Nurse actors on ER get input from field

The television show ER clearly impacts the field of emergency medicine, but it works both ways — the actors themselves are on the receiving end of input from real-life practitioners of emergency medicine. "Nurses come to work on the show and do trauma scenes with us," explains Yvette Preeman, who plays nurse Haley Adams on ER. "Between scenes, we sit and talk about the strike they’re dealing with, which we’re starting to address on the show now, and also how they work so closely together, and how things affect them."

The emotional side of working in an ED has really hit home with the nurse actors. "I asked, what do you do if a baby dies? They explained that they cry, talk it out with their spouses or each other, and sometimes you’ve just got to let it go, or it interferes with your work," says Preeman.

Every trauma scene features real emergency nurses in the background. "More than likely if they aren’t talking, they’re real nurses," says Preeman. In addition to on-set education, ER actors observe shifts in local EDs. "I did training in the ED at Northridge Hospital late Saturday night and saw two alcohol-related accidents come in at the same time, and heard the gallows jokes and all that," says Preeman.

The nurse "extras" aren’t given lines, but they receive specific direction by a technical advisor for the "choreography" of a TV code. "They know what they’re doing, so you can do a closeup on them and it looks right," says Preeman. "They also show me what I’m doing wrong. I wasn’t putting the IV in right, so the nurses showed me how to do it quick and neatly."

During the show’s first season in 1994, two of its nurse actors attended the Emergency Nurses’ Association’s (ENA) annual meeting. "That was the first time I came in contact with nurses as a professional and political body and interacted with them professionally and socially," says Ellen Crawford, who plays Lydia Wright on the show. She attended the meeting with Julianna Margulies, who plays nurse manager Carol Hathaway. "Emergency nurses have a lot of passion about their work; they’re proud of their decision making and are creative in that regard," says Crawford. "In that way actors and nurses have a lot in common."

Since then, Crawford has been active in emergency nursing issues. "The more I learned about nursing issues, I realized they need a lot more support," she says. "There are some things going on with layoffs that are dangerous to the public, and the more the public understands that the more they can be supportive of health care workers."

Most of the show’s story lines come from real life, such as "floating" nurses to the ED. "Every nursing field is so specialized now, and people don’t realize how nursing has changed," says Crawford. "L.A. County had big layoffs, which resulted in strange nursing shifts, and we covered it in our show. It’s bad for patient care, and if we educate the public, they can do something about it."

Crawford recently spoke at an American Nurses Association benefit in Washington, DC, on nurses challenging violence. "We were very honored to be able to speak, and [we] did some research about violence in the ED, and in general how violence has affected our society, and the ED is a microcosm of our society, and how little protection there is for health care workers in EDs," says Crawford.

The show has provided the most realistic depiction of emergency nurses to date. "Physicians have been very proactive over the years, and as a result there’s a clear picture of what they do," says Crawford. "Now nurses need to be equally proactive and speak up if they see something that’s not an accurate depiction of what they do."

It’s clear that the show has provided emergency nurses with leverage for key political issues, she notes. "Everybody has problems, but when it’s dramatized it brings it home for legislators," she adds. "It puts a human face on the issues when it comes into their living rooms."

Not everyone in emergency medicine is a fan. "Most health care workers I’ve met are very excited about the show, but occasionally somebody will pooh pooh the show or say something like, They make it look like CPR works every time,’" says Crawford. "I thought, if I had a choice, would I rather somebody had knowledge of CPR because of something they saw on the show, or not? If one life is saved, it’s worth it."

No one claims the show is 100% accurate, she says. "I know there are some arguments about that and that I do a 12-lead [ECG] faster than is humanly possible, but if we took a long time, everybody would switch to a different channel."

The bottom line is, the show is both entertainment and education. "It’s a drama; it’s not a documentary, but I think we come closer to portraying what health care workers do than other shows have in the past, and I really feel that’s important." says Crawford.

Attempts at accuracy aren’t always visible to the public. "When they have an AIDS patient, they hire an actor with AIDS, and his friends on the show were part of AIDS Project Los Angeles," says Crawford. "A lot of research was done to depict Gloria Rubin, the show’s health care worker with HIV, and when the show depicted a child with leukemia, they had him meet with a child his own age who has leukemia," says Crawford.

The show has another appeal for some emergency medicine practitioners. "One physician told me, It must seem odd that I’d come home from working a 12-hour shift and then watch ER, but I find it very cathartic, because I can watch the same things I’ve seen all day, but can laugh or cry or emote without it getting in the way of my work,’" says Crawford.

[Editor’s Note: The following is a message from the producers of ER.]

Wanted: Your ER experiences. The television show ER relies heavily on the generosity and expertise of the medical community to achieve its realistic portrayal of a county emergency department. We are always looking for medical experiences or anecdotes — serious, humorous, ordinary, or workplace-related — which explore the ethical challenges and emotional hurdles the ER presents on a daily basis. We are also interested in any work-related issues arising from the ever-changing health care reform of the 90s. If you would like to share your experiences with us, please write, call, fax, or e-mail:

Linda Gase, researcher, ER/WBTV, 4000 Warner Blvd., Bldg. #133, Room 102, Burbank, CA 91522. Telephone: (818) 954-3454. Fax: (818) 954-4007. E-mail: gaseink@aol.com

Please note that ER cannot offer any reenumeration or credit for research materials, but know that your help is invaluable in keeping our drama grounded in reality. If you have any second thoughts about seeing the experiences you’ve shared portrayed on our show, please call us immediately and we’ll remove it from our files.