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Doctor and Nurse React to 'Nurses' TV Show

— Does the TV drama match reality?

MedpageToday

, who goes by "Doctor Mike" on social media, is a board-certified family medicine physician at the Atlantic Health System's Overlook Medical Center in Summit, New Jersey. Watch him and a nurse reacting to a recent episode of "Nurses."

Following is a rough transcript:

Mikhail Varshavski, DO: Have you heard or seen anything even remotely like that happen?

Bianca Antisera, BSN, RN: No. No, no, no, no, no. No. No. No, no, no, no, no. Like, that could never happen.

Varshavski: I have been notified that there is a new medical drama called "Nurses." I needed a nurse to help me understand what's going on in the show. Welcome back, Bianca Antisera, to the channel.

Antisera: Thank you so much for having me. I am an ER travel nurse. I specialize in trauma. I believe this show kind of highlights ER nurses, so I feel like I'll have like a really good insight onto what we're about to see here.

Varshavski: Pew.

Nazneen Khan: Can you take my photo?

Varshavski: That is so you. I feel like you would take a selfie. You would ask a patient with an IV pole to take a selfie.

Antisera: I could tell she was, new, too. Because like when she's walking in, she's like, [GASPS] "Oh my God." Like, "Here's the hospital and it's just this..."

Damien: Listen up. I'm your charge nurse Damien, but you can call me Sir, or Sir Damien, or Damien, Sir.

Varshavski: For those who don't know, can you tell us what a charge nurse's duties are?

Antisera: Yes. A charge nurse is basically kind of like what you would assume a manager is in most roles that are like outside of medicine. The charge nurse is basically going to say who goes where, into what unit, and who's assigned to what things. If you have an issue, your first line of defense is going to be your charge nurse to try to rectify the issue. Or if you happen to need backup on a situation, you're going to want to talk to your charge nurse. Not only do they handle like the managerial side of it, but they also assist you clinically as well.

Sinead: I want you to know who you are and what you are because when you're elbow-deep in a 75-year-old man who's cursed with anal boils or checking the lady business of a half-dilated laboring woman who's bellowing like a gorilla, you won't be a rockstar. You'll be the one thing between that old guy and the death of his dignity.

Antisera: I love that she said that, actually, right there. Because one of the things that you're going to realize very early on, especially being a nursing student or like a fresh new graduate nurse, is you have to maintain dignity. There is dignity in things that most people would look kind of down upon, but you have to remember that everybody that you're dealing with is a human being with a whole history, and a whole life, and emotions, and everything. If you put yourself into those situations, especially medically speaking, you never want somebody to be scared to talk to you about an issue because they are embarrassed or they just don't want to be seen in that light.

Varshavski: Someone who's vulnerable is opening up to you, allowing you to see them in this vulnerable light, that should be something that's appreciated. I feel like nurses -- well, at least the ones I've worked with -- have been the ones that get so much positivity from those moments. Someone might say, "Oh, I don't want to help somebody. I'm tired," like this and that. But a nurse will say, "I'll go help," and then reap the mental health benefit from helping that person.

Sinead: All right. Listen up. As you've no doubt seen, a van's just driven into a courtyard of people down at the art college, so not the kind of day that anyone expected. Rise up. Lives depend on it. Whatever comes through that door is yours.

Grace Knight: John Doe. We're patching up a neck wound, plugging it down in the abdomen. FAST is positive.

Dr. Evan Wallace: Internal bleeding. Yeah, no kidding.

Grace: I'm now having problems ventilating.

Dr. Wallace: Okay, let's prepare to intubate.

Grace: Blast lung.

Dr. Wallace: What?

Grace: Nothing. It's just...

Dr. Wallace: It's a team sport. I want to hear from you.

Grace: EMS reported that there was a propane barbecue that the vehicle rammed into causing a mini explosion.

Varshavski: I love the fact that the doctor asked the nurse to speak up because she was obviously being nervous and hesitant. It is a team sport and I think hospital systems that encourage that type of speaking up actually give better patient care. Have you ever felt a doctor perhaps not allowing you to do that?

Antisera: All the time, actually, especially like when we get like a new set of residents. They all kind of come with a different mentality, but they kind of want to show that they know what they're talking about, so they're going to give you all different types of differentials and stuff like that, of what could be happening and what could be affecting this patient.

However, the nurse is the one typically who has the experience to say, "Yes, like I understand what you're talking about." But from a nurse's mindset, especially in a trauma situation, a lot of us have what's called like a TNCC certification, which is a trauma certification. We have a very specific algorithm that we're going through and so in our heads we're like, "Time is of the essence."

Varshavski: Got it. We need the 18-gauge needles in both arms. We need to undress the patient, do a full body scan, and no one is allowing you to do your job because they are trying to get like electrolytes on the patient or something that can be done later, and they're doing it out of order.

Lydia: Excuse me? Doctor?

Keon Colby: Nurse.

Lydia: Oh, sorry. I just assumed.

Keon: It's all good.

Lydia: I was near the Sororon Art Institute. I saw the whole thing happen. I fainted right on the sidewalk.

Keon: Were you dehydrated?

Lydia: I don't think so.

Keon: Have you had a cough recently?

Lydia: No.

Keon: Any cardiovascular condition?

Varshavski: Why is he, out of nowhere, like passing by in the hallway and then questioning the patient? I am confused.

Antisera: This is funny too because as soon as she said she fainted, I was like... they may think they are okay. Especially when I started out on the ambulance, you have people who are kind of like in shock, and they're walking around, and they feel fine because they have that adrenaline pumping through their bodies. But in reality, whenever you're taking their vitals and stuff like that, they could have a very high heart rate and very low blood pressure. They're showing signs of internal bleeding, but they may not be aware of it. When she said she fainted, I would have questioned her a little bit more as well, especially once I saw that she was pregnant.

Varshavski: Yeah. Absolutely. I think whenever adrenaline's going, you might not feel certain symptoms. My issue with sort of how this happens is it's very structured when you walk into an emergency room, at least where I've been, where they have a nurse assigned to a specific group of patients so that if someone's just passing in the hallway and someone says, "Hey, by the way, I passed out," the answer would not be, "Okay, what's going on?" Even though that's the correct line of questioning. It would be, "Okay, let me get your nurse or let me get your doctor and we can have that conversation established." Because if everyone just kind of strolled the hallways and started questioning patients, patients would end up getting frustrated because they continuously have to repeat the story, and when they do that they feel less inclined to give the same amount of details each time.

Dr. Wallace: Blast lung's going to make the anesthetist's job real tricky.

Grace: Yeah, if he makes it to the OR. There's no type O negative. I mean, we could push hydroxyethyl starch, but...

Varshavski: Why do they not have O blood?

Antisera: And they seem like they're in a very large city as well, so they should have this.

Varshavski: It's a level 1 trauma center, like...

Grace: What are you doing?

Dr. Wallace: I'm O negative, universal donor. We can buy him some time. Hook me up to him. Grace: What, are you serious?

Dr. Wallace: We'll do a whole blood transfusion. They do it on the battlefield. That's pretty much what we're looking at here.

Grace: Okay, chances are he'll react negatively.

Dr. Wallace: Chances are he's going to die.

Varshavski: I have never seen that happen, nor do I think that's ethical...

Antisera: No.

Varshavski: ... nor do I think that should ever be happening. I mean like, have you seen anything even remotely like that happen?

Antisera: No. No, no, no, no, no. No. No. No, no, no, no, no. Like, that could never happen. God forbid, what if he had something that this patient could contract from him? He may not even be aware of it, you know what I mean? Like, you could possibly do more harm than good.

Lydia: Is there something wrong?

Keon: Could you shift just a little to your left, please?

Lydia: Please tell me what's wrong.

Keon: I can't find the heartbeat.

Lydia: What?

Keon: I need some help here.

Varshavski: While it's important to figure out what's going on on the ultrasound, it's more important to make sure that the patient is comfortable and understanding the process that's going on.

Antisera: I believe that he's quite new. For him to be using this ultrasound as well, especially not with anybody watching him... of course this is a crisis situation, so I have to give them the benefit of the doubt. However, with his hand shaking and what he's doing, and he is saying that, "I can't find the heartbeat." He doesn't seem like he's very well-equipped to be handling this ultrasound, nor is he like possibly checked off or certified to use this ultrasound.

Nathan: I just bumped my head. Please go take care of my students.

Nazneen: Acute head trauma is a priority. We have to rule out paresthesia, otorrhea, rhinorrhea.

Varshavski: She has to rule out rhinorrhea and otorrhea?

Antisera: I feel like...

Varshavski: Like nasal discharge? Is she just rattling off medical vocabulary?

Nathan: Please just go take care of my students.

Nazneen: I will, right after I give you a full neuro workup. But in order to do that, I'm going to need a penlight. Be right back.

Nathan: Nurse, if you see my [STUTTERS]... ?

Nazneen: We need help over here.

Dr. Wallace: What's his name?

Nazneen: Nathan Richie.

Dr. Wallace: Nathan, look at me. Can you hear me? Nathan? His pupils are blown. It must be a brain bleed.

Varshavski: I would have liked to see the doctor, instead of rush to use the penlight, to actually check a pulse and see if the patient is not going into cardiac arrest.

Antisera: He should have been triaged. We should have had a set of vitals. His pupils should have been checked. All these things should have been checked.

Varshavski: Having different-sized pupils, also known as anisocoria, is a sign that there is some sort of neurological defect happening. The steps they are taking are valid, it's just the order of the steps seems off.

Female Doctor: You're welcome to assist in the OR.

Grace: No, they need me on the floor, thanks.

Female Doctor: I'll page you when he's in recovery.

Grace: Take care of him.

Female Doctor: We'll do our best.

Varshavski: Are they really in the O.R without face masks?

Antisera: Yes. I was like, "Tsk, tsk." They are.

Supervisor: Who are you?

Nazneen: I am Nazneen Khan. I'm new.

Supervisor: Nice scrubs. Do they come in your size?

Nazneen: Mr. Richie, he's just out of surgery, where should I leave him?

Supervisor: You shouldn't. I'm down two nurses to a Shawn Mendez concert and now this.

Varshavski: We have a video where you talk about "nurses eating their young." Is that what you feel is happening here?

Antisera: First off, I'm not sure if she was a nurse or if she was like the unit secretary, but I can definitely tell that this girl Naz, this nurse, she has what I feel is a romanticized version of what her first day is going to be and how it is going to be in a nurse, that I'm going to come in here and I'm going to take charge. She's got to learn really quick that like, you're not going to walk in here and find your patient like on page five of your textbook.

Nazneen: You should know Nathan suffered a subarachnoid hemorrhage. There's still significant swelling. We are hoping that that subsides.

Mrs. Richie: And what if it doesn't?

Nazneen: The damage will be irreparable, but there is still hope.

Antisera: That's a tough situation, especially in trauma where you have mass casualties, and I understand that they're kind of like in a crisis situation. However, I do not think that was her place to explain that at that moment. She should have had the care team. She should have had a discussion with the doctor, and the doctor should have explained that to the family member, and the doctor would have been there to answer any questions that she would have had.

Varshavski: Also, they mentioned the subarachnoid hemorrhage. Usually that presents with a really bad, like worst-in-your-life headache. He did not have a headache, so that was really unusual from a medical perspective. I will say that there are many times where another part of the healthcare team will start explaining things to a patient prematurely and sometimes inaccurately, where I have to go in and then debrief the patient on what they've already been told and what they already know, and then sort of put the things back into their correct place. It's a tough scenario where you want everyone to speak up and educate, but at the same time you want to just make sure that it's done accurately.

Grace: Our John Doe was the driver who did this.

Dr. Wallace: They saw him trying to save people.

Grace: Yeah, well they got it wrong. I was just sitting there holding his hand comforting him when he told me it was him.

Dr. Wallace: Linda, call security.

Grace: He's alive because of us.

Dr. Wallace: Grace, we didn't know.

Varshavski: Okay. If you did know, would that have changed your management?

Antisera: Exactly.

Varshavski: Our job is not to play judge or jury. Our job is to focus on one thing and one thing only, and that's helping patients irrespective of their criminal status, race, their ethnicity, whether they're nice, they're mean, or anything like that.

Antisera: At the end of the day, your job is to save lives in the best way possible. Regardless of her feelings towards the situation, she does need to notify the police and she does need to get security involved. That way this patient does not end up harming other people. But, yeah, it should not have changed the way that she rendered care at all.

Varshavski: And Bianca, how common is it for folks who have traumatic brain injury to say wacky things that are not true?

Antisera: Extremely common.

Dr. Vanessa Banks: Lydia, I'm Dr. Banks. I'm going to be delivering your baby today.

Lydia: Wow. That sounds so surreal.

Keon: Hi I'm...

Dr. Banks: The noob who couldn't find the heartbeat Yeah. You're already a bit of a legend around here.

Antisera: One of my biggest gripes in medicine is that conversation could have happened away from the patient.

Varshavski: Yes.

Antisera: That should not have been said in front of the patient. Because 1) it undermines the nurse and it affects the trust that the patient has in that nurse, and it also affects the way that the patient sees the doctor. That should have been something that was discussed behind closed doors.

Varshavski: The only time I will give the benefit of the doubt in a situation is if it's in the midst of an emergency or trauma...

Antisera: Yes, certainly.

Varshavski: ... and you have to make a correction in that moment. This is not one of those instances.

Mrs. Tippit: [COUGHING]

Grace: Nice try, Mrs. Tippit. Code blue. We have a carotid bleed in 68.

Varshavski: Why is she calling a code blue? In my hospital, code blue is a person who is pulseless.

Antisera: We don't call code blues, because I am essentially a part of the code blue team so I would have been there and we would have had the staff to have handled the situation anyways.

Varshavski: Everything's a code blue in the ER.

Antisera: Correct.

Secretary: This one's from seven years ago.

Keon: No.

Secretary: What?

Keon: No one ever changes their emergency contact.

Antisera: Oooh, no, no, no, no, no.

[PHONE RINGING]

Sarah's Voicemail: This is Sarah. Talk at the beep.

[BEEP]

Keon: Sarah, hi. I'm calling from Saint Mary's. Lydia's in the hospital.

Varshavski: HIPAA alert. HIPAA breakage alert.

Antisera: Yes. That is a thing, especially with nurses being at bedside so often, they get attached, and you have to be very careful. You have to be careful with the personal information that you give, but you also have to understand his patient was coherent at this point. If that patient wanted to call Lydia, whoever the emergency contact was, she had every right to do so.

Varshavski: Patient information is a protected asset, rightly so. Everyone is entitled to their own confidential healthcare record. The fact that he just thought it's the right thing to do, even if it works out, it's the wrong thing to do, and it's potentially a reason why someone could get fired.

Wolf Burke: My name is Wolf. I'm a nurse here, and I've actually been looking for you all day.

Male Patient: Don't tell me. You have my fingers.

Wolf: Actually...

Male Patient: Oh, wow. I was just joking.

Wolf: ... but due to the length of time that they've been separated from your hand...

Male Patient: They're toast.

Varshavski: That wouldn't be his call to make because there could be viable tissue there.

Antisera: Correct.

Varshavski: There could be tissue that can be cut off and the rest of the finger can be reattached. There is a lot of options here that I wouldn't even feel comfortable making, as a doctor, as a family medicine doctor. I would only be comfortable if a dedicated hand plastic surgeon would say that.

Male Doctor: Mrs. Richie, we've been closely monitoring Nathan as his ventilator support was removed while we conducted an apnea test. Unfortunately, his test results are positive.

Mrs. Richie: What does that mean?

Male Doctor: A positive result is defined by the total absence of respiratory efforts. It means Nathan has no brain activity.

Varshavski: That call would never be made within 24 hours of the accident. You would wait for inflammation to subside...

Antisera: Yes.

Varshavski: ... for the patient's blood levels to return to normal, electrolytes to return to normal, and only after a designated period of time of doing these tests repeatedly could you even come close to making a recommendation like this. I mean, I think he got out of surgery a couple of hours ago. Like how can you possibly know?

Antisera: Yeah.

Varshavski: The anesthesia could be wearing off.

[LAUGHTER]

Antisera: Seriously. No, I'm 100% there with you too. Like, this is literally like the same day that this is happening. In no way can you call something this quickly, especially with the inflammation and everything that you're talking about.

Varshavski: Yeah, and the neurological system is notorious for recovering slowly.

[MUSIC]

Antisera: For anybody who's wondering why they're lined outside of the OR, they're honoring the patient for his organs so that he will go on to save more lives.

Varshavski: Any thoughts on the show? Bianca, what do you think? Accuracy, 1 to 10? I'm low. I'm sitting at a 4.

Antisera: I want to say more of like a 5 out of a 10. Yeah. I feel like this is one of the shows that I have seen that goes kind of above and beyond to show nurses in their capacity. However, I feel like it's always like they'll show you nurses, but then they show too little of doctors. Like, it's very hard to find a show that shows the proper dynamics between them.

Varshavski: I hope you enjoyed Bianca and I watching the first episode of Nurses. We actually also played a game of Would you rather? Check it out here. Click on it. As always, stay happy and healthy.