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Newspapers and social media sites blast out shocking headlines like:
UK Nurse Lucy Letby handed life sentence for murder of 7 babies
How was a nurse able to kill 8 seniors over a decade?
Nurse in Germany murdered two patients so he could be ‘left in peace’
Pa. Nurse Accused of Killing Patients with Excessive Insulin, Saying Man Was 'Better Off Dead'
Nursing has long been ranked as a leader in trusted professions. Over my years of working with patients and families, I’ve heard this time and time again. I’ve heard people say that they reach out to nurses to help them understand and, sometimes, confirm facts after speaking with physicians and other healthcare professionals. They trust us with their lives. So what would make nurses take that trust and commit murder?
In my mind, it’s too simplistic to say that there are bad apples in every profession. I’ve met some nurses who should be working in another field. But there’s a difference between not being good at your job and deliberately taking lives. That’s not a bad apple.
Health care serial murder
There’s an official name for what these nurses did: health care serial murder, or HCSM. According to an article published in 2020 in the Canadian Family Physician, an average of 35 people in the United States are killed each year by HCSM. But that is only the number we know. The author, Dr. Chris Frank, wrote, “The true numbers are likely higher, given that these crimes are often missed for years. Most convicted of HCSM are charged with fewer murders than they admit to.”
If murderers believe they are killing to end suffering, particularly among older patients, the deaths might not be noticed as unusual or ignored. This means no arrests and no prosecutions.
Another point to keep in mind is that sometimes serial killers don’t mean for the deaths to occur. Some may have a “hero syndrome.” The professional may want to make the patient sick enough to require emergency care and be seen as a hero because their quick action saved a life.
In this BBC article, published in 2019, criminologist David Wilson discussed the case of a German nurse convicted of killing 85 patients. Wilson said that the nurse, who was given the nickname “Resuscitation Rambo,” showed signs of Munchausen syndrome by proxy. Munchausen syndrome is now called factitious disorder, which “… involve[s] mimicking or producing illness or injury or exaggerating symptoms or impairment to deceive others. People with the disorder go to great lengths to hide their deception, so it may be difficult to realize that their symptoms are actually part of a serious mental health disorder. They continue with the deception, even without receiving any visible benefit or reward or when faced with objective evidence that doesn't support their claims.”
Limited research into HCSM
There is limited research into HCSM, likely for a variety of reasons. One is that the murders are usually only detected well after the fact, when someone picks up on a suspicious death. Using forensics, a pattern is detected, and investigations begin.
Nurses aren’t the only healthcare professionals who have committed HCSM, however. Frank’s article says that some family physicians are also murderers, such as UK physician Harold Shipman, who may have killed 250 people over 27 years. A quick online search using “doctors who murdered patients” brought up many hits. However, the most notable one other than Shipman was Michael Swango, who killed or attempted to kill patients as a paramedic and then a physician.
Interestingly, the reasons differ between why doctors and nurses kill. In the BBC article, professor of forensic psychology Katherine Ramsland said that doctors often kill "from the desire to feel a godlike sense of power over patients or from experimental curiosity." On the other hand, nurses seem to be motivated by getting attention, wanting to feel a sense of power because they feel undervalued, fighting against what they perceive to be an unfair system, or acting out of frustration.
PhD thesis on nurses who murder patients
In 2008, John Field published a PhD thesis, one of the first academic studies on nurses who murder patients. As Field gathered data, he found that (by 2008), there were reports and mentions in the medical literature of about 48 cases involving nurses, killing more than 750 patients.
In an article published by Field’s school, The University of Adelaide, he said, “Of the 48 cases included in my study, 38 were serial killers. While other nurses may have harboured suspicions about the murderer for a while, it took a long time for their suspicions to be reported. This points to a need for more open communication in our hospitals.”
Field believes some of the blame is on the healthcare system itself. He explained that colleagues may be reluctant to report suspicions until they become much more apparent, and the administration's slow reaction to reported suspicions allows nurses to move to different facilities. I like what he wrote in his thesis: “While members of the nursing profession may not be held accountable for the actions of aberrant nurses who murder, there is a responsibility to understand how hospitals and units form crucibles in which murder can take place.”
So what can we do?
Frank offered some red flags that facilities and colleagues should watch out for, stressing that they are anecdotal. But upon reading them, they made sense to me, if combined with other possible red flags. For example, Frank lists frequent job changes and a preference for working shifts with fewer coworkers around. Many people job-hop for various reasons. I know several nurses who prefer off-shifts because they find the atmosphere more calming, with fewer people coming on the unit, fewer tests, phone calls, etc. However, if you take that into account with a history of disciplinary problems or other incidents, this could be suspicious.
Other issues Frank lists include:
History of mental instability
Attention seeking
Substance abuse
History of criminal behavior
Making predictions of which patients with die next
Higher incidence of emergencies, including deaths, when they are present
Colleagues giving nicknames, such as the above-mentioned Resuscitation Rambo
Colleagues finding the person in parts of the hospital or unit where they aren’t expected to be
Defensiveness or inconsistent statements when asked about emergencies or deaths related to their patients
Nurses, physicians, and anyone else in the healthcare system must speak up if they suspect anything untoward. Of course, this must be done with discretion because suspicions may be unwarranted. But anyone who sees or suspects that something is wrong must say something. Lives depend on it.
What do you think? Leave your comment below. Let’s get a discussion going.
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