By Theo Schall


News broke last week that American director Darren Aronofsky has signed on to direct a film adaptation of Charles Graeber’s The Good Nurse: A True Story of Medicine, Madness and Murder. The book tells the story of Charles Cullen, a prolific serial killer apprehended in 2003. Cullen worked as a registered nurse in New Jersey and Pennsylvania, where he was responsible for the deaths of at least 40 and as many as 400 patients. Since Cullen’s arrest and the subsequent public interest in his trial, 35 states have passed stricter laws requiring criminal background checks for licensure of health care professionals and mandated reporting of incompetent or negligent providers.


Sensationalized media accounts of extreme circumstances often shape public understanding of social problems. In this case, a killer brought public attention to the culture of the clinic, which Cullen was able to exploit for his own ends. It’s important to stress that someone like Cullen is an aberration – the vast majority of nurses choose a life of service because they’re passionate about helping others. Yet Cullen’s case points to the challenges faced every day by well-intentioned nurses.


An overburdened, understaffed healthcare system is vulnerable to mistakes and even misconduct. Hospital patients are sicker than ever, with more complex chronic conditions. Units are overstaffed and sometimes desperate to hire anyone qualified – unemployment rates among nurses are extremely low because the need for nurses is so high. Male nurses, who make up 9.6% of America’s nursing ranks, can be particularly difficult to find and may be more aggressively recruited. Rapid technological changes, including electronic record-keeping, increase the demands on individual workers.


Nurses are often best situated to spot problems first and advocate for patient safety, though their pleas are not always heard. An important part of Cullen’s story is its conclusion: a close friend, also an RN, found suspicious patterns in Cullen’s use of hospital computers and informed on him to law enforcement. While hospital administrators dragged their feet on investigating potential wrong-doing, coworkers at a number of hospitals voiced suspicions about Cullen’s patient outcomes and behavior.


In 2004, the American Nurses Association responded to the Cullen case by issuing a statement entitled Protecting Patients from Unethical, Incompetent, and Criminal Acts by Health Care Practitioners. The report’s policy recommendations began:

“Protecting patients against potentially harmful actions by nurses, either intentional or unintentional, is a multilayered, multidimensional responsibility involving individual registered nurses and nurse managers and employers’ human resources departments, as well as state and federal agencies.”

To paraphrase, hospital nurses alone can’t protect against potential harm to patients. While the laws passed in response to Cullen’s discovery have elicited some controversy, they’ve helped to improve hospital culture by bolstering accountability across systems. Yet there’s a wide gap between policing potential criminal acts and creating a culture in which nurses are able to act ethically. How can we help support nurses so they can remain resilient, able to care for and protect patients with the help of other allied health professionals, hospital administration, and law enforcement? How do we give nurses the power to do more when they see mistreatment of patients?


A group of nursing leaders published a report last month called A Blueprint for 21st Century Nursing Ethics in which they cataloged the challenges faced by the profession and proposed potential solutions to ethically compromised work environments. Their recommendations went beyond the brute force of legislated responses to get at the root causes of ethically compromised clinical cultures. Hopefully, by the time The Good Nurse reaches movie screens across the country, there’ll already be changes underway that will help keep patients safe from anything like Charles Cullen’s murders happening again.

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Theo Schall

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