Netflix romantic drama Virgin River features skilled advanced practice nurse
The new series features APRN Melinda Monroe, who flees L.A. to join the solo practice of a senior physician in northern California. The first season is mainly about small town romance in the shadow of past traumas. But Mel also shows advanced skills, managing issues including post-partum depression, emergency care at a remote marijuana camp, and the physician’s regressive views of nursing.
December 2019 – The Netflix drama Virgin River focuses on Los Angeles advanced practice nurse Melinda Monroe who, for reasons that are only gradually revealed, takes a job with a solo physician practice in a small northern California town. Fish-out-of-water drama predictably ensues, and on the surface the show resembles the CW’s Hart of Dixie (2011-2015), about a big city physician making a comparable transition. Mel is hired by the town’s mayor, who has concerns about the physician getting on in years. But the physician is totally opposed to Mel’s presence, and this is all complicated by the mayor’s relationship with the physician, which is gradually revealed to be…you get the idea. In a show that is mainly about the romantic pairings of damaged people, the key point for nursing is that Mel really is a highly skilled nurse practitioner and nurse-midwife. She gets many chances to shine, as she slowly wins over the physician. Mel provides creative psychosocial care to a mother with post-partum depression. She saves the life of the gunshot leader of an illegal pot-growing camp—after being kidnapped to the camp at gunpoint. And while there, she safely delivers a breech baby! Mel persuades a grandmother found in a hypoglycemic state to be more diligent about managing her diabetes, so she can be there for her orphaned grandson. Mel also works with the physician to treat a critically ill family who have apparently been poisoned by toxins leaking from the pot camp. And Mel is not a nurse only when she is on duty. She tries to persuade the mayor to change her lifestyle after she has a heart attack. And she tries to get the local bar owner Jack, a veteran, to address his PTSD. Mel has her own demons, but they don’t seem to impair her focus or her life-saving skills. And the people of Virgin River notice, giving her a high level of respect with little condescension. Netflix has renewed the show for a second season, and based on the first one, nurses should be pleased. We thank showrunner Sue Tenney and book series author Robyn Carr.
Top of her class
Episode 1 finds Mel being rescued from the ditch in which her city-slicker car has landed–rescued by none other than “Doc” Mullins, her soon-to-be physician colleague. He is displeased, since the town mayor, Hope, did not even tell him she had hired Mel (with what funds, it is not clear). Hope eventually persuades Doc to give Mel a trial period. Hope tells him Mel “ranked top of her class at UC Irvine, did her practical at County-USC, then she spent five years working emergency at Cedars-Sinai; her references are good as gold.” Other clinical experience surfaces in Mel’s interactions with the friendly bar owner Jack. She informs Jack that she worked in South East Asia with a group called Nurses Beyond Borders, as well as at a “Trauma Center Level One,” which is not quite the way we say that, but good enough. As a bonus, at one point Mel gets a Shakespeare reference Jack makes, so she is, you know, educated. Clinically, the episode is mainly about Doc being a jerk to Mel. She does get to provide some basic care to a very pregnant patient, diagnosing Braxton-Hicks contractions and noting some potentially worrisome protein in the patient’s urine. Mullins isn’t so concerned, and he can’t believe a nurse would question him; in the past they would know their place. Mel responds that she hopes he will join her in the 21st century. What Mel can do at the office is straighten it up and make coffee, he says. Mel isn’t having it. She goes to Mayor Hope and gives her notice.
The post-partum depression plotline is the focus of episodes 2 and 3, and that is where Mel begins to change Doc Mullins’ perceptions of her. In episode 2, Mel and Jack find the baby outside her practice’s office. Mel takes charge, directing Jack to fetch needed items and reporting that baby seems to have good vital signs. Mel wants to contact social services, but Mullins adamantly refuses, saying he is going to use his networks to try to locate the mother. The baby won’t eat and Mel is unsure what to do. Mullins uses that to attack her competence as a midwife. Mel explains, with some exasperation, that that is a separate specialty. Mullins basically responds, not in the real world. He then travels to a somewhat remote illegal pot camp, where he periodically provides care, thinking the baby’s mother might be a pregnant woman who is sometimes there. With Mullins out of touch, Mel struggles to care for the infant. Some others in the small town are critical of her plan to call social services, which is a big-city-outsider thing to do. Mel tells Jack she became a nurse because of good psychosocial care a nurse gave her as a kid when her mom was dying. After Mullins returns, having made no apparent progress, Mel says she had to call child protective services. Mullins says she had “no right” to do that and that although he knows she has already given her notice, she is “fired.” It seems clear that Mel did have the right, if not the duty, as a health professional to report an abandoned infant; whether Doc would have the right to fire her for following the law is less clear. But then Mel returns to find the townswoman she left to temporarily watch the baby breastfeeding it—she is the mother.
Episode 3 shows how they deal with this. Mel deduces that the woman has post-partum depression. Apparently the woman lost her husband six months ago, has a big farm to manage by herself, and is too proud to ask for help, even from her grown kids, who have left. Mullins confesses to being uncertain how to handle this. Mayor Hope urges him to stop being a jerk and accept help from the expert midwife, Mel. Mullins is still mad that Mel called social services, whose arrival is imminent. He says Mel does not accept his “authority.” Hope responds that Mel thinks for herself, a quality Doc used to admire. The distressed mother does not think she can handle her baby. Mel’s final pitch to her involves offering to foster the baby herself until the mom is ready; apparently, as a licensed caregiver Mel is the only one besides the family who could keep the baby in Virgin River. Mel says she understands because she herself had post-partum depression after her own baby was stillborn. The mother is inspired by Mel’s kindness and strength to reach out to a grown daughter to come home and foster the baby. By this point, the social services representative is involved. Doc assures her that Mel is highly qualified to handle this situation, which shocks Mel. And Mayor Hope persuades Doc to unfire Mel.
A pin with two screws
The next pair of episodes trace how Mel’s efforts to help Mayor Hope with an apparent heart attack turn into Mel’s involuntary presence at the pot camp and her ensuing heroics there. In episode 4, Hope is back home. Mel has various heart-health prescriptions for her, including a better diet and exercise, as the mayor seems to have been getting all her energy from caffeine and stress. Hope resists, and appeals to Doc, but he actually agrees with Mel. Later, while Mel and Jack are moving a mattress to help Hope set up for her recovery period, Jack aggravates what seems to be an old war wound from Iraq. Mel applies a topical analgesic cream that she just happens to carry everywhere, because “I’m a nurse.” Mel also has some specific diet recommendations for Hope. And in fact it is on a mission to find Hope organic vegetables at a farm that she and Jack suffer a flat tire. While they wait for a tow truck, the right-hand man of the pot camp’s leader forces them to accompany him back to the camp at gunpoint.
In episode 5, Mel sees that the leader has been shot and has bled a lot. This leader briefly complains that his guy was supposed to find Doc, not some nurse. But the growers quickly seem to accept Mel’s expertise. She places a tourniquet and organizes supplies, but she is worried that the leader will bleed out, and she repeatedly urges that he go to a hospital. The leader refuses, because a gunshot wound would be reported. Improvising, Mel seems to cauterize the wound by applying a burning-hot knife to it! Despite her worries that the leader will die overnight, she and Jack sleep elsewhere, outside in the cold instead of at the side of the patient. Jack relates all the places he got his war wounds. Mel responds by noting that she has a pin with two screws in her arm. She explains that it was a 300-pound schizophrenic on PCP in the emergency department, and it took two security guards and Haldol to subdue him. (This dose of reality is a marked contrast to other Hollywood shows, where such patients tend to be subdued by physicians alone.) The leader does survive till the morning. Mel finds no signs of infection and shows him how to change his dressings and watch for infection. The leader orders their release. But then Mel hears a scream from a nearby tent, and she sprints over to where she finds a woman in labor. Quickly diagnosing that the baby is in a breech position, Mel provides good psychosocial care to the woman, who is understandably distressed. And Mel expertly delivers the baby, guiding the baby’s father and Jack to assist her. That night, Jack offers to stay with the stressed-out Mel, but it is he who has a nightmare, about his time in combat. Mel sees his PTSD. But when she tries, in episode 6, to get him to consider addressing his apparent “night terrors,” he politely declines. Mel asks Jack’s veteran friend Preacher for help, but he warns her away of trying to help Jack with that.
Almost all of the season 1 episodes have some confident display of health care skills from Mel. These range from highly dramatic to more casual. Episode 9 finds Mel explaining to Doc why his continued expectation that she get him coffee is problematic, when a couple and their daughter rush in, regular patients of Doc’s. The daughter is having trouble breathing. Soon her parents have similar symptoms. Mel and Doc discuss a diagnosis, running through possibilities like allergies, and finally figure that it must be some toxin. As the daughter deteriorates, Mel starts an IV. They rush to hospital, deducing on the way that it’s likely poisoning from pesticides leaching into the family’s well water from the nearby pot camp. Mel suggests and then gives atropine en route. They arrive at a hospital and it seems the family will be OK. By this point Doc seems genuinely impressed with Mel’s work, and even offers to get her coffee! In episode 7, Mel learns that the diabetic grandmother of one of Jack’s bar employees has been incommunicado. Jack and Mel go to her house and find her on the floor half-conscious, seemingly hypoglycemic. Mel gently chides her, gets her sugar water, measures her insulin, and counsels her about watching her insulin better. The grandmother is suspicious and resistant at first. But Mel skillfully eases her concerns, with repeated references to the need to stay healthy for her treasured grandson. On the more casual side, in episode 8 Mel ably performs a closed reduction of a bone fracture to heal the hand of a tow truck driver, providing good psychosocial care. And by episode 10, the season finale, Doc has attached a hand-lettered addition to the bottom of the sign outside the practice saying “Melinda Monroe,” with the next line “Nurse Practitioner.”
Virgin River shows viewers a skilled and autonomous advanced practice nurse saving lives and making a real difference in a rural setting—the kind of setting where hospitals and physicians are less common, and APRNs do in fact provide a great deal of vital care. Mel’s skill set is very broad, but it’s certainly no less believable than what the physician characters on shows like ABCs Grey’s Anatomy, ABC’s The Good Doctor, and NBC’s New Amsterdam do. With regard to autonomy, Doc’s regressive attitudes may not always be refuted as aggressively as we might prefer. But the overall arc of the plot does show that they are wrong, particularly since Mel does not defer to him clinically. She consults with him as a colleague, but doesn’t really seem to need him at all. Some shows that depict strong APRNs, such as Fox’s The Resident, include damaging portrayals of other RNs as peripheral subordinates. But there do not seem to be any other RNs in the remote outpatient setting on Virgin River, so that is less of an issue. And the acceptance of a nurse as a true health authority in that setting is remarkable.