'The Pitt' and the Hidden Labour of Nursing

As a person with a high ick factor for blood and guts, I've never been a big watcher of medical dramas in general. However, after seeing extensive coverage of the show in various outlets and on social media, I finally gave in and logged onto my HBO Max account, where I was indoctrinated as a member of the Pitt Crew. For those unaware, The Pitt is a drama about the staff of the emergency department at the fictional Pittsburgh Trauma Medical Hospital. (One of the hallmarks of the show is that it takes place in real-time, à la 24, with each episode lasting roughly an hour of the shift.) After starting the show a few weeks ago, I was immediately drawn in and ended up binge-watching the whole season—making sure to cover my eyes during the particularly gory bits.

Much of the coverage concerning The Pitt has been praise for its accuracy, with many writers complimenting its medical accuracy and its portrayal of the stressors and tensions of jobs in medicine—particularly contextualised against the aftereffects and trauma of working through the COVID pandemic.

I'm not someone with a background in medicine, so I can't confirm what is or isn't believable about the medicine in The Pitt. However, one of my best friends works as a nurse in the United States, so I've been hearing stories about her experiences for a few years now. Based on that anecdotal knowledge, my initial confusion when watching The Pitt was that it seemed like an awful lot of the tasks realistically assigned to nurses were being done by doctors instead. From what I understand, doctors often don't have the time to monitor patients closely around the clock.

However, almost all the members of the main cast on the show are doctors, residents, or medical students, and they're shown handling the bulk of the hands-on care. The doctors on the show weren't just checking in on patients to give quick diagnoses and move on—each is depicted as being personally attentive and doing what they can in each situation to attend to the holistic needs of their patients and their families. One standout example from the first season involves Dr McKay (Fiona Dourif). A mother arrives at the hospital faking being sick to get her son David (Jackson Kelly) some help, as she's concerned that he might harbour violent thoughts against others at his school. When the teen runs off from the hospital, a concerned McKay calls the police to alert them of a potential threat—against the wishes of her attending Dr Robby (Noah Wyle).

Whatever one's opinion of McKay's actions on the show may be, it's clear that this is a highly involved form of care. While not necessarily part of the job description as a doctor, her character believes that her responsibility extends to protecting both David and members of the wider community. I repeat this plotline not to imply that doctors in real life don't do any care work at all. (My friend notes that doctors in hospital emergency departments are much more hands-on than others due to the immediacy of their work.) However, watching The Pitt did highlight the discrepancy between the work being done by nurses and doctors on television versus in real life.

In the show, the charge nurse Dana (Katherine LaNasa) is one of the most prominent characters and is introduced by Dr Robby to the new staffers as being 'the most important person you're gonna meet today,' calling her 'the ringleader of our circus.' Dana is shown to provide not only supremely competent logistical support but also a preternatural sensitivity to the emotional needs of both her patients and colleagues, knowing when to lend a hand when it's the most needed. But most of the other nurses are secondary characters—if prompted, I could rattle off the names of The Pitt's doctors, but I would definitely struggle to come up with the names of most of the nursing staff. Although they're depicted performing work typical of real nurses, the nurse characters are generally relegated to the sidelines, while the doctors are seen taking on most of the holistic responsibilities.

Medical shows obviously need drama to work with, so it's understandable that they may take some creative liberties when assigning certain characters with responsibilities that may not map onto what their jobs would look like in real life. But the problem is that the portrayal of doctors as the primary caregivers in hospital settings is a recurring trend, not a one-off. From Grey's Anatomy to The Good Doctor to House, and yes, ER and The Pitt, there is a tendency in television to portray doctors as being much more involved in patient care than they would be in reality. Meanwhile, there are very few shows that specifically focus on nurses—the one that comes to mind for most Americans is Nurse Jackie. In this show, the titular protagonist has a mental illness and a drug addiction. I mention this not to make a judgment of the perceived morality of a TV show (or of addiction and mental health more broadly) but to point to the issue of a lack of positive portrayals of the profession in mainstream media.

My pet theory for why shows prefer to represent doctors instead of nurses is that it reflects the cultural shorthand for intellect and hard work, which is often rewarded with money and prestige. On average, in the US, nurses make significantly less annually than doctors, with salaries of $76,976 and $267,915, respectively. Further, there is a gloss afforded to work that is culturally constructed as more masculine, with more nurses than doctors identifying as female, people of colour, and immigrants.

Of course, an utterly true-to-life show about a doctor would be very boring—I, personally, have no interest in watching someone go about their day writing prescriptions and charting for hours. So a curious contradiction in the portrayal of doctors on television lies in the fact that the relationships between staff and patients and the emotional labour involved is exactly what makes these shows compelling. The climax of an episode of a show like House may hinge on a diagnosis or a cure, but none of that is riveting television unless it's tied to emotion and connection—all of which stems from holistic care. Because of this, highlighting the importance of connecting with patients, families, and communities while ignoring the marginalised people who do this work is a sad act of erasure of the nursing profession.

I'm curious to know whether this consistent erasure of nurses' work perpetuates existing biases, leading to perceptions of nurses as glorified doctors' assistants rather than competent, credentialed professionals in their own right. My friend tells me that her patients will often doubt her assessments and diagnoses and will defer to the doctor—who will usually just repeat what my friend said to begin with. I love The Pitt, and I agree with those who say it's a revolution for medical dramas. But I also hope to see more television in the future that showcases the work of nursing and allows it to shine.