Suddenly, in the world of TV medicine, RN are the letters you want after your name. Two summer cable shows garnering considerable buzz, SHOWTIME’s Nurse Jackie and TNT’s HawthoRNe, shine the spotlight on nurses, the hospital heroes often relegated into the shadows of doctors on prime time. ScriptPhD.com got a sneak peak of the HawthoRNe pilot and the first half of the Nurse Jackie season.

Nurse Jackie (SHOWTIME)
ScriptPhD Grade: A

I didn’t want to love Nurse Jackie, I just want to say that for the record. First of all, she’s been taunting me on the billboards of Los Angeles all spring and summer long with that intimidating needle. Secondly, I didn’t know if I had it in me to get attached to yet another medical show. Third, after hooking me with brilliant shows like Dexter, Weeds and newcomer The United States of Tara, could SHOWTIME extend their magic touch to this newest addition to their franchise? They could, they did, and the result is some of the freshest television this side of basic cable. Starring three-time Emmy^®-winner Edie Falco, Nurse Jackie is based on the provocative tell-all journal of a real-life Manhattan nurse. Shot on location in New York City, the show spares nothing in projecting the goings-on of a big-city ER through the eyes of one very unorthodox nurse.

And Jackie Peyton is certainly not an easy character to love. She’s decidedly cantankerous and has little time for people or their stupidities. “I don’t do chatty,” she barks. “I like quiet. Quiet and mean. Those are my people.” She’s got an unhealthy attachment to painkillers. No matter the delivery system (mouth, nose, coffee) or the type (Adderall, Vicodin, OxyContin, Percocet), Jackie’s not very picky. She views rules as bendable at best, nonexistent at worst. Oh yeah, and then there’s the part where she’s cheating on her husband. But there’s two sides to every coin, and Jackie is no exception. At home, he’s a devoted wife and mother. Her picture-perfect husband Kevin (Dominic Fumusa) struggles between tending to their daughters Grace, sporting an escalating emotional anxiety disorder, and Fiona (Ruby Jerins and Daisy Tahan) and running his bar. At the ironically named All-Saints Hospital, she’s an extraordinary, deeply empathetic nurse. Whether she’s helping a 10-year-old take care of her mom with some contraband pharmacy supplies, assisting a terminally ill fellow nurse, helping a mute stroke victim shut up his obnoxious family or stealing money from a criminal to help a dead patient’s poor fiance, Jackie weaves through the murky moral grey area to ultimately do what’s right for her patients. Part saint, part sinner, Nurse Jackie is never less than totally compelling.

Trailing Jackie’s every move (much to her dismay) is overly earnest, perky nursing student Zoey Barkow (Merritt Weaver). Luckily, Jackie can take reprieve from her besotted young acolyte and her problems with the rest of her hospital family. Providing cover is her partner in crime, fellow nurse Mohammed “Mo-Mo” de la Cruz (Haaz Sleiman), with whom she bends the rules, shares coffee breaks and romantic advice. Providing narcotics and lunchtime quickies is pharmacist Eddie Walzer (Paul Schulze). Her best friend and confidante is the wry Brit Dr. Eleanor O’Hara (a razor-sharp Eve Best). She has a penchant for expensive clothes, snappy comebacks and mid-town lunchcapades with “Jacks”, but seems to be holding back a painful past. Peter Facinelli (Damages) is the handsome, young Dr. Fitch “Coop” Cooper, who could easily be dismissed as a one-dimensional, book smart but inept playboy. But with lesbian moms (the devine Blythe Danner and Swoozie Kurtz), a proclivity for Tourette’s-like inappropriate touching, and better doctor skills than he gives himself credit for, Coop is more than meets the eye. Rounding out the ensemle is rote ER administrator Gloria Akalitus (The West Wing’s Anna Deveare Smith), who rules with an iron fist, thinking she’s hip to every trick in the book. (By the way, who knew Deveare Smith had such a gift for physical comedy? Two gags with a Taser and some wayward painkillers had me rolling on the floor.)

Employing top-notch writing and directing, led by creative team Evan Dunsky, Liz Brixius and Linda Wallem, Nurse Jackie shies away from tired old medical show tropes to peel back the layers of a functional addict leading compartmentalized lives, to realistically show the challenges nurses face in saving lives under the limitations of our broken medical system, and to ask, “What does it really mean to be good?” Nurse Jackie may be addicted to bad behavior and every painkiller on the planet, but in the end, I’m addicted to her. I wouldn’t have it any other way.

Nurse Jackie airs on SHOWTIME Mondays at 10:30 EST/PT, following Weeds.

HawthoRNe (TNT)
ScriptPhD Grade: B

A number of high-profile film actors have recently settled comfortably in starring TV roles, most successfully Emmy® winners Glenn Close (Damages) and Alec Baldwin (30 Rock). TNT, with their long and storied tradition of strong female drama leads, from Kyra Sedgwick’s The Closer to Holly Hunter’s Saving Grace, extends the same small-screen opportunity to Jada Pinkett Smith, who stars in new medical drama HawthoRNe. Lest there be any doubt about the girl power behind this series, it is being co-produced by Pinkett Smith’s 100% Womon [sic] Productions. In the first five minutes alone, Christina Hawthorne races to Richmond Trinity Hospital in the middle of the night, out(wo)mans an armed security guard, tends to a wandering psych ward patient, pays care to a homeless woman she’s befriended and talks down a suicidal cancer patient. But it turns out, there are some cracks in Christina’s impenetrable armor. For one, the pilot takes place on the one-year anniversary of the death of her husband, whose ashes she still talks to. To celebrate, her rebellious, headstrong daughter Camille (Hannah Hodson) chains herself to the school’s vending machine, much to her mother’s consternation. And a deliciously saccharine Joanna Cassidy is the still-meddling mother-in-law who also serves on Trinity’s board.

As the hospitals Chief Nursing Officer, Christina is organized, uncompromising, decisive, empathetic, and always puts the needs of patients first. Her charges include nurse Bobbie Jackson (Suleka Matthew), one of her best friends and nurse Ray Stein (David Julian Hirsh), a man caught in a woman’s world. Alias’s Michael Vartan (welcome back to television Mr. Vaughn!) is Dr. Tom Wakefield, the Chief of Surgery with whom Christina often butts heads administratively, but who also treated her late husband for cancer.

Still working out its kinks, HawthoRNe feels a bit uneven at times, mostly due to relying on some trite, atavistic medical formulas that come off stale. A genuinely compelling storyline about a homeless woman besieged with mental problems giving birth outside the hospital is negated by an unnecessary (and gross!) side plot involving a grateful nurse (Christina Moore)…um…thanking a wounded soldier for his service. Her name is Candy. Seriously. And a chance to explore doctor-nurse synergy and conflict in providing effective patient care turns downright silly when the characters in question ride two extremes: the stupendously arrogant, omniscient doctor whose decisions Cannot. Be. Questioned. and the equally timorous nurse who dare not think independently. And don’t forget to save some snickers, because he’s a male nurse, which is funny, or was in 1975.

TNT may know drama, but HawthoRNe needs to tone it down a bit. To be fair, having only viewed the pilot, the show has definite potential to grow. With the departure of ER, no current medical show centerpieces medicine in a cash-strapped, blue-collar city hospital. Set in Richmond, VA, HawthoRNe has a unique opportunity to tell stories pertaining to the challenges of its setting and patient population. It also is clearly a character-driven drama, establishing some fascinating early relationships. The tension between Christina and her bitchy mother-in-law, tempered by working through the shared grief with her still-angry daughter, makes for a rather interesting family triangle. And sparks fly between Pinkett Smith and Vartan, who is obviously being set up as a potential love interest. But the biggest asset is Pinket Smith herself. She brings an intensity, compassion and resolve to a complex character. Her movie star power translates well to the small screen, and could easily make HawthoRNe a fine vehicle for her considerable acting chops. Assuming they steer clear of Clicheland.

HawthoRNe premieres this Tuesday, June 16th on TNT at 9 EST/PT.

This sudden focus on the nursing profession doesn’t come a minute too soon. According to the American Association of Colleges of Nursing, the United States is in the midst of an imminent nursing shortage, compounded by the rapidly aging baby boomer population and low enrollment in nursing programs that is not expected to meet this demand. As of July, 2007, total RN vacancies across the US totaled 135,000, or 8.1%, according to a report released by the American Hospital Association. Projections from the U.S. Bureau of Labor Statistics published in the November 2007 Monthly Labor Review foresee that more than one million new and replacement nurses will be needed by 2016. Contributing factors vary, from a shortage of nursing school faculty and projected enrollments, to a slowing rate of growth for the overall nursing population, resulting in a climbing average age of the nursing population. The result for nurses? Insufficient staffing is raising their stress levels, impacting job satisfaction, and driving many nurses to leave the profession. The result for patients? Inadequate access to quality health care. An eye-opening report released in August 2002 by the Joint Commission on Accreditation of Healthcare Organizations, revealed that a shortage of nurses in America’s hospitals is putting patient lives in danger. JCAHO examined 1609 hospital reports of patient deaths and injuries since 1996 and found that low nursing staff levels were a contributing factor in 24% of the cases.

Less than a month ago, members of major nursing unions that included the California Nurses Association/National Nurses Organizing Committee, the United American Nurses (UAN), and the Massachusetts Nurses Association, congregated on Capitol Hill as part of a National RN Day of Action in Washington, D.C., that included a conference focused on promoting legislation that would guarantee certain ratios of nurses to patients nationally, a march and rally, and visits to their congressional representatives to advocate on various legislative issues. The legislation, House Resolution 2273, also seeks to protect the rights of nurses to advocate on behalf of their patients, and to invest in training new nurses to address the current nationwide nursing shortage.

To discuss some of these issues, and to get a dose of real-life perspective on the profession, ScriptPhD.com sat down with Dr. Suzette Cardin, Assistant Dean of Student Affairs at UCLA’s venerable School of Nursing, ranked in the top ten of national nursing programs. Dr. Cardin has over 35 years of experience in nursing, and prior to her faculty appointment, she spent 14 years as Unit Director of the Critical Care Unit and the Cardiac Observation Unit at the UCLA Medical Center. She has been honored as a Fellow of the American Academy of Nursing and the American Heart Association. To read our interview, please click “continue reading”.

ScriptPhD: You have over 35 years of nursing experience. You’ve been in the trenches in the hospital, worked on the management side, and now are in academia training next generations of nurses. Safe to say, you’ve pretty much done and seen it all.

Suzette Cardin: Yeah, safe to say.

SPhD: In your opinion, what are the biggest challenges that the profession of nursing currently faces?

SC: I think the biggest challenge right now is to handle the [long-term] work force shortage with a large number of nurses getting ready to retire, and then a whole new workforce that will be replacing them. That, however, is being tempered with the fact right now that since we’re in a recession, the nurses who are scheduled to retire are not retiring. So that’s actually creating a double whammy in that the positions that people thought were going to be ready for students who were just graduating are actually not there. Because nurses have decided to stay and wait to see, waiting to retire is the problem. So that’s—the work shortage imbalance currently that we have. It was a year ago, we didn’t have enough nurses. But now we have too many nurses, because people haven’t retired due to the economic circumstances.

SPhD: Which is of course not a long-term solution, obviously.

SC: No.

SPhD: And I’m actually glad you brought it up, because my next two questions are completely pertaining to this. What are some of the reasons that nurses have been leaving the profession over the course of [the last few] years?

SC: I would say the main reason nurses leave is because they’re not happy with the work environment. So it could be related to the work conditions, it could be related to management style, it could be related to the type of patients that [they care for]. So, nursing is not what they thought it was going to be.

SPhD: Oh, I’m really surprised.

SC: What answer did you think I was going to give?

SPhD: I just thought it might have to do with the stress of the job over the course of however many years [they’re in the profession], or the aging population of current nurses. I didn’t realize that there was such a high level of dissatisfaction pervasive among the professionals.

SC: No, most nurses are happy. But there is a certain amount each year who leave their current jobs, go to another position because they’re not happy with the work conditions within. Now, there’s many professional organizations who have taken it upon themselves—The Association of Critical Care Nurses, and now here in California, the Association of Nurses–who have put out position papers on work conditions, and how does that work. They have seven or eight conditions that should be present in order for nurses to stay. The other important source of material is the magnet process, the magnet certification that hospitals undertake, in which there’s certain criteria, what they call “14 Forces of Magnet”, that institutes should have in place in order to be a magnet and attract nurses.

SPhD: We’ve listed some pretty dire statistics on the site with regards to nursing shortages, and stress levels on overworked nurses. There was a recent push on Capitol Hill [last month] to legislate mandated nurse/patient ratios to ensure patient safety, relieve workload and enhance quality of care.

SC: Which they already have in California.

SPhD: They do have that here in California?

SC: They have it in the ICUs and now they have it in emergency rooms and they have it on medical surgical units, they have it on OB/GYN. So, patients are classified according to an approved acuity system that’s acceptable and reliable. Then, based on that, they then assign high, medium, low acuity, and then you staff accordingly.

SPhD: But it seems like if you’re going to do it across the board, I mean the end goal is that nationally, regardless of what your status is as a patient, that for your benefit and for your quality of care it makes sense. You would have a certain ratio. But here’s my question. It seems to me, naively, you can’t just wave a magic wand and mandate that “You have to have a certain ratio of nurses to patients.” With such dire shortages and unchanging patient populations, what other fundamental legislative changes need to take place to rebuild the profession?

SC: I’m going to go on record as saying that I disagree with you, because we’re a profession, we have our own accountability and autonomy, and therefore we should be able to decide what is needed in what given situation. I don’t as a professional nurse like being mandated by the legislation that I need to do this in order to take care of patients.

SPhD: So you’re actually not a big fan of the mandated ratio legislation?

SC: No I’m not at all. I don’t like a group of lawmakers telling me what we should be doing that the force behind it is the Nurses’ Union. So I have very much a built-in bias [towards that]. What it does do is that it does assure patients that they will, based on their acuity and where they decide to be hospitalized, that they will get each nurse, say on a given unit may have four patients. But there’s no guarantee of the quality of those nurses. All it guarantees is that if there’s 32 patients on a nursing unit, and they each get four patients, that there will indeed be 8 nurses working that day. You have to assume the institution will guarantee the quality of those nurses. That’s just a given, but that’s not always the case.

SPhD: You’d mentioned these 14 forces of the magnet process that you have to have, etc. Extrapolating into the larger picture. Health care is hugely in the news right now. I know President Obama is going to a bunch of town meetings and we’re talking about health care reform. The health care system overall is broken in many ways. Surely, many of these overarching issues are tied together, i.e. it’s going to be tough to fix burdens nurses face without addressing uninsured patients or malpractice lawsuits or rising spending per patient or ERs closing around the country. These things seem to me to go hand in hand in the larger picture of health care overhaul. Is that a fair assessment?

SC: Yes, I think that’s fair. I think one of the reasons nurses leave [the profession] is because they get into it and they’re like, “Wow, this is really a mess.”

SPhD: Do you support a nationalized health care system, akin to Europe or Canada?

SC: I support a change being made. I’m not quite sure until I see what it looks like what I’ll support.

SPhD: Well, we’re talking somewhat within the context of Hollywood and medical show portrayal, which you had expressed concerns with in some of the emails we’d exchanged. What are the kinds of things that you see on television, film and the media, in terms of portraying what you do on a day to day basis, that frustrates you?

SC: Well, I think time and time again, the only people who can think are the physicians. The nurses are forever put in positions where thinking is not encouraged, we just do as we’re told, we’re the hand maiden to the physician. We don’t have a body of knowledge to make our decisions on. It’s kind of annoying. There’s a lot of jokes that are made about us. A classic one is [the television show] Scrubs. I mean, those nurses on that show are…. M*A*S*H was very good, in that it showed what nurses could do, however it was always at the expense of Hawkeye and his being a voyeur to nurses.

SPhD: You know, I think ER did a fairly decent job though, recently. Because Nurse Hathaway, who was the lead nurse of their unit, and a lot of the other nurses, were given a lot of respect and were shown working in concert with a lot of the other doctors. There was another example of fairly decent—sort of, kind of?

SC: Yeah, I wouldn’t say it was the best. Again, there was usually only one nurse highlighted that was always [working] about, and even the one nurse who ended up being highlighted, she ended up leaving to go to medical school.

SPhD: Right. Abby Lockhart, Maura Tierney’s character. When I watch medical shows, I have noticed a weird dichotomy. Either the focus is on doctors, in which case nurses seem to be these ephemeral accessories milling around in the background, or, if the focus is on nurses, they’re portrayed as somewhat antagonistic towards doctors (especially from the perspective of being book-smart versus street-smart). But in reality, wouldn’t that relationship have to be by nature synergistic to best serve patients?

SC: Well, it doesn’t reflect what actually goes on in practice. I would say the best example that I’ve ever seen was over at UCLA in the medical ICU. They would go on rounds in the morning, of course these were teaching rounds, but the nurse would have her say, the resident intern who was caring for the patient would say what was going on, and believe it or not the family member would also say and be able to ask questions. And the respiratory therapist was there, the pharmacist was there, I mean the whole team was there and everyone had an equal say with what was going on in the patient.

SPhD: And a lot of times you find that nurses are the vasculature of a hospital, ensuring that a patient’s day-to-day needs are being taken care of. So it makes no sense that they wouldn’t be involved on a higher level of patient care.

SC: Right. Right. So that to me is an excellent example of good synergy and people working together as a team.

SPhD: What are some key stories or issues that you would really like to see portrayed or addressed more in media and popular culture?

SC: Well, that example. That when information is given to patients, the patient is there, the family is there, all the health care team members are, everyone is incorporated into what’s going on, the nurse does more than just report what’s going on, they come up with the plan, this is what I see going on with the patient, I was thinking about this, what do you think, they kind of go back and forth. [It’s an] equal exchange of ideas.

SPhD: That ultimately medical care has a lot more synergy than is currently being portrayed. It’s not so compartmentalized.

SC: Exactly.

SPhD: We just had a slew of graduations here on campus and the UCLA Nursing program is a nationally renowned program. You guys regularly produce the best and brightest nurses in the nation. To a graduating nurse that is about to join the workforce, what is your advice?

SC: To be as open and flexible as they can in how they view the current health care system, to realize that change is going to occur and to go with the flow, they’re not all going to get the jobs they want, just because there’s now a scarcity of jobs. That’s going to be—we have a group of students who just graduated, who two years ago when they came [to UCLA], we said, “You are going to get any job you want.” Now they’re going around and scrambling around to get jobs. Not all of them have jobs, not all of them are going to get jobs, so that’s been really difficult in the last six months. Maybe they will have to get creative. With that I just think they need to be open-minded, be flexible, be adaptable.

SPhD: That’s excellent advice. I just wanted to on a personal note say that a lot of the stuff we talked about highlights problems that exist or dissatisfactions, but having been a patient numerous times, personally, I have yet to encounter a nurse that is not nurturing, caring, deeply passionate about his or her job and I just want to say on the record, on the ScriptPhD site, from me personally, that I think there is something so intrinsically nurturing about this profession. So thank you so much, for meeting with me and for what you do!

SC: Oh you’re welcome!

~*ScriptPhD*~