Suzanne Gordon; Author, Lecturer and Patient Advocate

Suzanne Gordon
The Boston Globe
Finally, hospitals’ unsung heroes carry the show
By Suzanne Gordon
June 18, 2009

SINCE THE BIRTH of television, Hollywood has given doctors a permanent starring role in prime-time hospital dramas. But most doctor shows have relegated the nation’s largest healthcare profession - nursing - to the status of bit players. Whether it was “Marcus Welby, M.D.’’ or “St. Elsewhere,’’ TV routinely presented RNs as mere handmaidens of physicians. In more contemporary shows like “Grey’s Anatomy,’’ “The Practice,’’ and “House,’’ medicine is now full of ethnic, racial, and gender diversity. Unfortunately, there’s hardly ever a nurse in the house.
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That’s why it’s so remarkable that two new shows put the spotlight on a nurse. In TNT’s “HawthoRNe,’’ Jada Pinkett Smith plays a chief nurse who’s smart and feisty. Showtime’s “Nurse Jackie’’ (Edie Falco) displays an edgier and far more realistic view of nursing.

In each show, we see the challenges of modern nursing depicted in an unprecedented way. In the first episode of the Showtime series, a young bike messenger is brought into the emergency room after being hit by a car. Because she’s a veteran RN, Jackie knows the boy has a brain bleed but a cocky young doctor blows her off and fails to treat it. The patient dies. In episode two, an angry man storms into the ER and socks Jackie in the jaw. Jackie figures out that the guy isn’t crazy, just distraught. He’s taking care of an obese, diabetic mother - a double leg amputee - all by himself. Jackie gets him an overnight stay and calls in social services.

“Hawthorne’’ is smart but a little too saintly, and Pinkett Smith is a one-note actress. “Nurse Jackie,’’ however, is a real gift to the nursing profession. The series reveals the critical role nurses play in healthcare and the price they pay for their expertise and commitment to patients. Jackie self-medicates because she injured her back on the job and is in constant pain. (In the real world, 6 to 11 percent of all nurses leave hospital work because of back, neck, and shoulder injuries). She’s a stressed-out recovering alcoholic. (Because of the stress of their work, more nurses do, in fact, have higher rates of stress-related illnesses, depression, and even suicide than the rest of the population.)

In spite of all this - and here Jackie may be functioning better than some real-life RNs - she’s worn out, but not burnt out. Like the best nurses I know, she displays deep compassion for her patients but without a shred of sentimentality. When a nursing student confesses to being unsure whether she’s cut out for the work, Jackie takes her aside and let’s her in on the secret of work in a modern hospital.

“You know what this job is honey, this job is wading through a shitstorm of people who come here on the very worst day of their lives. And just for your information, doctors are here to diagnose, not heal. We heal. And All Saints is in the business of flipping patients, that’s it, end of story. The fact that you have even the slightest inclination to help people puts you miles ahead of 100 percent of the population. So buck up.’’

Nurses are already reacting to nursing’s star turn. Three RN unions, including the Massachusetts Nurses Association, ran ads during commercial breaks on the first episode of “HawthoRNe,’’ advocating safe staffing legislation. And the blogosphere is buzzing with rank-and-file feedback on Jackie’s human foibles. Some RNs are upset that Jackie may hurt the image of their profession. The New York State Nurses Association is even demanding that the show’s producers run a disclaimer stating that Jackie violates nursing ethics.

To focus on Jackie’s flaws, however, is to miss the point. Most television doctors are oversexed, self-absorbed, and idiosyncratic. But when it’s time for diagnosis and treatment, they’re brilliant. Even though TV is supposed to be just entertainment, shows like “Nurse Jackie,’’ and even “HawthoRNe,’’ can help convince the public that nurses matter. Not just because they’re kind, sweet, and selfless but because they have the knowledge and skill that often makes the difference between life and death.

Suzanne Gordon is author of “Nursing Against the Odds.’’
© Copyright 2009 Globe Newspaper Company.

Since Nurse Jackie’s first episode aired on Showtime this week, a backlash has developed against the show.  Why?  Because nurses are confusing documentaries with TV entertainment.  Some nursing organizations, ones which I actually admire, are asking the show to put a disclaimer on that Nurse Jackie doesn’t represent the profession.  I think this is a mistake.  Of course, she doesn’t.  Neither does House, and his cast of ridiculous M.D.s .  Neither does Grey’s Anatomy, whose docs function in an almost nurseless institution.  But the American Medical Association and other medical organizations don’t ask for disclaimers on TV doctor shows.  Frankly, I think asking for things like disclaimers from TV producers is not a good strategy.  It suggests that nurses are naive.  That they are excessively  thin skinned and don’t understand the realities of the TV drama medium.  Time would be better spent doing hundreds of op-eds and letters to the editor explaining why Nurse Jackie has the problem she has.  Why is she working so much voluntary overtime?  It’s undoubtedly because her hospital doesn’t have enough nurses and so routinely staffs by asking nurses to stay late.  Why is she in so much pain?  Is it because her hospital doesn’t install lift equipment and so she, like so many other nurses, suffered an unnecessary back, neck or shoulder injury?  Why is she under so much stress?  Is it because she lacks authority on the job?  Look at the dispute she got into with the doc on the first episode.  What that shows is how docs treat nurses.  Marshall the studies by Rosenstein to show how much of a pattern this really is.  Don’t get hung up on the outrageous details.  Remember, this is TV.  It’s entertainment.  Keep your eye on the prize, which is that Jackie is smart, feisty, compassionate.  Yes, she violates ethics and this that and the other thing.  In real life nurses hopefully don’t do this (although, let’s not forget that the system asks them to violate patient safety every time a unit is short staffed or nurses are allowed to work too long, either voluntarily or because they are required to do so).  Let’s see how Nurse Jackie develops.  Give her a chance.

Just thought folks might be interested in seeing this video clip in which I worked with a group of nurses to help them better express their concerns about safe staffing in the current hospital workplace.

At the end of this week, Showtime airs its new series Nurse Jackie with actor Eddie Falco, morphed from Carmela on the Sopranos to an ED nurse.  I just went on line and watched the first episode on my computer.  So here’s my first impression.  A lot of nurses won’t like Nurse Jackie.  She takes uppers to keep herself going and pain pills because she’s got a back injury.  She was an alcoholic.  She’s married and has two kids and is having an affair with the hospital pharmacist.  She forges a young man’s signature on his license so it looks like he was a voluntary organ donor.  This she does after a cocky young doc doesn’t listen to her when she tells him the biker — who got hit by a car — is going to have a brain bleed.  The doc blows her off and the kid dies.  So it won’t be for nothing, she  makes him a donor.  When a prostitute is brutally slashed by a John, the woman slices off the man’s ear.  The hospital saves the guy’s ear.  Turns out the guy worked at the Colombian embassy and has diplomatic immunity.  The cops bring him into the hospital to have his ear sewn back on and Jackie has to take care of him.  He shows no remorse, for his act.  Quite the contrary.  He insists that the girl liked being carved up like a turkey.  “What do you like?” he asks Jackie.  Jackie flushes his ear down the toilet and steals his money to give to the biker’s pregnant girl friend.  I can hear some nurses wincing — screaming even — at every one of these scenes.

But if you’re tempted to scream out, or protest the show’s depiction of nursing.  Remember two things.  First, this is television.  Television has to be entertaining.  To be entertaining there has to be drama, conflict, humor.  And Nurse Jackie has it all, not to mention really good actors, acting and writing.  This show could be called Doctor Jackie — or Jack — because on doctor shows, MDs also  pop pills (think of House), have affairs, curse etc.  They have messy lives –each and every one of them.  But they are still brilliant in the OR, ED, on the floors.  Which leads me to the   second point you need to think about.  Jackie is smart.  She is no nonsense.  She cares like most of the expert, smart nurses I know — without a shred of sentimentality.  This is no inane smiling nurse (at least not in this first episode).  She’s gritty, wry, and has seen it all.  That hasn’t left her callous.  Not a bit.  It has left her worn out, but not burnt out.  And that’s the most important thing.  Plus, at least this first episode depicts a lot of what is real about nursing today.  Nurses work too many hours — and it’s not just mandatory — they volunteer for it .  Jackie pops pain meds because she injured her backat work.  Six to 11 percent of nurses leave their jobs because of back, neck and shoulder injuries.  I reccomend that nurses watch this show carefully.  That their bottom line should be  is Jackie smart, expert, feisty.  The question is –what does she have in her brain?  From what I saw on my computer screen the answer is — a lot.  If the pattern of this first episode carries through then I think nurses should support Jackie.  They should suggest themes for the show.  They should use Jackie as an opportunity to raise critical issues  about nursing with their friends and neighbors.  They should write op-eds and letters to the editor to discuss the show.

But give Jackie a chance.  And remember, this is TV land, not sugar and spice land.  Jackie gives you an opportunity to talk about what nurses do — really.  It gives you a chance to contradict the hearts and flowers image so many nursing organizations promote on Nurses’ Week.    It gives you a chance to wear your brains not your heart on your sleeves and talk about the kinds of things nurses know and how smart and feisty they really are.  Go for it!