Bartender of the emergency department

The Night Shift‘s first season

Kenny in the locker room Night ShiftOctober 2017 – Now that NBC’s summer hospital drama The Night Shift has finished its fourth and final season, it may be instructive to look back at the season that started it all, from summer 2014. That first season revealed the San Antonio-based show to be one of many descendants of the network’s classic ER. That means pulse-pounding trauma scenes at a public hospital emergency department (ED), romantic intrigue among the roughly seven physician characters who dominate, and an attractive major nurse character who’s not an idiot, along with a few minor nurse characters who actually talk. The major nurse character, Kenny, is a strong African-American man, continuing a recent trend–such characters have appeared on Showtime’s Nurse Jackie and short-lived shows like Combat Hospital (ABC/Global) and Miami Medical (CBS). Kenny displays some health knowledge, reports vitals and performs basic procedures. However, he also seems to know and do less than the major nurse characters on ER did. And it seems clear that the Night Shift nurses are there to carry out physician commands, fetch physicians, and convey information to physicians. The actor who plays Kenny, J.R. Lemon, observed in an interview posted on the NBC site in July 2014 that his character is like the “bartender” of the ER, not a physician but a “doctor of the heart,” deploying his interpersonal skills to help patients; Lemon also suggested that nurses run the ED, presumably in a logistical sense. But on the actual show, the physicians run the ED in every important way. In addition, consistent with Lemon’s implication that his character does not have the kind of technical knowledge physicians do, Kenny never takes the lead on a clinical case. The physicians perform the complex life-saving procedures. In fact, true to the standard Hollywood model, these nurses rarely speak to patients. Kenny’s personal skills are usually directed at the physicians, as he encourages the junior physicians, banters with more senior physicians, and helps the hospital administrator improve his online dating profile. Meanwhile, it is the physicians who educate, advocate for, and comfort patients. Although the show was canceled earlier this month, please join us in urging show creators Gabe Sachs and Jeff Judah to highlight the life-saving roles nurses really play in the ED in any future hospital programming they may do.

Click here to sign our petition or read more below…

Keeping the doctors focused and giving them room to work

The NBC website described Kenny’s role this way:

As a male nurse, Kenny keeps the doctors focused on the tasks at hand and is always at the ready. He works hard to ensure that patients get the care they need, even if it means he has to break a few rules.

OK, but note the stereotypical gender bias in the phrase “male nurse,” as if that was different from (and definitely weirder than!) “nurse,” and not something we could figure out anyway from his very male looking photo and the name “Kenny.” (We note that the physicians on the site are not described as “male physicians” or “female physicians.”) On the upside, the nurse characters’ scrubs are maroon—not a gender-identified color—and they are solid, not covered with cartoon characters or pretty flowers, so that helps them to look more like serious professionals. But the website’s descriptions of what Kenny actually does clinically are telling. They reflect no awareness that nurses have college science educations, that they do anything for patients on their own, or that they play any significant role in patient care other than to help the physicians who save lives.

The Night Shift castA number of examples from the 8-episode first season illustrate these physician-centric themes. The lead character is rebellious physician T.C. Callahan, a former combat medic who served in Afghanistan as a U.S. Army Ranger and who seems to have PTSD. At San Antonio Memorial Hospital, he works for night shift managing physician Jordan Alexander, his former girlfriend who is now with another trauma physician. The other major characters are Topher, a quirky ED physician who served with Callahan in Afghanistan; Drew, a current military physician who is also a gay man just emerging from the closet; Krista and Paul, junior ED physicians; Landry, an ED psychiatrist; and Michael Ragosa, the tough hospital administrator who oversees the ED. Besides Kenny, the nurse who emerges most often from the background is Nurse Ramos.

Mollie RamosIn the May 27, 2014 premiere and other early episodes, we get a sense of Kenny more as a social mentor of the junior physician Paul than for his clinical role. Nurse Ramos repeatedly appears to announce when victims of mass trauma and other patients will arrive—she seems to be the radio nurse. She also seems to specialize in getting physicians for other physicians. In clinical scenes, the nurses who appear tend to be passive order-takers and vital-sign reporters, the physicians commanding and expert. Unlike in real life, only the physicians generally speak with patients, and the physicians generally get patient hand-offs from paramedics with no nurse present.

Scenes in the June 17, 2014 episode, “Grace Under Fire,” illustrate the inadequacy of the clinical portrayal of Kenny. At one point, Kenny fetches supervising physician Jordan for help with a patient who has collapsed. Kenny can report that the patient’s heart rate is in the 30s, but only Jordan can discern that the patient is having a heart attack and develop a plan how to respond. It turns out that the junior physician Paul saw this patient but failed to look at her EKG, which Jordan clearly finds to have been a serious error on Paul’s part. Privately, Kenny reminds Paul that he, Kenny, had told Paul to examine the EKG. That interaction is about as close as the show comes to having Kenny act as an educator to the new physicians, and in general, it reflects the show’s tendency to set Kenny up as something like a social peer to the physicians, if not a clinical peer. In reality, experienced nurses play a key role in educating new physicians like Paul about substantive aspects of health care, helping to prevent deadly errors. However, why couldn’t Kenny relay his concerns about the EKG if Paul did not immediately react; did Kenny believe that only someone with actual skill or status should do so? Nurses have an independent responsibility to monitor patients and make decisions about their likely needs. Nurses do implement physician prescriptions and care plans, if they concur with the plans. But if they don’t concur, nurses spur the physicians to action, suggest better plans, and even take action and get physician sign-off later–flaunting rules that may require their sign-off beforehand, in order to protect patients. Experienced ED nurses like Kenny do not need Jordan to determine there is a significant heart attack in progress. And they certainly don’t need a physician to tell them that a patient is having seizures, as happened with Kenny in another scene in this episode.

Elements in later episodes also reflect the nurses’ limited roles. In the June 24 episode, after the ED is inundated with victims of a storm, the psychiatrist Landry seems to have some staffing authority, at one point directing Kenny to place a waiting patient: “Grab toga man and put him in curtain 3.” Meanwhile, Jordan seems to be in charge of triage. In real EDs, nurses decide what rooms, bays or beds to place patients in/on, and nurses do the life-and-death decision-making of triage. In the July 1 episode, Kenny and Ramos both spend a lot of screen time connecting physicians with other physicians. However, there seems to be no particular need for nurses to provide nursing care. After a busload of soldiers is injured, Kenny shoos a group of them out of an injured comrade’s room by telling them to “give the doctors room to work.” Apparently nurses don’t have important work to do. However, that same episode does have an example of Kenny’s skills–at improving the administrator Ragosa’s online dating profile! After discovering how woeful that profile is, Kenny tells Ragosa he will help, in exchange for the next two Saturdays off. (A nurse manager should be making that decision, you say? Ha ha.) The hunky, self-assured Kenny does take Ragosa through the dating profile process with some savvy advice. So nurses do have useful skills after all!

Kenny also seems to be a big brother figure to Paul. In the July 8 episode, when a stripper arrives after falling during her dance routine, Kenny advises the smitten Paul where the patient’s eyes are located, i.e., higher up than where he was looking. Paul manages to persuade the apparently recovered patient to give him a lap dance in a supply closet, but she collapses with a stroke. Kenny only half-mocks Paul as “our little virgin hero” because, as Kenny notes, had Paul not brought on the stroke with the lap dance, the stripper might have stroked out while driving. Of course, there is a hint of clinical knowledge here. And later, when Kenny is drawing blood from the stripper, he knows enough to note that it is unusually dark. Of course, it is Paul—inexperienced but still brilliant in that physician way—who figures out that it’s caused by anemia as a result of the many over-the-counter UTI medications that she earlier reported taking.

In the July 15, 2014 finale, the ED is caring for the victims of a chemical plant explosion. The psychiatrist Landry appears to be directing public relations, telling a crowd gathered to ask about victims that the ED staff are doing everything they can: “If you will just bear with us, the nurses will take down your information and we will let you know what we know.” Meanwhile, Ramos stands by silently, evidently preparing to take down information from relatives, rather than saving lives of the actual victims. But let’s be fair: At another point, we see Kenny doing chest compressions, a rare example of an active life-saving procedure by a nurse character, while the physicians discuss complex life-saving measures. However, Kenny does not do the defibrillation. A more typical Kenny action occurs when he encourages the uncertain junior physician Krista to believe that she can do an escharotomy, which she has never done before, because she’s done some “pretty badass things” recently, like remove a fork from the throat of a bulimic patient. Krista succeeds and actually thanks Kenny for his support. That’s nice in a minor way, but we wish Kenny had been able to show support to patients. Indeed, the comfort given to a dying burn victim in her last hours appears to be entirely a physician show, as several of the physician characters wait with her, arrange for a phone call from her distant mother, and so on.

On the whole, The Night Shift made more of an effort than most other current U.S. broadcast shows to present nurses as sentient beings who have something to contribute to health care. But surpassing the handmaidens of ABC’s Grey’s Anatomy and the stooges of Fox’s The Mindy Project is not really doing a lot. Please join us in urging The Night Shift’s creators to include more robust roles for nurse characters, to reflect the life-saving that real ED nurses do, in any future hospital programming they may do. And if they want some handy examples, they need look no further than some of the courageous and creative clinical moves of ED nurses Jackie Peyton and Zoey Barkow of Nurse Jackie.

Please click here to join our letter-writing campaign. Ask The Night Shift creators to show nurses doing the vital work of nursing and portray nursing more accurately.

Thank you!

 

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