Article originally posted on Working Nurse by Ersilia Pompilio, RN, MSN, PNP
Hollywood Versus the Nurse
“Healing, helping, fixing—fantastic!
That’s why you’re a nurse. When I was a little girl,
I took a butter knife and opened up a dead bunny.
That’s why I’m a doctor!”
– dialogue from the pilot of “Nurse Jackie”
This scene between the title character of Showtime’s “Nurse Jackie” and her physician sidekick is a rare example of Hollywood capturing what nurses are all about. Unfortunately, the media, and popular entertainment in particular, more often portray the nursing role erroneously—when they portray it at all.
Misrepresented or Ignored?
Practically since the birth of sound film, Hollywood movies and TV shows have treated the hospital setting as a showcase for heroic physicians. Doctors are shown taking patients’ vital signs; having long, empathetic conversations at the bedside; resolving family members’ issues; performing life-saving medical miracles; and sometimes even solving crimes.
It would be hard to count how many daytime soap operas and nighttime dramas have featured doctors as main characters. Recent primetime TV series have been no exception. “House” (Fox) focused on the adventures of a narcissistic physician and his entourage. “Grey’s Anatomy” (ABC) is about a group of surgeons.
Nurses do exist in series like these, but they usually appear as “forearm nurses”: seen on camera only from the forearms down. They’re most often shown answering a doctor’s call to action, but RNs are sometimes depicted as performing menial tasks like hanging up doctors’ jackets or ordering lunch.
Even when nurses get speaking parts in these shows, the results rarely do much to advance the nursing profession. In a recent episode of “Chicago Med” (NBC), a new physician (presented as a roguish “cowboy”) saves the life of a newborn baby. A nurse asks the doctor for the infant so that she can take him up to the NICU. The doctor refuses and insists on carrying the baby to the unit himself.
Whether the writer of this scene intended to suggest that the nurse was too incompetent to transport an infant or just didn’t want to shift the spotlight away from the physician hero even for a moment, the implication is clear: The nurse characters on “Chicago Med” are only important enough to stand behind desks, assemble cribs and plan ladies’ nights for the hospital staff.
When medical shows do feature prominent nurse characters, realism is often sacrificed for drama or laughs. One of the recurring characters on “Code Black” (CBS) is Jesse Sallander, a.k.a. “Mama,” a flamboyant ER charge nurse who mostly plays babysitter to the medical residents. (That’s right — a charge nurse babysitting residents!)
We rarely see “Mama” talking to or touching a patient. Mostly, he walks around the ER as if performing a stand-up comedy routine.
No more realistic is Morgan Tookers of “The Mindy Project” (Fox), a nurse who later becomes a nurse practitioner despite being an ex-convict. In the real world, Tookers would have not even been accepted to nursing school.
So-Called Reality TV
What about reality TV? Some reality shows do better than most scripted dramas in their portrayal of nurses. ER charge nurse Katie Duke, RN, MSN, AGACNP-BC, who appeared on “NY Med” (ABC), says that show demonstrated “how real nurses can make an impact instead of how dramatic television usually portrays us — as serial killers, sex objects and people who don’t wear stethoscopes.”
Duke says a good reality show “makes a greater impact than scripted TV shows.” That’s definitely been true for Duke herself, whose brassy, no-nonsense personality has made her a social media celebrity.
On the other hand, reality shows aren’t always a bed of roses for nurses. ICU RN Caroline Laska, who appeared on “The Millionaire Matchmaker” (Bravo) with a number of other female professionals, says she had a bad experience with the show. “Patti Stanger, the show’s host, picked me out of the group and proceeded to harass me as well as put my nursing profession down,” Laska told me. “I stood up to her and stated I would not tolerate her petty comments and disrespect. I am a professional and deserve to be treated like one. My negative encounter with Patti Stanger was cut from the episode.”
Just like scripted shows, reality TV thrives on drama and sex appeal, even when it makes participants and their professions look bad. Another example is the 2013 series “Scrubbing In” (MTV), which portrayed young travel nurses as frivolous party animals.
Telling the Truth
Television and movies impact the real world. What people see in medical dramas often skews their perception of what happens in the hospital setting, especially if they have no personal experience with nurses to compare to the dramatized versions. That’s why back in 2001, Sandy Summers, RN, MSN, MPH, then a graduate student at the Johns Hopkins University School of Nursing, joined forces with five other Johns Hopkins students to found The Truth About Nursing, a nonprofit organization that works to change public perception.
The organization was an outgrowth of the founders’ frustration with NBC’s popular medical drama “ER.” Summers and her colleagues had reached out to producers with a four-page letter detailing how the show was portraying nursing in a negative light. Unfortunately, neither the letter nor a conference call with the producers and medical advisor produced much change.
Rather than give up, the six nurses decided to establish an advocacy organization dedicated to challenging damaging media portrayals of nurses. That list is still very long. The organization’s reviews of healthcare-related TV series (www.truthaboutnursing.org/media/tv), which use a four-star scale to rate each show’s depiction of nurses, include many one-star or even half-star ratings.
The problems aren’t limited to entertainment. Another of the organization’s ongoing concerns is the “naughty nurse” stereotype, a demeaning but popular trope that sexually objectifies nurses and reduces a respected profession to a fetish.
The good news is that The Truth About Nursing has won some important victories. In 2010, for example, the group managed to scuttle “Cali Nurse,” a planned “sexy nurse” reality show. Three years later, The Truth About Nursing convinced MTV to make major changes to “Scrubbing In,” which was then canceled after only one season.
Not All Hollywood Nurse Portrayals Are Bad
The premiere episode of the final season of “Nurse Jackie” in 2015 had more than 1 million viewers, making it Showtime’s most successful show. The title character, drug-addicted, iconoclastic New York RN Jackie Peyton, originally drew protests from nursing groups.
However, The Truth About Nursing now calls the show “perhaps the strongest depiction of a modern nurse in the history of series television” and praises the creators for presenting a nurse protagonist with a “persuasively complex mix of great talents and frailties.” Yes, Jackie is deeply flawed, but she is also depicted as a fierce advocate for her patients and fellow nurses — a rarity for TV.
TV series from England, the birthplace of Florence Nightingale, have also offered a more authentic image of nursing. The highly acclaimed “Call the Midwife” (BBC), a period drama about nurse midwives in London’s East End in the ‘50s and early ‘60s, has been a ratings success since its debut in 2012. (It airs on PBS in the U.S.)
The show’s characters are a mix of lay nurses and Anglican sisters who perform nursing duties for an impoverished community. The nurses are presented as competent patient advocates, completing the majority of patient care, newborn baby deliveries and wellness check-ups. It probably helps that the series is based on the memoirs of a real nurse-midwife, the late Jennifer Worth, RGN, RM.
HBO managed to capture the BBC sensibility with the dramedy “Getting On,” an American remake of the British show. It was a brutally funny, fiercely smart portrayal of nurses caring for elderly women in an extended care facility. Nurses were shown advocating for their patients, questioning doctors’ orders that impede patient safety, comforting family members of deceased patients, struggling with confused or combative patients and dealing with “code brown” situations on the nursing unit. Unfortunately, the series was recently canceled after only three seasons.
New Standards for Storytelling
Changing Hollywood stereotypes of nurses will mean encouraging the industry to write scripts and create characters that break the mold. Of course, most film and TV writers and producers aren’t nurses and don’t have any personal stake in how the nursing profession is depicted. However, there are good reasons for the entertainment industry to defy the status quo.
One reason is that authenticity can help a movie or TV show stand out from the crowd. When “Nurse Jackie” debuted in 2009, co-creator Liz Brixius told the New York Daily News, “Every medical show out there has been about doctors. Doctors are absolutely unable to do what they have to do without nurses.” The writing team chose to focus on a main character who was a nurse, leading to seven successful seasons.
Another reason is that taking a more realistic approach to a character can bring critical acclaim, particularly for actors. In a comparable move, actor Remy Malik chose to consult a psychologist to help flesh out his role as an antisocial hacker on “Mr. Robot” (USA) and persuaded producers to hire the psychologist for the show full-time. The result? Malik received the 2016 Critics’ Choice Award for Best Actor in a Drama Series and the show was named Best Drama Series.
The same could be done for nurses’ roles.
The Role of Social Media
As The Truth About Nursing has demonstrated over the past 15 years, negative publicity can also be a powerful motivator. If enough nurses express their outrage on social media, producers and sponsors will often respond in a hurry.
In September 2015, the hosts of ABC’s daytime talk show “The View” mocked the emotional monologue Miss Colorado — Kelley Johnson, RN — delivered about her nursing career during the 2016 Miss America pageant. “Why is she wearing a doctor’s stethoscope?” asked co-host Joy Behar.
Millions of nurses took to Twitter, Facebook and Instagram in protest, using the hashtags #showmeyourstethoscope, #nursesunite and #nursesrule. Their strength in numbers paid off: “The View” responded with a segment in which the hosts apologized for their earlier statements. The show later invited stethoscope-wearing nurses (and other non-physician healthcare professionals) to educate the cast and viewers about their roles.
“Nurses should utilize tools like social media to make a greater difference in the world and show what nursing is truly all about,” says Katie Duke. Fellow reality TV veteran Caroline Laska agrees. “Advocating for a positive nursing image in Hollywood is key,” she says.
Becoming Media Savvy
“Nurses are great in dealing with the public and need to develop a comfort with being in front of the media,” says Diana Mason, RN, Ph.D., FAAN, Rudin Professor of Nursing at Hunter-Bellevue School of Nursing and co-director of Hunter College’s Center for Health, Media and Policy. “Nurses are not expected to stand up and voice their opinions and the media does not always value their special knowledge and skill set.”
Mason says that to change that, nurses need more training in media relations. “Media training is important for nurses, empowering them to acquire the tools needed to share their knowledge base,” she says.
Sadly, even those nurses who are great at making a point in only 140 characters may hesitate to speak out for fear of losing their jobs. Some hospitals have made nurses shut down their personal Twitter and Facebook accounts for making comments that didn’t meet with the hospital’s approval. Back in 2014, Katie Duke was actually fired over an Instagram post that her hospital deemed “insensitive.”
Hospitals need to empower nurses to speak to the media in order to educate the public on the true role and importance of the nursing profession. Media education and support for nurses, coordinated with a hospital’s public relations department, should be a basic part of new hire training.
Only a few nurses will go on to write screenplays or bestselling books and plays that are adapted into movies and TV shows. However, nurses who write opinion pieces for newspapers, submit articles for publication and speak up when filmmakers and TV producers step out of line can do much to change Hollywood’s ignorant portrayal of the profession.
On the critically acclaimed show, “Mad Men” (AMC) advertising agency creative director Don Draper famously said, “If you don’t like what they’re saying about you, change the conversation.” Nurses have the power to do just that.