PULSE: Caring meets controversy

By Laura Raines, Pulse editor

When Cindy Balkstra thinks of nurses portrayed on television, she fondly remembers a show from her childhood.

” ‘Julia’ [played by Diahann Carroll in 1968] was a black single mother and a nurse. She got into some funny predicaments, but she was very professional. I still remember her putting on her nurse’s cape and going off to work,” said Balkstra, MS, RN, CNS-BC, Georgia Nurses Association president.

“I always wanted to be a nurse growing up, and that show was probably a positive influence on me.”

Balkstra can’t say the same about Showtime’s “Nurse Jackie” and TNT’s “HawthoRNe,” two new shows with controversial nurses as leading characters. She’s hoping that NBC’s “Mercy” — which debuted Sept. 23 — is more realistic and positive.

“Part of me says, ‘Wow, three shows about nurses doing nurses work in one season,’ but mostly I’m saddened by the fictional portrayal,” Balkstra said. “This could have been a great opportunity to promote the profession and show nurses as strong, ethical, autonomous, critical-thinking, proactive patient advocates. Instead, television seems to have gone for the shock value.”

Edie Falco in Nurse Jackie

Edie Falco as Jackie O'Hurley and Merritt Wever as Zoey in Nurse Jackie (Episode 3) - Photo: Ken Regan/Showtime.

Billed as a dark comedy, “Nurse Jackie” centers around Jackie Peyton (portrayed by Edie Falco of “The Sopranos”), a veteran nurse who works in a tough New York City emergency room. A caring, competent nurse on one hand, she’s addicted to painkillers and forges a patient’s organ donor card, among other questionable practices. A married woman with children, she’s also having an affair with a pharmacist at the hospital.

Complex characters

While Balkstra believes that Christina Hawthorne (played by Jada Pinkett Smith) is a more positive character, she doesn’t see much reality in a chief nursing officer who runs around in a lab coat and handles “everything from suicidal patients to overwhelmed novice nurses, all the while continuing her administrative duties.”

In a GNA newsletter, Balkstra wrote that she was “extremely disappointed” in the summer shows. “The producers missed a huge opportunity to represent the nursing profession in an ethical, respectful manner. These shows could have served as recruitment tools, enticing more people into the nursing profession for the right reasons.”

Many of the newsletter’s readers agreed with Balkstra, but others said that “Nurse Jackie” and “HawthoRNe” are just TV shows and shouldn’t be taken too seriously.

“Some saw strong characters and pointed out that it was important not to show nurses just emptying bed pans and giving pills,” Balkstra said. “Whatever these shows do, it’s definitely a plus to have nurses talking about what they do and what their image should be.”

The American Nursing Association publicly disapproved of the negative images in “Nurse Jackie” and called for nurses to complain to Showtime. In a poll taken on its Web site (www.nursingworld.org), the association asked, “Do you think negative images of nursing as portrayed in TV shows like ‘Nurse Jackie’ and ‘HawthoRNe’ significantly hurt the profession?” Of 1,026 people who responded, 53 percent voted “yes” and 47 percent said “no.”

Role of nurses

Brenda Bryant, LPN, a pediatric nurse at West Atlanta Pediatrics in Lithia Springs, enjoys watching “HawthoRNe.”

“It’s a good drama,” Bryant said. “She may not always do what a nurse in her position would do in real life, but her love and her genuine concern for her patients comes through.

“In the scenes where she talks back to the doctor, she’s letting him know that nurses are also trained professionals and have opinions. She’s not overstepping her boundaries. Nurses do a lot more than take vital signs.”

Bryant has used the show to illustrate the role of nurses to her 27-year-old daughter, and explains why Hawthorne makes some of the decisions she does. She was looking forward to seeing how trauma nurses are portrayed on “Mercy.”

Janice Long, RN, Ph.D., an assistant professor at the WellStar School of Nursing at Kennesaw State University, is also a fan of “HawthoRNe.” “It captures the autonomy of nursing big-time, and is helping to dispel the myth that all nurses do is take doctor’s orders,” she said.

Having worked as a renal specialist, an ICU nurse, a legal nurse consultant and a nurse manager, Long recalled an episode that gave a good picture of the struggle between giving good care and keeping a hospital afloat as a business.

“Having lived in that role as a manager, I was moved by it,” she said.

Long wants to use some of the issues portrayed in the show when she teaches.

“Novice nurses have to learn to juggle caring for patients with their personal lives,” Long said. “Sexual innuendos made by patients? It happens.

“The fact that doctors look more important to patients and that male nurses can face adverse reactions in a female-dominated workplace are real situations.”

Although Long hasn’t seen “Nurse Jackie,” she knows that narcotics abuse happens in the medical field.

“If we suspect a problem, we screen and try to get someone into rehab,” Long said. “I’ve had recovered nurses referred to me because our unit didn’t have narcotics.”

Fact vs. fiction

That’s the difference between fiction and reality, and these shows are “fiction,” said Ginger Fidel, MSN, RN, instructor at the Medical College of Georgia’s School of Nursing in Augusta.

“I love my profession. It’s the essence of who I am, so I taped the shows to see what they would get right and wrong,” Fidel said. “Nurses can have personal problems, but not to that extent. Jackie is a mess and what she does is very far from reality.

“As a nurse, you can’t just walk into a pharmacy and pick up a narcotic of choice and give it to yourself. There are checks in place.”

Still, she finds some truth in the dramas.

“I think ‘Nurse Jackie’ may give us the tiniest fragment of what it must be like to work in an inner-city ER, where you never know what’s going to come through the door,” Fidel said. “I like that ‘HawthoRNe’ is making the social statement that minority nurses can and do become nurse leaders, and both shows make the point that nurses are not the handmaidens of doctors, that they have their own practice.”

Fidel also takes issue with the unethical behavior portrayed in the shows.

“Still, we’ve been handed lemons before, and these shows give us the opportunity to make lemonade,” Fidel said. “The public doesn’t have a clear perception of all that nurses do, so this is our opportunity to speak up and reach out.

“We can offer to speak to legislators, to schools, at churches and community organizations. We can explain our role as a registered nurse, a nurse practitioner or a nurse scientist. We can turn these shows into a positive by telling people what we really do.”

2 comments Add your comment

PULSE: 0ctober 2009 edition | Blog Break

September 23rd, 2009
4:44 pm

[...] Caring meets controversy [...]

Jennifer

September 25th, 2009
2:18 am

I’ve only watched “Hawthorne” a couple of times, but I’m rather impressed by the show because it portrays nurses as professional independent thinkers who use clinical judgment to handle patient problems. This is the first medical drama I’ve seen in which nurses are far more than obscure figures in the background who step in only to clean up messes involving bodily fluids, fluff pillows, or give shots. No, the nurses portrayed on this show don’t practice textbook nursing, but it is a start in the public getting an image of nurses as intelligent professionals. Regarding a CNO handling “everything from suicidal patients to overwhelmed novice nurses, all the while continuing her administrative duties” : That one sentence is a near perfect description of my job! Ok, I’m not a CNO but a house supervisor at a large rehabilitation facility, and yes on any given night I could be dealing with a suicidal patient, letting an overwhelmed new nurse (or family member) cry on my shoulder, help pass meds, respond to codes, in addition to chart audits, patient care assignments, employee evaluations, unit staffing, etc. Thumbs up for “HawthoRNe!!!