Another 24 episodes of misinformation about what nurses do
May 2014 – The tenth season of ABC’s Grey’s Anatomy followed the show’s by-now-familiar model, clinically speaking: ; Surgeons gave all important hospital care and nurses were generally limited to background roles, fetching things and absorbing commands, occasionally with an obsequious “yes, doctor!” In an April 2014 episode, surgeon Meredith Grey directed a nurse to go and remind Meredith’s husband Derek, also a surgeon, to pick up their kids. The nurse happily complied. There are still no nurse characters to complement the show’s surgeon stars, who now number more than a dozen. Not surprisingly, the show’s physician nursing continued, with physician characters regularly handling things that nurses do in real life, including all patient interactions. In a couple plotlines, working nurses did briefly emerge from the background. In both cases, their main role seemed to be to present obstacles to the bright but arrogant resident Shane Ross. In one short scene, a nurse from the show’s early years named Tyler reappeared, now supposedly “in charge” of the CCU. That part was all right. But he was just as disagreeable, smug, and unconcerned about patients as ever; basically, a battle-axe. In that plotline, the bright young surgeons also had to provide nursing care, and since that seemed to amount to changing diapers, was it ever disgusting and a waste of their precious time! Oh wait, a knowledgeable, autonomous, and decent nurse character did appear in one episode—but as we have seen before on shows like this, she was a patient’s family member. We guess having the surgeons collaborate clinically with a nurse like that might be too disruptive of the Grey’s world view. On the whole, the season was another 24 episodes of misinformation about what nurses do.
Picking up the kids at day care
We’ll start with a discussion of the tenth season’s typical treatment of nursing, then focus more closely on a few occasions that nurse characters did emerge, fleetingly, from the background. But we should stress that the more summary nature of this first discussion should not obscure the fact that the marginalization of nursing discussed here plagues the vast majority of the show.
The October 10, 2013 episode captures the show’s portrayal of surgeons providing virtually all bedside care, including a lot of care that it’s difficult to imagine anyone but nurses providing. In this episode, senior surgeon Miranda Bailey plays this “physician nursing” role in providing care to her own mentor, ailing sometime chief of surgery Richard Webber, as well as a difficult nearby patient. At one point, a nurse is having trouble with Webber—who seems to be lacking the will to live—particularly in getting him to do an exercise to build lung strength. Bailey arrives and basically dismisses the nurse. The nurse departs without a word, just a flunky glad to be rid of an unpleasant task. Bailey also seems to be providing all bedside care to a bigoted white man who is dying of cancer. Bailey not only gives him the bad news but also offers hospice brochures. And she seems to be stationed near his room, stopping in often enough to decline a chess game more than once. Nurses appear mainly by reference, most notably in the patient’s expressed hopes that the “Oriental nurse” will get him a new pillow and that there will be “topless nurses” at the hospice. Bailey, who like Webber is an African-American, offers an indignant defense of “my nurses.” That wrongly implies that Bailey is in charge of the nurses, although it is better than the disdainful distancing that has been more common from the show’s female physicians. And of course she is rejecting the naughty nurse image. Finally, Bailey has an epiphany: She places the white guy and Webber in the same room, and although they have their issues, both end up with better attitudes and outlooks. All because surgeons spend lots of time thinking about how patients’ immediate environments affect their psychosocial wellbeing!
The episode that aired on March 6, 2014 included a number of clinical scenes in which nurses, when they appeared at all, where no more than peripheral assistants. Only physicians talked to patients. There was a nurse-free ambulance handoff; those are common on Grey’s. At one point a physician tells a nurse, really just a nurse-like form, to alert the OR that his patient is on the way. The response: “Right away, doctor.” Another scene with a crashing cancer patient does seem to have a couple mute nurse helpers. The patient’s sister tearfully tells physician Alex Karev that she did not wake the patient when all the machines starting beeping, as if that was her job. No one seemed aware of who is actually the first line of defense when technology gives alerts that a patient is crashing.
But the April 17, 2014 episode may be the most striking illustration of nurses’ place in the Grey’s universe. Early in that one, after Meredith Grey learns that she has pressing surgeon business, she asks a nurse at the nurse’s station: ; “Kathleen, would you find Dr. Shepherd and ask him to pick up the children at day care?” Kathleen smiles and nods, turning away to carry out this vital clinical task. Kathleen does find Derek at his office, juggling important surgeon tasks. Kathleen: ; “Dr. Shepherd? Dr. Grey wanted me to remind you to pick up the kids at day care tonight?” Derek says OK. In real life, hopefully none of this would happen, since nurses have patients to save. Unfortunately, the practice of nurses addressing physicians with the “Dr.” honorific and being called by their given names in return is sadly realistic, and it diminishes the profession of nursing. ;In fact, even some female physicians have ;released a study on how being called by their given names by male physicians impedes their careers.
Changing diapers, restarting IVs, and getting peed on
The December 12, 2013 episode features a short but interesting break in the stream of physician nursing. In one plotline, junior surgeon Shane Ross insists on operating on surgeon Alex Karev’s estranged father, who appears to be having a heart attack. Junior surgeon Leah Murphy thinks they should wait for attending surgeon Cristina Yang or some other senior physician. Ross notes that Yang is at another surgeon’s wedding, and he insists he knows what he’s doing.
Ross (addressing a nearby nurse): Ruth, clear an OR right now and prep him for a sternotomy.
Ruth (with some force): ; Dr. Ross, I don’t think so. We should wait for an attending.
Ross: You want to wait, we’ll wait! Then you can explain to the attending how this man died because you wouldn’t let me help him. Is that what you want to do?
Evidently not, because Ruth and Murphy simply buckle. It seems that Ross browbeats Ruth less with the idea that the patient would die than that she will have to confront an attending about it. Ruth does at least get a name, albeit just a given name. We also note how the pre-op practice of circulating nurses seems to be reduced to “clearing” an OR, as if all they did was haul away junk.
But in the OR, Ross runs into trouble. There is a perforation and he can’t stop the bleeding. Murphy suggests doing a bypass, but Shane insists on stitching it, because he’s seen Yang do that. A senior OR nurse says, “Doctor, bypass.” Shane yells at her: “I have it, 2-0 silk.” He tries to stop the bleeding, but he fails, becomes desperate, and starts to lose his sense of reality. Murphy quietly asks the apparent circulating nurse to call for help, from “anyone.” Finally, Murphy herself finds Webber, now recovered from his own illness. He calmly talks Ross out of the OR, then directs an effort to save the patient using bypass. The ultimate result is unclear in this episode.
So two OR nurses do make limited efforts here to stop a reckless junior surgeon from killing a patient. But they fail, seemingly because they are scared of him and/or the wrath of the attendings who may end up endorsing his view. There is no suggestion that the nurses should have fought harder or should have the power to stop surgeons like Ross–the answer must be more oversight by senior surgeons. Or maybe this is just an inevitable downside of training surgeons. In any case, in the end, nursing weakness easily overwhelms nursing advocacy.
The March 27, 2014 episode includes meditations on different futures people might have based on certain decisions and events. In one plotline, the wife of a paralyzed car crash patient is a nurse who comes off as a sentient being—she knows what a C3 (the third cervical vertebrae) is! The plotline shows us different results when this woman gets Yang to wake up her comatose husband and ask if he wants to live in his condition. In one scenario, the husband chooses to live, but flashing forward to years later, we see the nurse-wife back in the hospital and at her wits’ end, complaining to surgeon Owen Hunt that she has done everything for her husband (including being a “nursemaid”) but her husband has never even wanted it. When Owen expresses sympathy, the nurse kisses him—perhaps they have developed a relationship, since surgeons spend so much time with patients like this! That’s one of a few iffy parts, but in general the character is a good example of a kind of portrayal we’ve seen before on Grey’s and House: ; a knowledgeable, fairly self-confident nurse as patient or family member. But as ever, there is no such nurse on the hospital’s staff, which would seem to violate the natural order.
The April 3, 2014 episode features the return of Nurse Tyler, a disagreeable jerk who appeared in some episodes in the show’s early years to abuse and erect roadblocks for the junior surgeons, giving them more to struggle against and prevail over. Staff nurse Tyler was basically a resentful serf, and he never displayed any concern for patient wellbeing. This new episode is about how a flu outbreak affects the hospital; the main effect seems to be how annoying it is to the surgeons, who might get sick, or at a minimum have to observe all these crazy precautions while providing all meaningful care. Unfortunately, the plotline also suggests that the baby surgeons could and would, in a pinch, be trusted to do nursing work. Our friend Shane Ross, working for Yang, seems to be in charge of three critical young heart patients, and he wants to have them placed in the critical care unit (CCU). There, unfortunately for everyone, he encounters Tyler.
Tyler: ; You want me to put the entire unit on lockdown, because of the flu.
Tyler: ; No.
Shane: ; All due respect, Dr. Yang left me in charge.
Tyler: ; That’s cute. Listen, I’m in charge of the CCU. You’re in charge of 3 patients.
Shane: ; Three very important patients who need protection–
Tyler: ; I’m not done. You can put your patients in pod 3. Then you can institute whatever kind of lockdown makes your heart [indistinct]. I have no nurses to spare, so you’re on your own. Now I’m done. (Ross coughs because he has the flu.) You should get that looked at.
Tyler now “in charge of” the CCU! Maybe a charge nurse, or nurse manager? We can’t recall Grey’s ever before presenting a nurse as holding any position of real authority. This glancing interaction suggests, vaguely, that nurses have practical authority over hospital units. At a minimum, Tyler has authority over nurse staffing. But he abuses it, just as we would expect of the old Tyler: we see the same blind hostility, the same lack of concern for patients. So he now amounts to a battle-axe, a senior nurse abusing authority because, well, nurses having authority is just not a natural thing. It’s good that Tyler pushes back against Ross’s assumption that physicians are in charge. But does Tyler himself have any concerns about the flu—shouldn’t the CCU take some general precautions or at least awareness raising? And the idea that a modern hospital would try to care for critical patients without nurses is absurd, as is the idea that surgeons could practice nursing.
But that seems to be just what the baby surgeons end up doing. One, Stephanie Edwards, is seen changing a baby patient’s diaper, unable to get away to do surgery—a tragedy! Later, she wakes Ross and suggests that he has been faking illness to avoid the lousy nursing work. Not for the first time, the show presents nursing as scut work, effectively a punishment for baby surgeons.
Edwards: ;I have been changing diapers, restarting IVs, getting peed on. I missed out on a surgery because you’re up here sleeping off your imaginary illness.
Somehow, the kids seem to do OK. But the idea that junior surgeons would or could provide nursing care is not OK. The show seems to assume that nursing consists of simple custodial tasks that any surgeon, or maybe anyone at all, could do. We are also meant to understand what a terrible waste of talent it is for a physician to spend time nursing. In reality, nursing is a distinct health science, and no physician could provide skilled nursing care without a nursing education. Critical care nursing in particular requires complex monitoring, treatment, and interventions that can mean the difference between life and death.
After 10 years, we don’t expect a dramatic change in how Grey’s portrays nursing. All we can do is keep charting the damage and asking the producers to do better.
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