ER vs. 'ER': Are Medical TV Shows True to Life as an ED Nurse?
How realistic are popular medical dramas? We asked real ED nurses to find out.
Channel surf any time of day or night and you’re almost certain to find at least one television program that is based on hospitals and the nurses and physicians who work in them. Whether it’s a serious real-life medical drama such as "ER" or "House," a lighthearted comedy series such as "Scrubs," a carefully crafted blend of both, a la "Grey’s Anatomy," or even a daytime soap opera like "General Hospital," viewers wanting to live vicariously through the imaginary cast of RNs, interns and doctors will not be disappointed in their quest for hospital shows. There are even medical reality shows such as "Trauma: Life in the ER," "Code Blue," and "Paramedics" that run on the Discovery Channel. But all these are simply the tip of the iceberg as far as medical-inspired television is concerned, and we haven’t included the reruns of classics like "M*A*S*H" and "St. Elsewhere."
Much of the dramatic action in successful medical TV shows centers around the ED. Dozens of TV shows are now — and have been in the past — set in hospitals with casts of fictional healthcare workers. It’s a formula that’s proven to capture audiences and win Emmy Awards. Pop culture has glamorized RNs and MDs for decades, and viewers can’t seem to get enough. With the popularity and abundance of medical shows expanding each television season, Working Nurse spoke with working ER nurses in Arizona and Southern California to find out if the scenarios depicted in these shows are realistic portrayals or wildly far-fetched, and whether or not they actually watch shows like "ER."
Expect the Unexpected
The one thing that all of the ED nurses we questioned unanimously agreed upon was that working in the emergency department means never knowing what kind of case will come through the doors — and that this was definitely part of the excitement of the job. While all nurses share a deeply committed dedication to serving and helping people, the unpredictability of the cases and the flexibility required of the RNs in the ED almost requires an additional adrenaline-seeking mindset to be able to cope with the pace and variety of scenarios presented on a typical 12-hour shift. There’s also no doubt that the RNs we talked to are passionate about working in the ED.
Martin Curran, RN, CEN, at Flagstaff Medical Center in Flagstaff, Ariz., particularly likes that, “You will never have the same day twice, and you never know who will be there.” His colleague Michelle Wenger, RN, CEN, also at Flagstaff, describes the difference between working in the ED as opposed to other nursing practices:
“It’s the variety of patients you see. On any given shift, we take care of neonates to geriatrics. As an ED nurse, you are a peds nurse, psyche nurse, trauma nurse, ICU nurse, telemetry nurse and med-surg nurse. I tell my friends and family that it is never boring. Some days are more of an adrenaline rush than others. When you have several trauma patients coming in, the adrenaline helps!”
Joy Hankowski, RN, CEN, MICN, at California’s Northridge Hospital Medical Center has always been an ED nurse. A self-described “adrenaline junkie,” she said comparing the ER to other nursing practices is “like comparing apples to doughnuts” because they’re so very different. Incidentally, one of Ms. Hankowski’s colleagues at Northridge, Dr. Joe Sachs, is a writer for "ER." Of the medical-based television dramas Ms. Hankowski has watched, she does feel they are pretty realistic. “Similar stories could really happen," she said, "but they just wouldn’t be happening all in one 60-minute period.” She also works as a flight nurse a couple of days a month at the Mercy Air Ambulance Company, where she frequently treats patients right at the scene of accidents.
TV vs. Reality
Many nurses we spoke to told us that they don’t especially enjoy watching medical dramas on TV because it’s “too exhausting” after working in the real ED, which can touch them deeply on a personal level.
For example, Betty Hull, RN, ENCC, and senior director of ED and critical care at O’Connor Hospital in San Jose, Calif., shared a poignant story with us. “My biggest impact case (at another hospital) was when a father brought his 18-month-old son in after accidentally driving his car over him, crushing his skull and body. The baby did not survive. This was very traumatic for the father, but also for me as well, as I had a child of my own the same age.”
Ms. Hull says it is always difficult for folks working the trauma center when kids come in. Still, it’s the opportunity to make a difference in an immediate crisis situation that keeps her serving as a nurse. “In 30 years, I have never once thought of doing something different. ED nursing is the best profession ever.”
At Scottsdale Healthcare in Arizona, RN Sandra York said, “I have spent my entire 18-year nursing career in the ED. I initially wanted to go into L&D out of school, but they didn’t have any positions open and ED did. Once I started, I didn’t want to leave. I am positive the reason most ED nurses love it is because of the adrenaline rush. Never knowing what may come in the door next is what keeps us on our toes. There can be some very harrowing moments, though.”
When asked if she ever watches the TV dramas, Ms. York said, “I watched 'ER' for a couple seasons. Not for the medical reasons but for the soap opera aspect. Sometimes when you are off work, you don’t want to think about it.”
Does the soap opera stuff happen in real life? Sharon Imperl, RN, BSN, CEN, CPN, also with Scottsdale Healthcare, told us, “I have never watched an ED series that really depicts the true feel of an ED. Patients do not come in and within five minutes are in the OR, or leave to go home that fast. What is somewhat true is the sense of camaraderie between staff. Collaboration with each other and trust build a great team. Everyone is not sleeping with each other. When I worked in a teaching hospital, some relationships developed with the medical staff and the nursing staff. These relationships were always kept private.”
So much for "Grey’s Anatomy," though another RN told us, “I hate to admit that the hanky panky goes on, but it does. That is human nature.” More common is the instant kinship described by Ashley Peak, RN, BSN, CEN, and clinical coordinator of ER services and trauma at Flagstaff Medical Center. “I’ve never caught staff having affairs in the medication room or fist-fights breaking out. However, the similarity to TV drama lies in getting to know a complete stranger in the most intimate fashion, having little efforts make a huge difference, and then never seeing the patient again — yet they’ve touched your life forever.”
Laughter Is the Best Medicine
After a grueling shift in trauma centers, many RNs just need to chill out and have a laugh. Some of the nurses we interviewed were fans of the medical comedy shows and sometimes found that pointing out all of the inaccurate gaffes on the medical dramas was amusing as well. Eve Leetch, RN, BSN, at Banner Thunderbird Medical Center in Glendale, Ariz., told us, “I love 'House,' although most of these shows drive me crazy because there is no nurse to be found. Have you really ever seen a doctor (not a student) put in a Foley catheter? PLEASE!” she enthused. “ED nursing is the greatest. I love it. It offers variety, spontaneity, flexibility and an addicting adrenaline rush. We take care of anything and everything, sore throats to gunshots, psyche patients to scorpion stings. You never know what will roll in the door.”
In Mesa, Ariz., at Mountain Vista Medical Center, David Lomu, RN, had this to say about the diversity of patients coming to the ED: “You can’t really get complacent when you don’t know what’s coming through the door.” David laughed about the way it’s presented on TV. “They have time to socialize in the ED — it’s not the case!”
Living the ED
At the Olympia Medical Center in the heart of Los Angeles, Calif., ED Charge Nurse Erwin Azurdia, RN, PALS, ACLS, BLS, was asked if he ever watches the TV medical dramas.
“No, I live it!” Mr. Erwin told us. “ED requires you to work long hours so you have to be passionate about your job and love to help people. On one of my shifts, a family requested a wheelchair for their relative. When I went outside, I found the patient naked, face down inside the car, not breathing. I ran back inside, grabbed a stretcher and two additional RNs, put the patient on a stretcher, ran inside and immediately began CPR/Code Blue. We resuscitated the patient, who was transferred to the ICU.”
When asked what emergency case stood out the most for them, our working ER nurses had us riveted with their true-life tales, though they mostly claimed that nothing compared to the outlandish TV scenarios. You be the judge and read the stories in the sidebars. Don’t be surprised if some of these wind up as plotlines in the next episode of your favorite medical drama. As ED nurses know, anything can happen!
True Tales of the ER: Nurses Speak
“I once delivered twin19-week-old fetuses in the ED. I gave them to Mom and Dad to hold, knowing that there wasn’t anything we could do to save them.”
—Sandi York, RN
“I’ve had patients come in with their skin moving due to maggots. The most horrific experience for me personally was an 18-month-old little girl who was suffocated by her babysitter on the sitter’s first day.”
—Ashley Peak, RN, BSN, CEN
“There are so many serious cases we see, it is hard to pick one. I have seen a young healthy woman deteriorate rapidly and die from necrotizing fascilitis. I have taken care of a boy my son’s age who died of injuries from an ATV. I have had a psyche patient pull out a knife. On the lighter side, I had a patient so worried about being admitted to the hospital because her dog — “her baby” — was in the car. I took her dog home with me, and then on to the boarding kennel to ease her mind.”
—Michelle Wenger, RN, CEN
“I never had a bomb in my ER!”
—David Lomu, RN
“We had some trauma cases that remind me of war emergencies. One time a nine-month pregnant woman on a motorcycle wiped out and came into the ED not breathing. She had an emergency C-section, but neither of them lived. There was an explosion at the Van Nuys Airport, and a man had his leg blown off.”
—Joy Hankowski, RN, CEN, MICN
“The drama is real. Child abuse. Sad endings. Exploding testicles (yes, it really happened). The exploding testicles case was totally bizarre but true. The urologist didn’t believe it until he saw it!”
—Eve Leetch, RN, BSN
“One that sticks out happened recently. A man was brought in in the back of a pickup truck with most of the bones in his extremities fractured (most open fractures). What shocked me was that when we got to the truck, he smiled politely and introduced himself. His extremities were going in every direction but the right one, and he was smiling and pleasan t— he was actually joking with us. I was blown away.”
—Martin Curran, RN, CEN