The Light and The Dark of Nursing: Our Shadow, Part I

I love nursing and I love being a nurse. That is what makes this post so challenging to write, admitting that the profession where my heart sings, where I have grown and evolved over the last twenty years, has a dark side. But if we take the advice of Jung, we come to realize, perhaps, that the shadow, the dark parts that we may try to hide or deny, needs to be acknowledged and integrated. We can learn to be loving and kind toward that which was previously denied or rejected. By shining a light on the dark places, we can invite those hidden areas to come out fully, to open up to our secrets and our darkness. While we usually think of shadow work as an individual challenge, the profession of nursing could grow and evolve from examining our shadow, from shining a light upon our darker sides.

The Shadow: Nursing in the Media

I recently read the book “The Good Nurse”by Charles Graeber. I remember listening to NPR and hearing about the book when it was released and being very upset that a book about a nurse serial killer was given such a title. To listen to what I heard on the radio in April 2013, visit this link:

The Good Nurse, NPR

It took me a year to work up to the challenge of reading the book, as I was so upset about the title alone, let alone the interview. Who was this outside journalist who came to investigate these horrendous acts, surely he did not understand nursing if he named the book in this manner. My own anger at the title of the book and the horrific situation should have been clue to me right there that I had something to face here, at least according to shadow theory. Still, I thought a book called the Good Nurse should be all about the good nursing does, not about this outlier who murdered perhaps dozens of patients. Why not call this book, “The Worst Nurse EVER”? or “The Abhorrent Nurse?”

What I didn’t realize at the time was that this book has an important message to deliver, an important message not just about Charlie Cullen, the RN who killed many, many patients, but about the whole healthcare system, about the dark side of medicine for money and the need to protect hospitals’ revenue stream dominating over the need for patient safety.  I finally purchased the book and settled into reading it over spring break 2014. About half way through reading the book, I contacted the author, Charles Graeber through email and began a dialogue about the book and his choice of the title. And I was surprised to find that Graeber was beyond generous in his responses to me, helping me to shine the light, expanding it further into this dark tale.

The story is about flaws in our reporting systems, about flaws in how nurses respond, report, react to concerns for patient safety, and about flaws in quality assurance. The book is about a call for justice, for action to be taken against the healthcare systems and the specific individuals who perpetuated Cullen’s killing spree by failing to act. There is no statute of limitations with murder charges, and healthcare administrators who knowingly supported the continuing practice of a murdering nurse may perhaps be found liable on some level for the many murders that occurred after knowledge of, or even suspicions of. multiple murders were not adequately addressed. You can read my full review of the book here:

Although we can clearly see Cullen carried a deep shadow with him into nursing, that he suffered from some sort of mental illness to have had these deep killing compulsions, that he was a manipulator or sorts who could put up a front as a hard working hero nurse, we have the obligation to also see what worked in the system, and identify the shadows that need to be addressed.

What worked, where was the light? The hero-nurse who helped to indict Cullen, the investigators who did not give up or turn a blind eye, and the penal system were the lights in this issue.This book itself also becomes a beacon to shed some light on the issue.

What did the light reveal about this looming shadow in nursing, what can we learn from this media portrayal of a nurse carrying a gigantic shadow? Perhaps we can consider if academia may have some issues with screening students; that some nurses may consider a nurse who works a lot/takes the hard patients/ and makes the coffee to be a “good” nurse; that QA/QI/surveillance issues around safety as related to nursing practice and competence is apparent; that nurses may have not been empowered to take action when their suspicions arose; and that systems failed in protecting patients through monitoring and reporting.

By increasing our awareness of shadow, dark side incidents such as this obvious one, we can begin to create change and perhaps prevent future devastation. While this is an extreme example of a shadow in our beloved profession, the next entry or Part II will examine some less extreme shadow issues and Part III will focus on actions we can all take to shine the light into darkness and further support our autonomy and evolution as a caring- healing profession.


Some history on the origin of the word “nurse”

Thomas Lawrence Long, from the University of Connecticut, has graciously provided a guest blog post on the etymology of “nurse.” I happened to see something Tom posted about Shakespeare and “nurse” and thought this would be an interesting topic to discuss here.

Because historians of health and health care are sometimes preoccupied with the slipperiness of the signifier nurse (see Monica Green’s (2000) caution concerning the term in reference to medieval and early-modern studies), a brief historical lexicography might illuminate the meanings that the word has accrued, absorbed, and may, to some extent, still carry. Here is examined the historical traces of a noun-substantive, from wet-nurse, to caretaker of children, caretaker of the sick, asexual hive bee, and health professional, in which the traces of ideologies of gender identity and gendered work appear to be retained.

The first instance in English of nurse occurred in the early thirteenth century as the Anglo-Norman nurice, derived from the fifth-century post-Classical Latin nutrice, a wet-nurse (hired to provide an infant with breast milk when the infant’s mother would not or could not do so), although by the time it entered the Middle English lexicon, it had already absorbed the figurative sense of any female caretaker of children (Oxford English Dictionary 2010). Etymologically it is related to our modern word nourish, to feed.

Already by the late fourteenth century nurse had also taken on the figurative sense of any thing or any place that nurtures or fosters a quality or condition, and by the early fifteenth century, any person who takes care of, looks after, educates or advises someone.

The earliest attested use of nurse in a strictly medical sense appears in Shakespeare’s Comedy of Errors (ca 1616): “I will attend my husband, be his nurse, Diet his sicknesse, for it is my Office” (V.i.99). The wife as nurse (and the advantage of marriage as engaging a live-in nurse) is also apparent in the Duchess of Newcastle’s Matrimonial Trouble (1662), which contends, “That he might do [sc. marry], if it were for no other reason, but for a Nurse to tend him, if he should chance to be sick.”

Another curious figurative usage is attested to in the early nineteenth century: nurse as an entomological term, explained by the OED as “A sexually imperfect member of a community of bees, ants, etc., which cares for the larvae; a worker,” citing Kirby and Spence’s Introduction to Entomology (2nd edition): “The workers, termed by Huber nourrices, or petites abeilles (nurses), upon whom the principal labours of the hive devolve.” The Huber in question was the Swiss naturalist François Huber (1750-1831) whose Nouvelles Observations sur les Abeilles was published at Geneva in 1792 and translated into English in 1806. Perhaps by association the later zoological term nurse shortly came to characterize any asexual invertebrate, a spineless sexless creature.

The semantic process whereby the word nurse begins by denoting a woman hired to provide surrogate breast milk and comes to denote a sexless worker insect may be related to the religious associations of woman as healer and caretaker of the sick, particularly the ubiquitous presence of European women’s religious orders comprised of celibates (and thus, in the medieval view, sexless) devoted to the wellbeing of others.


Green, Monica H. (2000). Documenting medieval women’s medical practice. Women’s healthcare in the medieval West. Aldershot, UK: Ashgate Variorum, pp. II, 322-352.

When you think of the word “nurse,” what comes to mind for you?

Welcome, nurses!

Hello readers/bloggers!

I wanted to say hi and introduce myself. I’m a nurse and diabetes educator. I wrote a post on our old blog about feeling disconnected from nursing at times. A specialty like diabetes education can do that to you, because it’s a multi-disciplinary specialty (dietitians, social workers, pharmacists, exercise physiologists, PTs, MDs can all be diabetes educators). I am in full support of a multi-disciplinary approach, especially when it comes to diabetes education and management. However, it makes me feel isolated from my nurse colleagues. Not to mention that I’ve been a department of one for the last twelve years! My hope is that this blog will be an opportunity to stay connected to nurses. We can share our thoughts, passions, ideas and more.

Thanks for joining us!