By Shawn Kennedy, AJN editor-in-chief
Having some down time over the holidays can be a good chance to catch up on some reading. Because so much of my work entails reading manuscripts submitted to AJN about nursing practice and research, I look for my leisure reading to be something not connected to nursing.
Well, the book I recently read—a quick, engaging read—was about nursing, sort of. The book was Charles Graeber’s The Good Nurse: A True Story of Medicine, Madness and Murder, the story of nurse-turned-serial-killer Charles Cullen. While I find the title to be a bit sensationalist, the book is not. There’s no real answer as to why Cullen did what he did—Cullen apparently had a miserable childhood, was often a target of bullies, had failed marriages and made many suicide attempts to gain sympathy or attention. Graeber doesn’t really seek to answer the why of what Cullen did but instead focuses on his behavior and relationships.
The chilling aspect of the story is how easy it was for Cullen to get away with his killing through the use of essential technology relied on by nurses for the care of hospital patients. The medication and computer systems that he manipulated to cover his tracks also eventually allowed an intrepid nurse colleague to help police prove their case—only a nurse knowledgeable about the day-to-day use of the systems could uncover the wayward patterns.
But the real issue that comes through is how hospitals, fearing litigation, would simply dismiss Cullen when other nurses voiced concerns about his practice, allowing him to find work elsewhere and become someone else’s problem. That’s something I think many nurses might relate to—I certainly can. I worked with a couple of nurses early in my career who, when we reported to the administration that there were consistent errors in the narcotic count or missing medications when they were working, were given a chance to resign or be fired. Neither was ever reported to the board of nursing.
AJN covered the Cullen case in our March 2004 issue—this link will take you to that month’s news section, where Cullen’s story (“Dial M for Murder or L for Lawsuit?”) is on page two (use the pdf version for best viewing). Also that year, former editor-in-chief Diana Mason addressed the issue of nurses’ silence about colleagues’ practice in an editorial that resulted in many letters.
I wonder—could this happen again? I believe technology has improved to make it more difficult to give the wrong medication, but the real question is whether hospitals—or other nurses—are more likely to take action today rather than just passing such a problematic employee along for others to deal with.
Maybe I need to go to the movies and find some lighter fare . . .
Agent Amy here…I was the nurse who uncovered Charlie’s computer evidence. All I can say is Charlie never really tried to hide his transactions with medications. It was sooo evident when the printouts were shown to me. Truly no one was watching the pyxis. The medication systems are better now however it all comes down to individual morals and corporate ethics. Charlie was a sad and very ill person and never should have been in nursing. Perhaps mental health screening could help however my personal feelings this: when hospitals became businesses we lost the heart and soul of our profession. Xo Agent Amy
You might want to see this editorial by Diana Mason, written back in March 2009 http://journals.lww.com/ajnonline/Fulltext/2009/03000/Who_s_Watching_.1.aspx . It was commenting on an investigative report on how easy it is to get licenses renewed (You can read it at http://www.propublica.org/series/nurses)
The same “no effective follow up” problem occurs in many fields, including my former experiences as an elementary and middle school teacher. Twice I saw teachers that staff believed to have obvios boundary issues with students go untouched. Both were eventually accused by more than one family each of “improper touch”, yet the administrators simply invited these predators to find new employment at the end of the year. Horrific. What legal fears fuel such passivity in the face of likely abuse? Very creepy human resources trend! This article, paired with those teaching experiences leaves me feeling we can only be more watchful of new employees with a suspicious number of mid-career employer changes. How very sad we are left to wonder if this is all management can offer to protect our patients and our profession.
I also read this and was very disturbed that he was just let go with no investigations…but I’ve worked with nurses who diverted meds and we’re let go also
Establish and reinforce consistent, unambiguous standards for nursing practice on your unit. It’s OK to raise the bar for performance, but it’s vital that each nurse on your unit knows where that bar is.The best nurse managers are visible to staff, patients, and family members on their units and know what’s going on at any time. Make regular rounds of both patients and nursing staff, take the time to observe and listen as you go around the unit, I’ve always encourage a shared governance of nursing by engaging unit staff in decisions that affect their daily practice. Adhering to the set organizational policies and procedures criteria when you suspect gross misconduct .
Agree that the real issue is hospitals do not report nurses (and physicians and other providers). I heard that less than half of all US hospitals have EVER reported a single health provider to the National Practitioner Databank.
In Minnesota, recently the Board of Nursing has been under scrutiny regarding “dangerous” nurses who should not be practicing. There has not been any scrutiny of what role employers might have in allowing these nurses to maintain their licenses. Your blog reminds us all that everyone in the profession has a role in ensuring that the nurses who hold licenses are safe.