You can’t make a TV show about a nurse without tackling the healthcare system. The system is nurses, and nurses are the system. They are one. Like tragically conjoined twins fused at a most unfortunate spot, it is impossible to separate the two without catastrophic consequences.
Talking about healthcare systems issues, though, can be…a bummer, man. And at the end of the day, a TV show is about entertainment. It’s about escape. So, how do you delight the audience while encouraging them to think about real-world problems?
If you’re the Nurse Jackie creators, you write a character embodying much of what plagues our current system, and you sprinkle her throughout the seasons to give Jackie something to work against professionally. You make her funny compared to Jackie’s sometimes grim palette of storylines. You make her likable. You create Gloria Akalitis.
Akalitis represents everything we love to hate about American healthcare: the labyrinthine bureaucracy, the maddening redundancy, the cutthroat bottom line. With her helmet-like hair, imposing stature, and militant demeanor, she is the Vader to healthcare’s imperial fleet of faceless administrators. She thwarts Jackie at every opportunity and drops in from time to time to remind us that healthcare is, in fact, a business.
Just when we might start being lulled into the warm, comforting thought that compassion and care are infinitely abundant, Akalitis pulls us back to reality. Behind every marketing slogan of “Compassion for All” or “Care Is Our Mission,” there’s an Akalitis stuffed away in an office, crunching the numbers and calculating just how much compassion and care the organization can afford.
We catch glimpses of our system’s corporate, contradictory, and all-around clown-town aspects through her. She chastises Jackie for working too much, yet in the same breath, asks her to pick up more shifts. She ruthlessly delegates bed space in the ER and casts her constant, watchful eyes on the staff. She calculates incidents of gun violence not by potential for human harm but by property damage. She threatens a Monseigneur with his life.
She also has incredible moments of tenderness, loyalty, and grace. So, we end up loving her. She tries to adopt a baby left behind in the hospital, crushes on a patient, and rallies alongside her staff when the hospital’s literal existence is on the line. Like Jackie, she is human; through this humanity, the writers can tackle more significant issues without preaching or clubbing us over the head. They can explore big systemic stuff like understaffing, insurance reimbursement, workplace violence, budgetary restraints, and hospital foreclosure—stuff that might otherwise knock us out faster than a Jackie-sized line of Xanax. We need a human guide. That’s Akalitis.
Who knows what the reboot will bring regarding how our healthcare system is depicted on screen? Early press reports said Jackie had lost her nursing license. And ‘All Saints’ was shuddered at the end of the last season, so it’s hard to imagine how a significant portion of the show could occur in any hospital. Maybe the creators are taking a hard left and pivoting away from any medical theme. I hope they don’t.
Ten years have seen a lot of changes in our discussion around nursing and healthcare and how they are delivered. The moment is ripe for cultural commentary, missing from other medical shows. I hope the reboot takes a stab at it. Also, I just can’t imagine the show without Gloria Akalitis. I don’t know if I even want to. What could I imagine? Jackie and Gloria are putting aside old differences and taking off on a whacky cross-country road trip. Vacationing in Mykonos. Retired, getting tanked together at Sip and Paints. Just spitballing here. Showrunners, call me. Plenty more where that came from.
When I rewatch episodes of Nurse Jackie as a now practicing emergency room RN, I laugh. A lot.
ER doctors performing open abdominal surgeries in Manolo Blahniks? No. I mean, I’ve never practiced in NYC, so maybe the culture is different there, but I have worked in many other ERs across the country, and I’ve never once seen any clinician wearing pumps, much less Manolos. There are too many body fluids to contend with. It’s Crocs, Hokas, or Danskos if you’re on the floor. Also, ER doctors don’t do surgery. Surgeons do surgery.
A nurse finding time for sex? AND post cuddles? No. ER nurses can barely carve out the time for a satisfying bathroom break, much less meaningful romantic relationship building.
ER staff sharing a champagne toast while euthanizing a past colleague, administrators hiding abandoned babies in their office, and endless quantities of untracked narcotics—Nurse Jackie is far from a realistic depiction of real nursing. It sometimes veers into outright fantasy. But would you rather watch an ER nurse have glamorous lunches at Le Cirque or spend two hours poking at a keyboard? I choose gossip at Le Cirque. Of course, the showrunners had to take some creative liberties, and I don’t fault them for that.
However, despite its stumbles in representing the day-to-day job, the show does succeed in addressing higher-level issues related to nursing. It tackles the stuff that really matters. It explores themes often discussed in nursing, like the treatment of nurses by patients and families, lateral violence, work/life balance, understaffing, sexual harassment, and substance abuse. It addresses ancient hospital hierarchies, intergenerational relationships, and how healthcare folks navigate a system that’s often in direct opposition to their professional oaths. And this is the juicy stuff we want people to see and identify with. This is the stuff that helps shift the public’s perception of nursing.
I’m not saying it’s always on the right side of these themes. One example is the scene where an angry family member hits Jackie. He yells, throws a fit, and clocks Jackie in the face. And she takes it on the nose (literally). When her nursing student, Zoey, expresses outrage—Jackie replies, “It’s part of the job,” rubbing her jaw and moving on with her day. That was a missed opportunity to pause and find a way to say, “Actually, that isn’t OK.” But also, the show initially aired almost twenty years ago. The culture was different. I expect the reboot to be more dialed into a more updated view of workplace violence.
So, no. Jackie doesn’t accurately represent real-world nursing because real-world nursing is harder. Time to self-reflect in the hospital chapel? Please. Patients passing away peacefully sans monitor alarms or multiple rounds of CPR? Um, no. Free Vicodin? If only. (THAT’S A JOKE, BOARDS OF NURSING). Jackie does, however, give us a more honest and humanizing representation of nursing’s challenges than the vast majority of other medical shows. And for that, I’m thankful.
Being a nurse at All Saints Hospital seems like a cakewalk compared to real life. Are they hiring?
Jackie’s back. Love or hate her, Nurse Jackie is being rebooted on Amazon Prime this year, with star Edie Falco to return. Join me, a practicing ER nurse, for a look back on the original series and its approach to its main character, the real-life job of being a nurse, and our healthcare system.
Nurses have long struggled to own their leading character energy in media and pop culture. We’re usually sidelined by narratives featuring physicians or residents or played as one of a handful of worn-out tropes. Nurse Ratched is a deranged, controlling battle-axe. ‘MAS*H’s’ Margaret “Hot Lips” Houlihan is an object of the male characters’ sexual thirst despite her incredible professional military accomplishments. And Greg Focker is essentially one feature film-length male-nurse joke in ‘Meet the Parents.’ Men in nursing! [covers mouth and ‘tee-hees.’]
But that’s if we make it into the foreground at all. Often, nurses are simply the blue-scrubbed, slightly out-of-focus ambient background action for almost every medical show ever made. And while nurses quite literally run the US healthcare system, you’d never know that by watching us portrayed in film and television.
Meet ER Nurse Jackie Peyton
Then, Jackie Peyton. Showtime’s wildly successful show, ‘Nurse Jackie,’ featured an NYC registered emergency department nurse as its main protagonist. Jackie appeared in nearly every scene of the show’s almost 100-episode run, single-handedly carrying the entire seven-season story arc from beginning to end. Jackie entered the chat, dominated it, and helped redefine the image of modern nursing for the U.S. public. Audiences devoured the show; over a million people watched the pilot episode, which was immediately purchased for a second season. All eyes were on nursing. Boom. We had arrived. Nurses, the nation over, rejoiced.
Not. It turns out that Jackie didn’t sit well with the real nurses. There was backlash—a lot of it. Many criticized heavily the show’s portrayal of Jackie as a person with an addiction and her tendency toward, I’ll say…eccentric professional behavior. They claimed it would sully the image of the nation’s most trusted profession and derail young folks from pursuing nursing as a career. Professional organizations even released a “statement of disappointment” and lobbied for a disclaimer before the show’s opening credits, warning viewers the show was not an accurate representation of the nursing profession. Organizations lost that fight, but they were decidedly un-team Jackie. They wanted a more wholesome representation, a more respectable, professional vision of an American nurse: more Taylor Swift, less Amy Winehouse.
Me? I’m team Jackie. I’m team Jackie, captain. Maybe I’m biased here because I’ve had a massive gay-to-straight crush on Edie Falco and her no-nonsense, steely feminine demeanor since her ‘Soprano’ days, but I think Jackie was a great rep for nursing’s brand. Was she a perfect nurse? Hell no. Was she a good nurse? I think so. It depends on how you view nursing’s role in the modern healthcare system. What she was, unabashedly, was human. And that’s how we want the public to see us. Too often, nurses are held to impossibly high professional and personal standards. We’re branded as ‘superheroes,’ capable of—and expected to—shoulder immense societal burden at the expense of our self-fulfillment. Superheroes, however, are notoriously impossible to relate to.
Nurse Jackie was Infallible
Jackie was not a superhero by any stretch of the most vivid imagination. She lied, stole, had affairs, yelled at people, disposed of body parts in toilets, berated public school counselors, was cagey about her personal life, and snorted enough Vicodin & Percocet to take down Lebron James. At the same time, Jackie was resilient, highly skilled, intelligent, hardworking, generous, kind, empathetic, and dedicated. She was human, and she was messy. She was an imperfect person trying to do good in an imperfect system; that kind of honest representation is good for nursing.
It strips away the scrubs, the clinical titles, and the professional mission statements and leaves just the human. We want people to understand that we make mistakes like they do, that our patience is limited, and that we get tired and angry sometimes. We want them to know that we are subject to the same kinds of temptations they are. Our humanity makes us relatable, it makes us real. The show wouldn’t have worked if Jackie had been a perfect professional or human. People would have been bored or felt preached to.
Watching the characters struggle and Jackie struggles a lot is compelling. She struggled with addiction, with relationships, and with the truth. Beyond creating a nuanced and fascinating character, witnessing these struggles also gives the audience a more honest picture of what modern nursing is truly like. It’s hard. It’s hard working twelve-hour shifts on your feet. Holding compassion for patients, colleagues, family members, friends, and yourself is hard. And being nice to people who aren’t nice to you is hard. Some shortcuts are inevitable, some vices too seductive, and Jackie falls prey to both. But her indiscretions and free-fall into addiction allow the audience a richer appreciation of nurses and the work they do. They provide a much-needed contrast to the ‘not all superheroes wear capes’ trope, which says that nurses should do hard work no one else wants to do and do it with little meaningful recognition. This expectation leads so many real-life nurses to burn out or make choices similar to Jackie’s. Instead, witnessing Jackie’s struggles and failures offers audiences a more relatable image of modern nurses, an image they can empathize with. Empathy and honest representation are the only way forward if we want professional progress.
If we want perfection, we should turn away from Jackie. But if we want to see ourselves onscreen in a more honest, sometimes uncomfortable, and human way, we should embrace her. Her spirit represented what nursing should be—advocacy, intelligence, and compassion. Her greatest strength, though, was her humanity. Humanity should be the goal when depicting nurses in media because a rosy professional identity alone can’t tell effective stories; only people can do that.
