What 'The Good Nurse' Teaches Us About Patient Safety

Charles Cullen may be the most prolific serial killer in U.S. history. He confessed to killing at least 40 patients across New Jersey and Pennsylvania, and some investigators believe the real number could be closer to 400. He kept working as a nurse for 16 years, moving from hospital to hospital, because the systems meant to catch him failed at nearly every step.

That failure is the part every nurse should study. Cullen is the cautionary tale; the gaps that let him operate are the lesson.

What Happened

"The Good Nurse," based on Charles Graeber's 2014 book of the same name, premiered at the Toronto International Film Festival in September 2022 and reached Netflix that October. It follows Cullen and Amy Loughren, the colleague who eventually helped detectives get his confession.

Cullen worked at roughly 10 hospitals over 16 years. At several, he was suspected in patient deaths. As Loughren learned his history, she pulled away from him, then started cooperating with investigators, quietly removing documents from the hospital. Once detectives suspected he was contaminating IV bags with insulin, they exhumed a young patient's body and tested it. Loughren wore a wire to a diner meeting and got him to confess.

In 2006, Cullen was convicted of 29 murders and sentenced to 11 consecutive life terms. In years of interviews with Graeber, he never gave a clear reason for the killings.

Where the System Broke Down

A nursing shortage and weak administrative followup gave Cullen room to keep working. The investigation exposed the specific failures:

Nobody checked his employment history. Cullen was investigated, forced to resign, or fired at seven of the 10 hospitals where he worked. He kept getting hired because new employers never verified his past.

Nobody questioned his gaps. He was once unemployed 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 criminal conviction. None of it surfaced in hiring.

Internal investigations went nowhere. In May 1998, patient Francis Henry was transferred from Liberty Nursing and Rehabilitation Center to Lehigh Valley Hospital after his blood sugar crashed. Nurse Kimberly Pepe told federal officials that Liberty was already investigating Cullen for stealing drugs and that he had been in Henry's room repeatedly. Administrators first agreed Cullen was responsible, then reversed course. They fired Pepe and kept Cullen.

Suspicions never reached authorities. After the death of Reverend Florian Gall, the hospital brought in toxicologist Dr. Steven Marcus, who told them to call the police. The medical director declined. Marcus recorded that conversation and reported the case to the state Department of Health himself. The hospital waited three more months to notify police. By then Cullen had killed five more patients.

Hospitals protected themselves, not patients. When facilities suspected Cullen in a death, they fired him or pushed him out instead of reporting him. At his last job, Somerset Medical Center, investigators believe he gave fatal doses to 13 patients. Detective Timothy Braun later said the only cooperation he got from Somerset came when they were under court-ordered subpoena.

Earlier chances were missed entirely. More than a decade before the arrest, a medical examiner skipped a test that could have stopped Cullen. Another coroner suspected a death was not accidental and never reported it. When licensing authorities did investigate, they didn't dig deep enough to find the earlier allegations.

What Nurses Can Take From This

Patients trust you with their lives, and protecting them is the job. Cullen is an extreme case, but the habits that guard against him also guard against ordinary, far more common errors.

Watch your own mental state. Burnout creeps up quietly, and a worn-down nurse makes mistakes. Protect your sleep, your health, and your stamina, because fatigue is a direct threat to safe care.

Run the five rights every time: right patient, drug, dose, route, and time. Deep into a 12-hour shift it's easy to skip a check. Don't.

Report dangerous behavior. Telling on a colleague feels lousy, but your duty is to the patient. Flag what you see to your manager and follow up on whether anything happens.

Push for open communication. Secrets are where harm hides. Build units where people speak up without fear.

Get involved in quality improvement. Good protocols catch oversights, accidents, and intentional harm before they reach a patient.

Sharpen your critical thinking. Test your assumptions, sit with ambiguity, and don't accept an easy explanation when something doesn't add up.

Educate your patients. A patient who understands their medications and warning signs becomes another set of eyes on their own care, and they'll flag changes you might not catch at the bedside.