37 to 0?
Fall 2010 TV Preview
September 2010 -- As the 2010-2011 U.S. television season starts, there appears to be no major nurse character on any regular prime time broadcast show for the first time in more than 40 years. In part that is because so many of the health-related shows from last year have left the air, including all of the shows that premiered in 2009, notably NBC's generally helpful nurse drama Mercy, but also CBS's physician-centric Three Rivers and Miami Medical, which did each have one recurring nurse character. Other departures had little effect on the portrayal of nursing, including the ends of the long-running Scrubs (ABC), which had shed its lone nurse character the prior season, and FX's nip-tuck, which never had a significant nurse character. The one returning show that did have a nurse character, ABC's Private Practice (premieres Sept. 23), killed him off at the end of last season, when nurse midwife Dell Parker died from a car crash, just after giddily announcing that he had been admitted to medical school. The dominant hospital shows, Fox's House (Sept. 20) and ABC's Grey Anatomy (Sept. 23), still have no nurse characters as they start their seventh seasons. There appear to be just two new shows with any real health care focus: ABC's Body of Proof (October), which stars Dana Delany as an elite surgeon-turned-medical examiner, and ABC's Off the Map (mid-season), a new product from Grey's creator Shonda Rhimes about five young physicians who work to save the poor at a remote clinic in South America. We see no nurse characters anywhere, though there are conflicting signals about whether one minor character on Off the Map is a nurse or physician. Leaving aside that mid-season character, of the five health-related prime time broadcast shows that are slated to start seasons this year, regular physician characters appear to outnumber nurse characters by roughly 37 to 0. Of course, nurses will not be completely absent from the small screen, since non-regular season cable shows Nurse Jackie (Showtime) and HawthoRNe (TNT) will return for third seasons in 2011. And there is even a nurse character on A&E's new summer police drama The Glades, which will return next year (though she is carrying on Dell's Hollywood dream by attending medical school). But given the dominance of the broadcast shows, which attract millions more viewers to many more episodes, the television landscape will remain dominated by programs that reinforce the false notion that physicians provide all important health care.
Overview: Where are the nurses?
Why do we say this may be the first essentially nurse-free regular television season in more than 40 years? Without getting too far into the TV weeds, there has been at least one (and usually only one) major nurse character on the following overlapping prime time broadcast shows, which, listed in reverse chronological order, reach back until 1969: Mercy, ER, Nurses, China Beach, St. Elsewhere, M*A*S*H, and Marcus Welby, MD. At times during this period, other shows also included major nurse characters. Most of the characters did at least suggest that nurses play a role of some importance in health care. Of course, not all of these characters were helpful to nursing, and at times, the characters may have been little more than a flickering candle in the darkness of Hollywood's physician glorification. But now there isn't even a candle, unless the minor character in Off the Map turns out to be one; of course, she will not appear till 2011 in any case.
On the other hand, 2009 did see the introduction of three new nurse-focused shows, and although Mercy regrettably did not survive past the end of its first season, Nurse Jackie and Hawthorne are slated to air their third seasons in 2011. And A&E's hot new summer police show The Glades, which will end its first season on October 3, includes competent nurse character Callie Cargill, though as the main character's girlfriend she has few clinical scenes, and it's not clear how long she will be considered a nurse anyway, since she is apparently taking medical school classes. Indeed, Hollywood's tendency to suggest that able nurses want to attend medical school has not diminished. In the last year alone we have also seen it on Private Practice, HawthoRNe, on which nurse Ray Stein is a wannabe physician, and even Mercy, a show with many great nursing portrayals, which tossed in a suggestion in its final episode in May 2010 that the smart but frustrated young nurse Chloe Payne would go to medical school. Of course, in reality, nurses are perhaps 100 times more likely to pursue graduate education in nursing.
In the meantime, prime time regular season viewers can expect even more of the same: an avalanche of serial dramas telling viewers that physicians do everything that matters in modern health care, including many key tasks that nurses do in real life, with the occasional direct insult to nursing thrown in for good measure. Four of the five physician shows, including both new ones, will be on ABC.
Body of Proof
The network's new Body of Proof features Dana Delany--who once played one of Hollywood's better major nurse characters on China Beach--as neurosurgeon Megan Hunt, who has become a medical examiner after losing sensation in her hands following a car crash. As the show's promotion stresses, the character "ruffles some feathers" in her new job, including those of her boss, the tough physician Kate Murphy--the first female chief medical examiner in Philadelphia, as we are also told. Since a central element of the show seems to be the interaction of these two physicians, the show will likely highlight the challenges that ambitious professional women face today. The show includes no nurse, though it might have, even with its overall theme. Lifetime's Strong Medicine also revolved around two female physicians and included hunky, subordinate nurse Peter Riggs, in a kind of "feminist" role reversal. It may be that this role is filled here by Hunt's apparent assistant, investigator Peter Dunlop. In any case, Body of Proof seems to include two additional recurring physician characters, bringing the total on the show to four. (See the show on the ABC site.)
Off the Map
ABC's Off the Map is the new drama from prodigious health care show creator Shonda Rhimes, who is also responsible for Grey's Anatomy and Private Practice. No one in Hollywood history has conveyed more contempt for nursing than Ms. Rhimes--such contempt often bears an inverse relation to a person's reverence for physicians--so it would be surprising if Off the Map said anything helpful about nursing. The show's basic concept is to follow three young U.S. physicians who travel to Ciudad de las Estrellas, a tiny town in South America, where a slightly less young hotshot U.S. physician and his assistant physician run a clinic, heroically caring for the poor people in the area. As in every Rhimes product, all the physicians appear to be pretty, smart life-savers, though some will be more experienced than others. The locale is new, but applying a "Doctor Barbie's Playset!" vision of health care to a story about professionals from wealthy nations working in a poor nation seems fraught with peril, and Off the Map may reinforce the idea that the U.S. physicians are brilliant saviors and the locals helpless victims.
The possible nurse is described in available materials as "Zita (Zee)"--in other words, she gets a nickname but no surname. That does sound like a Hollywood nurse character, and Zee also seems like a Hollywood nurse in her brief appearance in one clip at the ABC site, in which she, evidently a local, welcomes the wide-eyed U.S. physicians to the overwhelmed clinic. The ABC site does not bother telling us her profession; maybe she is simply a clinic staffer with no separate health care training. One other web site suggests that Zee is a nurse. Yet a third web site says that Zee is a physician, which could be the case if the show will treat local physicians in the same way Hollywood shows generally treat nurses--as peripheral subordinates. If Zee is a nurse, it seems very unlikely that she will merit the description "major character." Anyway, it does not seem that Off the Map will appear before 2011. (See the show on the ABC site.)
ABC's Grey's Anatomy remains popular heading into its seventh season, and it now features roughly 12 regular physician characters, all surgeons. In prior years of the show, nurse characters did occasionally appear, usually embodying stereotypes, particularly the helpless handmaiden and the bureaucratic battleaxe, which contrasted nicely with the awesome professional path that the show's modern female stars had chosen. In late 2007 the show introduced a nurse character named Rose as a love interest for neurosurgeon Derek "McDreamy" Shepherd, as he struggled with his romance with the central character Meredith Grey. Rose was not a total idiot, but she crumbled and fled to a job in pediatrics when Derek returned to Meredith in 2008.
Since then, the show has basically included no nurse characters, with the occasional exception of Tyler, a bitter, unskilled lackey who has appeared briefly in a minority of episodes since the show's beginning in 2005. Tyler functions mainly as a plot device to dump tasks on the surgical residents--showing how hard their lives are--and to convey indifference to patient care, which contrasts with the intense concern and expertise the physicians display. After all, we're meant to understand, these are the physicians' patients, and it is only the physician characters who provide the care that matters; the nurses just help them with menial stuff, right? Click here to send our most recent letter to Grey's Anatomy.
The Grey's spin-off Private Practice, starting its fourth season, focuses on an LA "wellness clinic" and features about eight major physician characters, led by "world class" OB/GYN Addison Montgomery. Of course, the big news here is that receptionist / nurse-midwife Dell Parker died in the last episode of the third season, broadcast on May 13, 2010. That was no great loss to nursing, particularly given Dell's elation at having been admitted to medical school just before his death, reinforcing the wannabe-physician stereotype with which real advanced practice nurses and men in nursing must still contend. Private Practice did, rarely, include minor plotlines in which Dell actually showed some aptitude for patient care and some limited autonomy, such as the March 25, 2010 episode, in which Dell did deliver an at-risk baby basically by himself in the field. But at times Dell still seemed to function as a receptionist, which the show clearly saw as appropriate for a nurse with a college degree. In addition, early episodes of the show explicitly mocked midwifery, presenting Dell as almost a complete health care novice, rather than someone in a graduate nursing program.
Looking to the future, Private Practice seems set to continue veering toward the standard Hollywood surgeon glorification. Not only did clinic physician Sam Bennett suddenly become a surgeon last season, but the show seems to have added neurosurgeon Amelia Shepherd (sister of Derek Shepherd from Grey's) as a regular cast member. This may seem odd, since the show's original premise involved surgeon Addison's adventures with the more diverse "wellness" crew in LA, but the lure of surgeon worship is clearly hard for Hollywood to resist. In fact, neurosurgeons alone far outnumber nurses in current Hollywood shows. We expect a more narrow, Grey's-like focus on surgical interventions as the most important thing in health care, an approach that marginalizes not only nurses, but also the majority of modern health care. Click here to send our most recent letter to Private Practice.
House is another popular show that is starting its seventh season without ever having a significant regular nurse character to balance its many (eight) physicians. Every episode of this show is a diagnostic mystery solved by a team of physicians led by the irascible genius Greg House. His team also tends to provide all meaningful care, including work that is really done by nurses or other health specialists. Overall House has had even less nursing than Grey's--mostly just the occasional sneer from House himself.
Even so, in the last couple seasons the show did offer a few plotlines that actually seemed intended to show that nurses might not be quite the morons House sometimes says they are. One notable feature of the show last season was the occasional appearance of Nurse Jeffrey, a snarky, effeminate nurse who at least made some effort to return House's obnoxious comments. However, clinical expertise was not a focus of Jeffrey's scenes. In addition, an attractive young female nurse occasionally appeared as a love interest of the married physician Chris Taub, though she had few lines and little chance to display health knowledge or skill. Of course, a stock character like that does help to reinforce the idea that nurses are romantic playthings of physicians, which is always fun. Let's just say we're not expecting a slew of strong, expert nurse characters on House any time soon. Click here to send our most recent letter to House.
Did we mention that at least Nurse Jackie and HawthoRNe will be back next year? And Jackie will reportedly start in spring 2011, so it's become sort of like a late mid-season show, rather than the summer show it began as. Of course, it would take many years and many shows to counter the hundreds of hours of powerful disinformation conveyed by shows like Grey's and House, which remain popular around the world. The 2009 nurse shows at least suggest that there is always hope.