Since Nurse Jackie’s first episode aired on Showtime this week, a backlash has developed against the show. Why? Because nurses are confusing documentaries with TV entertainment. Some nursing organizations, ones which I actually admire, are asking the show to put a disclaimer on that Nurse Jackie doesn’t represent the profession. I think this is a mistake. Of course, she doesn’t. Neither does House, and his cast of ridiculous M.D.s . Neither does Grey’s Anatomy, whose docs function in an almost nurseless institution. But the American Medical Association and other medical organizations don’t ask for disclaimers on TV doctor shows. Frankly, I think asking for things like disclaimers from TV producers is not a good strategy. It suggests that nurses are naive. That they are excessively thin skinned and don’t understand the realities of the TV drama medium. Time would be better spent doing hundreds of op-eds and letters to the editor explaining why Nurse Jackie has the problem she has. Why is she working so much voluntary overtime? It’s undoubtedly because her hospital doesn’t have enough nurses and so routinely staffs by asking nurses to stay late. Why is she in so much pain? Is it because her hospital doesn’t install lift equipment and so she, like so many other nurses, suffered an unnecessary back, neck or shoulder injury? Why is she under so much stress? Is it because she lacks authority on the job? Look at the dispute she got into with the doc on the first episode. What that shows is how docs treat nurses. Marshall the studies by Rosenstein to show how much of a pattern this really is. Don’t get hung up on the outrageous details. Remember, this is TV. It’s entertainment. Keep your eye on the prize, which is that Jackie is smart, feisty, compassionate. Yes, she violates ethics and this that and the other thing. In real life nurses hopefully don’t do this (although, let’s not forget that the system asks them to violate patient safety every time a unit is short staffed or nurses are allowed to work too long, either voluntarily or because they are required to do so). Let’s see how Nurse Jackie develops. Give her a chance.
Just thought folks might be interested in seeing this video clip in which I worked with a group of nurses to help them better express their concerns about safe staffing in the current hospital workplace.
At the end of this week, Showtime airs its new series Nurse Jackie with actor Eddie Falco, morphed from Carmela on the Sopranos to an ED nurse. I just went on line and watched the first episode on my computer. So here’s my first impression. A lot of nurses won’t like Nurse Jackie. She takes uppers to keep herself going and pain pills because she’s got a back injury. She was an alcoholic. She’s married and has two kids and is having an affair with the hospital pharmacist. She forges a young man’s signature on his license so it looks like he was a voluntary organ donor. This she does after a cocky young doc doesn’t listen to her when she tells him the biker — who got hit by a car — is going to have a brain bleed. The doc blows her off and the kid dies. So it won’t be for nothing, she makes him a donor. When a prostitute is brutally slashed by a John, the woman slices off the man’s ear. The hospital saves the guy’s ear. Turns out the guy worked at the Colombian embassy and has diplomatic immunity. The cops bring him into the hospital to have his ear sewn back on and Jackie has to take care of him. He shows no remorse, for his act. Quite the contrary. He insists that the girl liked being carved up like a turkey. “What do you like?” he asks Jackie. Jackie flushes his ear down the toilet and steals his money to give to the biker’s pregnant girl friend. I can hear some nurses wincing — screaming even — at every one of these scenes.
But if you’re tempted to scream out, or protest the show’s depiction of nursing. Remember two things. First, this is television. Television has to be entertaining. To be entertaining there has to be drama, conflict, humor. And Nurse Jackie has it all, not to mention really good actors, acting and writing. This show could be called Doctor Jackie — or Jack — because on doctor shows, MDs also pop pills (think of House), have affairs, curse etc. They have messy lives –each and every one of them. But they are still brilliant in the OR, ED, on the floors. Which leads me to the second point you need to think about. Jackie is smart. She is no nonsense. She cares like most of the expert, smart nurses I know — without a shred of sentimentality. This is no inane smiling nurse (at least not in this first episode). She’s gritty, wry, and has seen it all. That hasn’t left her callous. Not a bit. It has left her worn out, but not burnt out. And that’s the most important thing. Plus, at least this first episode depicts a lot of what is real about nursing today. Nurses work too many hours — and it’s not just mandatory — they volunteer for it . Jackie pops pain meds because she injured her backat work. Six to 11 percent of nurses leave their jobs because of back, neck and shoulder injuries. I reccomend that nurses watch this show carefully. That their bottom line should be is Jackie smart, expert, feisty. The question is –what does she have in her brain? From what I saw on my computer screen the answer is — a lot. If the pattern of this first episode carries through then I think nurses should support Jackie. They should suggest themes for the show. They should use Jackie as an opportunity to raise critical issues about nursing with their friends and neighbors. They should write op-eds and letters to the editor to discuss the show.
But give Jackie a chance. And remember, this is TV land, not sugar and spice land. Jackie gives you an opportunity to talk about what nurses do — really. It gives you a chance to contradict the hearts and flowers image so many nursing organizations promote on Nurses’ Week. It gives you a chance to wear your brains not your heart on your sleeves and talk about the kinds of things nurses know and how smart and feisty they really are. Go for it!
The other day I was talking to a woman in the neighborhood and we got on the subject of national health care — or what she automatically dubbed “socialized medicine.” All those people in Europe, Canada, Australia — pretty much every other industrialized country in the world — are in trouble she said because she was certain they all had to wait unconscionably long times to get to see a primary care doc or specialist. Here, in the US, however, there are no waits. You’ve got coverage, you’ve got a doc, when you need him or her.
What planet, I wondered, does this woman — and so many other Americans like her — live on? No waits in the US? For whom, Warren Buffet (I’ll get to him on another posting). Bill Gates? People who can afford to pay $2000 to $25,000 for concierge care and instant access to their doctor? Well for the rest of us insured Americans, even well insured Americans, there are waits and very long ones at that. Let me give you a couple of examples.
A woman in her forties who develops type 1 diabetes. She was diagnosed by her PCP and he began to treat her. He prescribed a particular drug. Nonetheless, he recommended that she see a specialist. The ones she called could only see her in four to six months. Finally, a friend of the family pulled some strings and got her an appointment three weeks later. And it was a good thing because the PCP was prescribing the wrong med. If she had continued on this medication for the six months it would have taken –without string pulling — to see the specialist, could have really hurt her. Unfortunately, most people don’t have any strings to pull.
I do and it certainly didn’t help me a couple of years ago when I just felt really sick but didn’t know what was wrong. Thinking I maybe had a UTI, Urinary track infection, I called my PCP and tried to get in to see him. This was in October and the secretary said maybe he could fit me in in February. February? For a UTI? Couldn’t I just come in and give a urine sample. I had to fight for that. Without seeing him at all, they gave me an antibiotic, which didn’t help because five days later when I went to the ER in a hospital in Vermont, I had acute appendicitis which he would have been able to diagnosis by palpating my stomach in the right spot. But since my appendicitis, like many, didn’t present with lower right quadrant pain, and vomiting, who knew? I didn’t and therefore didn’t think to press on my right lower abdominal quadrant, which, it happens, was very tender indeed. I can’t tell you how much it cost me to have surgery in a tiny under-staffed hospital. The complications still plague me.
A recent article in the Boston Globe enumerated the problem. In Boston alone the waits for non-urgent appointments for surgeons, dermatologists, OB-GYNs, orthopedic surgeons has grown steadily longer. Try to get to see an OB and the average wait — and this is for people with good health insurance — is 70 days. As for primary care docs, well there aren’t enough of them, and it is almost impossible to get to see one. Here are the facts folks, we actually have fewer doctors per 1000 people than some countries with so-called socialized medicine. We have way fewer primary care doctors than most other countries and the shortage of primary care docs is getting truly catastrophic. If we had more and they could handle things before they became catastrophic, we wouldn’t need to see speicialists so often.
So please — check out other countries and their wait times before you bemoan the evils of so-called socialized medicine. Yes some do have long wait times. But in others, things are far better than here. Several years ago, I had a stomach infection and a colonoscopy to see what might be wrong. The nurse from the gastroenterologists office called me to tell me that they found a suspicious spot in my gut. Maybe, at age 57, I had Crohn’s disease, but then again maybe I didn’t. Freaked out by this I asked a bunch of questions, to which she answered, ” I don’t know, you’ll have to ask the doctor.’ To which I replied, so put me through to him. No, she said, you’ll have to wait — as in WAIT — for three weeks till your appointment with him. Needless to say, this was a potentially devastating diagnosis. Terrified I called a good friend who is a nurse in Australia. Yes, I woke her up in the middle of the night. She was horrified. “You mean the doctor didn’t tell you this in person?” she asked. “A nurse who couldn’t answer you questions told you this? You have to wait three weeks to talk to him?” She was incredulous. “That would never happen here. You’d be in his office the next day and he would give you the results and talk you through them.”
Hello, It seems apt as Nurses’ Week is coming to an end to share this interview with you. I did the interview with Rob Fraser, a wonderful new nurse whose got a great website called Nursingideas.ca. Rob does interviews with all kinds of people and he did one with me after I did a workshop on how nurses should tell their stories in Toronto last year at the Registered Nurses Association of Ontario — another great group people all over the world should know about. Nurses’ Week is always a flutter of hearts and angels and other symbols that I think trivialize and sentimentalize nurses’ extraordinarily complex work. Just consider the International Council of Nurses’ choice of a symbol for Nurses’ Week this year — a light bulb with instead of a normal filament inside, a lit up heart. Need one say more. So I hope you enjoy this interview and let me know what you think of it.
Thanks and happy Nurses’ Week and thank you all for the educated brains that guide your educated hearts.