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Elmo, so good on vaccines and third person self-description, not so good on nursing

Surgeon General Vivek Murthy, Elmo, Nurse JaneApril 17, 2015 -- Today, Sesame Street character Elmo and U.S. Surgeon General Vivek Murthy teamed up in two public service announcements to promote vaccinations. The 30-second version emphasizes that vaccinations are safe and that they keep us healthy--an urgent message in the wake of the recent measles outbreak. Unfortunately, the three-minute version includes a 30-second interaction with "Nurse Jane," who appears to give Elmo a vaccination. Jane is dressed professionally, with a white coat and stethoscope. But there are many problems. While the spot makes a gentle joke of Murthy's many titles and credentials (we hope the Sesame Street audience is impressed by his "MBA"), the nurse is introduced only as "Nurse Jane"--no surname, no credential, no position. Murthy provides good information about vaccines and germs. But Nurse Jane shows no knowledge of anything except how to give the shot and then apply a little bandage with cute red and white hearts. She utters a total of 17 words. When Elmo asks if the shot Jane is giving will hurt, it is Murthy who answers and deftly distracts Elmo by encouraging him to sing, so Elmo does not even notice the shot--a classic nursing move. And while Murthy is authoritative, friendly, and funny, the Jane character seems amiable but a bit dim, like a low-skilled handmaiden who performs simple tasks while the physician does the patient education and public health policy. In fact, nurses are autonomous, college-educated health experts (with surnames!) whose scope of practice is notable for its focus on public health and patient education. One example is the U.S. Public Health Service's own Chief Nurse Officer, Rear Admiral Sylvia Trent-Adams, RN, PhD. The PSA was produced by the Daily Dot, written by Evan Weiss and Matt Silverman, and directed by Silverman. We have urged the PSA creators and the Department of Health & Human Services to pull the three-minute spot before it further damages nursing--and public health--and then to eliminate the degrading nursing element. Unfortunately, that has not happened. But we remain in discussions with them about working together in the future to create public health media with more positive depictions of nursing. Read more below the 3-minute video below.



Oh hi, Dr. Surgeon General, Vice Admiral Vivek H. Murthy, MD, MBA!

In the 30-second PSA (right), Elmo introduces his friend "Dr. Murthy," who says he is the Surgeon General and it's his job to help everyone stay healthy. Murthy wears the standard, military-like Surgeon General uniform. Elmo asks if Elmo can help. Yes, says Murthy, by getting all your vaccinations, the shots that help you stay healthy. Elmo seems scared: "Shots?!" Murthy says don't worry, it's just a little pinch, and it's safe. Elmo agrees to get vaccinated. Murthy kindly urges him to tell all his friends on Sesame Street to get vaccinated too. Elmo shrilly complies. This ad is fine because it says nothing about nursing; of course it might have been nice if The National Nurse for Public Health had joined Murthy, but he is a good choice for the PSA.  

The three-minute PSA is also basically fine apart from the nurse element. The explanatory text at the video's YouTube posting says that "the U.S. Department of Health & Human Services, Sesame Street, and the Daily Dot have teamed up to create this short video that you can share with friends, family, and new parents." There is also a link to an HHS site that provides more information about childhood vaccinations.

At the start of the longer version of the PSA, we see Elmo reading RELAX magazine. Murthy enters and Elmo greets him this way: “Oh hi, Dr. Surgeon General, Vice Admiral Vivek H. Murthy, MD, MBA!” Murphy responds: “Hi Elmo. You can just call me Dr. Murthy.” Elmo says he is there for a checkup, because he wants to be strong and healthy, but he is worried about getting a shot. Elmo wants to know why Elmo needs a vaccination (surprisingly, he does not ask if anything can be done about his tendency to talk about himself in the third person).

Good question, Murthy says, and he asks if Elmo carries an umbrella when it rains and wears a helmet when riding a tricycle. Of course, says Elmo. Surgeon General Vivek Murthy, Elmo, Nurse JaneMurthy goes on to say that just as umbrellas protect us from rain and helmets protect our heads, vaccines protect us from germs. He explains that germs are tiny creatures that can get into the body and make you sick. The good news is that your body can protect you, but in order to do so, it needs information. And, Murthy explains, vaccines have information about germs to help your body make antibodies to fight them. So antibodies are like superheroes, because they can kick out germs before they make you sick. This takes two of the PSA's three minutes, and so far so good.

But at the 2:00 mark, a smiling older woman appears. She is wearing a white coat with a stethoscope.

Elmo: "Oh hi, Nurse Jane."

Jane: "Nice to see you again Elmo, you're all ready for your vaccination."

Elmo: "Will it hurt?"

Murthy: "A little, but how about this. Turn around and sing a little song."

Surgeon General Vivek Murthy, Elmo, Nurse JaneElmo agrees and does so, choosing the very appropriate "Shake it Off" by Taylor Swift:  "...cause the players gonna play play play play play, and the haters gonna hate hate hate hate hate..."

Meanwhile, we see Nurse Jane inject the vaccine into Elmo's furry arm in close up.

Elmo: "OK, Dr. Murthy, let Elmo know when it's happened, OK?"

Nurse Jane responds, "Why, it's all done, Elmo," and she applies a blue bandage with little red and white hearts. He is thrilled and says "thank you," as Jane departs without another word. She is gone by 2:31. 

Elmo: "That was so easy, why doesn't everybody get a vaccination?"

Murthy: "That's a good question, Elmo. That's a good question." They look at the camera, holding their chins thoughtfully.

Oh hi, Chief Nurse Officer, Rear Admiral Sylvia Trent-Adams, RN, PhD!

Elmo's bandaidThis PSA delivers some good information about vaccines and even presents an example of how getting the shot can be essentially painless, a helpful message for the young audience. But the nursing element is very poor. Yes, "Nurse Jane" is dressed professionally, she knows how to give a vaccine and apply a bandage, and what little she has to say displays good psychosocial skills; she is friendly, not an ogre. But everything that surrounds her appearance combines to present nurses as nice but low-skilled physician helpers. It is Murthy whose expertise and credentials are emphasized, he who displays an admirable down-to-earth quality despite his prominence. Nurse Jane does not even get a surname, much less an "RN" or any indication of her education or position--is she a public health nurse? It is Murthy who has all the knowledge about vaccines. He even answers Elmo's question about whether the shot Jane is giving will hurt. Elmo's bandaidAnd he does so with an effective distracting intervention that is classic nursing; in fact, it's the kind of thing a nurse advisor would have suggested. Then Elmo asks Murthy to tell him when the shot Jane is giving is done. Jane at least gets to answer that question, as she applies a cute little bandage with hearts on it--which arguably reinforces the angel stereotype of nursing, although we suppose the hearts may simply be a standard pediatric care measure. Then Jane disappears, so that Dr. Murthy and Elmo can ponder the big question of why anyone would not get vaccinated. Evidently, just as nurses have no role in patient education, they are not involved in discussions of health policy.

These images in this PSA are tragically at odds with the reality of nursing, at a time when the profession remains under real stress, plagued by understaffing and other resource shortages throughout the United States. Nurses give vaccinations, and no one knows more about how to perform that task, including educating patients and managing associated pain. But nurses have also long played key roles in public health work, from administrative leadership to clinical innovations to cutting-edge research, from managing the Ebola outbreak to containing the measles outbreak that likely spurred this PSA, including initiating vaccination programs for at-risk communities like the Amish in Ohio. The nursing practice model has been a holistic, preventative one from the beginning, and no one is better placed to deliver the messages in this PSA than a nurse.

Sylvia Trent-AdamsIt is true that there is not yet a direct nurse counterpart to the Surgeon General, who heads the U.S. Public Health Service. But even in today's Public Health Service leadership group, there is a Chief Nurse Officer: Oh hi, Rear Admiral Sylvia Trent-Adams, RN, PhD, with your Master of Science in Nursing and Health Policy! In addition, many nurses have advocated for legislation that would designate the Chief Nurse Officer as the National Nurse for Public Health.

We have urged those responsible to withdraw and fix this PSA, to make amends to nursing, and to think about the messages they are sending about nursing in future public communications. We have engaged with the Surgeon General's office on this and they have pledged to work with us in the future to create more accurate messages about nurses. Stay tuned.


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