The premise
Jackie Peyton (Edie Falco) is an ER nurse at All Saints, a Catholic hospital in New York. Jackie is addicted to the painkiller Percocet (a blend of acetaminophen and the narcotic oxycodone), which she mixes with sweetener and takes throughout the day, often in coffee. On one occasion, the coffee is accidentally drunk by a co-worker, who gets very sick. On another, Jackie gives the spiked sweetener to a man who develops chest pain and collapses outside the hospital.
A patient, a child model, comes in to All Saints with head trauma after falling off his skateboard on a photo shoot where he wasn't wearing a helmet. He has fractured his elbow in four places and will require surgery to relieve the pressure in his brain. Dr. Fitch Cooper (Peter Facinelli) also thinks he hears an aortic aneurysm in the boy's abdomen, which will require additional surgery.
Dr. Eleanor O'Hara (Eve Best) disagrees with him, but Nurse Jackie (who has a mind of her own and frequently makes her own medical assessments in the series) stands up for him. Cooper turns out to be right. At another point in the episode, Jackie challenges Cooper on his tardiness in responding to a page on another patient (he has forgotten to turn on his beeper).
The medical questions
Wouldn't a nurse who is addicted to narcotics lose her license to practice? Is it common for this drug to be added to sweetener? Is it likely that a non-addict would get sick from a dose of Percocet that is tolerated by an addict? Are narcotics effective at relieving the symptoms of a heart attack? Is an abdominal aneurysm a possible complication of trauma from a fall? Does a nurse have a legitimate and important role in challenging a physician's diagnosis or behavior?
The reality
Some nurses who use drugs do eventually lose their licenses because of it, says Sandy Summers, co-author of "Saving Lives: Why the Media's Portrayal of Nurses Puts Us All at Risk," and executive director of the Truth About Nursing, a media advocacy group for nurses. By law, nurses will lose their license if they endanger patient safety or have been convicted of a crime related to their addiction (such as stealing opiates), says Dr. Timothy Fong, program director of UCLA's Addiction Medicine Clinic. But nurses may first go through rehab programs without losing their license and can even return to practice, generally in areas such as dialysis where there are no narcotics, Summers says.
