Ethics education, television, and invisible nurses.

Televised medical dramas often fail to include the nursing role in resolution of ethical dilemmas. Since the nursing role is portrayed inaccurately, excerpts from these dramas should not be included in the educational setting. Doing so would damage understanding between the health professions by wrongly sustaining physicians’ beliefs that they are the sole decision-makers in health care and by wrongly teaching nurses that they play no meaningful role in resolving ethical dilemmas. Czarny and colleagues (2008) report that a sizable number of medical and nursing students watch television medical dramas, and the authors note that these dramas may foster thought and discussion of bioethical issues among these students. Although many of these programs provide diversion, entertainment and a compelling way to study ethics, we disagree with the authors’ conclusions to “proactively use such programs in teaching.” While the majority of students with clinical experience discounted the information gleaned from the programs, work in the field of health communications demonstrates that people are substantially influenced by how the media portrays the roles and conduct of health professionals. Czarny did not test as to whether students in the study were able to discount the roles that professionals played in these television shows. Although the dramas are fictional, the “nurses”, (if they are portrayed at all), rarely participate in any substantive way with collegial or patient discussions related to the bioethical issues of the program and even when they do, the portrayals are deeply flawed. This invisibility belies any meaningful learning that could take place with the viewing of selected clips from the dramas, even with faculty guidance. Since the nursing role on these health dramas is to fade into the background and let the physicians hash out the ethical dilemmas amongst themselves, providing a faculty imprimatur to the fictional bioethical dramas damages collegial collaboration with all healthcare professionals. It would teach all health professionals that physicians have a master role in these dilemmas and nurses a subservient one. Physicians must learn to work collaboratively with nurses to prevent them from leaving the profession, as we are in the midst of the global nursing shortage—one of the world’s most pressing health crises. The ‘hidden curriculum’ is at least as important as formal education of ethics. Turow and Gans (2002) note, “fictional television can play a significant role in shaping public images about the state of our health care system” (p. 1). These dramatic presentations portray relationships