Movie & TV Nurses

Looking Back at “Nurse Jackie”

A former nurse addict and current recovery coach takes a fresh look at the controversial 2009–2015 Showtime series

­“Nurse Jackie,” a medical comedy-drama about a drug-addicted nurse in the chaotic thrum of a New York City emergency department, premiered on Showtime in June 2009.

For seven seasons, the series followed protagonist Jackie Peyton, married mother of two and accomplished emergency department nurse (skillfully portrayed by Edie Falco of “Sopranos” fame), as she cycled through addiction, sobriety and relapse—again and again.

WIDESPREAD OUTRAGE

The show had all the components of a riveting drama: Jackie’s failing marriage; her scandalous affair with a pharmacist who moonlights as her drug dealer; a daughter who suffers from anxiety disorder (and eventually a drug habit of her own); comedic coworkers; and attractive, flirtatious, condescending physicians.

It was also one of the very few medical shows with a nurse as a central character rather than just a supporting player.

Nevertheless, “Nurse Jackie” debuted to widespread outrage from nurses offended by the lurid content. I was one of them. At the time of the show’s launch, I’d been a nurse for four years.

Idealistic and proudly protective of my profession, I declined to watch “Nurse Jackie.” I was indignant that the media would dare to portray a nurse so far below professional and ethical standards.

TOO CLOSE FOR COMFORT

Flash forward to 2014, as I sobbed on an overstuffed couch in my chemical dependency counselor’s office. Profoundly burned out after years of high-stress patient care and experiencing debilitating migraines, I was physically and psychologically dependent on opioids.

Admitting this out loud in that office — that I was abusing prescription drugs — was the lowest point of my career. I’d been an honor student, a charge nurse and a role model to my peers; opioids corroded my character. I felt like a disgrace to myself, my family and — most painfully of all — to nursing.

My kindhearted, forgiving counselor suggested I watch “Nurse Jackie.” She told me, “You’re not a bad nurse. You have a disease you’ve been trying to self-medicate. You’ll see that a wonderful nurse can engage in bad behaviors. You’ll see you’re not alone.”

I was skeptical, but agreed to try.

That night, I warily pressed “play” and waited for enlightenment. My eyes followed the shiny red-and-white capsules dancing across the screen during the opening credits. My stomach clenched as I watched Jackie snort circular beads off a bathroom counter, crush a handful of white pills into powder and add this secret euphoria-inducing ingredient to her coffee.

CLICK. I turned it off and the screen went black. “No way,” I thought. “I don’t need this.”

It would be five more years — after a return to solid sobriety and enrollment in a monitoring program for healthcare professionals with substance use disorder — before I chose to give the show another look.

Now a champion for education, advocacy and the eradication of stigma, I was curious: Was “Nurse Jackie” a platform for a rich dialogue about addiction in the nursing industry? Or, was it just another bleak portrait of the opioid crisis, with a nurse playing the lead?

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A WARNING FROM THE ANA

It’s no surprise that “Nurse Jackie” sparked controversy as soon as it debuted. The American Nursing Association issued a statement warning that portraying a nurse in such a negative way could erode public trust in nurses, and might even discourage potential nurses from entering the profession.

The general public, however, loves an antihero, and the show was timely, coinciding with the second and third waves of America’s opioid crisis.

Applauded for its raw illustration of the ugly truths of drug abuse and the power of addiction, “Nurse Jackie” was nominated for 24 Emmy Awards and won five. Falco received six Emmy nominations and won the award for Outstanding Lead Actress in a Comedy Series in 2010.

Contrary to the ANA’s opinion, I acknowledge the value of highlighting a serious and often fatal condition that persists within our industry. It’s essential that the subject of addiction among healthcare workers is recognized and discussed.

A disturbing 2010 paper in the Journal of Clinical Nursing estimated that as many as one out of every five to seven nurses suffers from addiction, but the condition remains highly stigmatized, which discourages nurses from seeking treatment and recovery. “

Nurse Jackie” sheds a glaring light on this shadowy subject, paving the way for crucial lifesaving conversations.

TRYING TO UNDERSTAND JACKIE

Based on my own experience of recovery, I expected to relate intimately to Jackie Peyton, and I’ll admit there are scenes in “Nurse Jackie” that feel eerily familiar. However, as the episodes — and the character’s addiction — progressed, I felt a nagging sense that a key ingredient was missing.

Season One begins with Jackie already held hostage by her drug habit. She’s sleeping with the pharmacist in exchange for pills; scavenging, hiding and using wherever possible; and existing on a maintenance plan of uppers and downers.

As I watched the series unfold, I anxiously awaited scenes revealing Jackie’s history and the underlying conditions that led to her drug use, but my curiosity was never fully satisfied. We’re only given basic clues, such as her rocky marriage, an ambiguously described back injury and the fact she works in an area known for high rates of professional burnout.

UNANSWERED QUESTIONS

In Season Four, under duress, Jackie finally opens up to her rehab counselor, saying that it all began when her daughter Grace was an incessantly crying infant. “I stole 100 Percocet and was off and running,” Jackie explains.

I still felt deprived of depth and context, which made it difficult to fully empathize with the character. After a while, I was almost begging for a glimpse into Jackie’s inner landscape.

What led to her maladaptive coping? Was she raised in a family rife with addiction? Did she suffer childhood trauma (as do approximately two-thirds of people who turn to drug abuse)? Was she once an eager new nurse, steadfast in her integrity, who suffered remorse and shame as she crossed one professional boundary after another?

We never really find out. Jackie sometimes alludes to inner conflict (“I think I need rehab — I want to go, but I don’t”) and to the fear of losing her identity, but no flashback scenes elaborate on these feelings. Ultimately, she maintains her stoicism, walled-off personality and determinedly deceptive ways.

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SHOCKINGLY IMPLAUSIBLE PLOT TWISTS

Throughout the show’s run, Jackie travels a very different — and often unrealistic — route than do most nurses on this path. Shockingly, when her colleagues and employer learn of her drug habit, she continues to work in the ER, a stressful and triggering environment where she is assured steady access to narcotics. She is often enabled by her coworkers, who throw out her incriminating urine sample and even provide her with pills.

Through increasingly improbable circumstances, Jackie avoids consequences at every turn. It’s not until the final season when, charged with drug possession after a car accident, she (temporarily) loses her job as a nurse. Her suspension doesn’t last, however, and Jackie ends up right back where she started: as a pill-popping nurse in the ER at All Saints.

This circular arc provides a dramatic finale, but feels especially contrived. The show frequently sacrifices plausibility in favor of dramatic effect. The focus on Jackie’s depraved behaviors rather than a fully developed “origin story” is a cinematic choice that helped to get viewers hooked, but was also why viewers began to lose interest by Season Five.

HOW NOT TO APPROACH RECOVERY

Created to entertain, not destigmatize, “Nurse Jackie” is a cautionary tale of the destruction left in the wake of an opioid abuser, and a clear lesson on how NOT to approach recovery.

While nurses can and do hide substance abuse for years, we are, almost without fail, fired and reported to our boards of nursing as soon as administration becomes aware of the problem.

Depending on the severity of our violations and the punitiveness of the state’s standards of nurse discipline, our licenses may be suspended or revoked, and we may face criminal charges. In many cases, there is a more favorable option for recovery and license protection:

Forty states have alternative-to-discipline programs for healthcare professionals; New York (where the Jackie Peyton character is licensed) is one of them. These programs, which involve contracts lasting years, are less punitive than license revocation or jail time, but are an extremely challenging experience requiring a genuine commitment to sobriety and personal growth.

A MISSED OPPORTUNITY

“Nurse Jackie” misses an important opportunity. If the protagonist had displayed the vulnerability, resiliency and strength I see in real nurses in recovery, the show could have gone a long way towards dismantling the “addict” stereotype, and perhaps even won increased favor with nursing audiences.

Every year, an estimated 9,000 nurses in recovery return to the workforce. These are nurses who have survived their addiction, put in the hard and humbling work of rehabilitation, and overcome extraordinary circumstances. It’s a shame we couldn’t have seen the fictional antiheroine of “Nurse Jackie” become one of them.

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California BRN Intervention Program

California first established an alternative-to-discipline program for registered nurses back in 1984.

Now called the Intervention Program, it allows RNs with substance abuse or mental health issues to access individualized treatment and monitored recovery plans in lieu of disciplinary action by the BRN. Nurses who enroll in the program must place their licenses on inactive status, which means being unable to practice nursing for at least 30 days (and often longer).

However, the program’s recovery plans allow rehabilitated nurses to eventually return to practice without negative action against their licenses.

A nurse’s enrollment in the Intervention Program is confidential. However, since participating in the program requires not practicing for some time (and may entail practice restrictions once the nurse does return to work), individual nurses must decide what and how to tell their employers about the situation.

To learn more, visit rn.ca.gov/intervention.


TIFFANY SWEDEEN, RN, BSN, CPRC/CPC, works in critical care and as a clinical instructor. Follow her on Instagram @scrubbedcleanrn or at www.recoverandrise.com.

 


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