- Nurse Charles Cullen may have been the most prolific serial killer in U.S. history.
- He admitted to killing at least 40 patients in New Jersey and Pennsylvania, and some experts believe that the associated deaths may have been closer to 400 patients.
- Information revealed during the investigation and trial demonstrated significant gaps in the healthcare system that allowed Cullen to continue working despite reports of poor performance.
Charles Cullen was a nurse who admitted to killing 40 patients, but some believe it may be ten times that number. The movie “The Good Nurse” focuses on the relationship between Cullen and fellow nurse Amy Loughren, who played a key role in Cullen’s arrest and confession.
During the investigation of Cullen’s murders, investigators identified several areas where the healthcare system failed to protect its patients. These critical lapses enabled Cullen to have a 16-year nursing career, despite being fired from other hospitals for reasons including poor performance.
Review in this article areas where the healthcare system was flawed during Cullen’s nursing career and the steps nurses can take to protect their patients’ health and safety.
“The Good Nurse” Explained
The movie “The Good Nurse” is a true crime nonfiction biography based on a book published in 2014 by author Charles Graeber. The film debuted at the Toronto International Film Festival on September 11, 2022, and was released on Netflix on October 26, 2022.
It chronicles the story of Charles Cullen, a nurse who practiced in New Jersey and Pennsylvania, who confessed to killing up to 40 patients. In 2006, Cullen was convicted of 29 murders and sentenced to 11 consecutive life sentences. However, Graeber believes that Cullen killed around 400 people.
In the movie, Cullen ends his career at Parkfield Memorial Hospital, a fictionalized version of Somerset Medical Center, where Cullen held his last job. There, he makes friends with Amy Loughren, who eventually convinces him to confess.
Loughren begins to learn of Cullen’s history at 10 hospitals over 16 years. In some of those hospitals, he was suspected of being involved in patient deaths. She starts to distance herself from Cullen and then discovers he may have been involved in the death of a young female patient.
At this point, she agrees to help detectives by secretly removing documents from the hospital. Once the investigators suspect that Cullen is contaminating intravenous bags with insulin, they exhume the young patient’s casket and test her body for insulin.
At the end of the film, Loughren is wearing a wire when she meets Cullen at a diner and gets him to confess.
During Graeber’s extensive interviews with Cullen, Cullen never said why he committed the murders. Graeber could only offer motives from the little that Cullen did say.
Evidence of a Flawed Healthcare System
The tale of Cullen’s actions could barely be contained in the two-hour film or Graeber’s over 400-page book “The Good Nurse.” During his 16 years as a nurse in three states, Cullen moved from hospital to hospital when he was fired or forced to resign.
A growing nursing shortage and poor administrative follow-up contributed to the wake of the destruction he left in his path. In an article published in New York Magazine by Graeber, he recounts how Cullen worked in a burn unit, cardiac care unit, and intensive care unit during his hospital career.
There were several times that Cullen’s behavior should have been caught by the hospital administration, coroner’s office, and even the police. Yet, gaps in the healthcare system allowed Cullen to continue working. These gaps included:
- Failure to check previous employment: Cullen was under investigation, was forced to resign, or was fired from seven of the 10 hospitals in New Jersey and Pennsylvania. However, he could easily get a new job when hospitals did not check his past employment.
- Failure to check his gaps in employment: Cullen was unemployed at least once for six months, during which he was admitted to a psychiatric unit. He had a history of depression, at least two suicide attempts, and a conviction for breaking into a woman’s apartment.
- Failure to conduct internal investigations: Several hospitals failed to conduct appropriate investigations. For example, in May 1998, Francis Henry was moved from Liberty Nursing and Rehabilitation Center — where Cullen worked — to Lehigh Valley Hospital when his blood sugar dropped precipitously.
Kimberly Pepe was caring for Henry, and Cullen was assigned to Henry’s roommate. Pepe contended that Cullen was responsible because he was in the room repeatedly. She told federal officials that Liberty was investigating Cullen for stealing drugs before the incident.
Administrators at Liberty first agreed that Cullen was responsible, but they later changed their minds. Liberty fired Pepe while keeping Cullen.
- Failure to report Cullen’s behavior: Hospital managers and administration did not report Cullen’s behavior or their suspicions to the police or state board of nursing. After the death of Reverend Gall, the hospital launched an investigation and brought in leading toxicologist Dr. Steven Marcus.
Marcus advised the hospital to notify the authorities. He recorded the conversation with the medical director who decided not to inform the police. Marcus instead notified the state’s Department of Health.
Three months later, the hospital notified the police but five more patients had been killed by that time. The state attorney pointed the finger at the hospital, but the CEO Dennis Miller didn’t take responsibility for his inaction and blamed Cullen’s past employers who didn’t tell them he’d been fired.
- Failure to cooperate with investigators: On several occasions, hospitals were aware that Cullen’s actions may have resulted in the death of a patient. However, instead of reporting this to authorities, they fired him or forced him to leave.
Cullens’s last job was at Somerset Medical Center, where investigators believe he administered fatal doses of medication to 13 patients. Detectives Timothy Braun and Danny Baldwin broke the case and arrested Cullen. During an interview with 60 Minutes, Braun told the reporter that the only cooperation he got from Somerset was when they answered court-ordered subpoenas.
- Failure to report suspicions: More than a decade before Cullen’s arrest, a medical examiner failed to perform a test that could have stopped Cullen. Another coroner believed that a death was not accidental but did not report it to the police or prosecutors. At other times when the police or licensing authorities were investigating claims, they did not look thoroughly enough to find Cullen’s past allegations.
How Nurses Can Protect Patients’ Health and Safety
Patients place their lives in the hands of the nurses who care for them. The nurse is responsible for protecting patients’ health and safety while in their care. The healthcare system has learned a lot from the flaws exposed during Charles Cullen’s trial. There are several steps nurses can take to protect their patients:
Be aware of your mental state
Nurse burnout can creep up quietly on a nurse. Pay attention to your mental state to avoid nurse burnout and lower the potential you’ll be involved in an inadvertent medical error.
Prioritize your physical and mental health
Fatigue, exhaustion, lack of sleep, and poor physical and mental health can be barriers to providing safe, effective nursing care.
Practice the five rights of medication administration
These are the right patient, drug, dose, route, and time. After passing medication as a nurse throughout a 12-hour shift, it can be easy to overlook these checks. Missing one of the five rights can be disastrous for you and your patient.
Report dangerous behavior
While no one wants to tell on their colleagues, a nurse’s responsibility is to their patient. Report any dangerous behavior you notice to your unit manager and pay attention to whether it is followed up.
Advocate for open communication
Keeping secrets can be dangerous for nurses and patients. Advocate for an environment where open communication is valued.
Participate in quality improvement
Seek to develop processes and protocols that protect patients from oversight, accidents, and intentional harm.
Improve critical thinking skills
Nurses rely on critical thinking to care for their patients and juggle various tasks. Seek to test your belief system and assumptions, and recognize ambiguity in all situations.
Educate your patients
Educated patients can assist as your eyes and ears in their healthcare. When your patients understand the side effects of their medication or signs they may have an infection, they can notify you quickly of changes in their health status that may not be easily observed.