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Nurses and Nursing in the Media

I've now seen at least one episode of two different new Televideo shows about Registered Nurses: Nurse Jackie and HawthoRNe. Interestingly enough, within the past three days slave2tehtink passed me a link to a piece published, at least on-line, by the New York Times (link follows http://well.blogs.nytimes.com/2009/07/01/nurses-helpers-angels-or-something-more/ and I didn't need a login to view it...), that discussed the image of Nurses in the media. I'm not sure if this is going to be a rant. It will contain elements of being a review. No major spoilers, I'm sure, if you happen to be someone interested in either show.


I do not, as a rule, watch many of the health-care related dramas or comedies. This dates to before my becoming a Registered Nurse. In fact, the only entertainment I've watched with any regularity that involves hospitals is M.A.S.H., both the movie and the television series. Partially this is because, for example, House M.D., I work with arrogant obnoxious excuses for camel flatus like that and don't find that entertaining either. Or, I boggle at the business of an RN floating from unit to unit, not as a staff nurse but as the Charge Nurse. Or the Director of Nursing being out there running an individual unit. Or the general 'earthy' humour of people 'dealing with life and death decisions.'

In short, either I am not entertained or I find the willing suspension of disbelief to be impossible in the face of too many years dealing with the reality.

There is a shortage of Registered Nurses not only here in my country, but through out the world. Recent news reports about President Obama commenting that we should be able to find enough new RN's from our own population without luring nurses here from overseas. Yes, we should; though there are a number of factors in this which may or may not be obvious.

One does not remain in the profession of Nursing to become independently wealthy.

Income improved over the 30 years I've been practicing, and I am able to take care of my small family. Even save some money. Most of those savings, however, are in the form of tax-deferred investments which as with everyone elses, aren't quite what they were worth five years ago. Providing all goes well and I don't kill anyone, I will receive a pension from Hospital and could begin to receive that pension in about a year and a half. I am far from being independently wealthy, however. And even with some forethought and planning, while I will be able to receive that pension check, I won't be able to stop working.

Over those same 30 years, I've seen rather more than a few people enter the profession, and burn out or decide it really isn't what they thought it would be. Being a RN is not easy. Being a good one is downright difficult. As more of the role is delegated, and delegated is a very specific word choice here; there are aspects of the role which can not be done by someone not licensed as an RN, as more aspects are delegated there is growing confusion as to who are the RN's, and what do they do? The difficulty of the work, plus the confusion as to who is doing what, all make Nursing a less desirable profession to many people.

One of the reasons for the shortage is the success of the feminist movement. If anyone doubts those success' in light of other things also going on, I assure you, they are success'. When my aunts and even my older sisters entered the workforce, there were two positions in general open to them: Teacher, or Registered Nurse. This is no longer the case, and even with acknowledged differentials in pay between men and women doing the same work (generally - this is something at least locally which is not the case in Nursing), engineers still make more income than RN's do, MD's as well, plus the gamut of other professions available ing which women now work.

Now let us add another factor which many people do not know, despite the news that teachers are underpaid and there are all those cuts being made to education budgets in the current economy. It is a factor which I am familiar with through one of my sisters and through a friend, met here and only online through LJ, lolleeroberts. Nursing educators, despite needing the academic qualifications which make them eligible to become Advanced Registered Nurse Practicioners (ARNP's), are chronically paid less than they would make practicing as an ARNP. They are responsible for the practice of their students in the clinical settings. In other words, way more liability, hassle, and far less income.

So here we are, facing a severe shortage of practicing Registered Nurses, in an environment which burns those who are practicing because people do not know what they truly are doing for them, doesn't pay them then what people doing other profession level-equivalent intellectual work are being paid, and pays them even less to teach those who will be needed to replace the active practitioners.

Nursing, in short, is also suffering from an extreme role-perception dichotomy as well as a shortage. I don't particularly care which came first. However, we as a profession, despite being ranked as the Most Trusted Professionals (out-ranked by firefighters in the year after the disasters of September 11, and IIRC only in that year) need a damn site better Public Relations image than we've got.

Which leads to, Nurses in the Media. And what kind of role model are they. Doing what?

Nurse Jackie got a lot of publicity pre-airing as a strong character doing a difficult job. OK. What I've seen so far, though, doesn't show me a strong character, rather shows me a rude person. Who furthermore is exemplifying several of the cliche stereotypes of Nurses. Now, cliches, stereotypes, these become such because there is an element of truth in them. Nurses are human; as such we are subject to all human foibles.

Nurse Jackie, the character (rather than the show title) is a 'hot nurse strong character who parties hard.' In short, she is in an adulterous relationship with a pharmacist who is providing her with narcotic controlled substances that she takes while in the practice environment (at work). I'll go with she's a 'hot' person as she's not apparently neglecting her husband. You know (and this may shock a lot of people I know, won't others) I'm even OK with sexual relationships with more than one partner, providing all the parties involved are knowledgeable and consenting. It's pretty obviously not the case in this show, based on behaviors.

As for her drug usage, hmm. Well, I suppose that could be a story arc upcoming bit of business. Overcoming adversity or some such. Don't think the writer of this show did much research into either the role of a Registered Nurse nor the legal basis for our practice. That same drug usage? Controlled substances, much less narcotics, that are not prescribed and used accordingly will get a Nursing license suspended quicker than you can belch, once the use of same is out. And there is no way in anybodies ED that the effect that usage would have on professional judgment and work performance wouldn't be noticed. (Aside: this is one of my biggest problems with the whole House M.D. thing, too. Same applies.)

Over my 35 years in health care and 30 of them as an RN, I know, personally, three nurses who walked this road. One of them regained her license. Rest her soul as she is now dearly departed, she told me she figured one reason she did get her license back is she told the Board no, she didn't trust herself around narcotics after becoming an addict, nor even after reforming, and that was why she found a position practicing somewhere that narcotics would not be dispensed.

I don't much like the way the writer has this character 'helping' an orientee RN on her unit, either.

What did I like about the episodes I've seen? I like some of the patients. The featured patients. In them, I see real people. I like one of the supporting roles; he too is a stereotype, a gay RN. Even so, his character comes from (I'm thinking) a culture where such may or may not be tolerated. Not much said and done about that aspect; what I do see is his character caring about the patients. And more, yes. But I've seen caring from him.

The other show is HawthoRNe. Again, with the hype, a 'strong nurse doing the impossible'. In this case, she is referred to by other characters, and by herself, as the Director of Nursing for the facility of the show. In short - no. Based on what I saw, I am finding no willing suspension of disbelief. Not for anything which happened in the episode I saw. Not. Anything.

Daughter of the title character allowed to wander throughout the hospital, talking with and photographing the patients without consent or permission or challenge.

Upper Level Manager of the hospital not recognising the Director of Nursing. Um, hello, in my Hospital? Director of Nursing is a Vice President of the organisation, folks. Might or might not hold in all hospitals throughout the world, that the DoN would be a VP. You can count on it that the VP's or Presidents or CEO's or Whoever at that level of the organisation would know the DoN, as sure as you can count on needing to breathe to stay alive.

Patient movements involved... no. Just, No. Much less being organised by a Director of Nursing in that manner. No.

So.

Nursing, according to that NYT article, hasn't fared well in most medical dramas. None of them, to date, truly show what it is that Registered Nurses do for you when you need them. Gather data about your problems. Analyze and assess that data into information that leads to a Plan, to correct those problems to the best of the patient's ability. Implement that plan, which involves both direct Nursing actions and a whole lot of other people called the Health Care Team. Then do it again, to be sure it worked. Change as needed. Rinse and repeat. It's not Medical Diagnosis and Treatment; that's what Medical Doctors do. Yes, they order treatments and medications and then RN's administer those treatments or medications. That is, if something else in the patient's condition doesn't contraindicate it. Or change suddenly, which your M.D. won't see as they aren't at or near the patient bedside 24/7.

All that said, the two shows remain programmed for the DVR to record. Another one of my very good friends told me in the last 12 month, 'You're non-judgemental. That's a very good thing in your profession.' Yes, it is. Fixing those problems rather requires that non-judgemental aspect, and that is one reason why the two shows remain on the DVR schedule. Also Herself rather likes at least one of them. Still, won't be many more of the first one discussed that I'll watch if things don't change rather quickly. Only saw the one of the second one discussed, so there's at least two more viewings in my future.

And that said, I'm not hopeful.

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( 7 comments — Leave a comment )
quietdarkness
Jul. 4th, 2009 11:00 pm (UTC)
I saw HawthoRNe's first 2 episodes. I really wanted to hate it like the plague, but I didn't. Yeah, the Director of Nursing parading around the hospital, from the ER to pediatrics to the floor to the ICU saving patient's lives and all that jazz is really hard to buy. Our director is also a VP and whereas I see her, and she knows me (I chewed her ass out about patient safety and no staff during Hurricane Ike, I'm lucky I'm still working there) she is NOT going to sully her hands by doing any actual nursing. I also find it terribly amusing that they obviously rotate nurses from ICU to ER to the floor to peds. Oh yeah, maybe in a 50 bed rural hospital, but this isn't supposed to be a rural hospital.

Having said that, I commend the writers for making an honest attempt to show the issues facing nursing. Thus far, we've seen an unreasonable abusive patient that made the new nurse on the show cry. We've seen a really arrogant doctor be abusive to nurses when the doctor was in the wrong and there was actually a doctor who was going to address the issue with the doctor in question. We've seen the male nurse try to get his overtime pay out of the money guys sitting around administration who give him 3 different answers on what form to fill out to get his money and string him along. We've seen family members threatening to sue when things don't go their way.

Yes, there is plenty that sets my teeth on edge when I watched this show, but I can't watch any medical show without wanting to slit my throat. This one however, is taking a stab at showing some of the issues that we face on the job.

Not that I plan on being a regular viewer.

What we're seeing with our new BSN grads is that they are selecting students solely based on the GPA of like 3.8 or above. They are also telling these youngsters that they aren't going to have to work very hard and that they will delegate just about everything. These young people are high on brains, but totally crappy on compassion. And they whine like hell that it's SO busy and they have to work SO hard with their 4-5 or God forbid, 6 patients. They aren't trotting water or changing a bed or taking any patient to the bathroom because that's "not their job." My unit makes a concerted effort to train them, be nice to them, and support them, and then have them leave in a year or two because "the work is too hard. We shouldn't have to work like this." Fortunately, my alma mater sent me a questionnaire about the new grads that they are turning out, and hoo boy, I told them. I told them and I told them. They need to select just a little less for book learning and a little more for social skills. motivation and common sense.

I don't know about my hospital, but if I went back and got my Master's Degree, and went looking for a job utilizing it, I'd have to take a pay cut. I don't need more initials behind my name to feel important, I'd want them to show me the money.
firesmithsghost
Jul. 4th, 2009 11:09 pm (UTC)
Photobucket

Oh, when you said nursing.....
i_amsherlocked
Jul. 4th, 2009 11:40 pm (UTC)
AMEN!

i_amsherlocked
Jul. 4th, 2009 11:39 pm (UTC)
I won't watch many of the birth related shows (real-life drama or just TV fiction) because of the same reasons. (plus having been in a TLC "real life" birth show, I know how fake their 'Life Unscripted' shtick is.)
They just end up making me mad at how everything is portrayed so I avoid them.
jehannamama
Jul. 5th, 2009 12:49 am (UTC)
Oddly enough I love medical shows, much as I do sit and hoot derision at how unrealistic some of them are, like Nurse Jackie and HawthoRN.

I think you covered nursing pretty well. Once medicine became privatized business, the care level started dropping where I had worked dramatically, year by year, as the workload increased.

And you sure do point out about how the teachers are really underpaid. Most of them don't want to work as nurses anymore. A couple of the ones that I had didn't really like caring for patients at all anymore. And I had one that actually did pop valium in front of us on clinical duty days, because she was always a nervous wreck, screaming at us in front of patients.
snidegrrl
Jul. 5th, 2009 02:06 pm (UTC)
I just this weekend tried to watch the HawthoRNe show, since I don't have HBO or Showtime or whatever, I can't watch Nurse Jackie. But I have been reading all the nurse blogs around the blogosphere and I'm amazed to see the mixed results, some people hating it for all the reasons you mentioned, and some really liking the shows despite it. I didn't like the more soap opera aspects of it but I am still trying to give it a shot, though what with my nursing school prereqs I don't really have time for that. :)
madshutterbug
Jul. 6th, 2009 09:13 pm (UTC)
As of yesterday and watching the pilot episode (rebroadcast as part of a Nurse Jackie marathon... 5 eps is a marathon? WTF?); the timer to record this program is deleted. Done.

Herself says she likes HawthoRNe better on one viewing than Nurse Jackie after several. My opinion remains... dubious.
( 7 comments — Leave a comment )

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