The top rated television show ER, now in its tenth season, is the target of a letter writing campaign by nurses who say that the show's depiction of them is demeaning. Such a negative portrayal, they say, is contributing to the critical shortage of nurses in the United States.
The show is wildly popular with audiences around the world. Twenty million US viewers alone tune in every week to watch, for example, patients with gunshot wounds or terminal cancer, or wealthy hypochondriacs pouring in through the doors of a level one trauma hospital in Chicago. The care of patients in ER always triggers ethical conundrums. Tempers flare. Doctors clash. In the end, the right thing is not always done.
The issues that the show tackles have long made it a target of advocacy groups. Anti-vaccination campaigners and advocates for blind people have protested about segments of ER. Now nurses are the ones who are angry, saying that they are being depicted as “handmaidens” to doctors. This, they claim, is contributing to the critical shortage of nurses in the United States.
Sandra Jacobs Summers, executive director of the Center for Nursing Advocacy, the Baltimore-based organisation that launched the letter writing campaign, says that ER's portrayal of nurses is not only negative, it is inaccurate. “They have physicians doing nurses' work.” Ms Summers says that doctors are shown performing almost all defibrillations, even though “99% of defibrillations are performed by nurses.” She adds, “If viewers saw nurses doing defibrillations, they might realise that nurses have to understand complex rhythms, take serious action, and use autonomous thinking.”
Diana Mason, editor in chief of the American Journal of Nursing, echoes Summers' concerns, saying that the show “is absolutely a problem.” She is disturbed that in the show “every nurse considers going to medical school.” But she says, “If you ask most nurses if they had a choice... they would choose to be nurses, so why are they portraying every nurse as a doctor wannabe?”
Dr Mason, who emphasises that nurses are not looking for “perfect” television images, says the character Hot Lips Hoolihan in the television series M*A*S*H was “a bit loony, but she was about excellence in care; she was in charge of nursing and she was respected.”
She says, “We're in the middle of a nursing shortage that is a public health crisis.” She points to studies, recently reviewed in an Institute of Medicine report, showing that the higher patient to nurse ratios associated with cuts are positively correlated with increased medical error and, in turn, increased morbidity and mortality.
Figure 1.
Look who's doing the defibrillating
Credit: GETTY IMAGES
But others are not so convinced that ER portrays nurses negatively or that it plays a substantial role in the nursing shortage. Gabi Ford, an emergency nurse in Eugene, Oregon, says, “Overall the show has projected nurses in a very positive light.” In an article published in June in NurseWeek News, author Bree LeMaire describes how several advanced-practice nurses are involved with the show. She concludes, “The technical directors of ER have a built-in respect and regard for nurses.”
Some experts say that working conditions rather than television images are at the heart of the current nursing shortage. “Pay is always an issue,” says Frank A Sloan, professor of economics at Duke University. “ER is probably 87th among the reasons—we had this problem back when television was black and white.”
Professor Sloan says that as women have moved into areas that were previously closed to them and have gained degrees in subjects such as business administration and medicine, they no longer want to take jobs as nurses, which pay less and command less respect, even if undeservedly so. Some hospitals, he says, have job openings, but “they're not willing to pay what it will take to get [full time nurses] so they use travelling nurses and whatever else it takes.”
But Diana Mason takes issue with Professor Sloan's assessment. “Hospitals do have money,” she says. “Besides, there is data showing that if you staff properly, it will decrease length of stay, nurse turnover, and this reduces costs. It takes $60 000 to recruit a nurse. [Better staffing] reduces risk payouts as well.” Dr Mason emphasises that “collaboration and communication” between doctors and nurses is a critical predictor of patient outcomes—something that she says is missing in ER.
Warner Brothers Television has issued a statement saying, “We are very proud of the award winning television drama series ER, which goes to great lengths to portray medical situations accurately.”