The Good Nurse: Prioritising patients over personal gain

The Good Nurse is a Netflix film based on the true story of Charles Cullen, an American serial killer who was arrested in 2003 following a 16-year nursing career. He killed an estimated 400 patients through covertly administering lethal intravenous doses of insulin and digoxin. The story is told from the perspective of his co-worker Amy Loughren (Jessica Chastain) – a real-life nurse who befriended Cullen (Eddie Redmayne), and then worked with the police to have him arrested.

There are parallels between Cullen’s case and those of English serial killer nurses Beverley Allitt and Benjamin Geen. In 1991, Allitt was convicted of murdering four children under her care through large insulin doses. From 2003 to 2004, Geen injected lethal doses of insulin, sedatives, and muscle relaxants into patients to trigger respiratory arrest or failure. These cases illustrate the importance of effective safeguarding policies and reporting procedures in the UK.

Cullen had worked, and killed, at nine healthcare facilities before arriving at Somerset Medical Center (fictionalised as Parkfield Memorial Hospital in the film). He left his first hospital job after hospital authorities began investigating the IV bags he contaminated. The Liberty Nursing and Rehabilitation Center fired him for administering drugs to patients at unscheduled times. After Cullen murdered a patient at Easton Hospital, a coroner’s report showed lethal amounts of digoxin in the patient’s blood. Cullen was not apprehended.

One of Cullen’s co-workers at St. Luke’s Hospital found over 50 medication vials in a disposal bin. Cullen was found culpable, and he resigned. Seven co-workers informed the district attorney of their suspicions that he had killed patients using drugs. Despite Cullen’s presence at over 50% of the deaths, the case was dropped.

In July 2003, Somerset Medical Center was notified of a series of suspicious overdoses indicative of malpractice. They waited until October to report the case to the authorities. During this interval, Cullen killed at least five more patients and attempted to kill another. 

Though many hospitals Cullen worked at harboured suspicions about him, they failed to investigate thoroughly and communicate their concerns. A national shortage of nurses, and little interest in the stress and night-time hours of Cullen’s shifts, led hospitals to not persistently inquire about his past. 

Avoiding taking action raises ethical issues – unfit healthcare workers can jeopardise their patients’ lives. Before leaving his second job, Cullen’s history included two suicide attempts, a psychiatric commitment, a job termination, a criminal conviction, and a murder allegation. The list only grew to include further links to patient deaths. Had hospital administrations conveyed their concerns about Cullen,  lives could have been saved. There have never been criminal proceedings against these hospitals.

The failure of hospital administrations to stop Cullen endangered his co-workers. The Good Nurse highlights the danger Amy Loughren faced as she worked towards his arrest while he was still involved in her life. In one scene, the hospital’s risk manager and lawyer tell staff not to speak to the police without a hospital representative present. Amy, therefore, risked her career, and health due to her heart condition, to do what the hospitals did not.

Amy’s safeguarding efforts culminate in a scene where she meets with Cullen, wearing a wire, to get a confession from him. When she reaches for his hand, he swats it away, the clatter of cutlery from this outburst creating a jarring sound which mirrors Amy’s uneasiness. The police are nearby for support, and she remains calm throughout the exchange. Still, it is a psychologically challenging position for her to be in. 

The Good Nurse takes a sensitive and informative approach towards depicting true, harrowing events. It avoids glorifying the murders by centring Amy’s journey of uncovering the truth rather than Cullen’s warped perspective. The film’s gloomy colour grading reflects his sinister intentions, making his presence constantly felt without manipulating the narrative.

Redmayne and Chastain’s natural onscreen camaraderie deepens the impact of Cullen’s betrayal – even though the audience knows it is coming, an effect similar to Ted Bundy’s story being told from his girlfriend’s viewpoint in Extremely Wicked, Shockingly Evil and Vile (2019). In both films, the perpetrated violence remains offscreen to focus on the impact of the killers’ actions on those around them. The onscreen text at the end of The Good Nurse provides a modern-day update on the case, rightfully emphasising the lack of accountability from the hospitals involved.

When Cullen was committing crimes, there were no centralised reporting mechanisms for healthcare workers to use. Whistleblowing policies that staff are aware of, know how to use, and can use without shame, are critical for ensuring safety. Currently, National Guardian and NHS Health Education England provide the Freedom to Speak Up in Healthcare in England e-learning. Freedom to Speak Up Guardians encourage a positive culture where healthcare staff can have their voices heard.

The Good Nurse highlights moral, ethical, and legal dilemmas which are pertinent to healthcare professionals. It is important not only to identify red flags in healthcare workers but also to communicate this information and take action to safeguard patients and employees. Whistleblowing systems which are efficient and easy to use are essential for creating a safe and positive workplace environment.

The Good Nurse is streaming now on Netflix.