A couple of years ago, Baltimore's Center for Nursing Advocacy started a letter-writing campaign against NBC and the producers of ER. This group was protesting the episode where a central character, nurse Abby Lockhart (actress Maura Tierney), chucked her nursing career to go to medical school. The Baltimore group claims the TV show "is perpetuating long-standing misrepresentations that are contributing to the nursing shortage."

Never mind the fact that ER - watched by 20 million viewers - is far from reality television. The notion that the show is contributing to the nursing shortage is simply untrue. This TV program could depict nursing as the most glamorous career on the planet and real nurses would still be leaving their hospital jobs in droves.

Nurses are quitting because they are understaffed, underappreciated, underinsured, underpaid and under-you-name-it. Most nurses complain about the lack of respect from doctors. Sure you hear about record-breaking salaries and bonuses, but compared to whose record? At an average pay of $22 an hour, nurses are still among the lowest-paid professionals in this country.

Managed care is another reason nurses are leaving the bedside. It goes against everything our profession stands for. Under managed care, nurses are frequently denied the opportunity to deliver the quality of care they expect to deliver. Some patients die unnecessarily because nurses have too little time to spend with them. Yet when everything turns sour, nurses face more responsibility and liability than ever.

Many nurses I know endure nightmarish schedules, working 26 weekends and five holidays a year. Nurses also face serious on-the-job risks, such as bloodborne pathogens, latex allergies and back injuries from those long shifts pounding hospital floors and doing more lifting with less help. Isn't it ironic that the injured and disabled are treating the sick? No wonder nursing numbers are shrinking.

Speaking of disabilities, just look around at how many nurses smoke, drink and are overweight. Such symptoms of intense stress occur when people have too little time to properly care even for themselves.

Nurses are finding their own answers to these dilemmas. According to an American Nursing Association (ANA) poll, almost 19% of nurses do not work in clinical nursing. A study by the Center for Health Outcomes and Policy Research reveals more than 20% of hospital registered nurses plan to leave their jobs in the next year.

The significant development is not the fact that nurses are leaving or even why they're leaving - that's obvious. The news is where they are going. When nurses aren't valued in one arena, they take their nursing education and expertise and go elsewhere. They develop new careers outside traditional healthcare settings.

Maybe the Center for Nursing Advocacy should contemplate that fact. They might even suggest that ER present an episode about a nurse who quits her hospital job to become a Certified Legal Nurse Consultant.

Then those 20 million ER fans would really be watching "reality TV."