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The Nursing Narrative

Updated: Dec 16, 2019

Dear nurses, 

We have an image problem. 

Society votes us the most trusted profession year after year. But do they know what we do? 

Until halfway through college, I never considered a career in nursing, mostly because I had no idea what nurses did. I blame the medical shows of my youth. 

Medical dramas show physicians doing every imaginable task. The doctors draw the patient’s blood. Now they’re in the lab looking into microscopes. Then they’re performing surgery. Later, they’re giving the patient injections. Finally, they’re holding a grieving widow while she cries.

Where the hell are the nurses? 

To be fair, some shows do it better. Scrubs has a nurse with actual lines and a visible role to play in the hospital. Nurse Jackie’s antihero is a Registered Nurse. But for the most part, nurses barely exist on TV. And when they do, they’re either nice ladies in pastel scrubs who quietly complete tasks in the background, with one or two lines like, “I’m sorry, Mr. Jones. Visiting hours are over.”  Or, nurses are the butt of the joke.

Take this scene from the Grey’s Anatomy pilot episode. A cocky intern insults our lead Meredith Grey - also an intern - by calling her a nurse. Meredith indignantly responds, “What did you just say? Did you just call me a nurse?” Cocky Intern replies, “If the white cap fits.”

On House M.D., Dr. House approaches a nurse and says, “I’m sorry, I can’t remember if I’ve mocked you for being a male nurse yet.” The nurse replies, “I think this counts.”

Sure, these two characters are known for being assholes... who say what everyone is thinking, but everyone is too nice to say.

Some television shows avoid these typical nursing tropes. Instead, they simply erase the nurse's role in patient care. In an Intensive Care Unit, an RN is constantly at the patient's bedside, analyzing labs and vitals, adjusting ventilator settings, and titrating IV drips. Interestingly, whenever House gruffly questions a patient in the ICU, there is not a nurse in sight.

On TV, physicians shout orders at nurses who quickly obey with a "Yes, doctor." In reality, nurses do take orders from providers (Psst, every medical show ever - Not all Emergency Department providers are MDs.). But there's a lot more to our job than that. Nurses are the boots-on-the-ground of the healthcare team, frequently rounding on and assessing patients to evaluate their needs and track their progress. Nurses solve all of the problems that come up until one falls outside of our scope of practice - at which point, we'll page the doctor.

Often, nurses point out troubling signs to doctors and suggest the orders they know the patient need. Doctors rely on this support. They simply are not able to put in the bedside hours required to have an intimate knowledge of each patient's case and care needs. This is the role of the nurse.

Without nurses patients would die. No one would be there to notice if patients were turning blue or seizing. A doctor is only able to do their job, if the nurse can do theirs. By only showing these one-sided interactions between nurses and physicians, the complexity of the nurse-doctor professional partnership is lost on the audience.

Media is an excellent tool for sociological examination because it acts as society’s mirror. It reflects what society understands about a topic…and simultaneously reinforces this understanding.  Show runners - people influenced by society just like anyone else - create characters and plots based on how they imagine the healthcare world to be. The society pops some corn, logs into Netflix, and consumes these stories, thinking Huh, so that’s what nurses do. Voila! A societal feedback loop.

These shows misrepresent the vital role nurses play in patient care and healthcare delivery. Worst of all, they tell us that nurses don’t matter. This understanding among non-nurses does not represent the reality of the profession. This societal fundamental misunderstanding of nursing is the Nursing Narrative.

Nurses should be women. Nurses are 'doctor’s helpers'. Nurses are not professionals. These misunderstandings of the nursing role are pervasive in our society and are reinforced by every inaccurate medical show.

But so what? We know the value we bring to the care team, and that’s all that matters. We don’t do this job for the prestige. Why should nurses care about the Nursing Narrative? 

The Nursing Narrative that currently exists is costly. It costs nurses professional respect. It costs us self-esteem. It costs us future nursing talent. It costs us our voices.

We can’t correct the Nursing Narrative if we don’t call attention to its inaccuracies. We must inform the narrative, otherwise we give up the right to define our own profession and demand the respect we deserve.

These nursing myths harm us. They impede the development of our profession, and most importantly, they impede patient care.

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