Nurses remain silent and submissive on 15th straight season of Grey’s Anatomy
The ABC drama continued to offer a vision of hospital care in which surgeons did everything that mattered, at one point even providing all care for a sexual assault victim. There was a brief appearance by the assertive senior nurse Frankie, but she was mostly there to die tragically in childbirth, despite the heroics of the surgeons.
May 2019 – The 15th season of Grey’s Anatomy again told viewers that surgeons do everything that matters in the hospital, including exciting tasks that nurses do in real life. Meanwhile, the few nurse characters who did appear tended to be meek, peripheral helpers who had to be told what to do and who rarely spoke at all. In fact, a good way to tell at a glance whether a Grey’s character is a physician or a nurse is simply to ask: Is the character talking? Physicians alone defibrillate, physicians alone meet ambulances, physicians alone provide psychosocial care and patient education. In one priceless episode (episode 19), three female surgeons—surgeons—alone basically handled all the care for a sexual assault victim, including psychosocial care and forensic procedures. At a real major city hospital, this care would have been led by a sexual assault forensic examiner (SAFE) nurse. Two of the season’s 25 episodes did feature appearances by the cranky veteran Nurse Frankie. Frankie was apparently competent—she was a favorite of senior surgeon Richard Webber — but her main role was as a dying patient. Of course, this is a common way for physician-centric shows to involve nurse characters: not for their nursing — because how could fetching things make good drama — but as patients, family, or friends. Here, other nurse characters actually got a little attention as Frankie’s support system. Not that that attention was helpful: The other nurses were a motley crew of touchy, oddball serfs rather than anything resembling serious professionals. And the plotline reinforced other stereotypes, with a brief angel-oriented tribute to nursing by Webber, as well as clear indications that he had hired Frankie and could fire her if he wanted, continuing the show’s long assault on nursing autonomy. It’s hard to say whether giving nurses attention like this does any more good than the show’s usual approach of having the physician characters do the nursing and pretending that nurses are too peripheral even to appear onscreen. Shonda Rhimes created Grey’s Anatomy.
A killer job
For the vast majority of the season, nurses were no more than background color, forearms holding things for the surgeons, anonymous sheep bleating “yes, doctor!” Nurses did at times appear to give the important physicians phone messages or to call physicians to the phone, as in episodes 22 and 23. But only physicians could defibrillate, as in episode 2. Physicians often met ambulances by themselves, as in episode 1. That episode also suggested that an intensive care unit is one in which patients lie unconscious in bed, alone, while surgeons gaze at them through a glass wall. In episode 19, three of the female surgeon main characters alone handled the care of a sexual assault victim, including all psychosocial care and forensic procedures. In a real hospital in Seattle, that care would be done by the sexual assault forensic examiner (SAFE) nurses who are actually qualified to do it. In that episode, nurses at least did get to help push the patient on a gurney! And they were among the many female hospital staff standing at the sides of hallway in a dramatic #MeToo-oriented show of support as the patient was wheeled to, of course, surgery.
A killer job
But a couple episodes did include OR nurse Frankie. She was a cranky veteran who seemed to be there partly in a deeply misguided effort to pay tribute to nurses, but also partly to give the surgeons a hard time and to die tragically in childbirth. In episode 3, a visibly pregnant Frankie is critical of the scheduling of surgeries by the new chief of surgery Alex Karev, in a brief conversation Frankie has with the former chief, Miranda Bailey. Bailey corrects the problem without much discussion. Later in the episode, Frankie tells Bailey that Bailey’s gastric patient might be delayed going to post-op recovery because “this morning’s shift was down a couple nurses and it never got covered.” She would tell Bailey why, she said, but “I don’t want to speak badly about the chief”—meaning Karev. Acknowledging a problem, Bailey notes that the chief of surgery does need to look at the “OR staff report” to schedule surgeries. These scenes do show some independent thought and some willingness to speak up by Frankie. But there is also a sense that she is a sniping serf, gleeful at have caught a powerful physician in mistakes. In reality nurses, clerical staff, and of course surgeons all play a role in scheduling surgeries. But it is nurses who coordinate staffing, preparing for and facilitating the surgeries. This plotline wrongly suggests that surgeons control nurse staffing. And it presents a veteran OR nurse as almost an observer in the surgical process, when in fact nurses make the OR function. Frankie does have the juice to complain about a surgeon behind his back to another surgeon, but she is not a professional who could simply raise the issue with surgeon in question. And of course, typical of Grey’s, this rare moment when a nurse actually has some dramatic role associates the profession with administrative problems, not health expertise. Nurses are there not to provide skilled care, but to present or at least identify obstacles to surgeon progress, in this case pediatric surgeon Karev’s transition to the chief role.
In episode 7 Frankie is back. Early on, she greets senior surgeon Richard Webber, who also used to be chief of surgery, with some patient logistics. She still calls him “chief,” noting that he will always be her chief. And she also mentions that his intern doesn’t know anything (here again: sniping behind the back, yes; problem-solving, no). Webber says he thought motherhood would soften her edges. Frankie: “Who needs soft edges when you’re always right?” Webber says when he hired her, he knew she would be a pain in his ass. She says he hired her because she was number one in her class at “nursing school” and knew her “way around a central line better than anyone,” including him! They banter about names for her baby; there is a pool about what name she will choose on a nearby white board, which Webber joins, modestly adding his own name.
But pain overwhelms Frankie, and soon we see her in bed, with Webber asking about her symptoms. Many other nurses stand outside watching, as if they were observers rather than participants in her care, or too scared to come in while the mighty “chief” is there. But then another senior nurse does have the temerity to enter—this is the awkward, often agitated, comically aggressive Ginger. She starts taking Frankie’s vitals, asking what Frankie needs, saying her pulse is strong but she’s tachycardic, and then, addressing Webber, asking what “we” are thinking, meaning for a diagnosis. Frankie tries to calm Ginger, telling her that “Richard” is taking care of her, and he’s good. This suggests that Frankie has a surgeon, so has no need of nursing, although the show does get a point for having Frankie refer to Webber by his given name. Ginger backs off. Frankie tells Webber about her life plans, saying that she has “a killer job” (with no evident irony), but that she has no ring or husband, and she is pushing 40, so she decided it was time for a baby. Webber says he never saw a challenge Frankie could not rise to. Frankie has more pain and Webber identifies the problem as a wandering spleen, saying it is time to operate. Frankie objects, noting that it could resolve on its own. Now Ginger reappears to support Frankie. Webber says this is unlikely to resolve itself. Frankie says the only way to ensure the baby stays safely inside her is to stay out of the OR. She also says that this whole process of having a baby has cost her $41,632—for three rounds of IVF and a miscarriage. So she refuses the operation, telling Webber he should not make her “sick Ginger on you.” Webber relents, but insists on close monitoring. Ginger: “That part, we’ve got covered.” Do you really, Ginger? Anyway, now several nurses gather around Frankie, as if they actually were capable of the skilled monitoring Grey’s has spent 15 seasons showing the physicians do.
Later, we again see many uniformed nurses surrounding Frankie’s bedside, now laughing and bantering, evidently with nothing else to do at the hospital. Frankie herself, however, is still giving patient care instructions to them. She has more pain. Webber arrives, but Frankie assures him she is fine, her blood pressure is stable. Another nurse, a man, proudly says they checked the blood pressure manually twice, as if that is something Webber would insist on. Another man adds: “We’re not all just trashy magazines and noise violations.” We’re not totally sure what this comment means, but we guess the idea is that although nurses are mostly a poorly educated rabble, they are able to make some limited contributions. Anyway, Webber wants to do a quick ultrasound, behind a curtain for privacy. Ginger stays. Frankie says the nurses mean well, as if apologizing for what losers her nurse colleagues are. Webber: “You’re exactly the boss I always knew you would be. Tough, fair—” Frankie: “With a little bit of flair?” Webber: “You always had that.” This suggests Frankie may have some formal management authority, but the show never makes that clear; is she a charge nurse? A nurse manager? In any case, it appears that Frankie’s spleen is untwisting. She wants an admission that Webber was wrong, but he just says, “You weren’t wrong for waiting a while.” She says he’s cranky, and asks what’s wrong. Webber: “If you weren’t my patient I’d have you fired.” She asks after his family. As Webber leaves, Ginger tells him if he keeps up good work, “our girl may name her baby Richard after all.” Ginger hands him a cupcake as he goes. Maybe he is now an honorary nurse!
But before long, Frankie is again in great distress. As Webber arrives, Ginger reports to him that Frankie’s “blood pressure tanked and her pain level’s through the roof.” Webber notes that there is fluid in her abdomen, which is probably blood, meaning the splenic artery has burst. Webber plans to operate and wants Karev ready if they have to remove the baby. Frankie resists somewhat, but Webber prevails. In the OR, Webber is in command and true to Grey’s form, the nurses are assistive and play no significant role. Karev proposes taking the baby out, but Webber resists, noting that at 28 weeks that will mean a stay in the NICU and a lifetime of deficits. Webber gives a little speech: “Nurses in our hospital put their own needs, their own lives aside every day for the good of their patients. So I owe it to them to do everything in my power to keep that baby right where he belongs.” But soon he must relent and they remove the baby. Frankie crashes. Karev defibrillates, to no avail. Frankie dies. Webber, upset, must tell the nurses who have assembled outside. They all cry. Ginger hugs Webber. In end, it appears that Frankie’s baby, at least, will survive. And in episode 8, we get a glimpse of that baby in the nursery, where his listed name seems to be “Frank.” A sign lists his “doctor” as Karev. No nurse is listed.
This plotline is in part an effort to pay tribute to nurses. Frankie projects some authority and knowledge; she knows about central lines! She has some undefined managerial role, and she has Webber’s respect, as far as that goes. The other nurses at times display basic health knowledge; they know about blood pressure and tachycardia. But these minor benefits are overwhelmed by handmaiden and low-skilled stereotyping. The plotline explicitly tells viewers that Webber hired Frankie and he can fire her. But in fact, nurses manage other nurses. On the whole the nurses here are like lost toys—quirky, socially maladroit, a little resentful, a little sad, and unsure how to treat the godly surgeon Webber. They do seem to mean well, but the show clearly does not take them seriously as health professionals. They claim to have a monitoring role, but we don’t see them do anything that will strike viewers as significant in Frankie’s care. All the care that matters is done by Webber and Karev. The nurses are dressed in their hospital uniforms, but they don’t seem to have other responsibilities besides hanging around Frankie. And Webber’s tribute is nothing but the unskilled angel image: Nurses put their own needs aside for their patients. Of course, for anyone who has actually paid attention to the show, that also rings false. The nurses who do emerge from the background are more likely to be bureaucratic battle-axes whose real dramatic role is to present a temporary obstacle to the surgeon stars. The fact that Nurse Frankie’s son lies in a NICU bed labeled with the name of a surgeon, but not any of the nurses who actually run NICUs, tells you all you need to know about this tribute to nurses.
We urge Grey’s Anatomy to add skilled, autonomous nurse characters or, in the event that hell does not freeze over, to at least to have the many surgeon characters spend less time doing things that nurses do in real life.