PAGE 37 / APRIL 10, 2007

SCRIPTDOCTOR: MEDICINE IN THE MEDIA Media Portrayals of Nurses (Part 1 of a 3-Part Series)

By Andrew Holtz, MPH hears and understands the criticisms Andrew Holtz, MPH, is a former CNN Medical Correspondent from nursing groups, but says she r. Gregory House injects and the author of “The Medical Science of House, M.D.” This works hard to help the writers be as a patient with edropho- column examines mass media programs, particularly realistic as possible. “ nium chloride. The drug entertainment TV, for insight into popular perceptions, so that “I’m trying to even out the fairness D blocks acetylcholinester- rather than merely wincing at distortions or of the portrayals in ways that I can, ase and can boost muscle strength in oversimplifications in the portrayals of medicine on these while still keeping the drama in the people with myasthenia gravis, so it is shows, health care professionals can learn something from show,” Bergstrom says. “It’s a show sometimes used to help confirm a that works. It’s really a fantastic show. media professionals about the way that medical and health diagnosis. The patient, who had been The writing is excellent and I love topics are presented. Send questions to him about how the too weak to even sit up, suddenly working on the show. I’m very proud media treat medical topics or suggestions for future columns stands. But the effect is temporary and of it.” to [email protected] after a moment, the patient crashes to Bergstrom concedes that the physi- the floor. Dr. House looks down at him. cians on House do a lot of nursing, as “This is exactly why I created nurs- they do in other shows. es. Clean up on aisle three!” Dr. House “The reason they do that on our bellows. shows set in hospitals, features a cast in Espinosa catches an intern’s error and show is that the way the show is writ- This scene from the Fox TV show which doctors far outnumber nurses; takes charge of handling a patient’s ten, the scenes are so intimate that to House is one reason the series is unlike- while of course in real hospitals the seizure. The lead writer of the episode, have an extra person in there, doing ly to win any awards from nurses. ratio is the other way around. But a Angela Nissel, says that even though what a nurse would actually do, would Indeed, when the Center for Nursing nurse, Carla Espinosa, is featured the show is a comedy, the scene echoes take away from the drama of the Advocacy announced its “Golden Lamp among the leads. She’s no mere bed- reality. scene.” She notes that the attending Awards” for media portrayals of nurses pan-changer—as one retort to the hos- “Over and over we do hear doctors physicians also invade the turf of all earlier this year, House was listed pital’s Chief of Medicine makes clear: say that when they start, they are sorts of specialties, such as radiology, among the worst shows. “You’re worried about what I can amazed that nurses know so much pathology, and every type of surgery. “Grey’s Anatomy and House are the handle? Vascular surgery wants an up- more than they do. You’ve just finished worst offenders,” Center Executive date every two hours on bed one. I’m all these years of medical school, and to Director Sandy Summers stated in the weaning Mrs. Jones’s dopamine from have a nurse step up and say, ‘No, awards announcement. “These globally 10 mics to 5. Mrs. Myers’ abdominal that’s not how you do it.’ Or to have a popular shows portray nurses as brain- wound is dehiscing. And Mr. Wilder’s nurse actually save someone’s life, it less servants, while heroic physicians about to be turfed to psych because he must really put you in your place really provide all important care—much of thinks he’s Flo from Alice,” Carla says. quickly and let you know how much of which nurses do in real life, like defib- One of the patients, Mr. Wilder, a newbie you really are,” says Nissel. rillation, triage, and patient education. chimes in, “Kiss my grits!” By the way, her mother is a nurse. With a nursing crisis stemming in large Carla responds, “Exactly, Flo, (See sidebar) part from undervaluation of the profes- exactly.” “I just wanted my Mom to look at sion, this is unacceptable.” In another episode noted by the an episode and smile for once and say, Other popular shows on the cen- Golden Lamp Award judges, Nurse ‘Thank you! After four years of writing ter’s “worst” list include episodes of on Scrubs, you actually showed what NBC’s ER and Heroes, and HBO’s The we do,’” Nissel says. “It was important Sopranos. There is one, just one, prime- to show a nurse as something other time show on US television that won “‘Grey’s Anatomy’ and than a background character. praise from the nursing group: NBC’s ‘House’ are the worst “Carla is supposed to be a head Scrubs. It’s a comedy. nurse. She’s a Registered Nurse. Scrubs, like all other entertainment offenders, portraying She’s been there a while. She obvi- ously went to college. She knows a The depiction of nurse Carla nurses as brainless lot of stuff; and to have one or two Espinosa on Scrubs, portrayed by Judy Reyes, has won praise servants, while heroic episodes out of a hundred where she Clinical Notes shows what she went to school for is from nursing groups. continued from page 36 physicians provide all important.” So why don’t other shows fea- important care—much ture similar nurse characters? Accurate, But Not Dull Dr. King said he believes the device can of which nurses do in “It’s like asking why the ratio of potentially capture mesenchymal stem female superheroes to male super- Bergstrom says the writers and others cells as well. These unspecialized cells, real life, like defibrillation, heroes is so low. We just have this thing working on House want to be accurate, which form tissue, bone, and cartilage, in our society about what the hero or but they dare not be dull. could be used in tissue engineering or triage, and patient the main character looks like, and it “A good example is that in order to bone marrow transplantation. education. With a takes a long time to get over that. And take a pulse accurately in the real “The main advantage of the also because the majority of nurses are world, you have a minimum of 20 sec- implantable nature of the device is that nursing crisis stemming women, but the overwhelming majority onds to check it. Twenty seconds of it filters the peripheral blood 24 hours a of writers are male. When it comes time checking a pulse on TV is death to the day,” Dr. King said. “Thus, if circulat- in large part from to write the main characters, most of drama. So if you are watching a televi- ing tumor cells are being filtered, it is undervaluation of the them tend to be male,” suggests Nissel. sion show and you say, ‘No one could hoped that metastasis can be prevented It’s not that writers and producers ever check a pulse that quickly,’ you or significantly reduced. In the case of profession, this is are unaware of the role of nurses, even are absolutely right, but nobody wants stem cell therapy, native cells can be at House. Bobbin Bergstrom, RN, has to watch somebody check a pulse for 20 manipulated without having to remove unacceptable.” been helping shape episodes of House seconds.” O them from the body.” T since its first season. (See sidebar) She (continued on page 38) PAGE 38 / APRIL 10, 2007

ScriptDoctor continued from page 37 Scrubs Writer/Producer Angela Nissel: ‘I’ve Grown Up

ngela Nissel has been on the and doctors compared with what assistants. Most people get most of And while she’d like to see more “Scrubs” writing team since the most people I work with have. I’ve their ideas about what nursing is nurse characters doing more of the A show’s second season. Over those five grown up hearing that nurses are the from television, so they think that all nursing on medical shows, she says the years she’s grown up from being, as ones you should trust when you go in nurses do is stand by doctors, listen to dominance of physicians merely re- she puts it, a “baby writer” to a con- the hospital,” Nissel says. orders, and change bedpans or adult flects the attitudes of society in general. sulting producer. “My Mom always said the nurse diapers.” “I’m not sure why, but physicians She takes a personal interest in will spend hours with you, and the Nissel says she feels fortunate to are still revered as next to godliness, the character of Nurse Carla Espinosa. doctors will run in and out. And I’ve have that familiarity with nursing in and that makes them interesting to peo- “My Mom is an RN, so I grew up always known there were different her background, but it can also stir ple. Many people think, ‘I could never with the opposite ideas about nurses levels of nursing, LPNs and nursing conflict with her fellow Scrubs writers. be a doctor.’ It’s a mystery to them. And so doctors are more glamorous than nurses,” Bergstrom says. “Being a nurse, I think it’s very sad, but I don’t think the general public finds nursing an interesting thing to hear about.” Still, that means that physicians are seen performing nursing tasks, thus making nurses seem superfluous. But since physicians are the main characters on the show, Bergstrom points out that it’d be rather dull to have them just standing there, doing nothing, when they are talking with a patient. The scenes demand action, so the physician characters go around hanging IV bags, giving injections, drawing blood, and doing other things that real physicians rarely do after they finish their residen- cies.

TV physicians are often seen performing nursing tasks, thus making nurses seem superfluous. The scenes need action, so the MD characters hang IV bags, give injections, draw blood, and do other things that real physicians rarely do after finishing their residencies.

From her perspective, some of the criticism misses a key point: Most of the negative comments about nurses come from the character of Dr. Gregory House, who is written as a flawed and unhappy person. “He does act like nurses are stupid. That’s part of his character, so I can’t take that away in order to build nurses up. I can only do it in other areas of the show, where it’s appropriate,” Berg- strom says. Viewers “love to hate” Dr. House, and that’s part of the fun of the show; so viewers shouldn’t think the show is trying to endorse or agree with what his character says or does. The formula of the show demands that Dr. House charge ahead with his (continued on page 40) PAGE 39 / APRIL 10, 2007

Hearing that Nurses are the Ones You Should Trust When You Go in the Hospital’

“It’s supposed to be a show about up, after school I used to hang out in going strong in its sixth season, which “We get to do some of the stories our doctors, and so sometimes I come the changing room at my Mom’s job, means the underlying premise has that have been hanging on our story across as the super-nursing-advocate. where all the nurses got changed. And had to adapt. After all, it started as a list for awhile, and there tend to be I try not to push it too much, because I remember all the conversations tale of young, inexperienced interns. more and more Carla stories on there, it’ll seem like I’m pushing for my about doctors, and their work, and Now, the interns have grown up. about her nursing career, that I’ve Mom!” patients. And I remember thinking, Those stories of fledgling doctors been trying to pitch for the past five Nissel says that as a writer she’s ‘This would make a great show!’” tackling their first cases have been years. So hopefully we are finally get- really pushed by the great stories that Nissel says everyone involved told, so the writers are exploring other ting around to them. And my Mom flow from the experiences of nurses. with Scrubs is a bit surprised by its situations and fleshing out other char- will get some of her pitches in as “I remember when I was growing long network run. The show is still acters. well.” —AH PAGE 40 / APRIL 10, 2007

ScriptDoctor continued from page 38 House Advisor Bobbin Bergstrom, RN, Aiming to Do What She Can for the Image of Nursing brand of extreme medicine. “In a way it’s better for the image obbin Bergstrom, RN, has been with the recognition that the point of and where it won’t take away of nurses for them not to be there, B advising the House team on the the show is to entertain, and if it does- from the drama,” she says. because if they allowed [those proce- technical aspects of medicine since the n’t, then ratings will fall and the show “In the beginning I did say, dures] to happen, then that would show, now in its third season, began its will die, accomplishing nothing. ‘Well, there would be a nurse in destroy the credibility of what nurses network run. She earned her RN almost “I do try to take my crusade to the here.’ And they would point out do. We are patient advocates. I’ve got- two decades ago and began advising limit in those areas where I can. And that if [Dr.] House is talking to ten in between patients and physicians TV shows in the early 1990s. the writers and creators allow that, the patient, why is the nurse just myself in my career,” Bergstrom notes. Bergstrom has to balance her they want that. They definitely want to standing there, why isn’t she or Indeed, she says that given House’s desire to boost the image of nurses infuse reality where it’s appropriate he imposing their opinion, like outrageous actions, if nurses were pre- they would?” And Bergstrom notes that the writer didn’t invent common stereotypes about nurses and physicians. “I had an experience in the emergency room where I was working with a female ER physi- cian and I had a male nurse coun- terpart. When the patient was responding to questions asked by the female doctor, he answered to the nurse, because the prejudice in his mind was ‘male equals doctor, female equals nurse,’ even though it was exactly the opposite. That still happens in the real world.” Within the constraints of the show’s premise and the impera- tive to entertain, Bergstrom says she tries to do what she can for the image of her profession. “I frequently will try to take away some of the business from Cameron. If the three of them [Dr. Cameron, Dr. Chase, and Dr. Foreman] are in a room and they have only one of the doctors doing something, I’ll ask the directors to take it away from Cameron and give it to one of the male doctors, so she doesn’t always look like she’s a nurse, thus supporting that stereotype that all physicians are male and all physicians are female.” Things would be different, if the main characters were nurses. So, does Bergstrom think such a series will someday glow on TV screens? “It think that would be great and I hope it does happen.” —AH

sent, they’d constantly be put in unten- able positions. “The nurse would never allow him to put a needle in the heart and perform a cardiocentesis [as happened in a recent episode, without warning, in unsterile conditions]. We would put ourselves in the way. That’s really a great example of why you can’t always have a nurse present, when there would really be one there. Because they would stop the procedure, and the story would be gone.” And ultimately, on TV, it’s all O about the story. T

Next time: A historical perspective— Nurses MIA on TV.