destructive, grossly inaccurate messages about nursing

[nursegoodlove]

See: http://www.nursingadvocacy.org/news/2003oct10_er.html

and take action on:

October 9 "ER" sets a new world record for harmful inaccuracies & distortions about nursing.

Inaccuracy No. 1. The big staffing problem for nurses today is that hospitals are cutting senior nurses back to part-time, so they can cut their benefits & hire cheaper traveling nurses & new grads who will work for "minimum wage". Does this sound like the nrsg. shortage that currently threatens global health? That includes such rampant short-staffing & forced OT that is driving man from the profession they still love? That forces hospitals to hire agency & traveling nurses who are in reality far more expensive? In Oct. 9 ER episode, many of the veteran RNs sign a petition & stage a walk-out when they learn the hospital has the plan outlined above for them. As a result, six RNs are fired by chief of ER medicine (Romano) & a number of other nurses are given 90-day suspensions. Lockhart does not join in the petition, at least in part because she is upset by a breakup letter from Dr. ,boyfriend, Carter, & perhaps because the show has assigned her a supervisory postion that the show itself does not seem to understand. Here she is called a "charge nurse", though last season she was forcibly made "nurse manager". The show clearly has little idea what either of these positions or any nurse mgr. job entails. At one point a character says that some of the nurses will be speaking to "nrsg. admin." about the problem, but no more is heard about that. This story line seems mainly designed to show how the beleaguered Lockhart is caught in the middle, & that Romano lost none of his arbitrary cruelty when he lost his arm. But it also sends a message that there is such a glut of nurses eager to work for nothing that hospitals can jerk them around at will. Although real life nurses obviously were targeted for cuts some yrs. ago & this has been a significant factor in the current shortage, this story line is a dangerous fantasy. "ER" has virtually never shown any awareness of or concern for the real nrsg. shortage, but blundering into volatile situation like this is inexcusable. It's possible that the comment by nurse character Lydia that the new grad nurses will be pd. "minimum wage" is not meant to be taken literally, but will viewer who know little or nothing of nursing understand that? Many viewers assume that nurses really do earn something like minimum wage. And the traveling-nurses -are-cheaper element shows profound ignorance of the reality of nrsg. today. In addition, the episode shows nurses casually abandoning their pts. mid-shift, which would be a serious ethical violation & rarely if ever occurs. Of course, if you view nrsg. as largely peripheral work the pts. can probably do without, such abandonment is no such a big deal. The med. students & clerks can pick up the slack. And they do: the episode shows medical students giving meds. on their own, with no nurse present. There is one bright spot. As part of their discussion, Lockhart does briefly tell Romano that cutting the RN-to-pt. ration will likely result in pt. deaths :imbar . But the show does little to show why that might be.

Inaccuracy No. 2 Nurses report to physicians & serve at their will. This is not new for "ER" but this episode is an esp. powerful example of this continuing, destructive inaccuracy. "ER" has always stressed that RNs work for Drs, who can fire them if they choose. Here, Lockhart tells Romano that he "Can fire nurses," though she does not say why. Romano responds that he can if they walk off the job. To this Lockhart has no real response, as is often the case. The makers of "ER" continue to be interested in showing RNs absorbing DR abuse, but they still have no clue what a real RN might say in response, or how the nrsg. profession is actually govenerned, i.e.: by RNs. As in the past episodes, the firings & disciplinary measures go through with no evident involvement from any RN mngr., despite the suggestion that the RNs were going to see "nursing administration." It is no clear what managers do because they never appear & they never seem to have an impact on what happens on the show. AN ER Dr. tells Lockhart she can't tell a pt. she has a fatal condition - Lockhart has no response but to look hurt. The implication is taht the pts. belong to DRs & that RNs are merely appendeges. In reality, RNs have professional responsibilities to their pts. which do not depend on what DRs think & RNs work with DRs but do not report to DRs, & pts. concerns are as muchthe province of nrsg. as medicine. In this case, Lockhart --as a pt. advocate should have fought for what she believed was in her pts. best interest & taken this issue to the hospital's ethical committe, if necessary. Nor would it seem consistent with Lockharts' ethical responsibilities to simply ignor the parent's concerns & tell the minor pt. anyway, as the episode's last scene seems to suggest Lockhart does.

Inaccuracy No. 3 Nurses can excel by learning some medicine, but they should know their place. The episode begins by having Lockhart take charge of showing a new batch of medical students some things about the "ER", including actual health procedures. Of course, as usual, the implication is that the nurse has only enough knowledge to help medical professionals who are somehow impaired, in this case by their inexperience. Other elements of the episode send more troubling messages about RNs skills. In one scene, Lockhart urges the reluctant DRs to crack a crashing pts. chest. They resist, though Lockhart pushes so hard for the thoracotomy that she is, as Lewis notes with disapproval, practically ready to do it herself. This is consisten with this yrs. apparent theme of showing Lockhart to have significant technical knowledge & an increased willingness to push the DRs to consider her ideas for tx, at times actually appearing to prevail in the resulting dispute. Here, Lockhart even mocks the DRs for their reluctance to do the procedure. And as it happens, cracking the pts. chest here is indeed an obvious call given the pts. condition. However, it is pretty clear that the show feels Lockhart is being driven to insolently challenge the DR care by her own frustrations, probably some anti-DR animus related to her problems with Carter. The show thinks she is being insubordinat. But another fundamental problem is that, as in the past, the show is suggesting that RNs excel by learning medicine, not in nrsg. Despite all the anan. RNs who function on the show's human wallpaper, the show rarely focuses on actual nrsg. care. It appears to have little idea of how one might show nrsg. expertise or professional development, to say nothing of the work of the nation's 200,000 graduate-prepared advanced practice nurses. Like serfs trying to show their worth to the higher classes, both Lockhart & her predecessor Carol Hathaway have demonstrated their real value only by showing interest in & aptitude for medicine. Higher nursing education does not exist. The show seems to think all RNs are basically interchangeable. At one point in the episode, veteran minor nurse character Malik tells Lockhart that he is not involved in the walkout because he is an LVN & so "it don't get no cheaper than me." This is truly bizarre. In all the yrs. malik has been on the show, apparently doing the same jobs as Lockhart & the other ER RNs, there has been no hint that he is not an RN. In fact, LVN's generally do not even work in level 1 trauma center EDs, as they aren't trained in many of the nrsg. tasks required. Even within this dangerously flawed vision of nurse achievement through medical knowledge, the show wants us to know their are limits. Lockhart is portrayed as overstepping her bounds. And Lewis is not the only attending DR to make clear that she is out of line. The highly respected surgeon Corday also peers across the thoracotomy pt. at Lockhart, then explains why they won't do what Lockhart wants. In doing so, Corday seems more perplexed than annoyed--what is this nutty RN on about? Only the relatively inexperiences resident Pratt seems to feel Lockhart had some justification for her actions, though he is hardly a poster boy for appropriate conduct himself. Perhaps the most notable comment on nrsg. expertise in the episode comes from the hotshot surgeon Dorset, who is presented as the epitome of arrogant surgical brilliance, swaggering, irresistible rogue. Med. students swoon over his mastery of sightless surgery & Corday is soon intimate with him while on a coffee break. The show gives no indication that any character feels anything but justified awe for the man. Into the mouth of this godlike character the show inserts an extraordinary line.At one point during Dorset's virtuosic intervention into a pts. chest, he asks a medical question, that 2 gawking med. students can't answer. Lockhart tentatively does answer the question, prompting the surgeon to note that the students have been "nurse slapped". Lockhart seems to take this as a crude compliment, & at first glance it kind of sounds like one, since it suggest that she has contemptuously shown them her superior power (in the form of knowledge). But this does nursing no favors. First, as noted above, it suggests that RNs excel only to the extent they can absorb some medical knowledge. Second, the comment paints Lockhart as an abusive aggressor, which--the show's apparent view aside--is no model or professional conduct. In fact, Lockhart's actual demeanor in answering the question has the opposite problem--she is far to meek in offering hr modest little view to the Great Man. most fundamentally, Lockhart has a BSN in nrsg., some med. school & many yrs. of hospital experience. Is it a great compliment that she knows more than a couple fresh-faced med. students? What it does suggest is that for a med. professional to be upstaged by a lowly female RN, not matter how much more experiences she is, is akin to being an oppressed woman dealt a dismissive physical blow.

Inaccuracy No. 4 No one wants to be a nurse, and really, why would anyone want to? Perhaps for the first time on "ER", the show actually shows a RN, in this case Lockhart, acting as the triage nurse. Triage is a critical ED function in which RNs autonomously determine how sick people are & how quickly they need to be seen, life & death work that the show only recently even admitted that RNs do. Unfortunately, even this laudable effort is corrupted by the show's vision of the job as some kind of glorified babysitting, as Lockhart sees a succession of kooky people with fairly trivial complaints but an excessively demanding attitude. The idea is to show how this annoying parade helps to wear Lockhart down on her bad day. Dealing with a range of distressed people is indeed a part of triage nrsg. But the fear is, the average viewer will conclude that is all there is. The show gives no sense of the job's critical importance or the real nrsg. expertise it requires. Real triage RNs save lives all the time. But with only one exception, no pt. Lockhart sees at triage appears to need urgent care, & a critical opportunity to educate the public is wasted. Even worse, in a bid to heighten the comic effect that actually serves to emphasixe how mechanical & trivial the show thinks the work is, the show repeatedly has Lockhart punching the time stamp on pts. charts, as if she had a simple, monotonous job on an assembly line. As if the romantic jilting, tedious work, petty annoyances, staffing problems & Dr. abuse weren't enough - the public does not respect nurses. This reality is brought home to Lockhart when she escorts a gaggle of cute male & female school kids to an upper fl. of the hospital. Their teacher asks if any of them wants to be a nurse. The response from the kids is silence. Then one cute girls says she wants to be a DR., and other kids scream "me too!" Lockhart's response? Hurt silence. As for the children's views, well yes. That is how many people think, & you can hardly fault a show for telling the truth. But would it have been too much to expect some stab at a response, some small effort to let viewers know why people think this way, or that is is a threat to our future, or that nurses do critical work saving lives & nrsg. can be very fulfilling despite the problems? Guess so. With no hint of any alternative vision, who could blame a viewer for concluding that the children are simply using good sense by rejecting nrsg. As Lockhart herself says at one point, "I hate my job.

Thus, an episode that the makers of "ER" may well have viewed as hard-nosed but empathetic look at challenges RNs face amounts to one of the most damaging assaults on the nrsg image ever seen. In general, "ER" is so damaging because it strives so mightily to portray medical diagnosis & tx. as they really are that viewers may well believe that is is equally dedicated to a realistic portrayal of nrsg. and the roles health care professionals play.

Why does this happen? For one thing, it seems clear that the show continues to refuse to consult experienced RNs in developing its scripts. The episode is consistent with a show that gets all its significant technical advice from people who may have worked with nurses but have never understood what RNs actually do. Moreover, without impugning any motives or the fine work of any health care professionals, one can't help note that the show's grossly inaccurate presentation of nursing as subordinate, peripheral work does no obvious harm to the standing of the medical profession. While it is appreciated that "ER" attempts to emphathize with RNs, they must be urged to honor one of the key tenets of the medical profession: first do no harm.

TAKE ACTION!

Let those responsible for "ER" know how you feel about its damaging effect on the nursing profession.

*See the above link on how to do this*

[psychomachia]

Nice story review, but the best line was when Kerry told Romano that HE was HER *****!! HA!!

Oh...wait a minute... this isn't the ER show review thread???

Sorry...

[psychomachia]

Wait a minute!!! I can't say *****??? For those who didn't see the show, the word is B and then an I and then a T and then a C and then an H....hahha

[RNonsense]

I saw it. The B*tch comment was funny, but I HATE how they have written Abby's character. :rolleyes:

[gwenith, BSN, RN]

I find nursingadvocate's unrelenting negative reports on how nursing is portrayed in the media to be a little off putting. Thier campagns to get RNs to sign petitions protesting every portrayal of nurses, I fear will only pertetuate the "nurses as whingers" stereotype that will do our profession far more harm.

I have mentioned this is Sandy Summers and I will reiterate it here. We will catch more flies with honey than we will with vinear. Instead of writing protest we should be writing to graciously thank the show for attempting to bring issues to light and then correct any innacuracies if neccessary. Be nice and they will be nice to us.

[nursegoodlove]

Hi Gwenith, According to the nrsg. advocacy website, they did start off with "honey" :kiss by opening a dialog with "ER" 2 yrs. ago. The Centre had apparently put together a coalition of the Dean & a number of professors from John Hopkins University & the (then) past, current & future presidents of the Emergency Nurses Association to sign the initial letter & then (much of the same group) to sit in on a conference call they had set up with "ER". They told them all the "good things" that they liked about their show & expressed their concerns about the inaccuracies in an hour long conference call that was with a co-executive producer & the medical advisor. In follow-up communications with "ER", they basically told the Centre to stop contacting them & refused to make even one of the seven changes they requested, including the very simple change of changing the language on their website that said Lockhart was "demoted to nurse".

Gwenith, if you want to use "honey" to get them to change their depiction of nursing, click here for the contact info. of the producers:

http://www.nursingadvocacy.org/news/2003oct10_er_contact.html

Let me know if you have any better success than the Center appears to have - "not"!

[Tink RN]

I liked it when the dude was talking while he was intubated and on a vent. I was pondering over just how he managed to do that - but then the thought occurred to me that it is FICTION.

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[nursegoodlove]

Hi Tink,

Well the "FICTION" may become our worse "SCIENCE FICTION" in that the public do not always know what exactly it is a nurse is or does, their value, education, skills, autonomy, etc. And by portraying nurses as having no say, hating their jobs, doctors having sole control over everything from patients to the hiring and firing of nurses, etc. to the point where even little children know better than to be a nurse - we may very well bury our profession for "minimum wage" workers - as suggested by this show...

I for one am not going to take that lightly. It's not wonder the mess we are in.

[VivaLasViejas, ASN, RN]

And that's the whole point: it's HOLLYWOOD, not reality!! Anyone with the IQ of a lawn chair knows that. Come on, folks, get over it and start fighting for the things that matter.....improved staffing, better pay and benefits, and getting big business out of health care so that patients, not profits, come first. Getting all bent out of gear over a TV show is NOT the way to make the public sit up and take notice of us, unless of course we want to be seen as a bunch of complainers, like the "food police" and the groups who whine about cussing in movies. But, that's just MHO.

[nursegoodlove]

And how do you make "positive change" besides injecting a little "reality" into what "real" nurses do/are? Perhaps then, "Hollywood"/the public would take us seriously enough to make all the improvements you have mentioned. And I do not seriously think for one moment that the general public "know" what is going on inside the walls of the hospital - and it is up to us to educate them. Our "complaints" do not have to go to the "public" - rather the dream weavers of this production - see the website for direct email.

[Tink RN]

Howdy right back at ya nursegoodlove!

Obviously this truly disturbs you - so I will refrain from further sarcastic remarks.

My husband is a policeman ... I'm sure glad he doesn't get all worked up about fictional shows with crooked cops ... I would never have any piece and quiet.

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[psychomachia]

Cops, firefighters, paramedics, public servants of all kinds get the same overblown Hollywood treatment, but nobody with half a neuron actually uses what they see on tv while setting policies, so why should we think that a script from ER will set nursing back a decade or two? Sorry, but I bet most people who watched the show can't even remember what happened from week to week without the "previously on ER" segment to refresh their oh-so-short term memory, much less remember/care about the trials and tribulations of poor ol' Abby!

And let's not forget that ER DID show a nurse getting hammered and they DID show her having a brain and they DID show how stupid admnistration can be, so really, what is the big deal???

I tend to think that the people who really like ER and watch it faithfully probably watch a lot of the "real ER" shows that the Discovery Channel produce, so there is somewhat of a balance. ER makes its stories the way they are SO PEOPLE WILL WATCH, PERIOD!!!! Enjoy it for what it is and don't expect to much "reality."