Tearing up the bureaucracy

The fall 2018 TV season offers mixed portrayals of nursing

Call the Midwife can be expected to offer a consistently good portrayal of nursing. Chicago Med and The Resident will show viewers some nursing skill, advocacy, and autonomy. But the physician-focused vision of top shows like Grey’s Anatomy and The Good Doctor, on which nurses are still handmaidens, will likely dominate another Hollywood season.

September 2018 – Most health-related shows in the new U.S. prime time season remain physician-centric. Still, several will likely convey some helpful information about nursing. So the season looks to be among the more promising in recent years. The only significant new U.S. prime time show appears to be NBC’s New Amsterdam (premiering Sept. 25). It is set at a fictional version of New York’s Bellevue Hospital, with a lead physician character who is “going to tear up the bureaucracy to create a hospital that cares.” All six major characters are physicians. But among returning shows, the BBC’s powerful Call the Midwife (early 2019) will offer an eighth season of nurse-midwives providing expert, autonomous community health care in  1960s London. Netflix’s reboot of the 1970s family sitcom One Day at a Time will be back for a third season (early 2019) featuring nurse lead character Penelope Alvarez. There is not much nursing. But Penelope, who practices in a primary care office and is studying to become a nurse practitioner, has shown knowledge and toughness in several health-oriented plotlines. Overall, though, physician-focused shows still dominate. ABC’s The Good Doctor (Sept. 24), a major new hit last year from House creator David Shore, focuses on a brilliant young physician who is on the autistic spectrum. There are five other major physician characters, but no nurses. Along similar lines, ABC’s Grey’s Anatomy (Sept. 27) returns for a 15^th season with a dozen sexy, brilliant surgeons doing everything that matters–including the nursing–with a few appearances by meek handmaiden nurses. NBC’s Chicago Med (Sept. 26) is mainly about six physicians, although it has two competent emergency (ED) nurse characters who actually think and talk (sometimes to each other!). Plus, a hospital executive who is a nurse heads up the trauma center. Fox’s The Resident (Sept. 24) returns for a second season focusing on the exploits of a rebellious Atlanta hospital resident and his rebellious young physician colleagues, but also the remarkable nurse practitioner Nicolette Nevin, the resident’s main clinical ally. She displays skill, advocacy, and some autonomy. Sadly, the show’s other nurse characters are mostly handmaidens. Other returning shows, like the U.K.’s The Good Karma Hospital and the Australian The Heart Guy (a.k.a. Doctor Doctor) (both available in the U.S. on Acorn), will continue to offer physician-centric visions in which nurses tend to play only minor clinical roles. Given the imbalance, please join us in encouraging better portrayals of modern nursing!

New Shows

New Amsterdam (NBC)

Returning shows

Call the Midwife (BBC/PBS)

One Day at a Time (Netflix)

The Good Doctor (ABC)

Grey’s Anatomy (ABC)

Chicago Med (NBC)

The Resident (Fox)

Conclusion

Take Action!

 

New shows

New Amsterdam

The only significant new U.S. prime time show appears to be NBC’s New Amsterdam, set at a fictional version of Bellevue, New York’s legendary public hospital. NBC promotion says that lead physician character Max Goodwin, as medical director, is “going to tear up the bureaucracy to create a hospital that cares.” And previews suggest that he will spend a lot of time haranguing colleagues to stop worrying so much about rules, money, and self-promotion. It seems that instead, he wants them to provide holistic nursing care, especially psychosocial care! Sadly, though, it appears that the show will have only physician characters doing it, consistent with the Hollywood model. (When physicians adopt nursing ideas–in fiction or real life–they become miraculous medical breakthroughs!) Max Goodwin also seems to have a hidden illness. All that makes it seem like the show may be a gritty East Coast version of CBS’s Pure Genius (2016-2017), whose lone season also featured an idealistic outsider hospital leader out to revolutionize care delivery, albeit from the whiz-kid tech billionaire perspective. Anyway, as with Pure Genius, there is nothing innovative about New Amsterdam’s dramatic structure, since all six major characters are physicians and previews provide no reason to think nurse characters will be more than peripheral subordinates.

For more information on New Amsterdam, see the show’s website.

  

Returning shows

Call the Midwife

The BBC’s Call the Midwife (airing on PBS in the U.S.) returns for a Christmas special in December 2018 and an eighth season in early 2019. The drama follows the exploits of community-based nurse-midwives caring for poor women and others in London in the 1960s. We count roughly 10 major nurse characters (!), but the show does not pretend only nurses provide care; one of the nurses is married to a kind, skilled community physician who plays a critical role in some plotlines. In its first seven seasons, the show has generally presented the midwives as expert and autonomous community health workers. Their 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, often confronting the effects of larger social problems. The midwives also provide critical community-based care well beyond midwifery. In the seventh season premiere, for example, nurse Phyllis Crane provides great psychosocial care for an older woman with cancer whose flat is in the midst of a major council demolition project, advocating to keep the project at bay until the patient can die in peace. Meanwhile, nurse Trixie Franklin and new midwife Lucy Anderson expertly handle a breech delivery and Rhesus blood complications for a young single mother who is desperate to escape her job as an exotic dancer.

See our webpage featuring analyses of the show over previous seasons, or see the show’s website, where you can find episodes.

One Day at a Time

This Netflix reboot of the pioneering 1970s Norman Lear sitcom about a single mother will be back in early 2019 with a third season featuring nurse lead character Penelope Alvarez and her family in East Los Angeles. Alavarez is a Cuban-American military veteran who served as a nurse with the U.S. Army in Afghanistan, where she was wounded. Now, she practices in a goofy older physician’s primary care office and is studying to become a nurse practitioner. Penelope struggles as a single mother with two school-aged kids and depression linked to her wartime experience. The show is mainly a traditional home-based sitcom exploring social issues, so health-care does not usually take center stage. Still, episodes in the first two seasons have shown Penelope doing some patient education and advocacy. In episode 2 of the first season, she pushed to have her ideas for better office care systems taken seriously by her male physician employer (with whom she has a generally strong, respectful relationship). In the season 2 finale, Penelope explained to her family about her mother’s condition after a stroke and advocated for her mother with a hospital nurse whose skills seemed marginal. The NP element has been mixed. Penelope’s struggles with the course work (especially in episode 2 of the second season) indicate that NPs have to learn difficult material like biology. However, Penelope has also complained about that course content as if she doesn’t understand why she has to learn it, also suggesting she didn’t have to learn any to become the RN she is now. And the show has failed to really make clear that this would be a graduate program and that Penelope would already need to have an undergraduate degree in nursing. The show has implied that this is her first college experience. Penelope is generally portrayed as a tough, committed, and knowledgeable nurse. But those benefits are undermined to some extent by the limits of her practice at the outpatient office and by the show’s undervaluation of nursing education.

See the Netflix site for One Day at a Time for more information about the show.

The Good Doctor

ABC’s new hit The Good Doctor, back for a second season, showcases the physician-centric vision of hospital care we would expect from House creator David Shore. The show focuses on Shaun Murphy, a brilliant young surgeon with autism and savant syndrome. That status seems to enable him to perform amazing medical feats, but it also presents daunting social challenges. Six of the show’s eight main characters are physicians, none are nurses, and in the great majority of clinical scenes, nurses do not even appear. When they do, it is typically as meek assistants. The nurses receive commands from the physicians or silently complete basic tasks, like handing the physicians things during codes. In a couple episodes early in the first season, nurse characters do emerge from the background to play minor roles that underline Murphy’s unique situation. In episode 2, an attending surgeon assigns an experienced nurse to supervise the clueless new Murphy for the day, as Murphy performs what the show regards as scut work. At one point this nurse says that physicians rarely listen to nurses. But the show never really tells us why they should. Indeed, this nurse is an obstructive battle-axe who focuses on protocols and throughput but shows little real interest in helping patients. In episode 6, a veteran emergency nurse delivers a few authoritative-sounding lines in preparing for a mass casualty event. But The Good Doctor soon outgrew these nods in the nursing direction. The last two-thirds of the season showed physician characters delivering all the care that mattered, including patient interactions, while nurses appeared, occasionally, as low-skilled helpers. We anticipate more of the same.

For more information, see The Good Doctor’s ABC website.

Grey’s Anatomy

Name every Grey’s Anatomy doctor? Yes we can! This month ABC’s Grey’s Anatomy begins airing its 15th season, and as always, it will feature about a dozen regular characters, every one a surgeon. Consistent with that lineup, the show continues to reinforce the idea that only physicians matter in health care. Over the years, nurse characters have appeared on Grey’s, usually embodying stereotypes, particularly the helpless handmaiden and the bureaucratic battleaxe. In the 14^thseason, physicians often provided all bedside care. That  includes things nurses would do in real life, not just exciting procedures like defibrillation but also patient monitoring, psychosocial care, and even wound care. Anonymous nurses did at times appear in the background to provide color or absorb physician commands, perhaps with an obsequious “right away, doctor!” Once in a great while they displayed knowledge, but almost always in an assistive role. In the 20^thepisode, one nameless nurse was high-functioning and assertive in requesting physician help with a coding patient, but she was also somewhat panicky and unable to do much more herself than report symptoms. The only notable nurse appearance of the season came in episode 21, in which Nurse Olivia returned from the show’s early years to get treatment for her injured son, displaying some health knowledge. In a 2005 episode, then-surgical resident Alex Karev had cheated on his then-girlfriend with Olivia, giving Olivia syphillis, although as she relates here in a calm but pointed way, she was the one labeled “skanky syph nurse.” The new plotline gave the show a chance to show how Karev had evolved into a more decent guy over the years. But it also at least suggested that maybe that old plotline was not so great for nurses, that maybe they are not just disposable physician groupies. But then, like all Grey’s nurse characters, Olivia was disposed of. And the coming season promises more of the usual disrespect, especially since there is still no sign of any major nurse character.

For more information see our Grey’s Anatomy page with analyses over the years or the show’s website on ABC.

Chicago Med

NBC’s Chicago Med, which returns for a fourth season, is probably the best of the current U.S. network hospital shows for nursing. The show is dominated by about six physician characters, and many scenes do suggest that nurses are mainly there to assist them. But the nurses regularly display skill and knowledge, with limited obsequiousness. And three nurse characters (right), all women of color, get significant screen time. April Sexton, a young ED nurse, is solid in the clinical setting. She does not just report vital signs but also displays knowledge and interacts with patients, although the show probably spends more time on her romantic life and other personal issues. In episode 8 of the third season, she had a nice insight about how a patient contracted a superbug. Occasionally, April pushes back when disagrees with a physician care plan, although sometimes her perspective seems to be a limited, emotional one. In season 3 episode 3, April did that with physician Ethan Choi, her boyfriend, who wanted more aggressive treatment of a longtime patient. April pointed out that the patients were as much hers as his! (It has been extremely rare for Hollywood shows to even hint that this may be the case.) But Choi’s broader clinical understanding seemed to prevail. The show seems to portray the more senior Maggie Lockwood as a permanent charge nurse, and she runs the ED, logistically. In episode 14, she successfully did a cricothyrotomy when no physician was available. Both of these characters are serious, skilled assistants to the physicians, in the ER mode. The third nurse is hospital executive Sharon Goodwin, who has overall responsibility for the trauma center. She is wise and tough, not a battle-axe. In episode 20, she was the public voice of the hospital with regard to a cutting-edge conjoined twin separation. Goodwin struggles to balance her financial responsibilities with good care. Episode 6 had Goodwin and Lockwood confronting nurse short-staffing driven by the hospital’s limited budget. All three nurses seem to be personal friends with the physicians, something that would be unthinkable on a show like Grey’s Anatomy. Of course, Chicago Med’s structure still generally indicates that physician skills and actions matter most.

For more information see the Chicago Med page on the NBC website.

The Resident

This Fox hospital drama will offer a second season of exploits from renegade senior resident Conrad Hawkins, who also displays an interest in tearing up the bureaucracy to create a hospital that cares. Specifically, he breaks rules in order to save lives despite being surrounded by powerful corrupt forces (mainly the senior physicians) at an Atlanta hospital. All major characters are physicians, except for nurse practitioner Nicolette Nevin, arguably the best single nurse character now on U.S. television. Nic is a sometime love interest of Conrad’s. But she is also his chief clinical ally, and she regularly displays intellect, skill, autonomy, and patient advocacy. In season 1 episode 2, she advises a new resident not to rely on an EKG reading but to use a stethoscope, advice that is validated when he discovers a heart murmur. That same episode includes a scene in which two physicians discuss why the gifted Nic is not a physician. Reasons range from the plausible (nurses spend more time with patients) to the ridiculous (NPs earn more money than resident physicians, as if NPs think the first three years of salary is all that matters). Nic is, evidently, pursuing a doctorate in nursing. Yet her name tag reads “BSN, NP,” when an NP today would likely need at least a master’s degree to be practicing. In episode 3, Nic outwits and defeats a medical billing expert who has recklessly pushed for an MRI test that could threaten a patient. And one major season-long plotline involves Nic pursuing a powerful research oncologist who seems to be committing insurance fraud through egregious overtreatment of her patients, with career-threatening results for Nic. On the other hand, Nic often seems to be basically a skilled aide-de-camp to Conrad. Her quasi-physician role also seems to give her the right to boss meek staff nurses around. And that points to the show’s main problem. Nurses other than Nic rarely speak and mostly seem like little more than peripheral subordinates, suggesting that Nic has risen above the nursing profession by becoming more like a physician. There is a limited exception in episode 4, which shows that ED nurse triage skills matter by contrasting a respected veteran nurse with a clueless neophyte. The Nic character presents some very helpful features, but most of the other depictions of nursing are no better than those on The Good Doctor.

For more information see The Resident’s page on the Fox website.

Conclusion

The ongoing physician-centric narrative of much U.S. prime time television is exemplified by shows like Grey’s Anatomy and The Good Doctor. In fairness, shows like Chicago Med and The Resident do offer some substantial examples of nursing skill, advocacy, and autonomy. However, for most Hollywood shows, handmaiden portrayals remain the norm, and only the amazing Call the Midwife can be expected to offer a consistently good portrayal of nursing—in the 1960s.

Take Action!

With all these shows, we need your help! Please first sign all our petitions, speak to show creators, and consult our Take Action page for more ideas. Since we cannot monitor the world’s media by ourselves, please watch one or more of the shows with a nursing element and let us know if you see a good or bad portrayal at info@truthaboutnursing.org. If we all work on a piece of the puzzle, we can build a society that respects nursing in line with its true worth, helping to strengthen the profession so nurses can deliver better patient care.

See all of our Fall TV previews over the years here.