Nurse Jackie is one of Showtime's hottest shows this season. Featuring Edie Falco, an HBO veteran from the hit The Sopranos, as an amoral emergency room nurse dedicated to saving lives, while cheating on her husband and indulging in powerful painkillers to combat her back pain, the show transcends typical medicine dramas popular in primetime television by focusing on those who heal, not those who diagnose.
This Showtime drama also features The West Wing's Anna Deavere Smith as Gloria Akalitus, a nurse-turned-hospital administrator. Akalitus is the butt of many a joke in the show, getting giddy off of Jackie's Percocet-laced coffee, accidentally tazering herself in an elevator, and questioning a gay nurse about how to obtain adoption papers for a child left at a nursing station.
Where lies the line between fact and fiction in the characterization of this hospital administrator? Frankly, the line zig-zags. Hospital administrators play an important part in the inner workings of the hospital, and help to keep everything running smoothly. But in a dark comedy like Nurse Jackie, Akalitus is a walking punch line, providing a much needed dose of laughter amidst so much darkness. However, if her employees behaved themselves, Akalitus would most likely seem like an average nursing supervisor.
In one notable episode, Akalitus urges Jackie Peyton to make a dying man vacate a bed due to overcrowding. Jackie asks her to look at the man again, not as a healthcare administrator, but as a nurse. Akalitus allows Jackie until the end of the day to find him another place to stay, because she realizes that he'll be dying soon.
This aspect of Akalitus' character may be legitimate. It would be logical for a nurse to become a supervisor. Many hospital administrators began as healthcare workers. However, it's not a simple jump from nurse to administrator. Most have at least a Masters degree in Health Services Administration, although some pursue degrees in public or business administration. Hospital administrators with financial backgrounds may go on to become Chief Financial Officers or Chief Executive Officers.
Education includes a year of interning in a health care center, and most administrators begin as administrative assistants for large hospitals, before pursuing higher positions in smaller institutions. Therefore, it's unlikely that Akalitus would be working alongside her former peers, as she probably would have needed to move elsewhere to find a position.
In another episode, Akalitus stays late to oversee Jackie making the time schedules, having noted that she always seems to be working with friends. One of the responsibilities of the hospital administrator is the maintenance of the budget. The hospital administrator would be responsible for the schedule of the nurses being overseen.
Finally, Gloria Akalitus appears to work alone. This is definitely true. There is often only one hospital administrator in a small hospital, and larger hospitals need a single administrator for each department. All Saints, the fictional hospital at which Nurse Jackie works at, seems like a large hospital. As a result, it would be common for a health care administrator to oversee the entire department alone.