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When Nurses Kill

Observant coworkers can spot the danger signals.

Why would someone who'd worked hard to become a nurse, a caregiver, turn around and harm her patients? The truth is that some people enter healthcare professions not to help others but to gain power, control, or attention. If they decide to harm or kill, victims and methods are readily available. Until recently, it hasn’t been difficult for determined predators to commit and cover up murder in healthcare institutions. They exploited the atmosphere of trust.

As a result, more precautions are now in place. Healthcare serial killers have been found among physicians, nurses, and key support staff. A study published in the Journal of Forensic Sciences in November 2006 examined 90 cases from twenty countries of criminal prosecutions between 1970 and 2006. Fifty-four of the defendants had been convicted and other convictions were pending. Most had used one or more of the following methods: the injection of lethal substances, suffocation, poisoning, and/or equipment tampering.

Nurses (male and female) comprised 86% of healthcare serial killers, and the number of suspicious deaths attributed to the confirmed killers in the study totaled over 2,000. Often they work alone, but a few have killed as a team.

Understandably, coworkers, administrators, and potential patients want to know how to spot and stop dangerous nurses. So do investigators who might be called in, because these deaths are notoriously difficult to document as murders. Yet we have learned that healthcare serial killers tend to show the same types of behaviors, even when different motives inspire them. Thus, we can form a list of red flags that will assist those who believe they're working closely with one.

Often, these killers have been allowed to drift from one hospital to another, perhaps fired under a cloud of suspicion but rarely brought to justice until after their murder toll has reached shocking levels. Thanks to the number of cases successfully identified, we now understand that statistical analysis assists to determine the comparative death rate on the shifts of suspects vs. their colleagues. If a suspicious number is documented, then officials can examine whether a high percentage had been unexpected, or if the death symptoms failed to match the patients’ conditions.

It’s also important to investigate whether a suspect has a history of mental instability, depression, or odd behavior—especially aggression toward patients who annoy them.

Several professionals who study these cases worldwide have listed traits and behaviors that should be taken seriously. While none is in itself sufficient to place someone under suspicion, a number of them occurring together is reason to pay attention. In retrospect, we know that nurses who turned out to be serial killers:

  • were given macabre nicknames by patients or others on staff, such as “Death Angel,” or “The Terminator.
  • were seen entering rooms where unexpected deaths occurred.
  • had moved often from one facility to another.
  • were secretive.
  • had a persistently difficult time with personal relationships.
  • liked to “predict” when a patient would die.
  • made inconsistent statements when asked about suspicious incidents.
  • preferred shifts where fewer colleagues and supervisors were around (generally the night shift).
  • were associated with several incidents at different institutions.
  • craved attention.
  • complained a lot about what a burden patients were.
  • tried to prevent others from checking on patients.
  • were seen in areas or patient rooms where they didn't belong.
  • hung around during the immediate death investigation.
  • possessed the suspect substance in their home, locker, or personal effects.
  • had lied about some detail of their personal information or credentials, or had falsified reports.
  • had been involved in other types of criminal activities.
  • had a substance abuse problem.

Identifying such people as soon as possible requires documenting patterns of behavior and items of physical evidence that link the suspected individual to the suspicious death. Stopping them requires a sharp eye, knowledge about their typical traits and behaviors, and a desire to ensure that suspicious people be taken seriously.