Today Showtime launches Nurse Jackie, its new series starting Edie Falco. (Click the video above to watch the first episode.) The publicity people at Showtime saw my initial post on the trailer, so they sent me the first six episodes to watch. (Don’t worry, nothing I write here should spoil any major plot point in the coming episodes.)

This is already a controversial series. Postings on a nurses’ listserv indicate that many nurses who have watched the trailer or first episode aren’t thrilled with nurse Jackie Peyton. She’s addicted to pain medication that she obtains from the hospital pharmacist with whom she is having an affair. Although she’s smart and a fierce advocate for patients, she often goes beyond the bounds of appropriate professional conduct, as when she forges the signature of a dead bicycle messenger to authorize donation of his organs. (The disregard for official procedures and rules shown by Clint Eastwood’s Dirty Harry character came to mind when Jackie flushed down the toilet an ear that a prostitute had cut off the john who’d stabbed her.)

For over a decade, nurses at the Center for Nursing Advocacy have decried the depiction of the nursing profession on the many television series with health care themes, such as ER, House, Grey’s Anatomy, and others. These programs have featured nurses as wallpaper, backdrops to the ever-present physicians who provide not only medical care but the care nurses typically provide. The nurses are often dim lights, leaving one to wonder why anyone would go into nursing after watching these popular series. Any strong nurse character inevitably decides to go to medical school.

Nurses across the blogosphere and at nursing advocacy centers have provided blistering critiques of these hit series and called for producers to develop a prime time series that features a nurse as the lead character. More recently, the Web site Truth About Nursing has posted an excellent critique of the pilot episode of Nurse Jackie.

I don’t know if my input made the least difference in the final product, but some months ago I was contacted by a writer for Nurse Jackie who wanted to talk with me about nursing and the series. I told her that I wasn’t looking for the perfect nurse character, since I know that perfection is not the stuff of great drama and comedy. But I did want to see a program that would show nurses who acted as smart advocates for patients, played the central health care roles that they assume in real life, provided nursing care that saved lives, supported patients through trying times, and were everyday heroes.

Nurse Jackie delivers on all of these points. Jackie is an expert nurse. She can look at a patient and get that intuitive and experience-based message that the patient is “going down the tubes,” even when the physician says everything is fine. She challenges physicians and others when she thinks she’s right (and the time she doesn’t go far enough, the patient dies). She tries to right the wrongs of health care, as when she supports an elderly woman in refusing treatments for her dying husband or helps a former nurse colleague to die when metastatic cancer has overwhelmed any hope of recovery. And it’s not unrealistic at all that her drug addiction arose from a back injury—an injury that is all too common among nurses.

Nurse Jackie is a complex character in a dark comedy. Edie Falco, Emmy-award winning actor for The Sopranos, is perfect for this role. She’s filled with contradictions (for example, her extramarital affair with drugs, despite seeming to be in love with her husband and committed to their children). She bounces between being dour, witty, in-charge, vulnerable, soft, and tough. Life isn’t simple or easy for Jackie—and it’s not for any of us. That’s one of the beauties of this series.

I understand the concern of those nurses who hate her addiction and on-duty sex. But it’s been a very long time since there’s been a great nurse lead character in a series that showcases her smarts and advocacy but allows her to be full of contradictions. The last one I recall is Hot Lips Houlihan on Mash. She was belligerent, bureaucratic, driven by her desire for love, but uncompromising in her expectations for the best of care for patients. She could have been Nurse Jackie’s teacher.

And besides Edie Falco, there’s Anna Deavere Smith, the brilliant author and actor many will know from her role in The West Wing. In Nurse Jackie, she plays the hardened nurse administrator who, on the surface, seems more worried about protecting the hospital bureaucracy than in serving staff and patients. Her performance in one episode left my husband and me laughing out loud.

To like this series, you don’t have to agree with everything that Nurse Jackie does. And who knows how the character will unfold? The promotional materials I was sent included the statement that “Perhaps there will be a time when Jackie can break free of her secrets and addictions . . . ”

I suggest that nurses rally around this series and stop wishing for perfection in any lead nurse character. Diahann Carroll’s docile nurse character in Julia in the 1960s wouldn’t attract viewers in today’s entertainment world. There’s not another program that shows nurses as smart, fierce advocates who actually provide nursing care. Sure, I’ll cringe when Jackie pops another painkiller or steals from a jerk of a patient and gives the money to the pregnant woman who can’t afford a taxi home. But Nurse Jackie isn’t perfect, and neither am I. I’m signing up for Nurse Jackie now.

–Diana J. Mason, PhD, RN, AJN editor-in-chief emeritus

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