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The Good Nurse: A True Story of Medicine, Madness, and Murder
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Audible Audiobook
Listening Length: 11 hours and 35 minutes
Program Type: Audiobook
Version: Unabridged
Publisher: Hachette Audio
Audible.com Release Date: April 15, 2013
Whispersync for Voice: Ready
Language: English, English
ASIN: B00CCY92WO
Amazon Best Sellers Rank:
'The Good Nurse' describes the horrific acts of Charles Cullen, who killed hundreds of people in New Jersey and Pennsylvania Hospitals, by injecting them with a variety of drugs. The story is well known through the news media, and this book was supposed to tell the inside story of Cullen's acts. The problem is that is really doesn't do this.The book is written as a series of relatively short chapters with numerous footnotes, which are incredibly distracting and force you to leaf to the back of the book and stop reading. I am not sure why the author chose to use this method, but, given the numbers of footnotes, it seems like he could have incorporated these into the story to make it more interesting. Ultimately, I just stopped reading the footnotes because I couldn't stand to continue flipping to the back of the book.The other main problem with the book - and this may not be the fault of the author but instead the unwillingness of the murderer to cooperate - is that we really never understand why Cullen did what he did. Was it his childhood? Did he fell like he was saving those he murdered? Or was he simply a mentally ill person carrying out some internal need for satisfaction? The truth is that Charles Cullen must have had some sort of serious mental illness or personality disorder, but this is not explored. Even more frustrating is that when he finally confesses, the author just summarizes the confession in one or two paragraphs and doesn't give the details that you want at the point in the book that it happens.The book's not all that bad and it does tell the story in superficial detail enough to make you read it to the end. But the lack of depth, as well as the style of writing make this book unsatisfying to say the least.
When I first heard about this book on NPR, and heard the author interviewed, I was angry. I am a nurse myself, one who works toward empowering others and advocating for the empowerment of nurses. What made me most angry was the title of the book, "The Good Nurse...", when clearly the book's topic is far from describing a good, competent, caring, ethical nurse. So I opted not to read the book, and then somehow stumbled across the book again, a year after the big publicity push for the release of the book, and decided to give it a read. After all, in order to move beyond and heal from events such as described in the book, the profession needs to acknowledge and shine a light on our dark side. And this book does illuminate not just an aspect of the dark side of nursing, but more importantly the healthcare systems that allowed for this type of behavior to continue on unchecked for years.Cullen is clearly a damaged personality and it is interesting to me that some of his co-workers perceived him as a "good nurse"... was it because he kept to himself, made the coffee, and was always working overtime? It certainly does need seem to be because of compassion, caring, safety, ethical practice, and leadership skills; the things I believe make a good or excellent nurse. Are nurses so overworked and stressed that simply having a seemingly competent nurse in place to lower our nurse-patient ratios deems them a good nurse?The book clearly details how the system from beginning to end failed to address this man's murderous acts. As a nursing faculty member myself, I had the concerns whether signs of Charles Cullen's issues likely started to emerge in nursing school and went undetected as for 16 years he moved out into the professional world.While the author provides some detail around Cullen's background, I did feel I wanted to know more about him. I also was still very much bothered by the title as I was reading the book. This lead me to emailing the author and having an ongoing verbose email exchange over several days. Mr. Graeber was prompt with his in-depth replies and both generous and gracious with his thoughts. He mentioned that he did not go into more detail about Cullen himself, because the man was fairly uninteresting as a personality, and that the true horror of this story revolves around how the system failed to protect the victims and the victims' families, as the facilities and the administrators seem to have avoided persecution. He explained to me how the title emerged for him and he told me of his own ideas around "doing good" vs. being a good moral agent. I have to agree with the author here, and it seems justice has not been served, and the systems and administrators themselves should be held liable and accountable for many of Cullen's murderous acts. If you thought you could trust your local hospital to provide you with caring, safe, professionals, this read might change your mind. As a concerned public we need to let our outrage around the actions of these institutions be known and continue to call for justice to be served: there is no statue of limitations around murder charges and I would deem a number of these institutions to be key players in the ongoing murders. Civil action should be the least of these facilities and administrators' worries.Some of the best parts of the book detail the heroes who emerge as the drama around Cullen's eventual "capture" unfolds. The investigating team and the truly good nurse emerge in ways that are memorable and call upon us all to live up to our highest ethical standards when it comes to protecting patients.I do think that nurses, patients, and administrators should be reading this book, bringing light to the darkness of the situation, and that agendas should be developed for better protecting the public.
As a nurse starting after this case was concluded, I started reading it with the knowledge of current (2016) standards of patient privacy, medicine access, and Texas nursing peer review law. Looking at it from that standpoint, the hospitals seem malicious in their negligence and was horrified at the sequence of events. Then, I remembered that nursing practice law is dictated by each state, and even if the Texas reporting structure was in place at the time, it wouldn't necessarily apply to Pennsylvania and New Jersey.For those completely horrified of hospitals, several changes were made based on this case. A few patient safety laws were passed after the arrest, state nursing boards revised their processes, and internal process changes were made. Hospitals with electronic records will audit who is accessing patient charts, with consequences up to termination from the organization for accessing a chart of patients with no established working relationship. Pyxis stations do not currently behave in the way that Cullen manipulated them; individual compartments within each drawer are now electronically locked and only the compartment for the medication being accessed will pop open. Pharmacies and nursing units also audit medication access, administration, documentation, waste, and return, but this usually focuses on narcotic administration.Unfortunately, hospitals still do not give out negative referrals and it is common practice not even to disclose whether an RN is eligible for rehire, unless it is an off-the-record conversation between colleagues at different hospitals. Will make me think more than twice before hiring someone I cannot get a positive referral for and think a bit before hiring someone with a positive report!Reinforced the importance of reporting nurses when terminating them for nursing practice (currently in Texas, the BON requires an automatic report when a nurse is terminated for practice issues). Reinforced for me as a nurse the importance of explicit verification and witness of what I am cosigning for. Will pass along this story to my coworkers!This case was meticulously researched (I was reading so fast, I didn't notice the footnotes until chapter 5 - rich store of information in the back of the book!) and extremely well written. I finished in 6-7 hours with quick breaks. Comparable to Erik Larson's writing and research. Will definitely be reading Charles Graeber's work from now on.This book is an excellent "lessons learned" resource. Of course, in hindsight, the choices to make are obvious, but cases never play out this way. Even trying to prove who was committing the crimes (and even figure out if it was accidental or intentional) is never as easy as it looks retrospectively, with all of the details available. From the hospitals that reported to the police and were told they did not have enough to go on, to the police force that wanted to involve the FBI earlier, but was told not to, to the RNs that report suspicions and are told not to worry about it. With the amount of malicious and bad-faith reporting that occurs, it's never easy to tell the truth from the fiction.
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