here to support our book program. Thank you!