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ER (1994-present) (Archived 2003-2004 review)
Starring Noah Wyle, Maura Tierney, Laura Innes, Anthony Edwards, George Clooney, Julianna Margulies, Eriq La Salle, Sherry Stringfield, Alex Kingston, Goran Visnjic, Ming-Na, Sharif Atkins, Mekhi Phifer, Paul McCrane, Linda Cardellini, Parminder Nagra
Executive Producers: John Wells, Christopher Chulack, Michael Crichton, Jack Orman, Lydia Woodward, Dee Johnson
Constant C Productions and Amblin Television/Warner Bros. Television
NBC
TV-14
Most Recent Season (2003-04) Ratings and Review
Review and Synopsis (2003-04 season)
Portrayal of Nursing (2003-04 season)
| Nursing rating |  |
Rating guide: |
| Artistic rating |  |
"ER" is arguably the best major health care-related television series since "M*A*S*H," and it is one of the most medically realistic dramatic series ever. When "ER" leaves prime time after more than a decade on the air, it will also have been one of the most popular shows in history. And it will likely continue for years in syndication in the U.S. and around the world. Accordingly, it will continue to have a tremendous influence on how the global public views health care, including nursing. "ER" has generally portrayed nurses as competent, caring professionals and avoided the worst nursing stereotypes. But the show's physician-centric world view has led to a continuing failure to give viewers an accurate or complete picture of the vital role the nursing profession actually plays in modern health care. The few nurses who emerge from the "ER" wallpaper are skilled but essentially fungible, serving mainly as subordinates and romantic foils for the heroic physicians.
Since its inception in 1994, "ER" has focused on the professional development and personal lives of a shifting cast of about 10 emergency department (ED) and surgical physicians, and the personal life of one ED nurse, at "County General," the main public hospital in Chicago. Keys to the show's success have been its adrenaline-happy depiction of emergency procedures, complete with whirling camera work and faster-than-the-speed-of-light technical dialogue, and an addictive soap opera approach to the intersecting lives of the main characters. "ER" has also featured some inventive plotting, strong characters, effective direction and fine acting. In recent years it has slowed down creatively, certain plot lines have not worked well, and some digressions into the characters' non-work lives have grown tiresome. But "ER" is still capable of engaging work, and it remains very popular as it enters its 11th season.
In its early years, "ER" introduced the model that would prove so effective: dedicated, intelligent physicians staggering under the volume and complexity of cases seen in a Level One Trauma Center, and trying to cope with the effects on their professional and personal lives. The show's plot is too intricate to summarize here, but major characters in the early years included John Carter (Noah Wyle), a wide-eyed medical student from a wealthy family who would ultimately become chief ED resident, and who will likely end up as the most important character in the show's history; Mark Greene (Anthony Edwards), a sensitive, decent ED chief resident whose marriage to an attorney ultimately fell apart and who became, as an attending, the show's moral center; Kerry Weaver (Laura Innes), an insensitive, physically disabled ED senior resident who consistently put herself before her colleagues, and became chief of emergency medicine; Carol Hathaway (Juliana Margulies), a troubled but tough and competent ED nurse who became a nurse manager; Doug Ross (George Clooney), a hunky pediatric ED resident whose maverick ways would eventually lead to his departure from the hospital and the show, followed by long-time flame Hathaway; Peter Benton (Eriq La Salle), a coldly intense surgical resident who seemed to have a maximum allotment of one smile per season, which he didn't always use; Jeanie Boulet (Gloria Reuben), an earnest, HIV-positive physician's assistant; Susan Lewis (Sherry Stringfield), a down-to-earth ED resident who would leave the show for several seasons; Elizabeth Corday (Alex Kingston), a skilled English surgeon who would ultimately marry Greene; and the great Robert Romano (Paul McCrane), an acid-tongued, highly skilled surgical attending who would become the chief of medicine and who served, along with Weaver, as the show's enduring character-you-love-to-hate.
By the early part of this decade, some of these characters were on their way out, and a new crew was moving in. Ross and later Hathaway departed for the Northwest to raise their twins, Benton left for a job that would allow him to care for his young son, and perhaps most significantly, Greene succumbed to brain cancer, leaving Corday to raise their young daughter alone. Romano lost his arm to a helicopter rotor and his job as chief of staff to the relentlessly ambitious Weaver. Then he spiraled downward until the show finally killed him off--by having a helicopter fall on him. Lewis returned, for some reason. Weaver took advantage of Romano's decline to become chief of medicine, meanwhile coming out as a lesbian and having a baby with her firefighter partner, who soon died in the line of duty. The show anointed Carter, now ED chief resident, to be Greene's successor as its moral and professional heart. In these years Carter thrived professionally but not in his personal life, getting close to a marriage proposal to newcomer Abby Lockhart (Maura Tierney) before pulling back and making several soul-searching trips to provide care in war-torn Congo, returning with a new girlfriend (Thandie Newton); their baby was stillborn. Lockhart, who arguably became the show's most important character besides Carter, was a somewhat confused, alcoholic former OB nurse. She started on the show as a medical student, then settled in as the post-Hathaway major ED nurse character, then reversed course yet again and went back to medical school, joining the ED as an intern.
Other new characters in the early 00's included Sam Taggart (Linda Cardellini), a tough but not quite in control single mother who replaced Lockhart as the show's designated major nurse character. Jing-Mei Chen (Ming-Na), a contemporary of Carter's who had briefly appeared on the show near the start, returned as a resourceful but troubled senior resident. Luka Kovac (Goran Visnjic) was a Croatian ED attending who replaced Ross as the show's designated hunk, but who had difficulty overcoming the death of his wife and children in the Balkans war; he had romances with Lockhart and later Taggart. Michael Gallant (Sharif Atkins) was a bright, decent medical student whose education was funded by his commitment to the U.S. Army, and who was ultimately sent to Iraq. Gregory Pratt (Mekhi Phifer), an often arrogant intern struggling to care for his mentally disabled brother, had a relationship with Chen. Neela Rasgotra (Parminder Nagra) was a bright medical student who went through her last year of school alongside Lockhart, then accepted a prestigious internship at the University of Michigan.
Since the beginning, the show has also featured a diverse group of recurring minor nurse characters. They have included Chunie Marquez (Laura Ceron), Haleh Adams (Yvette Freeman), Lydia Wright (Ellen Crawford), Malik McGrath (Deezer D), Lily Jarvik (Lily Mariye), Yoshi Takata (Gedde Watanabe), and Connie Oligario (Connie Marie Brazelton).
"ER" has generally depicted nurses as competent, caring professionals with technical training who contribute to patient outcomes. Unlike many shows, it has resisted showing them as Nurse Ratcheds or sex objects. It has shown some nurses to be men and members of minority groups, though all three of the major nurse characters have been straight white females. The Carol Hathaway and Abby Lockhart characters are, along with "M*A*S*H"'s Margaret Houlihan and "China Beach"'s Colleen McMurphy, among the most influential portrayals of nurses in television history. They are capable, nuanced and generally positive. Hathaway in particular was a strong character and a nurse manager. Although Lockhart was fairly weak early on, in later seasons she began to show signs of an actual nursing identity, explaining why she chose to remain a nurse rather than continue with medical school, teaching Gallant the ropes, and questioning physician treatment decisions. Unfortunately, Lockhart appeared to grow frustrated with nursing and abruptly reversed course, returning to medical school, which sent the inaccurate message that nurses who wish to pursue graduate education typically do so in medicine rather than nursing. Current major nurse character Taggart is a stronger character with obvious skills and a willingness to advocate for patients, though her toughness has arguably veered into inappropriate aggression. The recurring minor nurse characters, who are well drawn considering their limited screen time, likewise have been shown as caring professionals with skills. For a time those skills seemed to be getting a little more attention, but most recently they were marginalized, with only one generally appearing in any given episode. In the show's early years, it focused some attention on nursing issues, for example during the labor dispute in the third season. It did so again in its remarkable 10th season, in which it seemed to go out of its way to try to show sensitivity to nurses, albeit with disappointing results.
On the whole, "ER"'s treatment of nurses as peripheral has failed to reflect nursing's vital role in clinical health care delivery. The show has consistently and inaccurately portrayed nurses as subordinate to the physicians who dominate it, rather than as members of an autonomous profession--as exemplified by its frequent and continuing depictions of physicians disciplining and even firing nurses. For all its medical realism, "ER" also remains a victim of what Kalisch and Kalisch have called "Marcus Welby syndrome": the inaccurate depiction of all significant health care being provided by physicians. As a result, it has frequently shown physicians performing critical nursing tasks, such as triage, patient teaching, and preventative care such as vaccinations. Nurses are not the only ones affected by this; the show commonly has physicians doing the jobs of social workers and respiratory therapists as well. Perhaps the ultimate example of the marginalizing of nurses is having only one of the roughly 10 major characters be a nurse, when in a real life Level One Trauma Center the nurse-physician ratio would likely be about 5:5. This 10:1 ratio would make it difficult for the show to portray the two professions' roles accurately even if it wanted to. The show also gives viewers little sense of the independent, science-based assessment and intervention that is central to the nursing process. In recent seasons it has occasionally depicted nurses in their patient advocacy role, which can entail questioning physicians' care plans and catching their mistakes. But this has almost always been when the physician is somehow impaired, as by inexperience; otherwise, the nurses tend to lose out in such discussions. "ER" has rarely shown a nurse acting as a primary force in a patient's outcome. Instead, physicians receive all the credit or blame for the results.
The show pays virtually no attention to nurse managers or the professional development of nurses generally, such as through advanced nursing degrees, research or scholarship. Nurse characters have limited opportunities to display their special knowledge and skills, especially since nursing students are never shown. This stands in stark contrast to the show's obsessive focus on each stage and feature of the physicians' professional development, from medical students through the chief of medicine, a feature that has certainly continued unabated through the 10th season. Tellingly, Lockhart finally chose a medical career and Hathaway flirted with one, as if to prove that they were worthy of the show's attention despite "only" being nurses. All three major nurse characters have also spent most of their time in romances with the show's physicians, and in a number of episodes, a key role of the minor nurse characters has been to comment idly on the lives of the physicians.
Finally, though the show prides itself on being on the cutting edge and often refers to the budget crisis in public hospitals, it has still paid no serious attention to the current nursing shortage, a shortage that now constitutes a major threat to global health--but which "ER"'s generally inadequate portrayal of nursing has done little to address.
In sum, "ER" has some appreciation for the role nurses play in modern emergency care, but that recognition almost invariably gives way to its obsessive focus on physicians. In real life, nurses, physicians and other health care professionals have complementary and interdependent work relationships. But on "ER," the bottom line has usually been that the physicians' role is unrealistically large and robust, and the nurses' role correspondingly small and flat. In dramatic terms, the physicians are the tragic heroes, while the nurses are essentially members of the chorus.
Most Recent (2003-04) Season Ratings and Review
| Nursing rating | |
Rating guide: |
| Artistic rating |  |
Review and Synopsis (2003-04 season)
In its 10th season, the remarkably resilient "ER" remained generally watchable and sometimes engaging, as old characters moved on and new ones moved in. However, there were signs of fatigue and even desperation, notably a growing reliance on Big Vehicle Drama (e.g., a tank threatens to attack the ED staff). The show seemed to struggle to find interesting things for many of its veteran characters to do. This was exemplified by the once-compelling Robert Romano's devolution into a one note annoyance (and his witless execution by helicopter), as well as the marginalization of the never-very-compelling intern Greg Gallant. The one exception was nurse Abby Lockhart, whose return to medical school did provide some interesting material, however damaging to nursing it was. Most of the sparks came from new characters Neela Rasgotra, a brainy last year medical student, and Sam Taggart, the tough, troubled nurse who assumed the show's lone major nurse character role.
Most characters underwent major transition. The biggest, of course, was Romano. The character's bitterness about his prosthetic arm became increasingly shrill, until he was little more than an empty professional sociopath. The show capped this creative collapse by having a helicopter--the same machine whose tail rotor took Romano's arm last year--actually fall on top of him. (Kerry Weaver's use of the bigoted surgeon's general bequest to County to start a gay, lesbian, bisexual and transgendered clinic did redeem this uninspired exit to some extent.) Weaver herself finally managed to have a baby with firefighter girlfriend Sandy, but her domestic hopes were shattered when Sandy was killed in the line of duty, and Weaver ended up in a horrific custody battle with Sandy's homophobic family. John Carter broke up with Lockhart by letter during his African soul-searching. He returned with his new flame, Kem, who was pregnant and considered moving to Chicago. But the baby was stillborn, leaving the relationship in doubt and Carter seeming more lost than ever. Military physician Gallant, long neglected by the show anyway, was sent to Iraq. Greg Pratt and Jing Mei Chen broke up but seemed to be circling each other, as Pratt assumed more responsibility at County, and Jing Mei struggled with her mother's death and father's disability following a car accident in China. Luka Kovac, ironically, was fairly stable, seeming to draw strength from his stints in Africa, his budding romance with Taggart, and his increasingly paternal relations with her young son Alex. Taggart herself was something of a swashbuckler, a veteran nurse with obvious skills but who tended to react to adversity aggressively, even violently, and who struggled to raise Alex alone. Elizabeth Corday started seeing men again; as with Romano and Pratt, the show no longer seemed to know what to do with her. Susan Lewis became pregnant by her on-and-off boyfriend, flight nurse Chuck.
The year's main work theme was the professional development of last year medical students Lockhart and newcomer Rasgotra. As these two worked their way through different rotations, the show generally painted Lockhart as the practical one who was good with people but struggled academically (how nurse-like of her), while Rasgotra excelled at theory but had trouble operating effectively in the real world. Ultimately both graduated and passed their boards, with Lockhart set to start as an intern at County, and Rasgotra supposedly on her way to a prestigious internship at the University of Michigan, a position she did not really want.
Portrayal of Nursing (2003-04 season)
This season was possibly the most significant for nursing in "ER"'s decade on the air. Not only did Lockhart finally abandon nursing for medicine and Taggart fill the show's designated lone nurse role, but the show at times seemed to go out of its way to try to show sensitivity to nursing concerns. Unfortunately, given the show's physician-centric structure and continuing refusal to seek meaningful nursing input, the results ranged from mixed to outright disaster.
Lockhart's switch to medicine sent a horrendous message not because that never happens (it does), and not because it flew in the face of her recent rejection of medicine and seeming embrace of nursing. The switch was a problem because "ER" has long suggested that nurses achieve primarily by learning or pursuing medicine (Lockhart's predecessor Carol Hathaway likewise flirted with medical school), even though in real life nurses are at least 50 times more likely to pursue graduate education in nursing than in medicine. A far more likely career path for Lockhart would have been to get a master's degree to become a clinical nurse specialist. Of course, "ER" viewers have little reason to know that the nation's 200,000 advanced practice nurses even exist, as they (like nurse managers) have virtually never appeared on the show. The argument that Lockhart's medical move actually shows that nurses are smart and able enough to be physicians reflects disrespect for nursing, as if nursing did not require those qualities. Lockhart's departure from the profession could have been an opportunity to address the critical global nursing shortage, but "ER" seems destined to leave the air never having addressed the shortage in any meaningful way. Though Lockhart's reasons for making the switch were never made entirely clear, she appeared to chafe at what the show viewed as the constraints of nursing--her inability to do really important things like medical diagnosis and treatment--as well as the lack of respect she received as a nurse, which the show illustrated but made no effort to counter. It wasn't all bad. At times the show certainly suggested that Lockhart was doing important things right in her training at least in part because of her nursing background. But no one asked Lockhart to consider remaining a nurse; everyone, including the nurses, seemed quietly proud that she was "moving up". No one reminded her of what was good about being a nurse. No one noted that the nursing profession was losing a valuable nurse at a time of critical shortage. And no one suggested that Lockhart might actually do more good as a nurse than as a physician.
Taggart's arrival was more of a mixed bag. From the first, it was obvious that she was a stronger character than Lockhart, as she leapt to sedate an unruly patient before even really beginning her first shift. In some episodes she also engaged in fairly technical discussions of medical choices with the physicians--the highest compliment the show seems able to bestow on a nurse--though she frequently seemed to lose arguments along those lines. (We have yet to see a significant nurse-nurse care discussion or argument; that would suggest that nursing was complex enough for people to disagree about.) On occasion Taggart was also seen doing critical work at the show's new triage area. Over time, it became clear that her can-do nature could turn aggressive and even violent; at one point she went into Uma Thurman mode on a patient who grabbed her, leading Weaver to chastise her, in a predictably supervisory way. Likewise, though Taggart's difficulties in raising her son alone are fair enough, the show had her bring the troublesome little guy to the ED with her so many times that it really called into question her basic professional judgment. As Taggart's character became more established, she settled into the traditional main mode for the show's major nurse character: that of romantic interest for the show's physicians, in her case (currently) the newly stable Kovac. By the end of the season, Taggart's professional life had largely disappeared.
In a number of ways the show seemed to make efforts to deal with nursing in a more accurate way than it has in the past. For instance, after more than nine years, it finally introduced a triage area, and sometimes showed a nurse staffing it. At another point, Lockhart actually gave a brief nursing report to Taggart, albeit one that was really more of a physician's report. And in another episode, a significant plotline had Taggart caring for a sexual assault victim with a surprising level of autonomy and skill.
Unfortunately, these new efforts were often overwhelmed by the show's basic approach, and an apparent inability to grasp what nursing autonomy and practice might really mean. The show increasingly had authoritative physicians Weaver and Romano refer to a director of nursing, but always in the context of enforcing some discipline against the nurses that the physicians wanted, suggesting that the director of nursing was really a bureaucrat the physicians had hired to handle annoying personnel issues they did not have time for. Of course, the director did not appear. The show also seemed to delight in having these same authoritative physicians deliver brutal anti-nurse putdowns, especially to Lockhart, such as Romano's remark that nurses knew enough to treat 90% of the patients but at the risk of killing the other 10%, or another surgeon's remark that she was not in the habit of justifying her care plans to nurses. It's pretty clear that the show regards these comments as inappropriate, but Lockhart's repeated failure to say anything significant in response--that is, her failure to make any effort to defend nursing--signaled to viewers that the physicians' remarks were nasty but essentially correct. Likewise, in the astonishing October 9, 2003 episode--perhaps the most significant for nursing that "ER" has ever done--Lockhart had no reaction when a gaggle of cute schoolchildren react to the idea of a nursing career with silence, but whoop with joy at the thought of becoming physicians. That episode also featured Lewis forbidding nurse Lockhart to talk to "her" patient, Romano firing nurses en masse because of a badly misconceived depiction of a nursing job action, and other elements apparently intended to show how hard it is to be a nurse, but which radically distort the profession and fail to convey much of what is good about it. The few genuinely positive elements--such as Lockhart telling Romano that cutting the nurse-patient ratio would likely lead to patient deaths--were lost in the avalanche of distortions and abuse.
In other respects, the season's portrayal of nursing was business as usual. Physicians regularly did exciting and responsible work that nurses generally do in real life--what we might call "physician nursing"--including patient education, family support, giving medications and blood, defibrillation, caring for critical patients on trips to CT scan and meeting ambulances. This occurs because the show remains determined to showcase physicians, even though physicians do not typically do many of the dramatically interesting ED activities. Of course, autonomous nursing work was rarely shown. Patients thanked only physicians for saving them, and nurses spoke about how a given physician was "the best." (To the show's credit, nurse Chunie Marquez did note that Lockhart would "kick ass" as a doc because she would always be a nurse.) Countless subtle touches, such as having a nurse hand a resident a stethoscope as he entered a trauma room, reinforced the handmaiden myth. The show's producers apparently made a decision to marginalize the valuable minor nurse characters. Generally only one of them appeared in any episode, though a line or two might be given to a more anonymous nurse, especially one of the Filipina nurses hired to replace those fired by Romano, whose specialty seemed to be an obsequious "Yes, Doctor!"
Near the end of the 10th season finale, after Lockhart had finally passed her medical boards, a patient asked her if she would be back the next day as his nurse. Lockhart noted evenly that she would not, but that she would be back, and he should ask for "Dr. Lockhart." It was hard not to share some of the understated elation actress Maura Tierney brought to this moment. We only wish the show could conceive of a world in which someone would display that kind of feeling about becoming a nurse. We only wish that in the show's eleventh season, the producers would devote even a small percentage of the attention they have lavished on physicians' professional development to that of nurses. We dream of an "ER" in which major nurse characters confront the challenges of the last year of nursing school and their nursing boards, a show in which we see all the drama of their turbulent first year of practice, as we no doubt will for Lockhart and Rasgotra. In short, we dream of a show that sees nurses as the critical professionals they are, rather than as subordinates and romantic interests for physicians. In that show, Lockhart would still be proud to be addressed as "Dr. Lockhart." But the doctorate would be in nursing.
Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Last updated: September 18, 2004
This is the 2003-2004 "ER" season review. Also see:
The 2004-2005 "ER" season review.
The 2002-2003 "ER" season review.
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Center for Nursing Advocacy.
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