Understaffed
Fall 2011 TV Preview
September 2011 -- Health-related shows in the new U.S. television season are dominated by nearly 40 physician characters, and there appears to be no major nurse character on any prime time broadcast show. Two new shows have different spins on Hollywood's health care portrayals, but neither seems likely to question the industry's view that physicians are everything. A Gifted Man (CBS, premieres Sept. 23) centers on a brash 'n' brilliant neurosurgeon, nothing new there, but the twist is that his ex-wife recently died and her ghost is back to make him a better human being! There's no sign, though, that she'll be imparting any divine wisdom about the value of nursing. Hart of Dixie (CW, Sept. 26) offers not just an awesome pun on the lead character's name, but a romantic comedy-drama about a cute young New York physician who finds herself in a small Southern town--how will she cope? It'll be without recurring nurse characters, anyway. The returning shows also remain virtually nurse-free. ABC's surgeon-worshipping Grey's Anatomy (Sept. 22) still has no significant nurse characters as it starts its eighth season. A few episodes last year did feature hunky nurse Eli, who actually displayed a little skill and briefly stood up to the physicians, but by season's end he was mainly a love interest for attending surgeon Miranda Bailey and he no longer did any nursing work on screen. 
ABC's Private Practice (Sept. 29), a Grey's spinoff, used to have minor nurse character Dell Parker, but it killed him off two seasons ago. Fox's diagnosis-is-everything House (Oct. 3), which is starting its eighth and possibly final season, has still had no significant nurse character, unless you count all the ciphers who say "yes, doctor!" as being essentially one character. ABC's Body of Proof (Sept. 20), about an elite surgeon-turned-medical examiner, returns for a second season with no significant nurse character. Like last year, nurses will not be completely absent from the small screen. The powerful, nurse-focused off-season show Nurse Jackie (Showtime) will return for a fourth season in 2012. And a new 14-part documentary airing on BBC America, 24 Hours in the ER (Sept. 27), profiles nurses and other staff, not just physicians, at London's King's College Hospital. Sadly, the summer show HawthoRNe (TNT) was recently canceled after three seasons; the show had flaws, but it did present a strong, expert nurse executive and regularly showed bright nurses improving patient outcomes. Some non-health-related shows also have minor recurring nurse characters, but we rarely see any strong, expert nurses in clinical settings. So this year the television landscape looks set to remain dominated by the notion that health care is all about smart, commanding physicians, and nurses are little more than low-skilled helpers.
TV nurses from Jackie to Jesus
TV nurses from Jackie to Jesus
In our fall TV preview a year ago, we explained in some detail why the 2010-2011 season appeared to the first essentially nurse-free regular TV season in more than 40 years. Up till then, there had always been at least one (usually only one) major nurse character on some prime time broadcast show. We won't go through all that again, but we will revisit the fate of the three new nurse-focused shows introduced in 2009. NBC's Mercy, the only nurse-focused regular season broadcast network show in decades, included many helpful portrayals of smart, expert nurses, but regrettably it lasted just one season. HawthoRNe survived three summer seasons on TNT, though that meant only 30 total episodes--basically a long regular season--and fewer viewers than Mercy had. The only show left is Nurse Jackie, with its fierce, vastly talented (and flawed) central nurse character Jackie Peyton and her talented protégé Zoey Barkow, but it is still a premium cable show with 12-episode seasons and even fewer viewers than HawthoRNe had.
One additional health-related broadcast show aired this summer, when ABC aired a 13-episode Canadian drama called Combat Hospital, set at a military hospital in Afghanistan. The show focused on the heroics of its 5 main trauma physician characters, but there was a recurring nurse character--Commander Will Royal. Like Tuck Brody in CBS's short-lived Miami Medical (2010), Royal was a nurse manager who occasionally showed clinical knowledge and often displayed authority, though it tended to be of the logistical variety, and the show also stressed that physicians were the real health experts in charge of trauma care, with nurses as their skilled helpers. It's not clear if Combat Hospital will return.
Other shows have nurse characters. During the regular season, one character on NBC's Parks & Recreation, Ann Perkins, is a nurse. One of the lead characters on the BBC America series Being Human, Nina Pickering, is a nurse (and a werewolf). In the summer, there are recurring nurse characters on Showtime's True Blood (a strong, good-hearted witch named Jesus (!) who was briefly shown to be a competent nurse when first introduced) and A&E's The Glades (the lead detective character's girlfriend Callie Cargill is a competent nurse with occasional chances to show clinical skill). These characters are generally positive, at least within the contexts of their respective shows, and perhaps there is some benefit to that alone--the underlying message that nurses can be strong and decent and have normal intelligence, which mildly counters some nursing stereotypes. But the Glades character is also a medical student, reinforcing the wannabe physician cliché, and the nurse characters on the other shows spend little if any time nursing.
So what remains? An avalanche of widely-seen serial dramas telling viewers that physicians do everything that really matters in modern health care, including many key tasks that nurses do in real life, with the occasional direct insult to nursing thrown in for good measure.
A Gifted Man
CBS's new redemption drama A Gifted Man focuses on neurosurgeon Michael Holt, who heads a boutique practice in New York. Show star Patrick Wilson told TV Guide that "like a lot of surgeons, Michael's a control freak with a God complex." Michael's dead ex-wife was also a physician, but she ran a clinic for poor people. Now her spirit (or is it Michael's own conscience?) pushes him to take over the clinic and treat patients who can't pay, almost like in some bizarre alternate United States where everyone is entitled to decent health care. It appears that another regular character will be a physician at this clinic, but there appear to be no nurse characters. Michael's boutique practice "assistant" Rita might be one, or might be mistaken for one by an audience used to thinking of all assistive females in clinical settings as nurses.
One Gifted Man producer is physician Neal Baer, who also worked on ER; his more recent show Law and Order: SVU has included awful depictions of sexual assault nurses. Baer has told the media that Gifted Man will highlight disparities in health care delivery. But we have no reason to think that will extend to the disparity in who gets credit for providing skilled health care; from here, it looks like physicians all the way, and especially surgeons. In fact, neurosurgeons alone far outnumber nurses in current Hollywood shows, and they are the lead characters on this show and Body of Proof. See the show's website on CBS.
Hart of Dixie
This new CW comedy-drama about a hot young New York physician who "inherits a local medical practice" in a small Southern town seems to be mostly about the fish-out-of-water angle. And it does not seem that any other major characters work in health care at all--of course, there will still be clinical interactions. In any case, there seem to be no significant nurse characters; reports suggest that a minor one may appear in the first episode, but then quickly disappear. To the extent the show does include health care portrayals, its conventional overall set-up suggests that it's pretty likely to rely on the standard Hollywood convention that physicians alone provide all meaningful health care. And in considering how likely the show is to challenge industry traditions, maybe it's worth noting that this is not even the first time a Hollywood show has used the "Hart" pun in its title; the early 1980's detective show Hart to Hart did the same thing. See the show's website on the CW.
24 Hours in the ER
This new U.K. "docu-series," airing on the basic cable channel BBC America, follows a month in a busy London emergency department, filming in the ED using only remote-controlled cameras (not human crews). And according to TV Guide, the producers didn't just film the hospital, but prepared by watching U.S. hospital dramas like Nurse Jackie, ER, and Grey's Anatomy in order to convey what producer Amy Flanagan calls a "strong sense of character." Uh . . . OK. As a result, according to the magazine, the series "doesn't simply focus on patients and M.D.s"; instead, "orderlies, receptionists, and even the janitorial staff all get their due." That sounds pretty great, and we know that's not an exhaustive list, because the BBC America site's "staff" section for the show actually lists nine nurses ("sisters") along with the 13 physicians, as well as two porters, one technician, and one clerk. (We note that U.K. physicians do not typically get medical doctorates, but instead get bachelors degrees in medicine.) Although the show may not attract nearly as many viewers as the other shows discussed here, it certainly has the potential to display more of the reality of health care today, including the central role that skilled nurses play. See more about the show on the BBC's website.
Grey's Anatomy
ABC's Grey's Anatomy remains popular heading into its eighth season, and it now features roughly 14 regular physician characters, every single one a surgeon. In prior years, nurse characters did occasionally appear, usually embodying stereotypes, particularly the helpless handmaiden and the bureaucratic battleaxe, which contrasted sharply with the professional path that the show's modern female stars had chosen. In most episodes, the show included no identifiable nurse characters, with the occasional exception of Tyler, a disagreeable, low-skilled lackey who has appeared briefly in a minority of episodes since the show's beginning in 2005. Tyler has functioned mainly as a plot device to dump tasks and hostility on surgical residents--showing how hard their lives are--and to convey indifference to patient care, underlining the intense concern and expertise the physicians display.
But last season, there were a couple nurse characters worthy of note. One November 2010 episode included a limited but fairly good portrayal of a nurse--as a patient's mother. This nurse had basic health knowledge and was a strong advocate for her critically ill son. But having expert nurses act as clinical colleagues of the physician characters seems to be a threat to the natural order, so the surgical residents appeared to be the only hospital workers who provided any significant care to the nurse's son--no practicing nurse appeared. Yet in the second half of the season, there were occasional appearances by nurse Eli (above). He briefly showed some skill with pre- and post-operative patients and even pushed back against physician care with which he disagreed on a couple occasions, though he ultimately seemed to concede that senior physicians were in charge of patient care--he was threatening the natural order. By season's end, Eli's most important role seemed to be as the sex partner / boyfriend / it's complicated of physician Miranda Bailey, and it's not clear if he will have any clinical role in the future. So despite these few limited suggestions that nurses have some knowledge, nurses on Grey's remain mostly mice who appear only to absorb commands from the awesome physicians who do everything that matters. See our full range of reviews on the show and see more about the show on the ABC website.
Private Practice
The Grey's spin-off Private Practice, starting its fifth season, focuses on an LA outpatient practice and features about nine major physician characters, led by "world class" OB/GYN Addison Montgomery. During its first three seasons, the show did have a minor regular nurse character, the receptionist / nurse-midwife Dell Parker. Dell began the show with little more apparent skill than a lay person and the show initially mocked midwifery, though as time went on there were minor plotlines in which he actually showed some aptitude for patient care and some limited autonomy. But he died in the last episode of the third season, apparently because the producers had no real idea what to do with a nurse-midwife character. And the producers also could not resist amping up the drama by having Dell display elation at having been admitted to medical school just before his death, reinforcing the wannabe-physician stereotype.
Since Dell's departure, the few nurses who appear on Private Practice play the same blank, subservient role as those on Grey's, and the show has moved closer to the standard Hollywood surgeon model, with more flawed but brilliant surgical characters. The show's original premise involved surgeon Addison's adventures with the more diverse "wellness clinic" crew in LA, but the lure of surgeon worship seems to be hard to resist. The last season of Private Practice ended with a cliffhanger in which holistic physician Pete has a heart attack as his wife Violet, a psychiatrist, embarks on a book tour against his wishes. Says executive producer Betsy Beers: "It will take several of our doctors to save Pete's life." We're sure it will, and that no nurses will be involved, though they would be critical in real life. And despite appearances from the dead Dell's daughter, there is no sign that his ghost or any other nurse character will appear. See our full range of reviews on the show and see more about the show on the ABC website.
House
House may end after this, its eighth season, without ever having a significant nurse character to balance its 7-8 elite physicians. Every episode of this show is a diagnostic mystery solved by a team of physicians led by the irascible genius Greg House. His team also tends to provide all meaningful care, including work that is really done by nurses or other health specialists. Overall, House has included even fewer nurses than Grey's. For the most part, House nurses are there to deferentially absorb physician commands or the occasional sneer from House, or maybe to appear fleetingly as a love interest of one of the physicians, reinforcing the idea that nurses are romantic playthings. As the new season starts, House will be in prison for crashing his car into his ex-girlfriend Lisa Cuddy's living room. Now Cuddy is off the show, and there will be new recurring characters, but both of the ones we know about are female physicians. There's no sign the show will suddenly notice that nurses play the central role in hospital care. See our full range of reviews on the show and see more about the show on the Fox website.
Body of Proof
The hero in ABC's Body of Proof, which is starting its second season, is neurosurgeon Megan Hunt, who became a medical examiner after losing sensation in her hands following a car crash. Her boss is physician Kate Murphy--the first female chief medical examiner in Philadelphia. The show also includes two other recurring physician characters, but no nurses. Body of Proof is essentially a girl-power detective drama, with Hunt as what amounts to a female Greg House / Sherlock Holmes character. Hunt uses her observational and deductive brilliance to solve murders while the men under and around her go slack-jawed, but she is also clueless if not obnoxious in her personal interactions. Body of Proof spends virtually no time in clinical settings, and not all that much time in the morgue--Hunt is often in the field showing homicide detectives what's what--but the show still sends the message that physicians are the masters of human health, in this case by virtue of their expert knowledge of how and why death occurs. In particular, the show does not seem to tire of reminding us of Hunt's clinical awesomeness, often setting it against her troubled personal life. She's a Talented Woman. Anyway, despite the increasing role of forensic nurses in real life, nurses have virtually no role in this show. See more about the show on the ABC website.
Conclusion
Did we mention that at least Nurse Jackie will be back next year? Of course, it would take many years and many shows to counter the hundreds of hours of powerful disinformation conveyed by shows like Grey's, House, and the rest. And while two of the three 2009 nurse shows are now gone, the new physician shows (like this year's A Gifted Man and Hart of Dixie) just keep coming, every year. Still, there is always hope. Did we mention Nurse Jackie?
Educate the world that nurses save lives!
