Grey, green, and the thin white line

May 25, 2005 -- Today the Philadelphia Inquirer published a powerful op-ed by David L. Knowlton protesting the "I hate nurses" approach of ABC's huge new hit "Grey's Anatomy." Knowlton (right) is the former deputy commissioner of the New Jersey Department of Health and Senior Services, and he now heads up the New Jersey Health Care Quality Institute. The op-ed makes great points about how poor depictions of nursing in popular mass media products like the show harm nursing and public health at this time of critical shortage, and it urges everyone who works to improve the quality of health care to speak up about it. We were especially impressed with the piece's discussions of Dana Beth Weinberg's book Code Green and the "Grey's Anatomy" series premiere, both of which contained material lifted verbatim (but without attribution) from the Center's own recent reviews of those works. We commend Mr. Knowlton and the Inquirer for publishing the parts of the op-ed that he wrote, and the parts that we wrote!

A major theme of Mr. Kowlton's op-ed, "Show of disrespect to nurses," is that nurses are "front line warriors in the battle to ensure patient safety and health care quality." Thus, just as British infantrymen were once described as the "thin red line" and modern police have been called the "thin blue line," nurses may be regarded as the "thin white line," working long hours under "challenging" conditions for "inadequate" pay to heal the sick. Mr. Knowlton stresses that nurses "play as large a role in health care as do physicians," and that physicians recognize this. Nurses are not "peripheral," but "critical to patient safety and care," proposing alternatives and catching errors. Among other things, nurses "provide invaluable education" to physician interns.

Given all of that, Mr. Knowlton was distressed to discover that "Grey's Anatomy" presents such a negative and inaccurate vision of nurses. The piece explains that this kind of popular depiction matters greatly now because of the nursing shortage. It cites Weinberg's 2003 book Code Green, which explains "how two Boston hospitals responded to severe market pressures" with moves that "sacrific[ed] quality nursing care and patient well-being on the altar of cost cutting." Describing the episode of "Grey's Anatomy," the piece notes that "[t]hough nurses do occasionally appear, the show is really a series of intense interactions among its nine physician characters." Indeed, "[o]nly surgeons play significant roles in care discussions, and only their actions" affect patient care. Mr. Knowlton was especially disturbed by scenes in which an intern dismisses a nurse's patient advocacy, and in which the intern intentionally offends another intern by calling her a nurse (the op-ed inaccurately describes the first intern as the second intern's supervisor). Incidentally, all of the quoted language in this paragraph appears either in the Center's April review of Code Green or in its late March review of the "Grey's Anatomy" premiere, and much of the op-ed's analysis appears to rely on our show review, though the Center is not mentioned in the op-ed.

Mr. Knowlton is rightly concerned about the "impact shows like "Grey's Anatomy" will have on the choice of nursing as a profession and ultimately on the state of the public's health" as the nation confronts the shortage. And he hopes that ABC "has already heard from many of the thousands of nurses justifiably outraged by the program." Getting nurses to contact the show with their concerns--what a fantastic idea!

The Center thanks Mr. Knowlton and the Inquirer for this very helpful op-ed, and once again urges everyone to join our "Grey's Anatomy" campaign. The massively popular show--whose season finale drew over 22 million viewers--needs to hear from many more people who are concerned about its portrayal of nursing while it is beginning production of its second season.

See the op-ed "by" David Knowlton "Show of disrespect to nurses" in the May 25, 2005 Philadelphia Inquirer.

June 15, 2005 -- Today the Philadelphia Inquirer printed a clarification entitled "Clearing the Record" that stated in full: "A May 25 commentary, "Show of disrespect to nurses," relied on material from the Center for Nursing Advocacy Web site and should have explicitly credited that source."