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TV has become, in just 80 short years, the most influential medium in human history. Medical shows were a popular genre from the very beginning, and with them came a portrayal of nursing that has ranged from relatively harmless to outright offensive.

"There's no question that the portrayal of nurses on television has been dismal," observes Cynthia Saver, RN, MS, president, CLS Development Inc., and a frequent lecturer on the topic of image and nursing. "A better image isn't a luxury, it's a necessity. Image undermines how we think of ourselves, so a negative TV image of nurses plays into a poor self-concept, which can in turn affect how we act, resulting in a vicious cycle."

The 1950s saw a number of medical dramas, almost all of which placed the focus on the life-saving heroics of physicians. One of the first was "The Doctor" (1952-53, NBC), which featured nurses only in peripheral roles. Another was "Medic" (1954-56, NBC), which dramatized case histories from the files of the Los Angeles County Medical Association. Again, nurses - if portrayed at all - were merely background.

Doctor dramas really hit their stride in the 1960s with such stalwarts as "Ben Casey" (1961-66, ABC) and "Dr. Kildare" (1961-66, NBC). "Ben Casey," one of the most popular medical dramas in the history of TV, starred swarthy, intense Vince Edwards in the titular role, while "Dr. Kildare" featured the more traditionally handsome Richard Chamberlain. Holding to tradition, both series placed the greatest emphasis on the interaction between doctor and patient, with only a passing reference to the nursing staff.

The first show to focus exclusively on nursing was "The Nurses" (1962-65, CBS). Filmed in New York, the series dealt with the personal and professional lives of nurses working in a large metropolitan hospital. Shirl Conway played Liz Thorpe, the older, more experienced nurse, and Zina Bethune played Gail Lucas, the young, naive student nurse. In 1964, Dr. Ted Steffen (Joseph Campanella) and Dr. Alex Tazinski (Michael Tolan) brought some beefcake to the show, and the title of the series was changed to "The Doctors and the Nurses" to include them.

In 1968, a TV series premiered that was truly historic. "Julia" (1968-71, NBC) starred Diahann Carroll as Julia Baker, a young, independent black woman who worked as a nurse in the medical office at Astrospace Industries. The show was groundbreaking in that it cast Carroll, already an established entertainer, in her own comedy series and in a prestige role — a TV first.

Julia's profession was integral to the series. She worked with another nurse, Hannah Yarby (Lurene Tuttle), under crusty Dr. Morton Chegley (Lloyd Nolan), and much of the show's humor stemmed from the group's office interaction. More humor sprang from Julia's personal life, which even included a couple of romantic relationships.

The late 1960s also saw the premier of the concerned family doctor with "Marcus Welby, M.D." (1969-76, ABC) and yet another teeming metropolitan hospital with "Medical Center" (1969-76, CBS). In both series, nurses played relatively prominent roles. Dr. Welby (Robert Young) was assisted by office nurses Consuelo Lopez (Elena Verdugo) and Kathleen Faverty (Sharon Gless), while numerous nurses populated the staff of Medical Center. As with earlier series, however, their roles tended to be secondary to the life-saving doctors.

Despite its popularity, Saver says she was less than impressed with "Marcus Welby."

"At first, I didn't even know that Consuelo was a nurse and stopped watching early on," she recalls. "Dr. Welby blatantly co-opted what nurses do for rating. He acted more like a nurse practitioner than a physician."

A wide variety of medical shows - both comedic and dramatic - filled TV screens during the 1970s. Among them were "Emergency" (1972-77, NBC), "M*A*S*H" (1972-83, CBS), "Doctor's Hospital" (1975-76, NBC), "A.E.S. Hudson Street" (1978, ABC) and "Temperatures Rising" (1972-74, ABC), a series that holds the dubious distinction of being redrawn and recast three times over two seasons. With the arguable exception of "M*A*S*H's" Margaret Houlihan (Loretta Swit), a character that started out as a humorless harpy but matured into a respected caregiver, the impact and influence of the nurses in these series was fairly negligible.

The depiction of nurses on TV improved somewhat with "St. Elsewhere" (1982-88, NBC), an ensemble series in which physicians continued to be the focus but which also featured strong nurse characters in Helen Rosenthal (Christina Pickles), Shirley Daniels (Ellen Bry) and Lucy Papandrao (Jennifer Savidge). The series addressed both the professional and the personal lives of the main characters, and in one memorable story line Helen Rosenthal was diagnosed with breast cancer, requiring surgery.

"That was the very first time such a story was (presented) on television," Pickles tells Nursing Spectrum. "It was very accurate, and in my opinion very well done."

"Nurse" (1981-82, CBS) was another '80s medical drama, but one that focused primarily on the professional and personal lives of the nurses at a big-city hospital instead of the doctors. Michael Learned portrayed nurse Mary Benjamin, who returned to work following the death of her physician husband. Much of the series dealt with how Mary coped with the trials of widowhood while also caring for her patients.

Perhaps the most lauded show of the 1980s to portray nursing was "China Beach" (1988-91, ABC), a series set during the Vietnam War at a combination evacuation hospital and USO entertainment center near the U.S. base at Da Nang. Though "China Beach" was essentially a wartime soap opera, Dana Delaney was admirable as nurse Colleen McMurphy, a dedicated professional who did her best under often extreme and adverse circumstances.

The 1990s equivalent of "St. Elsewhere" was "ER," created by best-selling author Michael Crichton, who's also a physician. Several nurse characters have been prominently featured on the series, which is currently in its 14th season, including Carol Hathaway (Julianna Margulies), Haleh Adams (Yvette Freeman) and, more recently, Abby Lockhart (Maura Tierney) and Samantha Taggart (Linda Cardellini).

The fact that "ER" is still going strong is a testament to the continued popularity of the medical series genre. Equally popular with current audiences are "Grey's Anatomy" (ABC), "House" (Fox) and "Scrubs" (NBC).

But just because a TV series is successful doesn't mean that it portrays nursing in a positive or even accurate light. In fact, it's been just the opposite in recent years, says Sandy Summers, RN, MSN, MPH, executive director of the Center for Nursing Advocacy in Baltimore. Many of the most egregious portrayals of nurses and nursing have occurred on some of the most popular medical series, including "Grey's Anatomy" and "House."

Summers cites research that shows TV does more than merely entertain — it also sways opinion. As a result, the persistent negative portrayal of nurses and nursing can influence everything from the number of young people entering the profession to government funding for nurse research and education.

"We have to change what television is telling young people about nursing if we hope to change what they think about the profession," Summers says. "A 2000 study found that as a result of television, many young people believe nursing is just for girls, and that it's a technical job, not a profession. Worse, many come away believing that nursing is too lowly for them."

The misconceptions perpetuated by TV are many, Summers says. They include:

• Physicians consistently performing duties that nurses do in real life. This is particularly evident on "House" and "Grey's Anatomy," where physicians defibrillate, give IV meds, provide 23-hour surveillance, regulate complicated ICU machinery and provide all psychosocial support.

• Nurses being supervised by physicians, who have the authority to hire and fire them. "This is untrue, and makes people think that nursing is a subset of medicine," says Summers. "We are autonomous professionals. We report to other nurses and have our own code of ethics and our own licensing structure. We work in collaboration with physicians, not for or under them."

• Nurses becoming physicians rather than pursuing advanced-degree nursing. "Nurses are 100 times more likely to go on to become a nurse specialist than they are to become physicians, yet twice on "ER" they've had a nurse character pursue medicine," says Summers.

• Nursing as dull and lowly compared to medicine. During the first season of "Grey's Anatomy," Summers notes, a female physician bristled with outrage when called a nurse as an insult. "To these characters and the show, nursing is something smart, independent women have left behind," says Summers. "They make it appear as if nursing no longer has value now that women can become physicians."

The Center for Nursing Advocacy has been lobbying TV producers and writers since 2001 to improve the image of nursing, with only moderate success. Writers, Summers says, are strongly reluctant to make changes to characters or storylines, though there have been a few bright spots. The Center was able to convince the writers of "Grey's Anatomy" to stop the blatant insults toward nurses, and in 2005 "ER" introduced the character Eve Peyton, a nurse manager who had an RN and a PhD. The Center for Nursing Advocacy was thrilled with the character, who extolled many of the organization's core ideals, and even presented "ER" with its Golden Lamp Award for the handful of episodes in which Eve Peyton appeared. Unfortunately, this good work was trashed when the writers had Peyton get fired for punching a patient and pouring urine on him.

TV creators may be reluctant to acknowledge the medium's dismissive attitude toward nursing, but many of the actors who portray nurses are well aware of what's going on.

"Nurses in real life do much more than what they are shown to do on 'ER,' " Yvette Freeman, who has plays nurse Haleh Adams, tells Nursing Spectrum. "[Efforts by the Center for Nursing Advocacy] aren't going to work because 'ER' is a 'doctor show.' They're the glorified characters. That's why we'll show four or five doctors in a trauma room and maybe one nurse, even though that's unrealistic."

However, portraying nurses on TV tends to make actors respectful and appreciative of the real thing.

"Nursing takes smarts, energy, and dedication," says Freeman, who once presented a commencement speech at Mount Carmel College of Nursing in Columbus, Ohio. "Nurses truly have a calling because they could not do what they do without having some spiritual or other kind of connection to the job. A person has to be special to do that."

Christina Pickles agrees, noting, "I think nurses are extraordinary. They're unsung heroes, and very few people really know how hard they work. I'm very proud to have represented nursing because it's such a noble profession."

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Don Vaughan is a freelance writer. To comment, e-mail editorNTL@gannetthg.com.