Healers and heroes

 

Fall 2016 overview of nursing on television

fall_2016-7October 2016 — The new U.S. prime time season includes many health-related shows, but as in recent years, most are physician-centric. It appears that the only major new hospital show in the traditional fall season is CBS’s Pure Genius (premiering Oct. 27). Here, the usual hotshot physician crew is assembled by a tech billionaire who provides free cutting-edge care to those with rare diseases; naturally, his team is headed by a surgeon! Looks like about five physicians and no nurses. Among returning shows, a few do feature nurse major characters, although most of those are not mainly about health care. An exception is the BBC’s powerful Call the Midwife, which will be back in early 2017 for its sixth season, with London nurse-midwives providing expert, autonomous community health care in the early 1960s. PBS’s Mercy Street (Jan. 22, 2017), about a hospital treating soldiers during the U.S. Civil War, will return for a second season with nurse central character Mary Phinney, who displays some strong patient advocacy, if not much substantive knowledge. Outlander (Starz) will return in 2017 for a third season of adventures by the intrepid and skilled time-traveling nurse Claire Randall among the rebels of 18th-century Scotland, although Claire (at least in her 20th Century incarnation) has now become a physician. See a trend? Nurse-focused shows must be set in the distant past, when strong women could be nurses instead of physicians! A few crime shows feature nurses. The expanding Netflix stable of Marvel Universe shows includes nurse-to-the-superheroes Claire Temple, now appearing in Luke Cage (Sept. 30)–not a lot of health care, but Claire is skilled, tough, and savvy. And when the BBC’s Sherlock returns with a fourth season in January 2017, so will Mary Morstan–the formidable assassin / nurse married to John Watson. But among present-day health-focused programming, physician-focused shows still predominate, including four returning for second seasons. The first, CBS’s Code Black (Sept. 28) is about a busy Los Angeles emergency department (ED). The show has one senior nurse character–basically a savvy aide-de-camp to the physicians–and about eight major physician characters. Chicago Med (Sept. 22) also portrays a busy urban ED and is dominated by 6-8 expert physicians, although it has two competent assistive nurse characters, plus an executive who no longer practices as a nurse but has overall responsibility for the trauma center. Fox’s Rosewood (Sept. 22) follows a charismatic Miami “private pathologist” who teams with a police detective to solve crimes; no nurses. And ABC’s sitcom Dr. Ken (Sept. 23), also back for a second season, features a cranky HMO physician with a faithful nurse named Clark–really more of a lap dog, Clark displays little expertise or authority. Among older shows, there will be more of ABC’s Grey’s Anatomy (Sept. 22) (sexy, brilliant surgeons; handmaiden nurses) and the Hulu sitcom The Mindy Project (Oct. 4) (quirky but skilled OB-GYN physicians; stooge nurses). NBC’s summer show The Night Shift seems likely to return in 2017 with about seven heroic ED physicians assisted by a few competent nurses who actually talk, including the macho regular character Kenny. Please join us in encouraging better portrayals of modern nursing!

New Shows

Pure Genius (CBS)

Luke Cage (Netflix)

Returning shows

Call the Midwife (BBC)

Mercy Street (PBS)

Outlander (Starz)

Grey’s Anatomy (ABC)

Chicago Med (NBC)

Code Black (CBS)

Rosewood (Fox)

Dr. Ken (ABC)

The Mindy Project (Hulu)

The Night Shift (NBC)

Conclusion

Take Action!

New shows

Pure Genius

Pure GeniusCBS says this new drama is about “a young Silicon Valley tech billionaire who builds the ultimate cutting-edge hospital that treats only the most rare and insurmountable medical mysteries–at no cost. Lending credibility to this new venture is a maverick surgeon who’s the first to discover that his boss’s mission is to get bureaucracy out of medicine, use the most forward thinkers in technology, and just save lives–including his own.” The billionaire’s gloriously high-end Silicon Valley hospital is named “Bunker Hill”–get it, a revolution in health care?! So maybe the real solution to the millions who die worldwide each year from preventable diseases, poor sanitation, and a lack of nursing is to persuade billionaires to set up high-tech hospitals to treat rare conditions. And available preview clips suggest that this tech billionaire isn’t exactly hands off, but instead will be spending a lot of time lecturing physicians about health care and seeking out the rarest deadly conditions to treat–not coincidentally, he has one himself, so his endeavor is personal. Not surprisingly, the show seems to have no major nurse characters, but, in addition to the rich whiz kid, it does have five physician characters and an “enthusiastic 3-D printer programming whiz.” A good portrayal of nursing seems unlikely. For more information, see the Pure Genius pages on the CBS website.

 

Luke Cage

night-nurse-claire-temple-allThe Marvel Universe is always expanding, and the new Netflix show Luke Cage features a seemingly indestructible Harlem superhero who appears to have the distinction of being the first African-American one to head up a major U.S. television series. Claire Temple is a nurse who appears, in several current Netflix Marvel shows, to be a composite of the Claire Temple of the originating comic book series (that character was a physician) and the Marvel character Night Nurse, another comic book figure with a complex backstory that appears to include some striking patient advocacy. In any case, Netflix Claire has made many appearances in Daredevil, which focuses on the blind lawyer superhero and has so far aired two seasons, and one appearance in Jessica Jones, an unusual female-focused show that has aired one season. Now, it appears that Claire will have a significant role in Luke Cage. She does not spend too much time dispensing health care, but she is a problem-solver with real skills, as she shows in patching up a wounded bad guy for Luke in episode 6, and she operates with autonomy, toughness, and no apparent fear.  See more information on Claire Temple on her Wikipedia page.

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Returning shows

Call the Midwife

cast_of_three-2The BBC’s Call the Midwife returns for a Christmas special in December and its sixth season in early 2017. The drama follows the exploits of nurse-midwives caring for poor women and others in London, and it’s now set in the early 1960s. The Sisters of St. Raymond Nonnatus and their lay colleagues–we count roughly 10 nurse characters! — try to cope with the many births and other health issues in the East End. In its first five seasons, the show has generally presented the midwives as skilled and autonomous community health workers whose abilities vary in accord with their relevant experience, just as on physician-focused shows. The nurses visit pregnant women to monitor their progress, deliver babies under difficult conditions, and advise the new mothers, in an environment in which women seem to function as baby factories and one-person day care centers, although birth control methods have just been introduced. In the fifth season, examples of the midwives’ exploits included Patsy’s skilled management of a typhoid outbreak in the third episode, Sister Julienne’s strong but sensitive care for babies born with problems caused by Thalidomide in the fourth episode, and excellent care by former party girl Trixie in several episodes, including managing an inverted uterus and the freaked-out teen mother in the sixth episode. See our webpage featuring analyses of the show, or see the show’s website, where you can watch trailers online.

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Mercy Street

mary_phinney1smMercy Street is a PBS Civil War drama about a Union military hospital in Northern Virginia that treats the wounded from both sides. The show is remarkable in that one theme, at least in the early episodes, is the roots of modern nursing in the U.S. First season characters included the fierce Union Army nursing superintendent Dorothea Dix (briefly) and a former colleague of Florence Nightingale named Anne Reading, who appears here as the jealous, petty Anne Hastings. These characters stress order, hygiene, comfort, and wound care. The main nurse characters, though, are inexperienced young women (one from each side of the war) who struggle to cope with the carnage they confront, as well as surgeons who bully them and/or don’t want them there at all. Union side Mary Phinney, the show’s main character, is based on a real historical figure who wrote about her experiences–and to some extent on Louisa May Alcott, who also acted as a nurse during the war. On the Confederate side, Emma Green, with a lesser role, was also a real figure whose family did own and live next to the commandeered hotel that was the site of the hospital, although in real life she was not a nurse. The younger nurse leads don’t yet show a lot of technical skill, but they do have intellect and independence, with Phinney in particular displaying some forceful patient advocacy. But the technical knowledge seems to reside mostly with the surgeons who call the shots. lucy2In some ways the show resembles Cinemax’s The Knick, since one of Mary’s main tasks in the first season has been managing a gifted but drug-addicted surgeon in very difficult circumstances. It’s not clear how much this series will increase public understanding of modern nurses, but it is commendable that the show offers a look at nursing in this period. See Mercy Street‘s website on PBS, and The Knick‘s website on Cinemax for more information.

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Outlander

claire3Outlander (Starz) is based on a series of popular books about British World War II combat nurse Claire Randall, who time travels between the 20th Century and 18th-century Scotland, where she marries a handsome Scottish rebel and has adventures across Europe. The series finished airing its second season in July 2016 and will return in 2017. Claire has regularly displayed some impressive health skills, and although they have not played too great a role in the show overall, Claire is smart and tough. In the long first season she was called upon to heal wounds, treat asthma, master herbal remedies, comfort the dying, diagnose mysterious ailments using her advanced knowledge from the future, and even reverse a life-threatening poisoning with a “decoction of belladonna.” The second season also included some health care from Claire; for instance, she diagnosed and acted to limit a smallpox outbreak and, as always, tried to manage battle wounds. She also had to contend with her own PTSD from the years she spent as a combat nurse during World War II. But not enough is made of her nursing background in particular — in the 18th century she is really seen more as a “healer” — for nursing to benefit too much from her occasional health exploits. And that will likely be especially so in future seasons, since by the end of the second season she had spent 20 years back in the 20th Century and become a physician. In fact, Claire always seemed to display skills across the range of what is now done by nurses and physicians. That is convenient for the show’s dramatic purposes, but it may also imply that able nurses excel by acting as physicians. And given prevailing assumptions, the nurse-to-physician transition can be troubling because it can reinforce the sense that nursing is not enough for bright, ambitious modern people. For more information, see Outlander‘s website on Starz.

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Grey’s Anatomy

tamir_dahr1ABC’s long-running Grey’s Anatomy has begun airing its 13th season, and it now features about 15 regular characters, every single one a surgeon. Consistent with that lineup, the show persistently reinforces the idea that only physicians matter in health care. Over the years, nurse characters have occasionally appeared on Grey’s, usually embodying stereotypes, particularly the helpless handmaiden and the bureaucratic battleaxe, imagery that contrasts sharply with the cool professional paths the show’s female stars have chosen. The twelfth season featured almost constant physician nursing, with physicians often providing all bedside care, including not just exciting procedures like defibrillation but also patient monitoring and psychosocial care. Anonymous nurses did at times appear in the background to provide color or absorb physician commands, either in deferential silence or with an obsequious “right away, doctor!” They even popped up to do something basic or display a little knowledge, but always in an assistive role. In one March 2016 episode, a nurse character actually got to say two whole sentences in the OR, but they were: “Dr. Kepner! Dr. Avery’s wondering how long you’ll be?” The coming season promises more of the same, as there is no indication of any major character who is not a surgeon. The October 13, 2016 episode did include a nurse character named Tamir, a petty bureaucrat and quasi-battle-axe whose main role seemed to be torture disgraced surgeon Alex Karev (who had been banished after assaulting a fellow surgeon), to perform “scut” work in Tamir’s in-hospital clinic. For more information see our page with analyses over the years.

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The Mindy Project

3-nursesMindy Kaling’s sitcom The Mindy Project continues with its second season on Hulu after three seasons on Fox. Set at a small obstetrics practice in New York City, the show focused mainly on Kaling’s lookin’-for-love character and her baby daddy Danny, who are quirky but skilled OB-GYN physicians, until last season when they broke up. Meanwhile, the practice’s regular nurse characters are kooky in different ways, but united by their lack of significant health skills. The main one, Morgan Tookers, is a goofy ex-convict. Morgan specializes in inane comments, comical misunderstandings, wild overreactions, and frequent suggestions that he lives in poverty. Morgan’s cohort is Tamra, an off-the-wall nurse who at first seemed like she would play an insult-comic role, but in recent times has been more of an assertive variation on Morgan as well as an off-and-on romantic interest for him. Beverly, a dangerously inept and hostile nurse the practice fired then re-hired as an office assistant, exists to comment on the action in some unhinged way. And new last season, nurse Colette Kimball-Kinney is the sister of a practice physician; she seems silly, but maybe not as awful as the others. Of course, all the show’s characters behave foolishly at times, and the nurses sometimes play roles in the plotlines that are similar to roles the physician characters play. But the show never suggests that the physicians are idiots in a professional context, while the nurses are potentially dangerous clinical subordinates. ben_mindyEarly episodes of the 5th season actually include a strike by the practice’s nurses (for more money and benefits) as well as an apparent romance between main character Mindy Lahiri and Ben, a new nurse character, who is likely to be temporary. The plotlines appear to mix stereotyping and suggestions that nurses have more to offer than physicians realize. But the episodes do not seem to convey much of nurses’ real skills, and they seem to trivialize the real challenges nurses face in the clinical setting. For more information see our page with analyses over the years.

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Code Black

jesse2This CBS drama seems to be another in a long line of efforts to update NBC’s legendary drama ER, with some of Grey’s Anatomy‘s superficial egomania thrown in. As usual, a key theme is senior physicians training junior ones; there are roughly eight major physician characters at different levels of seniority, including several residents. Here the added twist is how overwhelmingly busy the show’s Los Angeles emergency department (ED) is, supposedly the busiest (and of course the best) in the nation. In the first season, that led to chest-thumping, some of which came from the one nurse character, Latino “senior ER nurse” Jesse Sallander. He does get some snappy lines that the show thinks are clever. In one scene in the premiere, Sallander led a group of new physician residents around, bragging about the ED and telling/warning them he will be their “Mama.” And who is “Daddy”? Why it’s the awesome female physician who directs the physician residency program, of course! Sallander does have a special professional bond with her, as was especially evident in the episode in which he had a big heart attack (he recovered). He also seems to be involved in managing the department’s logistics, and he does periodically call out vitals or describe symptoms in emergency scenes. In one January 2016 episode, Jesse was even involved in a discussion with the physicians regarding whether and how to implement a DNR (do not resuscitate) order. But the physician-heavy structure and limited overall nursing role means the show leaves viewers with the same impression ER did–that nurses are at best skilled assistants to the physicians who dominate and whose actions really matter. For more information see Code Black‘s website on CBS and a preview on YouTube.

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Chicago Med

april_maggieNBC’s Chicago Med is the third of producer Dick Wolf’s four Chicago shows. Like the others, Chicago Med focuses on dedicated everyman public servants confronting the challenges of modern urban life–there isn’t much “we’re the best!” boasting in Dick Wolf shows. The show’s pilot was actually an episode of Chicago Fire that aired in April 2015. The NBC site now describes the show as “an emotional ride through the day-to-day chaos of the city’s newest state-of-the-art trauma center and into the lives of the courageous team of doctors, nurses and staff who hold it together”–a far more inclusive characterization than the show started with a year ago. And although the show remains dominated by 6-8 physician characters, there are now two characters practicing as nurses. The NBC website now describes them as April Sexton, a “smart, bold and intuitive ER nurse dealing with an illness of her own [tuberculosis] as well as a relationship that might be moving too fast for her to handle,” and Maggie Lockwood, “the confident charge nurse and the eyes, ears and brain of the emergency department.”

Well, at least whoever revised the website made an unusual effort to show respect for nursing! Unfortunately, the show itself does not quite live up to that ideal. In fairness, the nurses are generally serious, skilled assistants to the physicians, in the ER mode. sharon-goodwinAnd the hospital executive Sharon Goodwin, apparently the “head” of the hospital or at least the trauma center, was also identified as someone who used to practice as a nurse in a May 2016 episode–signaling to attentive viewers that nurses can be authoritative leaders. All three of these characters are African-American. And in the September 29, 2016 episode, Lockwood tells Goodwin that since it is July 1, she has to keep the new resident physicians from “killing people.” Yet in that same episode, Lockwood peels a concerned family member away from an incoming emergency admit by telling him to come with her so “the doctors” can do their work. Thus, as on Code Black, the show creators are making some effort, but the physician-dominated structure and assumptions about hospital care combine to leave the impression that physicians are the ones whose health skills and actions really matter. For more information see Chicago Med‘s website on NBC and a preview on YouTube.

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Rosewood

cast2In Fox’s Rosewood, returning for a second season, Miami’s “top private pathologist” teams with tough Detective Annalise Villa and other police to solve crimes. Beaumont Rosewood is a cheerful, charismatic, and brilliant physician, with extraordinary detecting abilities–kind of like that other talented Miami crime scene investigator Dexter Morgan, but with something more like a Light Passenger rather than Dexter’s Dark Passenger. Rosewood does seem obsessed with death, maybe because he has serious health problems of his own. The show is a cop-physician buddy show like TNT’s Rizzoli and Isles, in which a medical examiner helped her detective cohort solve crimes (that show just ended after seven seasons). As expected, the odd couple spends a lot of time sparring for our entertainment, and in this show, dealing with unresolved sexual tension. The show also includes Rosewood‘s sister, a toxicology specialist, and her former fiancée, a DNA specialist. But there is no sign of any significant nurse character, and the show tends to reinforce the idea that physicians are the only real health experts. For more information see Rosewood‘s site on Fox and a preview on YouTube.

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Dr. Ken

clark2ABC’s Dr. Ken is a sitcom about the escapades of Ken Park, an arrogant, cranky, and supposedly competent “HMO clinic” physician played by real-life-physician/comic Ken Jeong. One of the characters is nurse Clark, a faithful but silly underling who inexplicably idolizes Ken. In one October 2015 episode, Ken learned that “his nurse” Clark was also his “friend” and should be treated better. Unfortunately, the plotline also suggested that nurses are low-skilled servants looking for a physician to possess them. In particular, viewers were told that (1) Clark, formerly a “nurse” or “doctor’s assistant,” had just become a registered nurse by taking his “boards,” after studying in an RN program “since last summer”; (2) this transition was like a “streetwalker” becoming an “escort”; (3) nurses are subordinate work spouses of physicians who essentially belong to the physicians, rather than serving patients under their own practice model; (4) physician abuse of nurses is unfortunate but also kinda funny; and (5) men in nursing do not embody traditional notions of masculinity. The show has yet to suggest that nurses have health skills–in contrast to Ken, who offers a few indications of expertise in each episode. This adds up to toxic stew of nursing stereotypes: the unskilled handmaiden, the angel, the weak male, and even the naughty nurse. Season 2 promises more of the same, with Clark engaging in standard sitcom banter and shenanigans, but displays of nursing skill or autonomy seem unlikely. See our previous analysis on Dr. Ken or more information on ABC.

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The Night Shift

kenny_wheelingNBC’s The Night Shift, which focuses on ED physicians at a struggling San Antonio hospital, seems likely to return for a summer 2017 season in light of its high ratings during the third season that just ended. The show is another descendant of ER, and it’s even more amped up. That means pulse-pounding trauma scenes not only at a public hospital ED but at disaster sites all over the metro area, and indeed the world, as well as romantic intrigue among the roughly seven physician characters who dominate. And as on ER, there is an attractive major nurse character who’s not an idiot, along with a few minor nurse characters who can actually talk. The major nurse character, “charge nurse” Kenny, is a strong, competent African-American man who displays some health knowledge, reporting vitals and performing basic procedures. But the Night Shift nurses are basically there to carry out physician commands, fetch physicians, and convey basic information to physicians. Physicians perform the life-saving procedures, and they are the ones who generally educate and advocate for patients. There are exceptions with Kenny. In a July 2016 episode, he brought a protégé high school athlete to the hospital, looking to get her healthy for a big college scholarship tryout; this being The Night Shift, on that same shift she lost her soccer career to a terrorist bomb and discovered she had lung cancer, but Kenny did give her good psychosocial care. The nurses were also on strike for part of that episode, seeking mainly higher wages, although better staffing was also mentioned. Without the nurses, the physicians had trouble finding things, but there was no suggestion that the nurses had any skills the physicians did not. Still, Kenny and the other nurses do act like sentient beings. For more information see The Night Shift‘s website on NBC.

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Conclusion

This season a few shows may counter the physicians-are-everything narrative on U.S. prime time television, which is exemplified by Grey’s Anatomy, Dr. Ken, and Pure Genius. Call the Midwife is likely to remain excellent, and shows like Mercy Street, Chicago Med, The Night Shift, and even Luke Cage may offer glimpses of nursing skill, advocacy, and (more rarely) autonomy. But of shows that focus on modern health care, handmaiden portrayals remain the norm, and only Call the Midwife can be expected to offer a consistently good portrayal of nursing–in the 1960s.

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Take Action!

With all these shows, we need help! Please watch one or more of the shows and let us know if you see a good or bad portrayal at info@truthaboutnursing.org. And please join our letter-writing campaigns to speak out to show creators, and consult our Take Action page for more ideas. If we each work on a piece of the puzzle, we can build a society that values nursing according to its true worth, strengthening the profession so nurses can deliver better patient care. Thank you!

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