Director: Carolyn Jones
Producers: Carolyn Jones and Lisa Frank
Not rated by MPAA
The American Nurse opens nationwide today!
The American Nurse is a fine feature-length documentary about five nurses from director Carolyn Jones’s 2012 book of portraits with the same name. The nurses, three women and two men, work in varied settings: a home health nurse in Appalachia, a prison nurse in Louisiana, a nun at a nursing home in Wisconsin, a military nurse working with veterans in San Diego, and a labor and delivery nurse at Johns Hopkins. The movie consists mainly of commentary from the nurses and footage of them in clinical interactions, particularly end-of-life care. It has a quiet, restrained power, reflecting the evident strength and dignity of the nurses and the moral gravity of their work. Without fanfare, Jones reveals that nurses today do far more for patients than would be expected under the traditional conception of nurses as smiley hand-holders. And the film is extraordinarily good at conveying nursing autonomy, without saying anything about it directly. These nurses come off as strong, committed people who are thinking holistically and making their own decisions; there is no suggestion here that nursing is about following physician orders. The nurses are articulate in describing how they got into the profession, what they do for patients in a basic sense, and what it takes to keep doing it. And the film highlights their psychosocial care, while avoiding the angel stereotype. Sadly, there is far less to show that the nurses have advanced physiological skills and virtually nothing about their nursing educations, although the film does reveal that at least some of the nurses were academically adrift in high school. And despite the diversity of care settings, the film’s focus is a bit narrow for one called The American Nurse. These are all direct care nurses. There are no advanced practice nurses, nurse managers, or union activists, and there is little or nothing about nursing research, innovation, or policy leadership, the profession’s history or care model, or its recent challenges. It’s a collection of personal stories, and no one says much about “nursing.” Still, the film is an engaging, affecting look at how modern nurses can improve lives.
The American Nurse begins with imagery of nurses from many decades ago. In voiceover, Jones explains that before, she never considered whether nurses did anything more than smile and hold people’s hands. Then she got breast cancer, and she discovered that it is the nurses who really get patients through ordeals like that. The rest of the film shows that nurses do far more for patients than their traditional image suggests. It is worth noting that the film, like the book, is part of the American Nurse Project, which is financed in large part by Fresenius Kabi, a major drug company. But while the film does avoid conflict and aims to be uplifting, Jones is not interested in the kind of gooey angel imagery that has infected some efforts by another drug company to promote nursing.
The film moves quickly to the five nurses, alternating segments about each for the remainder of its run time, with no further explanation from the director. Each of the five nurses is briefly identified by name and nursing specialty, but not specific job titles or credentials.
Jason Short is the son of a Kentucky auto mechanic who did some of that work himself, as well as truck driving, before he decided on nursing. Short gives home health care. We see him visit patients in remote areas, at one point driving his vehicle up a small river to access his patient, and doing some hands-on care. He speaks with families frankly but with sensitivity. Short is one of the nurses who notes that he did poorly in high school; viewers do not hear about his eventual nursing education. They do get some sense of what nursing in his Appalachian community means to him now. In his brief statement in the 2012 American Nurse book, Short said that “once you get a taste for helping people, it’s kind of addictive.”
Tonia Faust is a nurse at Louisiana’s state penitentiary at Angola, a maximum security facility where her mother previously worked as a guard. Faust says that she is the prison’s hospice coordinator, and we see her provide some care to the inmates, although we do not get too much explanation of the range of conditions she sees or what she does specifically to address them. We do hear about how Faust meets the challenge of caring for inmates who have done terrible things. And the film spends a lot of time with one inmate, part of a group who help Faust care for other inmates when they are dying, which seems like a good community health intervention.
Brian McMillion works with veterans in the San Diego area. He explains that much of his work involves visiting veterans and their families at their homes, helping them with post-traumatic stress disorder and other issues. McMillion was also one of the nurses profiled in a very good 2012 PBS television report about nurses working out of the large Veterans Administration hospital in San Diego, and he is a strong, engaging representative of that work. Here McMillion suggests that after high school, he was adrift. So his father told him that he could either go to college or enlist in the military, but that he was not ready for college. So evidently the military was it. McMillion indicates that his work visiting patients around San Diego has taken a toll on his personal life, evidently causing him to lose a relationship, although he does not get specific.
Sister Stephen Bloesl practices at the Villa Loretta Nursing Home in Wisconsin. Sister Stephen’s approach to geriatric care includes extensive interactions with animals, and she has over the years collected what resembles a petting zoo at the nursing home. Evidently this provides animal therapy to the patients and attracts their families, encouraging contact with loved ones. Although the segments with Sister Stephen focus on the emotional support she provides, the film does not really offer much angel imagery or try to merge nursing and Christianity as a general matter. It’s clear that Sister Stephen has some authority; if you look very closely, you can see that her name tag reads “director of nursing services.” But the film does not really make anything of that.
The last nurse profiled is Naomi Cross, a labor & delivery nurse at Johns Hopkins in Baltimore whose work draws on some tragic personal experience. Perhaps not surprisingly, Cross’s clinical segments at the hospital include more indications of advanced physiological skills than others in the film. For instance, we briefly see her giving report to a colleague in highly technical terms. And the film makes clear how much her work means to appreciative parents. But even in these segments, a good deal of the time is spent on why Cross got into nursing, as well as comments from her family about the emotional strain of nursing and what her work means to them.
Perhaps the best thing about the film’s portrayal of nursing is its vision of nurses as autonomous health workers helping patients in tangible ways. In the vast majority of the clinical scenes, the featured nurse is working on his or her own, interacting with patients and family members, or explaining some aspect of the work, at least in basic terms. There is no suggestion that the nurses are simply following physician care plans. Of course, no doubt the nurses’ work does involve collaboration with physicians, and physicians do appear in a few of the L&D scenes, but in general the film simply focuses on what the nurses are doing.
And what they are doing is not fluffing pillows, but providing direct care–examining patients, giving medications, providing other treatments, confronting death, speaking with patients and families about their conditions. These interactions demonstrate good psychosocial care and the nursing profession’s holistic focus. The scenes with Short, McMillion, and Sister Stephen make especially clear that they view the patients and families as connected and within the scope of their care. Sister Stephen’s animal therapy idea seems like a good one, as does Faust’s inmate-assisted hospice program. The nurses are articulate in describing their care and their backgrounds. And there are very few vague, sentimental comments about what a privilege it is to be a nurse, how great it is to hold hands and give comfort in time of need, and so on–the statements that nurses have traditionally been socialized to embrace and repeat in efforts to distinguish nursing from professions that get more respect and resources. We see that the work these nurses do is worthwhile and fulfilling, and they don’t need platitudes to pump it up.
More emphasis on nurses’ advanced health skills–which the public really needs to learn more about–would have been helpful. And in a related vein, perhaps the weakest parts of the film are the suggestions that neither Short nor McMillion were ready to continue their educations after high school. Of course there is nothing wrong with that by itself, but the film never really closes the loop about what education they eventually got to become nurses. And none of the other segments makes clear what education is required either. With no significant explanation of nursing education, limited inclusion of technical specifics, and no mention of nursing leaders, viewers may be left with the impression that nurses are people with strength, common sense, and interpersonal skills, and maybe some technical knowledge they picked up on the job, but not professionals with college science degrees. The nurses’ own tendency to translate what they are doing into simple terms that lay people can understand–a great virtue in clinical settings, so patients and families actually know what is going on–can work against them in media like this, subtly reinforcing the sense that they are not doing anything very complex. And the film poster’s tagline, “Inside the Nation’s Most Trusted Profession,” is certainly consistent with the idea that nurses are awesome people but not necessarily health experts.
It seems likely that Carolyn Jones (right) chose these five nurses in part because they work in very diverse settings. That allows her to show that nurses make contributions and find interesting work in widely varying ways, from the cradle to the grave, a point that will not be lost on career seekers. The decision to stay mostly outside the hospital may also have been an effort to locate nurses in more clearly autonomous settings. Perhaps Jones feared that physicians and excessive deference to them would intrude in environments in which they play a larger role, as often occurs when the media visits hospitals. Indeed, in a scene in which Cross participates in a C-section, introductions of the team handling the procedure involve calling the physicians “Dr. _____” but simply identifying the nurses by their given names and surnames. But a potential drawback of minimizing the use of hospital settings is that it appears to mean fewer immediate life-and-death situations and high-tech elements, which might have featured prominently in portrayals of critical care nurses.
The film offers an unusually strong focus on community health and end-of-life care, which is a major part of what viewers see Faust, Short, and Sister Stephen do. That focus is admirable and appropriate since those are such important parts of what nurses do, though again it may not offer as many opportunities for nurses to showcase skills that viewers will see as advanced. The psychosocial skills on display in these segments, and in McMillion’s work with veterans, can be mistaken for simply being kind and sensitive. In addition, since viewers don’t really get to know any of the patients very well, the drama may be too subtle to engage some of them.
Two of the five nurses are men. That proportion is about 300% more men than are actually present in nursing today, but it does send a helpful message to viewers about what the future of nursing could look like. Both of the men in the film have backgrounds with traditionally masculine elements (the military, auto mechanics, truck driving), which counters stereotypes about men in nursing, though neither of the men makes much of the gender imbalance in the profession. In addition, a film representative has informed us that Naomi Cross and Brian McMillion have Hispanic backgrounds, although it is unclear whether many of the film’s viewers will be able to discern those backgrounds. The book The American Nursealso included minority nurses, such as New Orleans family nurse practitioner Deborah Nettles (right).
In the end, the decision to focus on these five nurses is an effective one, allowing the nurses to show and tell some important things about their work and their lives. They are flesh and blood, not abstractions or advocacy vehicles. There are even hints of the stresses under which the nurses operate. McMillion makes a reference to a lost relationship and Cross’s husband notes that it can be difficult for nurses to share their work with family. Of course, the film doesn’t want to be intrusive, edgy, or critical–there is no mention of issues like understaffing, mandation, whistleblower protection, or compassion fatigue–and so those themes are not developed.
The American Nurse is a thoughtful, interesting, and at times moving effort to give the public a fuller sense of who modern nurses are and what they do for patients. Everyone should see it.
Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed May 2, 2014
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.