The Night Shift‘s third season
October 2017 – Now that NBC’s summer hospital drama The Night Shift has aired its fourth and final season, let’s take a look back at the third season, from summer 2016. A descendant of the network’s classic ER, the show featured intense trauma scenes at a San Antonio public hospital emergency department (ED), romantic intrigue among the physician characters who dominated, and in Kenny Fournette, an attractive major nurse character who was not an idiot, along with a few minor nurse characters who actually talked. Kenny is strong, athletic, and socially adept. He displays some health knowledge, reporting vitals and performing basic procedures. And as an African-American man, he sends a good message about nursing diversity. But it seems clear that The Night Shift nurses are mostly there to carry out physician commands. In general, the physicians run the ED, perform the complex life-saving procedures, and provide the patient advocacy and support. They also do some physician nursing, handling tasks that nurses are more likely to do in real life. Kenny’s care plotlines have tended to be the least emergent ones. And in the third season there was a distinct focus on his enterprises outside of nursing—life coaching, personal training, gym ownership—as if nursing wasn’t enough to sustain his professional (or our dramatic) interest. Other nurse characters, particular a senior one named Molly Ramos, did get a few substantive lines, but on most occasions the nurses were merely assistive. A July 2016 episode included a nurses strike, and that plotline made a few good points in passing, including that nurses are often understaffed. However, it was pretty perfunctory, with generic statements from physicians about the nurses’ value. The physicians seemed to miss the striking nurses more for their knowledge of where equipment and supplies were, rather than for the nurses’ health care skills. Although the plotline managed to avoid directly suggesting the nurses reported to physicians, it was never quite clear who the “management” the nurses were negotiating with was—no nurse manager appeared. 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-related programming they may do.
The real bosses
The Night Shift is dominated by physician characters. So in the third season clinical scenes that did not involve Kenny, which is to say the great majority, nurses tended to be absent or passive assistants. Often, they did not even speak, or perhaps they simply acknowledged a physician command (“yes, doctor!”) or called out a vital sign. There were nurse-free patient admissions. When nurse characters did speak to physicians, it was often just to relay general information about arriving patients or where other physicians were. Nurses also spoke to patients, although not with much health expertise. In a typical scene, they would direct family members to the waiting area. But the nurses other than Kenny were rarely more than helpers and commenters on the main action.
One minor subplot in a July 2016 episode was actually a nurses strike. An early scene showed the ED physician Drew wheeling a young female patient through the parking lot in a wheelchair (a good example of physician nursing, since we have rarely seen that in real life). Soon, we saw pickets and nurses in street clothes, holding signs with slogans like “No Nurses No Care,” “Healthy Pay for Nurses,” and “Our Wage$ Would Make You Sick.” As Drew and the patient went past, the patient asked the senior nurse Molly why they were wearing the street clothes. Molly handed the patient a leaflet: “We are on strike, honey.” Another nurse: “The hospital promised us raises three years ago and still hasn’t followed through.” Another: “And they always have us working short-handed.” The patient asked Drew if he had anything to do with all that.
Drew: I do not, Ma’am, no way. In fact, they [the nurses] are the real bosses, don’t forget that. [To the nurses.] We’re all on your side, so good luck.
Several nurses thanked Drew as he wheeled the patient past. But another physician named Topher (right), who seemed to have some management authority, did not have such good relations. Topher arrived and informed Molly that she could catch more flies with honey. She was not impressed. Topher asked Molly where the EKG paper and hand-held urinals were. Another nurse said, “Ask the scabs you called in to replace us.” Topher complained that only two scabs showed up, and he tried to bond by saying that they were all getting screwed by the hospital. Molly: “Some of us are getting screwed just a little bit more.” Topher said it was the patients who were getting screwed now. Molly: “You’re really going to go there? You’re going to put that on us? You need to take those hand-held urinals, and shove them straight up your—“ Topher left.
Inside, physicians were trying to cope without nurses. But again it seemed to mainly be about not knowing the location of equipment and supplies, rather than a lack of nursing knowledge, skills and acts of life-saving. Kenny, for his part, had been chosen in a previous episode as “union liaison” at a meeting of nurses because he failed to show up for it, which was not exactly a great image of the value of nurses advocating for the profession. He appeared at the hospital despite the strike, but he did so as a friend to a high school soccer player he was mentoring, who he said could not be left to the “scab” nurses. While there, he did have time to tell physicians where the EKG paper was. The physician Jordan, carrying lots of supplies, told Kenny they needed the nurses back. He advised her to tell “management.” Topher: “We did, management’s taking their own sweet time with negotiations.”
These early scenes suggested vaguely that modern nurses have legitimate grievances, including understaffing and inadequate pay. But they also presented nurses as helpers who mostly keep track of logistical matters. And some elements implied that physicians have something to do with nurse staffing. Those include Topher’s management status, the comments about scabs, and even Drew’s statement that the nurses were the “real bosses”—which is actually something a person might say about people who are just the opposite, as a blundering way to express appreciation. Of course, nurses are not asking to be or be perceived as the “bosses” of physicians. They do want recognition of their own professional autonomy. But no nurse executive ever appeared, leaving the identity of the “management,” with whom the nurses were negotiating, unclear.
The nurses were not out for the whole episode. The health crisis of the week was that a former patient with a grudge had brought an anthrax bomb that exploded near the hospital entrance, injuring many. There was a certain amount of chaos as emergency responders tried to control the scene. The nurses eventually managed to get back into the hospital to help. Topher and Drew were having trouble controlling some frustrated patients and family. But nurse Molly appeared and began informing family members about where patients had been evacuated. Another nurse character: “The strike can shove it on a day like this.” Molly told Topher to get back to the patients: “Everybody else, listen up, we’re going to tell you what’s happening.” Another nurse approached Drew and Shannon: “What can I do for you guys?” Drew was thrilled, requesting a tetanus shot for one patient. Eventually the anthrax was contained. Near the end, Kenny got a call: The nurses had gotten a pay raise and the strike was over.
We appreciate the show’s limited effort to highlight nurses’ real concerns about their working conditions. But it was pretty nominal, and the staffing issue was never really explored, or, apparently, resolved. Perhaps management thought it was a straw issue nurses didn’t really care about–they were really only in it for the money? The scenes in which the nurses reappeared did reaffirm their commitment to patients rather than money, and Molly’s role did suggest some of the role real nurses play in keeping families informed. But the scenes also suggesting that nurses need physicians to tell them what to do—the nurses could at least have started with initial nursing assessments and then asked more specific clinical questions. “What can I do for you guys?” wrongly suggests the nurses work for the physicians, rather than patients. And we never really did see the nurses do much that suggested more skill than shot-giving and giving families basic information.
The life coach
Kenny is confident, articulate, savvy, and reasonably skilled, as he calls out vital signs, does basic care tasks, and displays some health knowledge. He interacts with the physician characters and occasionally even patients, showing good psychosocial skills. Kenny is something of a romantic player—actually he is a former football player—even advising some physicians on their romantic activities. Kenny does often play an assistive role, and he tends to be on the less knowledgeable side on clinical issues. In a June 2016 episode, the ED treated a white patient charged with murdering a black youth. Kenny, understandably suspicious, was convinced the patient was faking illness in order to delay his court proceeding, an idea some of the data supported. But the patient turned out to have a serious problem, as the physician Jordan suspected.
Unfortunately, the show puts so much emphasis on Kenny’s extracurricular talents and activities that it often seems they matter more than his nursing. In a couple June 2016 episodes, Kenny acted as a mentor / cheerleader for the professional goals of a paramedic he was dating. This paramedic wanted to become an attorney so she could try to help some of the domestic violence victims she was seeing earlier in the process. Eventually she was admitted to a good school. But Kenny could not travel with her to help her settle in because he was opening a gym that week! In another June episode, Kenny persuaded the somewhat hapless physician Topher to let Kenny act as Topher’s life coach, a role that has at least some relation to nursing. Kenny was strict about Topher taking the stairs and not consuming bad food. Topher took evasive actions and seemed ready to give up. But by the end, he was running around a track with hunky lead physician TC Callahan, a success for Kenny, we guess. In another June episode, Kenny admitted that his childhood dream was to play pro football, although he also said he loved being a nurse.
Perhaps Kenny’s most substantial mentoring relationship has been with the younger physician Paul, who is, like Kenny, African-American. This has ranged from a lot of advice about women to enlightenment about the situation of African-Americans less advantaged than Paul, who comes from a wealthy background. It has even, at times, had clinical elements. In one June 2016 episode, the resident physician Shannon Rivera consulted Kenny rather than Paul on how to deal with a clinical issue. But Paul resented this because he was trying to impress Rivera, in whom he had a romantic interest, and his comments to Kenny about it showed contempt for nursing. The show never made clear who was correct clinically, but Kenny characteristically got the upper hand in social terms. Later in the episode, Kenny paged Paul for a consult on a patient who supposedly had massive cranial swelling. But it turned out to be a large inflated green balloon with a photo of Paul stuck to it. Kenny had gathered other nurses to watch as he facetiously asked Paul: “Can you explain that, doctor? Because we lowly nurses sure as hell can’t.” Paul had nothing. Later, in an effort at revenge, Paul tried to play Kenny by putting a “kick me” sign on his back, but Kenny was immediately wise to it and dismissed him: “Amateur.”
The July 2016 episode with the bombing and the nurses strike illustrated both the primacy of Kenny’s mentoring and the secondary role of his nursing on the show. Kenny was there despite the strike to help a patient named Lauren, a high school soccer star he had been training. Lauren had come to the hospital because of a general feeling of illness, which caused special concern because a college recruiter was coming to watch her play the following week. But the bomb badly damaged her leg. The physician TC had to tell Kenny that the leg was hemorrhaging and that they needed a tourniquet. Then he sent Kenny for morphine and a gurney. Kenny stayed with Lauren as she went to a surgery, despite an injury to his own shoulder. At one point, Kenny did manage to report that her “white count’s over 20,000” and that her temperature had climbed to 105. The surgeon Scott discovered that Lauren was septic and wondered if she was immuno-compromised. Kenny noted that that would explain her pneumonia and why she had felt so sick for the last few weeks. Scott ultimately found a mass on a scan; Lauren had lung cancer. Although her prognosis was good, elite soccer did not seem to be likely. Kenny told her he was sorry he had brought her in that day, in view of the injury. But Lauren noted that if he had not been there, she would not have known about the tumor in her lung. And she confided that she did not want to be a pro athlete as much as he had anyway! But she felt bad that her college dream seemed to be over. Not so, Kenny argued: With her hard work, plus today’s story as the college essay and a great recommendation from him, she’d still get a scholarship. This plotline was a mixed bag for nursing. Kenny did display some health knowledge and strength under pressure, but he also needed to be told some basic things and acted mainly as an assistant to the physicians.
In the final episodes of the season, from August 2016, viewers learned that Kenny had a substantial debt to some scary characters, apparently because of flooding damage to his gym. A loan shark came to the hospital and threatened Kenny if he failed to pay. In the finale, Paul’s wealthy father actually bought the hospital, saving it from closure, but he also fired Topher for not being business-minded enough. Other ED staff resigned in protest, including Paul and Kenny, who told Paul’s father to “add another ER department” to his to-do list. That would have been more powerful if Kenny had not effectively used the redundant phrase “room department.” And outside in the parking lot, Kenny’s fearsome loan sharks were waiting, as the season ended.
On balance, in the third season Kenny and the other Night Shift nurses were valued team members with some health knowledge and other positive attributes. But the physician characters were the ones with real authority and expertise, and they dominated the show, consistent with the prevailing Hollywood vision of hospital care. Please join us in urging the show’s creators to include more robust roles for the other nurse characters, to reflect the life-saving that real ED nurses do, in any future hospital-related programming they may do. Click here to sign our letter or you can use our form to send a letter of your own. Thank you!