2015 Fall television preview
October 2015 -- The new U.S. prime time television season includes many health-related shows, but almost all follow the physician-centric model. CBS's new Code Black (premiering Sept. 30) focuses on an overwhelmed Los Angeles emergency department (ED). The show has one senior nurse character--who brags that he plays "Mama" to physician residents--along with seven major physician characters. NBC will offer a new entry in producer Dick Wolf's "Chicago" franchise, Chicago Med (Nov. 17), which also portrays a busy urban ED. The action-packed show has one seemingly competent nurse character and at least three authoritative physician characters. There are a couple new troubled-physician-genius shows. Fox's Rosewood (Sept. 23) follows a charismatic Miami "private pathologist" who teams with a local police detective to solve crimes. Like TNT's Rizzoli and Isles, this seems to be an odd-couple buddy show with no nurse characters. NBC's Heartbreaker (mid-season) is about a world-class female heart surgeon who must battle people, especially men, who are slow to recognize how awesome she is. There seem to be four major physician characters and one nurse. And ABC's new sitcom Dr. Ken (Oct. 2) is all about Ken Park, a cranky "HMO clinic" physician who is "brilliant" but has no bedside manner. Nurse character Clark reportedly serves as Park's "faithful nurse, confidante and partner-in-crime" and one of his "support staff." Among returning shows, the biggest news is the end this past spring of Showtime's Nurse Jackie, arguably the best showcase for nursing expertise in U.S. prime time history. At least the BBC's powerful Call the Midwife will return in early 2016 for its fifth season, with London nurse-midwives providing expert, autonomous community health care in the 1960s. Outlander (Starz) will return next year with the adventures of nurse Claire Randall among the rebels of 18th-century Scotland, but unfortunately, indications are that Claire will now be a physician, so medicine will likely get credit for her skilled exploits from here on. Also returning, Cinemax's The Knick (Oct. 16) revolves around a pioneering surgeon in the bad old days of early 20th-century New York City; the one nurse character has so far been notable mainly for her co-dependent crush on the drug-addicted surgeon. Back in the present day, we face the return of ABC's endless Grey's Anatomy (Sept. 24) (sexy, brilliant surgeons; handmaiden nurses) and the Hulu sitcom The Mindy Project (Sept. 15) (quirky but skilled OB-GYN physicians; stooge nurses). NBC's The Night Shift (2016) will be back with heroic ED physicians and competent but subordinate nurses, mainly a hunky African-American man who does at least display some skill. And HBO's Getting On (late 2015 / early 2016) will return for a final season of comically sad health workers, mainly nurses, flailing at a backwater geriatric care facility. But there is always hope. Please join us in encouraging better portrayals!
Although the proliferation of new television content in the U.S. has made it impossible for even industry insiders to keep track of everything, we'll try.
Code Black (CBS)
Chicago Med (NBC)
Dr. Ken (ABC)
Call the Midwife (BBC)
Getting On (HBO)
Grey's Anatomy (ABC)
The Mindy Project (Hulu)
The Night Shift (NBC)
The Knick (Cinemax)
This CBS drama seems to be the latest in a long line of efforts to update NBC's legendary drama ER, with some of Grey's Anatomy's superficial egomania thrown in. As usual, a key theme is senior physicians training junior ones; we count seven major physician characters at different levels of seniority, including four residents. Here the added twist is how overwhelmingly busy the show's Los Angeles emergency department (ED) is, supposedly the busiest (and of course the best) in the nation. Previews and the first episode suggest that will lead to some chest-thumping, some of which seems to come from the one nurse character, "senior ER nurse" Jesse Sallander (right). In one scene, he leads a group of new physician residents around, bragging about the ED and telling/warning them he will be their "Mama." And who is "Daddy"? Why it's the awesome female physician who directs the physician residency program, of course! Sallander seems to be involved in managing the department's logistics, as the similarly swaggering Tuck Brody character was on CBS's 2010 Miami Medical. But we don't see Sallander display much clinical skill in previews (we did catch a "vitals are dropping!"). And even if that does happen occasionally, the physician-heavy structure means the show will likely leave viewers with the same overall impression ER did--that nurses are at best skilled assistants to the physicians who dominate the real action.
NBC's Chicago Med is a spin-off of producer Dick Wolf's Chicago Fire and Chicago P.D. shows (now it is a "Chicago trilogy"). Like those shows, the new one focuses on dedicated everyman public servants confronting the challenges of modern urban life--there isn't much "we're the best!" boasting in Dick Wolf shows. The show's pilot was actually an episode of Chicago Fire that aired in April 2015. The NBC site describes the show as
an emotional ride through the day-to-day chaos of the city's most explosive hospital and the courageous team of doctors that holds it together.
There seem to be at least five major physician characters, as well as one nurse, April Sexton (right), who is a former romantic interest of one of the main firefighter characters. The pilot suggests that Sexton is committed and competent, and she does seem to play a substantive role in patient care, even acting heroically to subdue a violent patient at one point. But overall her role seems to be limited and mainly assistive, and she does not seem to have a chance to display too much skill. So the physician-dominated structure and conventional assumptions about hospital care will likely combine to leave the impression that physicians are the ones whose health skills and actions really matter.
The impression of physician centrality is especially pronounced when a show's key premise is how awesome one star physician is. And that seems to be the case with NBC's Heartbreaker, which focuses on heart surgeon Alex Panttiere, who is also her hospital's "chief innovations officer." The show is based on the life of real-life heart surgeon Kathy Magliato, who is one of the show's producers. Previews suggest there will be some butting heads with stupid people, especially men, who fail to appreciate the female lead's genius. But despite Fox's House, shows with the brash-physician-genius premise often fail, as did ABC's 2014 Black Box, which focused on a female neurology superstar. In any event, here there seem to be at least four major physician characters, and one nurse, "Nurse Gi-Sung," although available previews reveal nothing about what her role might be. The show seems so focused on the star's brilliance in every aspect of hospital care that it's hard to see how anyone else could really register, much less a nurse.
In Fox's Rosewood, Miami's "top private pathologist" teams with "tough-as-nails Detective Annalise Villa" to solve crimes. Fox promotion calls Beaumont Rosewood the "Beethoven of private pathologists." Previews and the first episode suggest that the cheerful and charismatic physician is indeed brilliant, with extraordinary detecting abilities--kind of like that other talented Miami crime scene investigator Dexter Morgan, but with something more like a Light Passenger rather than Dexter's Dark Passenger. Rosewood does seem obsessed with death, maybe because he has serious health problems of his own. The show seems to be a cop-physician buddy show like TNT's Rizzoli and Isles, in which a medical examiner helps her detective cohort solve crimes. Naturally, the odd couple will spend a lot of time sparring for our entertainment. The show also includes Rosewood's sister, a "toxicology queen"; her fiancée, a "DNA specialist"; and Rosewood's mother. But there is no sign at this point that there will be any significant nurse character, and the show is likely to reinforce the idea that physicians are the only real health experts.
ABC's Dr. Ken is a sitcom about the escapades of Ken Park, a perpetually cranky "HMO clinic" physician played by real-life- physician/comic Ken Jeong. Park is apparently a "brilliant" GP, but he has no bedside manner. Promotional material describes the one nurse character, Clark, as Park's "faithful nurse, confidante and partner-in-crime," and one of his "support staff." Clips and the first episode suggest Clark will have little to do beyond assist and react to Jeong, whose over-the top antics tend to be the center of attention on the show. And the main focus seems to be Ken's family life anyway. In that sense, among others, the show is reminiscent of Surviving Jack, the 2014 Fox sitcom about a hardcore physician trying to take care of his two teenagers while his wife goes to law school. Displays of nursing skill or autonomy seem unlikely to appear on Dr. Ken.
The BBC's Call the Midwife returns for a Christmas special in December and its fifth season in early 2016. The drama follows the exploits of nurse-midwives caring for poor women and others in London, and it's now set in the early 1960s. The Sisters of St. Raymond Nonnatus and their lay colleagues--we count 11 current nurse characters! -- try to cope with the many births and other health issues in the East End. In its first four seasons, the show has generally presented the midwives as skilled and autonomous community health workers whose abilities vary in accord with their relevant experience, just as on physician-focused shows. The nurses visit pregnant women to monitor their progress, deliver babies under difficult conditions, and advise the new mothers, in an environment without birth control where women seem to function as baby factories and one-person day care centers. In last season's fourth episode, new midwife Barbara Gilbert not only skillfully delivered babies but also persuaded a father to accept his baby girl, even though he desperately wanted a son to carry on the family business. In that same episode, the meek Sister Winifred provided supportive care to a pregnant prostitute with syphilis and even pushed for more education of prostitutes to reduce the risk of the disease. See our webpage featuring analyses of the show, or see the show's website, where you can watch episodes online.
Outlander is a Starz series that finished airing its first season in May. It's based on a series of popular books about British World War II combat nurse Claire Randall, who is transported back in time to 18th-century Scotland. There, she falls in with local rebels, has romantic adventures, and occasionally displays impressive emergency health skills--which are at times mistaken for witchcraft! There's not too much health care, but nurse Claire is smart and tough. In the long first season she was called upon to heal wounds, treat asthma, master herbal remedies, comfort the dying, diagnose mysterious ailments using her advanced knowledge from the future, and even reverse a life-threatening poisoning with a "decoction of belladonna." In those scenes, Claire seemed to display skills across the range of what is now done by nurses and physicians. That is convenient for dramatic purposes--there were not exactly a lot of physicians around--but it may also imply that able nurses excel by being like or acting as physicians. And in fact, in the second book in the series on which the show is based--the book that will form the basis for the upcoming season--Claire has become a physician, after time-traveling back to the 20th century. Of course, anyone should free to choose whatever career she likes. But given prevailing assumptions, the nurse-to-physician transition is always potentially troubling because it can reinforce the sense that nursing is not enough for bright, ambitious people. Still, at least in the first season, the show offered a compelling vision of a strong nurse saving lives.
For more information, see Outlander's website on Starz.
HBO's Getting On, which will soon air its third and last six-episode season, follows the work and personal affairs of the staff at a geriatric care facility in southern California. Almost every regular character is a pathetic loser, and much of the drama comes from how much each is also venal. The show has three characters in nursing, along with one physician, so it does suggest that nurses play the central role in this care. The main character is probably nurse Dawn (center), a meek, odd person who allows the physician Jenna (left) to bully her. Dawn does have some health knowledge and at times seems committed to the patients, although the benefits of those features are outweighed by the overall impression of her as a sad mouse. Didi (right) is an apparent LVN who seems to be the most normal character and best with the patients; she is the only major character who is not deeply self-centered. The woefully inadequate nursing supervisor Patsy is a man who is full of absurd modern workplace jargon and misconceived initiatives but seems unsure how to deal with actual patients. Grossly insensitive to Dawn--who spent the first two seasons inexplicably grasping at a romance with him--Patsy is hypersensitive himself. Unfortunately, despite Patsy's presence, the show often suggests that the nurses report to physician Jenna. The show also consistently makes fun of Jenna's research interests, which focus exclusively on anal and genital functions. In fairness, the show is a persuasive, compelling vision of some of what's wrong with U.S. health care and those who provide it. The second season examined the potential for corruption in hospice care. But whatever its dramatic and social virtues, presenting most of the nurses as self-absorbed twits is not that helpful, even if physicians are seen that way as well.
ABC's Grey's Anatomy will air its twelfth season, and it still features more than a dozen regular physician characters, every single one a surgeon. Consistent with that lineup, the show persistently reinforces the idea that only physicians matter in health care. Over the years, nurse characters have occasionally appeared on Grey's, usually embodying stereotypes, particularly the helpless handmaiden and the bureaucratic battleaxe, imagery that contrasts sharply with the cool professional paths the show's female stars have chosen. The eleventh season featured constant physician nursing, with physicians often providing all bedside care, including patient monitoring and psychosocial care. Anonymous nurses did at times appear in the background to provide color or absorb physician commands, either in deferential silence or with an obsequious "right away, doctor!" They might even pop up to do something basic or display a little knowledge, but always in an assistive role. In one October 2014 episode, cardiac surgeon Maggie Pierce arrived at a code scene to have a nurse quickly tell her how long the patient had been down, that the patient "Bradied and . . . went into asystole," and that the nurses actually started CPR! But then Pierce took over the compressions, defibrillated, and absorbed all the praise for saving the patient's life from a tearfully grateful family member at the bedside. That brief interaction, a transition that seemed as if it might have been suggested by an on-set nurse advisor, was as good as it got. The coming season promises a replacement for the now-deceased Derek "McDreamy" Shepherd character, but the chances of that character being anything but a physician appear to be roughly zero.
Fox canceled Mindy Kaling's sitcom The Mindy Project after three seasons, but the show has moved to Hulu, where it will presumably be a little edgier. Set at a small obstetrics practice in New York City, the show has come to focus mainly on Kaling's lookin'-for-love character and her boyfriend Danny, who are quirky but skilled OB-GYN physicians. Meanwhile, the practice's three main nurse characters are kooky in different ways, but united by their lack of significant health skills--three stooges, essentially. The main one, Morgan Tookers (center), is a goofy ex-convict. Good-intentioned but very odd and a little scary, Morgan specializes in inane comments, comical misunderstandings, wild overreactions, and frequent suggestions that he lives in poverty. In an October 2014 episode, he had supposedly become a nurse practitioner, but that did not change his staggering ignorance, which includes not knowing how "etc." is pronounced. Morgan's cohort is Tamra (right), an off-the-wall nurse who at first seemed like she would play an insult-comic role, but in recent times has been more of an assertive variation on Morgan as well as an off-and-on romantic interest for him. The last nurse character is Beverly (left), a dangerously inept and hostile nurse the practice fired, then re-hired as an office assistant. Beverly exists to comment on the action in some unhinged way. Of course, all the show's characters behave foolishly at times, and Tamra and Morgan sometimes play roles in the plotlines that are similar to roles the physician characters play, reacting to Mindy's latest zaniness or moving the plot along in a standard sitcom way. But the show never suggests that the physicians are idiots in a professional context, while the nurses are wacky, possibly dangerous clinical subordinates.
The Night Shift
NBC's The Night Shift, which focuses on emergency department (ED) physicians at a struggling San Antonio hospital, will return for a third season. The show is one of many descendants of ER, and it's even more amped up. That means pulse-pounding trauma scenes not only at a public hospital ED but at disaster sites all over the metro area, as well as romantic intrigue among the roughly seven physician characters who dominate. And as on ER, there is an attractive major nurse character who's not an idiot, along with a few minor nurse characters who actually talk. The major nurse character, Kenny (right), is a strong and competent African-American male, continuing a recent trend--such characters have appeared on Showtime's Nurse Jackie and short-lived shows like Combat Hospital (ABC/Global) and Miami Medical (CBS). Kenny displays some health knowledge, reporting vitals and performing basic procedures. But it seems clear that the Night Shift nurses are basically there to carry out physician commands, fetch physicians, and convey information to physicians. Physicians perform the life-saving procedures, and they educate and advocate for patients. The nurses never really take the lead on a clinical case, and although Kenny has interpersonal skills, they are mostly directed at the physicians. The nurses rarely speak to patients. In a March 2015 episode, Kenny did try to counsel an injured football star by describing Kenny's own lengthy recovery from a very serious football injury, which led him to become a nurse. The patient responded bitterly that that meant he could look forward to some bedpans! Kenny did not dispute that, although he did later explain to a physician colleague that it was the nurses who had taught him how to walk again and who really made the hospital work, which is a little vague and not really borne out by the show itself. Case in point: an April 2015 episode in which several physicians "promoted" Kenny to a supposedly new charge nurse position. That's ridiculous and terrible for the public's understanding of nursing skill and autonomy, because in reality, every shift has a charge nurse selected by a nurse manager, with no physician involvement. Still, Kenny and the others do act like sentient beings, which is something.
For more information see The Night Shift's website on NBC.
Cinemax's The Knick, which will return for its second season, focuses on the exploits of early 20th-century surgeons at a New York City hospital that serves a poor community. The show's tone is harsh, corruption is everywhere, and the main surgical star, Thackery, is a desperate addict. But the show still manages to reflect the traditional view of surgeons as the brilliant, if troubled, heroes of health care. The nurses are peripheral handmaidens. The only one who really emerges from the background is Lucy (right), who falls for Thackery but whose affections do not seem to be returned. And in the first season she was pretty co-dependent, going to somewhat degrading lengths to procure drugs for him. Reports are that after he rejects her, she will become stronger and more empowered in the second season. Given the overall structure and focus of the show, however, a serious improvement in the portrayal of nursing seems unlikely.
There seems to be little in the fall shows to counter the physicians-are-everything narrative on U.S. prime time television. We know of no new show that promises to give much sense of what nurses really contribute to health care, and more handmaiden portrayals are likely. Meanwhile, Nurse Jackie aired its seventh and final season this past spring--the last survivor of the three nurse-focused U.S. shows debuting in 2009. Of the ongoing shows, only Call the Midwife can really be expected to offer a good portrayal of nursing (in the 1960s). Still, that's better than nothing. So please stay tuned and help us monitor the media.
With all these shows, we cannot possibly monitor them all on our own. Please watch one or more of the shows and let us know if you see a good or bad portrayal at firstname.lastname@example.org. And please join our letter-writing campaigns to speak out to show creators. There are a mountain of ideas about how you can help transform the way people think about nursing on our Take Action page. We are sure at least one of the activities there will be a good fit for you. If we all work on our little piece of the puzzle, we can build a society that respects nursing in line with its true worth, helping to strengthen the profession so we can deliver a higher quality and quantity of patient care. Thank you!