Did you just call me a nurse?
October 21, 2009 -- Are the nurse characters on Mercy and the other new Hollywood nurse shows just self-righteous nags who have forgotten their proper place, which is certainly not to challenge physicians who are trying to do their supremely important work? Shouldn't nurses' highest aspiration be to attend medical school, or at least to marry someone who has? Some elite media critics seem to think so. Ginia Bellafante's contemptuous September 23, 2009 New York Times review suggested that Mercy's nurse characters were pathetic bridge-and-tunnel women who had fallen pretty far from ER nurses, who got to marry George Clooney and maybe even join their "superiors" by attending medical school! And today, Heather Havrilesky's roundup of new shows in Salon was practically seething about Mercy; apparently, it's a "mercilessly self-righteous" vision of nurses "wagging their fingers" at "cartoonishly self-concerned" physicians. In other words, these nurses may think they're fighting for patients, but they're really more like tiresome sitcom wives, nagging and wagging. There are reasons to fault Mercy as a drama, but it and the other nurse shows have gone out of their way to include positive counterexamples of physician conduct (the lead physician in each is smart, able, and attractive) and to show that the nurse leads are deeply flawed and sometimes wrong. It seems like some critics can't handle the idea that there really are smart, educated nurses who do (and must) challenge the care plans of physicians who are not so McDreamy in their professional roles. We can't recall such media critics attacking the far more extreme and unrealistic heroic-physician / servant-nurse narrative that has dominated the last 100 or so other hospital shows. Bellafante acknowledges that shows like House suggest only physicians matter, but apparently there's something unseemly about an "angry little soap" like Mercy trying to counter that vision. Some critics seem to identify more with physicians--the master class that smart, ambitious women like the critics themselves can now join--than they do with nurses, the sad yestergirls who still do subordinate "women's work." Sadly, the dismissive attitudes of female media figures speak volumes not only about the hard road faced by shows like Mercy, but also about why nursing itself remains undervalued and underfunded. Few may consider shows like Mercy subversive, but they do contradict some powerful "feminist" assumptions. Maybe the shows hit too close to home: How dare they suggest that nurses are like me?
Bellafante's piece does spend a little time on context, suggesting that the new nurse shows may actually be a reaction to years of neglect by Hollywood, as exemplified by shows like House. But while she seems to recognize why nurses might feel disrespected, she is careful not to say whether it's a good thing that we start paying any attention to them. And we can't say Bellafante questions the assumption that nurses are the nice but dull subordinates of the physicians who, let's face it, are the real brains and skill in the health care operation. Thus, she is incredulous about the new shows' pro-nurse premise:
The presumption in each case isn't merely that the nurses remain more generous caregivers, but that they are more intuitively apt, smarter, more committed and as technically able as their superiors, with none of the accompanying arrogance.
Absurd, isn't it? It's no surprise, then, that she considers Mercy "an angry little soap, Grey's Anatomy as if conceived by Michael Moore." (Bellafante says that like it's a bad thing, but we think Grey's would be way more fun if some "skanky syph nurse" with a camera crew demanded to interview the hospital CEO about deadly nurse short-staffing.) Mercy's lead character Veronica Callahan displays skills that Bellafante clearly finds very unlikely coming from a nurse. The critic notes that in Veronica's tour of duty in Iraq she "presumably acquired more knowledge than anything four years at Stanford medical school might have offered." Yet Veronica is "forced to endure insults from those who ought to express infinite gratitude." Like that's ever happened to real nurses! Or if it did, like gratitude should matter to those whose main job description in real life, after all, is to be "generous." Bellafante pursues the early episodes' class warfare theme, describing how the striving nurses in Mercy soon learn how limited their horizons really are. In a scene that must have appeared in her reviewer's copy but apparently never aired, a nurse character suffers a putdown from one of her superiors at a Costume Institute party because she has confided that she got her designer dress on e-Bay. Bellafante concludes:
In the days of ER, nurses dreamed of medical school and even went. They married George Clooney, and there was somewhere to go. Now, apparently, they're lucky enough to shop well at discount.
Heather Havrilesky's comments about Mercy on Salon today are brief but just as revealing. Excoriating the show as "mercilessly self-righteous," she observes with some wonder that it "unexpectedly won its time slot" the week before, "so those tireless nurses are likely to keep wagging fingers at cartoonishly self-concerned doctors for a little longer."
These two pieces feature lazy stereotypes posing as rigorous analysis. Both mockingly overstate the claims the nurse shows do make for nurses, which in turn makes the shows easier to dismiss. Contrary to Bellafante's assertions, though, the shows have not suggested that the nurses are "smarter" or "more committed" than the physicians. Nor has Mercy suggested that Veronica's Iraq tour gave her more health knowledge than four years at medical school (though NBC promotion did foolishly claim that the Iraq tour had given her more medical knowledge than all the hospital's residents combined). But note the inclusion in Bellafante's list of sins that the nurse shows suggest the nurses are "as technically able" as physicians, as if even a claim of technical equality was outrageous.
It is fair to say that the shows have suggested that the nurses generally have better psychosocial skills and are less arrogant, with a more holistic practice model. Is that really so radical? Apparently the only thing Bellafante might have accepted was a suggestion that nurses are "more generous." But it seems pretty clear that she finds that notion of comparing nurses' technical skills to those of physicians ridiculous, and that she sees the nursing profession as basically about unskilled handholding, the work of handmaidens. Her casual reference to physicians as nurses' "superiors" confirms this. Of course, physicians are not nurses' "superiors" in any sense, certainly not in the master-servant way that Bellafante means, and not in the larger sense that the remainder of her analysis seems to implicate. Nurses report to senior nurses, not physicians.
But can we really expect a TV critic to know all that? Well, how about a TV critic who describes House as presenting a world in which "human suffering is relieved solely at the altar of a brilliant and unfailing empiricism"? If you're going to bring such a penetrating intellectual analysis to television dramas, then maybe you do have some responsibility to understand the basics of your subject. Incidentally, it makes little sense to suggest that House relies more on empiricism than nurses do. Certainly his brilliant deductions are ultimately based on sensory experiences involved in observing, testing, and so on, but nurses are no less likely to form sophisticated care plans (and save lives) based on tests and careful observations of patients. Of course, we realize Bellafante probably just means House relies on cold scientific data while nurses hold hands and lift hearts.
Both critics suggest that Mercy creates a one-dimensional universe in which nurses are good and physicians bad, but that is simply false. The show features nurses resisting physician care plans they disagree with and fighting for patients. But it's obvious that the nurses are very flawed, driven by their own needs and frailties, and they often fail. The nurses are no more "self-righteous" than countless physician characters on other shows who do the same kinds of things, but we can't recall this kind of critical questioning of the actions of, say, ER's John Carter or Grey's Anatomy's Miranda Bailey. Veronica (like Nurse Jackie) abuses drugs (alcohol) and is barely under control, and when she loses that control, the show makes clear that bad things happen, as when she reacts to a disagreement with a physician by throwing a cinder block through his car windshield.
Let's list of some of Mercy's supposed absurdities. Veronica advocates strongly with one physician for a dying cancer patient's right to stop treatment, and argues with another physician in trying to prevent a combative homeless veteran from being discharged; she wants to get him into a hepatitis treatment program. Veronica has also been shown to have more advanced critical care skills than some physicians. At a car crash site, she decompresses a tension pneumothorax, as a nearby dermatologist demurs. And she suggests that a young shooting victim might have a fat embolism and might benefit from Heparin, but a junior physician ignores her advice, and the patient dies.
But none of this is implausible by TV standards, though it may come as a shock to a TV critic whose information on nursing comes mainly from the mass media. Veteran ED nurses actually do know more about critical care than dermatologists and junior physicians, and they know more about nursing than any physician. Nursing really is a distinct, autonomous health science with a unique knowledge base and scope of practice. Hundreds of thousands of nurses have graduate degrees in nursing. And nurses are supposed to advocate for patients and protect them from harm--it's a professional responsibility. Really--look it up! All of Veronica's actions are things that real nurses could and might well do in similar situations (though the show wrongly suggests that her expertise comes from the Iraq tour, rather than the nursing education and experience that any veteran critical care nurse would have). And when she does these things, is it really any more "self-righteous" or "tireless" than in the hundreds of instances when TV physicians have done comparable things on other shows? Or is it just "self-righteous" when a nurse does it? Did these critics really mean "uppity"? "Acting like a physician"?
But aren't the physician characters all "arrogant" and "cartoonishly self-concerned"? Actually, no. Certainly the physician characters on these shows have their flaws, but in each show, there is an extremely positive major physician character who is the love interest or best friend of the main nurse character. On Nurse Jackie, it is Jackie's best friend, the expert, witty Eleanor O'Hara. On HawthoRNe, it is Hawthorne's good friend and emerging love interest, the kind, expert surgeon Tom Wakefield. On Mercy, this role is filled by the hot surgeon Chris Sands, who fell in love with Veronica in Iraq and has pursued back to her New Jersey hospital. He is clearly a capable physician, but he listens to Veronica and supports the nurse characters. The other major physician character on Mercy is ED medical chief Harris, who is certainly humorless and hard on Veronica, but he is also presented as able and trying to help patients. In one scene, he displays sensitivity in breaking bad news to a distraught mother. He grudgingly allows that Veronica is a good nurse, though he not unreasonably views her instability as a major problem. He is also capable of changing course when a nurse shows him something he did not expect, as when new nurse Chloe Payne persuades him that an apparently faking patient really does have a serious problem. The show does wrongly seem to think the nurses report to Harris, but even when he is telling Veronica that he is in charge, he is not one-dimensional. Likewise, when a senior physician who appears to be the chief of medicine chastises Veronica in the series premiere, he is reasonable; he is trying to help her. Even the young physician Veronica yells at for ignoring her advice about the heparin is not "cartoonish," just inexperienced, somewhat insensitive, and apparently baffled by the idea that a nurse might have valuable technical knowledge. (Imagine.) With the possible exception of the relentlessly contemptuous physician Marshall on HawthoRNe, no physician on the new shows lacks any redeeming qualities. And no character has been as "cartoonish" as some characters on Grey's.
Indeed, even with whatever pro-nurse bias Mercy has, the show is far closer to reality than the physician-centric shows that have long dominated network television. On shows like House and Grey's, the brilliant physician characters spend half their time doing things nurses actually do, from key technical tasks like defibrillation and medication administration to vital patient monitoring and counseling. In these shows, the physicians are godlike and the nurses tend to be mute clerks who appear to accept commands, if they appear at all. Bellafante seems to recognize this physician-centrism; she just doesn't seem to think it's particularly troublesome, and she does not really suggest that it's unrealistic. Perhaps nurses are "more generous," but being "generous" doesn't make for much of a drama, which must be why the nurse shows have to be so unrealistic, pretending that nurses can be tough, smart patient advocates who save lives all by themselves. Earth to Hollywood! Nurses are just scut-work saints and dim handmaidens, remember?
Granted, there may be some small space between the TV worlds these writers are describing and their own views, but they don't bother to let us know anything about that space. All they are doing is mocking what they see as the nurse shows' too positive vision of nursing and their too negative vision of physicians. So it's hard to imagine any reader coming away from these pieces thinking that the critics really view the physician-centric visions of House and ER as inaccurate or damaging.
Why do these critics describe the nurse shows so unfairly and seem to react so negatively to the shows' underlying messages? It's hard to escape the conclusion that it's because these and other critics have assimilated the heroic physician narrative so completely that they assume it's basically correct. A lifetime spent in media and social environments that revere physicians and see nurses as little more than helpful pets takes its toll. Few people like to have their basic assumptions or their basic sense of the world upended. So stop pretending that nurses would actually be displaying in-depth health knowledge, acting autonomously to save lives, or standing up to physicians on important issues, or that physicians can be selfish, arrogant, and less skilled at anything than nurses are. I said stop, you angry little nurse shows, na na na na I'm not listening na na na na.
And of course, there is the female angle. Why would female critics seem to take what almost seems like offense at the shows' suggestions about nurses and physicians? Consider Havrilesky's extraordinary reference to the Mercy nurses' advocacy as "wagging their fingers," and Bellafante's reference to the show as an "angry little soap." Of course the show is a soap, like virtually all other recent hospital shows, but it's telling that both critics also dismiss the show in the classic ways used to degrade women. Why is Mercy a "little" show? As far as we know, it runs just as long as other current network dramas, and it also seems to occupy the same physical space on our TV screens. A critic might argue that it has "little" aesthetic quality, but is that really persuasive in a universe in which a show like "Grey's" is wildly successful?
It seems more likely that Mercy is "little" because it promotes the interests of women who these female critics see as inferiors, just as all women were once seen as "little girls" who were inferior to men. And why is the show an "angry" one, with nurses "wagging their fingers"? Apparently the critics' own empirical journeys have failed to reveal the truth of the third Terminator's maxim that "anger is more useful than despair." In fact, dismissing things as "angry" (or "self-righteous") has long been a common way for the powerful to dismiss the concerns of the less powerful. Suggesting that there is something uncool in how someone is advocating distracts others from the underlying injustice the advocate is discussing. Is that how these critics discuss shows in which other female professionals fight for the public interest? Do the critics suggest that female police officers or lawyers or physicians who resist misguided professional decisions are just "angry" women "wagging their fingers" like nagging wives in some 1950's sitcom? Do they fault those women for not being, in essence, the good wife?
Bellafante's priceless last paragraph actually seems to embrace the tired stereotype that the highest aspiration for nurses is to either become or marry physicians. In the days of ER, "nurses dreamed of medical school and even went"? Nothing in either review more clearly reflects the uninformed bias that medicine is simply better than nursing. And as for marrying George Clooney, who played physician Doug Ross, nothing is more damaging to nursing than to suggest that nurses' best hope for the future is to hook up with a physician. Just ask Dr. Phil!
One obvious explanation for all this is that most elite media figures identify far more closely with physicians than nurses, and women in particular often seem focused on the fact that smart ambitious women now have far more professional options. Now that women can be physicians (and critics for elite publications), many modern, well-educated women see nursing as a menial, subordinate job they have left far behind. Consequently many such women have contempt for nursing. The "feminist" disdain for the profession has been well-documented; it is a major theme in our book Saving Lives (Chapter 6: Who Wants Yesterday's Girl?). It may be that some media figures are far more likely to be acquainted with physicians. On the other hand, they may not be close to many nurses, and may assume that's because they didn't attend some community college or trade school, wherever it is nurses get their 6-week training course. Unfortunately, many able modern women seem uneasy with suggestions that they have anything in common with nurses, except basic biology--you know, the kind of science stuff that physicians know about.
As Meredith Grey once snapped, after a male surgeon had uttered what is apparently the worst insult some female physicians can receive: "Did you just call me a nurse?"
Please educate these writers about the value of nursing!
See Ginia Bellafante's article "From Iraq Hellfire to Hospital Halls, TV Nurses Wage a Battle for Respect" in the September 22, 2009 edition of the New York Times.
See Heather Havrilesky's "The best and worst of the new TV season" posted on Salon on October 21, 2009.