4 things Grey's Anatomy got wrong (and 1 it didn't)

“Grey’s Anatomy” follows the personal and professional lives of several young doctors as they climb the ranks of general surgery. But are they the only heroes at Grey-Sloan Memorial Hospital (formerly Seattle Grace)? From the perspective of a Texas Children’s nurse, here are four things “Grey’s” got wrong about the nurse-physician relationship:

1. Hospitals are not staffed solely by doctors.

Watching “Grey’s Anatomy,” one would think there are no other personnel at Grey-Sloan Memorial Hospital. Surgeons are amazing, but their role is very specific to, well, surgery. They would not be able to single-handedly evacuate a NICU during a hurricane. There’s no way they would voluntarily run a code by themselves. They have neither the time, nor at times training, to run blood gases, ambulate patients, administer respiratory treatments or wheel stable admissions down to MRI. There’s a host of other health professionals needed to make that kind of facility work and everyone has their niche. “Grey’s” has the doctors carrying out nursing tasks, like giving scheduled meds or positioning patients, while nurse characters get relegated to romantic false leads. This essentially results in the erasure of nurses in the public mind. When we’re not being dismissed as clueless, we’re not being represented at all. Maybe Derek “McDreamy” Shepherd wouldn’t have a better shot at survival if nurses had been around to point out that his endotracheal tube was taped in the most egregious fashion. Nursing has an unfair stigma as grunt work, and that leads to showrunners assuming they aren’t smart, interesting people worth creating shows about. Why didn’t Nurse Rose or Nurse Eli have complex storylines of their own? Not to mention that advanced practice nurses, like nurse practitioners and nurse anesthetists, make decisions and write orders very similarly to the way physicians do. Residents are overworked enough as it is—let’s give them a break and not make them run the whole unit alone.

2. Doctors don’t know how to give meds.

It’s not that they lack an understanding of medication administration; they often just don’t know how to use the equipment. Nursing is centered on coordinating and delivering all the care that a patient routinely needs, so nurses are experts on obtaining materials, programming machines, diluting substances and engineering complicated infusions simultaneously. Doctors need to be very knowledgeable about the settlings on a CRRT (continuous renal replacement therapy) circuit, but most don’t have a clue how to actually change the dialysate bags. It’s not their job; that’s a nursing responsibility. And while it’s not quite accurate to say that doctors are only in charge of determining the correct orders and nurses are only in charge of carrying them out—there’s a lot of feedback given and interventions initiated by both parties—there is a certain amount of role clarity when it comes to who does what. In an emergency, everyone needs to know what their job is so they can focus on doing it well.

3. Just kidding—they do.

Remember what I said above, about role clarity? Role flexibility is also important. During a code, if there aren’t enough nurses, doctors absolutely step in to push drugs and start IVs. And if a resident doesn’t know what to do, nurses offer feedback about the appropriate plan of action based on experience. We’re the eyes and ears at the bedside, so we’re in the best position to notice early changes in patient status. Physicians always appreciate a heads-up that things are taking a turn for the worse. This give-and-take of information is only possible when everyone feels like they’re on an even footing with their teammates. Yes, there are toxic work environments out there, but that’s not what TV should strive to emulate. Mutual respect influences patient outcomes, which is why my unit’s culture requires doctors and nurses to call each other by their first names. As a new nurse at Texas Children’s, my jaw dropped the first time a fellow asked, in complete seriousness, “Do you have any recommendations? Can this patient be transferred tomorrow? What orders do you need?” Media had taught me that doctors wouldn’t listen to me, but my everyday experience proves “Grey’s Anatomy” wrong. Which brings us to…

4. Professional communication between nurses and doctors is crucial.

Hospitals are dangerous places—but not for the reasons you think. I remember watching “Grey’s Anatomy” and saying, “Is Grey-Sloan Memorial Hospital a deathtrap? How many medical professionals have died there? Do we need to get OSHA involved? People are getting shot, drowned and electrocuted all over the place and they’re not even the patients!” Joking aside, any time vulnerable people are treated with invasive substances and procedures, there is an element of risk. Way too many people die every year across the world from medication errors, and those are often made due to inconsistencies in communication. Being calm and polite reduces the chance we might accidentally be giving the wrong dose, or amputating the wrong limb, or memorably, as in one episode, setting fire to a patient’s open chest cavity. There will be no smooching in empty exam rooms. There will be no screaming, crying, hurling insults or yelling “DON’T GIVE UP ON ME” in the operating room. If you lose your composure, you’re not safe to provide patient care.

5. Nurses and doctors hang out together!

Yep, “Grey’s” got that one right. Hospitals are tense environments, and strong relationships are built when you’re forced to rely on your team. That kind of trust produces lasting friendships—not to mention a support system of people who understand the particular stresses and rewards of working in health care. Many of my busiest shifts have ended with nurses, doctors and respiratory therapists going out for breakfast. If you’re throwing a dinner party, why not hedge your bets and invite someone who could do abdominal thrusts if you choke on the steak? In the unlikely event of an emergency, it’s nice to know that 90 percent of the party guests are CPR certified. You know—just in case of any flooding, ferry accidents or plane crashes we might encounter in our day-to-day lives.

This blog was originally published on voiceofnursing.org.