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As seen on TV: Nursing in high definition
By Diane Sieg

 Edie Falco as Jackie Peyton in "Nurse Jackie"
Edie Falco as Jackie Peyton in "Nurse Jackie"
Photo: Christian Weber/Showtime
“Life is full of little pricks,” reads a billboard on Denver’s South Broadway Boulevard. The sign, which pictures a nurse holding a hypodermic needle, is advertising “Nurse Jackie,” a new series on Showtime. “Nurse Jackie,” along with another new nursing series, TNT’s “HawthoRNe,” is bringing some welcome controversy and exposure to the nursing profession. Jackie, an irreverent emergency-room nurse, is played by Edie Falco, and Hawthorne, a virtuous chief nursing officer, is portrayed by Jada Pinkett Smith. Both actresses are giving nurses something to talk about.

Although Nurse Jackie’s dark humor sparks controversy, the character and story line, which originated in an encounter that executive producer Caryn Mandabach had with a nurse, are oddly compelling. With all of Jackie’s contradictions, which aren’t always appealing or heroic—such as having an affair with the hospital pharmacist or taking pills on the job for her back pain—she comes across as real. Jackie is smart and gutsy and, although sharp-tongued, she says and does things most of us would like to, if we could: telling off a young, cocky resident when his incorrect decision contributes to a deadly patient outcome; flushing the ripped-off ear of an abusive diplomat down the toilet after he severely cuts up a prostitute and says, “She just wanted attention”; or taking money from a pimp and giving it to a young, pregnant widow who doesn’t have cab fare. As one nurse who watched the pilot remarked, “She is Robin Hood in scrubs!”  

For all of its pushing of boundaries, this fast-paced program is laugh-out-loud funny as it explores Jackie’s imperfect but human tendencies. Despite the show’s sometimes-absurd humor, “Nurse Jackie” vividly portrays the responsibility, skill and heart that nurses must have today to survive.

 Jada Pinkett Smith in "HawthoRNe"

Jada Pinkett Smith in "HawthoRNe"
Photo: TNT/Turner Broadcasting System

In contrast to Jackie’s edgy wit, TNT’s “HawthoRNe” comes across as somewhat bland. The whole show feels more like the sort of heart-tugging medical drama that’s been around since the days of “Dr. Kildare.” Pinkett Smith’s character lacks the realism and appealing rebelliousness of Nurse Jackie, although—in full disclosure—I may be biased because of my own 23 years of emergency-room nursing. Nurse Hawthorne comes across as more of a martyr, running around the hospital to save the day by placing scalp IVs in newborns and taking responsibility for overlooking a homeless woman’s pregnancy. These activities don’t seem realistic for a chief nurse, and her character development thus far inspires indifference.

Perhaps the most controversial scene of the “HawthoRNe” pilot is one where a staff nurse follows a doctor’s orders, after double-checking with the physician (even though the nurse knew the orders were wrong), and puts the patient in serious danger. This sort of “problem” feels manufactured and fails to demonstrate the critical-thinking skills required of nurses, including the ability to refuse to carry out an order if doing so will endanger the patient.

What both of these shows do—most of the time—is put nurses at the forefront of decision making, patient advocating and critical thinking.It is interesting that, thus far, the “Nurse Jackie” story lines have created much more controversy among nurses than those for “HawthoRNe.” Jackie is the one who has nurses talking, with mixed comments ranging from “I love her!” to “I can’t believe how she is portraying nursing, since we do not all abuse drugs, forge patients’ signatures or have sexual affairs on the job.” Of course we don’t. Television drama has to exaggerate to create the entertainment factor, an idea validated by another nurse’s comment: “If I want real-life hospital drama, I can just go to work!” But love them or hate them, it’s exciting to see these shows generating such strong responses.

 Merritt Wever as Zoey and Edie Falco as Jackie in "Nurse Jackie"

Merritt Wever as Zoey and Edie Falco as Jackie in "Nurse Jackie"
Photo: Ken Regan/Showtime

From the perspective of nursing practice, whether you actually like either of these characters is really not important. The fact that people are talking about the shows and even that they stir up controversy provides a real opportunity for nursing to be seen, heard and understood on a whole new—and much more complex—level. Our profession isn’t served by being portrayed as either the handmaiden saints or bimbos in short skirts so often passed off as nurses in TV shows of the past.

Nurses are human beings, too, with hopes, dreams, challenges, contradictions, and yes, even blunders. What both of these shows do—most of the time—is put nurses at the forefront of decision making, patient advocating and critical thinking. And both shows, unlike typical medical dramas of the past, minimize the role of the physician, a refreshing approach that allows nurses to take the lead on TV as they so often do in real life, because, indeed, life can be full of little pricks. RNL

 Diane Sieg
 Diane Sieg
From the chaos of the emergency room to the calm of her yoga mat, Diane Sieg, RN, BSN, CYT, CSP, gives nurses who are overworked and overwhelmed life-saving strategies. An emergency room nurse for more than 20 years, today Sieg is a speaker, facilitator, author, life coach and yoga teacher. She recently received her CSP credential—Certified Speaking Professional—the highest designation for professional speakers. She can be reached at diane@dianesieg.com or www.dianesieg.com.

BSN, RN, 7/9/2009
by: Susan M Wadsworth
Rating: 5
I couldn't have said it better! Your review of both Nurse Jackie and Hawthorne is excellent.
BSN, RN, 10/21/2009
by: Andrea Young, BSN
Rating: 5
Excellent review of both programs. I haven't had the opportunity of viewing "Nurse Jackie" but from the trailers I felt it was more true to life than "Hawthorne". I watched 3 episodes of "Hawthorne" and felt it did not reflect nursing. I have not met any CNO's that would attempt to do any of the things that Jada Pinkett portrays. After reading your review I will be sure to catch an episode of "Nurse Jackie". It is refreshing to see nurses taking a lead instead of doctors in tv. I feel we have more to tell because after all we see more than doctors. They spend couple of minutes with patients. We spend 12 hour shifts.
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