Nursing A Lousy Image: RNs Blame Crisis On TV's 'ER'
By Sandra G. Boodman
Washington Post
November 18, 2003

Policymakers have spent years debating the causes of the nationwide shortage of registered nurses, a problem that has been repeatedly shown to harm patients.

Now a nursing advocacy group in Baltimore has come up with a new reason for the shortage: "ER," one of television's most enduringly popular prime-time shows, which attracts more than 20 million viewers per week.

The Center for Nursing Advocacy, a two-year-old nonprofit group whose advisory board includes several of nursing's most prominent leaders, has unleashed a protest e-mail and letter-writing campaign against NBC and the producers of the Thursday night show.

The group's executive director, nurse Sandy Summers, accused the show of perpetuating "long-standing misrepresentations that . . . are contributing to the nursing shortage."

The nurses' protest comes at a time of mounting concern among public health officials about the scarcity of nurses. Two weeks ago a panel from the Institute of Medicine warned that patients are being endangered by medical errors exacerbated by nurses' working conditions, especially the fatigue caused by shifts of 12 hours or more. A growing number of hospitals and nursing homes require long nursing shifts to compensate for cost-cutting staff cutbacks.

Summers said that "ER" routinely and inaccurately features doctors usurping jobs typically performed by nurses -- wielding a defibrillator to shock a patient's heart, holding bedside counseling sessions with families and sprinting into a parking lot to haul the latest victim into the emergency room. She said her group was particularly incensed after the lone major nurse character on "ER" -- Abby Lockhart, played by actress Maura Tierney -- recently decided to chuck her career in nursing to return to medical school. A few weeks earlier, an attending physician on the show summarily fired striking nurses, replacing them with inexperienced foreign-born practitioners willing to work for "minimum wage."

In reality, hospitals -- especially those in urban areas -- are paying large bonuses to attract registered nurses. And ER doctors don't have the authority to fire nurses, who are supervised by nurse managers.

"Wasn't there a nursing shortage before 'ER'?" asked one executive affiliated with the show who spoke on the condition that his name not be published. "I mean, this is a television show, not a documentary. There needs to be dramatic license."

Clashing Views

So far, Summers said, more than 100 nurses have peppered executives at NBC and "ER" with e-mails in an attempt to persuade producers to make changes that in Summers' view "would portray nurses and nursing in a more accurate light -- not as handmaidens to physicians."

"People think what they see on 'ER' is real," Summers said. "Viewers, especially kids, see our profession as less than it really is, a horrible job. They see the show and think, 'Who would want to be a nurse?' "

Phil Gonzales, a spokesman for Warner Brothers Television, the show's production company, disagreed. "ER," he said, "goes to great lengths to portray medical situations accurately," adding that there are nurses on the set as advisers. "The series will continue to do its best to entertain television audiences while bringing to light the important work of doctors and nurses," he said.

Diana J. Mason, editor-in-chief of the American Journal of Nursing and a member of the advocacy group's advisory board, said the organization has singled out the show, now in its 10th season, because of its enormous popularity.

A study conducted last year by the Kaiser Family Foundation found that regular "ER" viewers learn about health-related subjects from the show and some consult their doctors because of what they have seen. An earlier study found that children's strongest impressions of various medical professions were primarily derived from "ER" and other television dramas.

To Mason, who last year urged in an editorial in her journal that nurses boycott "ER" to protest its depiction of nurses, the show's fictional nature is no excuse for what she regards as demeaning inaccuracies.

"I'm so disgusted with the continued invisibility of nurses and their expertise," she said. "When the show first started, there was a good, strong nurse character, Carol Hathaway (played by actress Julianna Margulies)." But Mason said she deplored the plot line in which Hathaway pondered becoming a doctor, even though it was an idea the character ultimately rejected.

"There's this continuing idea that you can be a nurse if you can't be a doctor," Mason said.

Linda C. Pugh, director of the baccalaureate program at the Johns Hopkins University School of Nursing, complained that the show is misleading in its portrayal of nurses as subservient to doctors.

"Nurses are the guardians of patients, rather than just being at the elbows of the physician," Pugh said. "They don't portray nursing as an independent career or a discipline."

Mason said that the group supports the development of characters like "Hot Lips" Houlihan of "M*A*S*H." "She was a loony-tune but she knew her stuff, she ran a tight ship, she cared about patients and the doctors didn't mess with her," Mason said. "We wouldn't mind a mixed story line, as long as it's accurate."

Summers said she has analyzed and rated other television shows as well as films for their portrayal of nurses. Among the few with high ratings are "Wit," the Pulitzer Prize-winning cable film that featured Audra McDonald as an empathic nurse. Those with low ratings include "Nurse Betty," starring Renee Zellweger as a nurse who can't distinguish medical soap operas from reality, and the infamously sadistic Nurse Ratched in "One Flew Over the Cuckoo's Nest."