Maintaining perspective in the aftermath of the Quakers Hill tragedy

Events unfolding in Sydney should prompt calm reflection not overreaction, writes John Field.

While in Turkey last week, I woke to the news of an Australian nurse being charged with the murder of several aged care residents in Sydney. I was in Antalya in Southwest Turkey to deliver a presentation at the 5th International Nursing Management Conference. The title of my paper was Murder by nurses: a challenge for management and leadership.

My reaction to the news was great sadness. A nurse being charged with murdering patients is a rare but by no means unique phenomenon. It was the focus of my PhD. Even in Australia we have had nurses charged with multiple counts of murder in relation to patients though none has ever been successfully convicted in this country. The fact that the police have acted with such alacrity in this case suggests that they believe the fire to be deliberate and the death of the patients to be intentional. However, if this nurse is guilty (and we need to remind ourselves that he, like everyone else, is entitled to the presumption of innocence), history is nevertheless against the police so far as obtaining a conviction is concerned.

This is a time for calm reflection by both the profession and the public. For the profession, this incident will fill us with dismay. It is almost impossible for nurses to accept that any of their colleagues could or would ever murder a patient in this or any other way. But nurses are human, with all the foibles and failings that entails, and among the several million nurses around the world who provide care to those in their care, it is only to be expected that there occasionally will be one who is aberrant. Even among the couple of hundred thousand nurses who provide such superb care to Australians this is so. Moreover, all of the precautions in the world may not be able to protect the public from such an individual. This is no different to the situation with fire-fighters who start fires or police who turn their weapons on others. When it happens we will be distraught, but history demonstrates that it will inevitably happen. The challenge for the nursing profession and for health care systems is to minimize the possibility for this to occur. To do this, we must accept that such individuals exist, and be alert to a number of indicators.

This case will produce many casualties. First and most obvious are those who lost their lives or who have been burned in this fire. And then there are the families of these victims. Past cases of nurses who have been convicted of murder of patients show us that the families of the victims suffer greatly. They are impeded in their grief by the knowledge that their family member was harmed by the people who should have been most trustworthy. People trust nurses and when nurses intentionally and maliciously kill a patient it is, apart from anything else, a betrayal of that trust.

I anticipate that the nurse, Roger Dean, will also be a casualty, particularly if he is innocent. Irrespective of whether he is guilty or innocent, he will be pilloried. In the media he is likely to be cast as ‘sick’, as mad, or as a monster. He will very quickly be dissociated from his status as a nurse through language such as ‘former nurse’. He will be presumed to be guilty in the minds of the profession and the public. As nurses, we need to understand that the extraordinary, aberrant nurse will look no different to any other nurse.

It is the public who has the most to lose when a nurse murders patients. We risk losing confidence in the profession of nursing even though every one of us will eventually find ourselves requiring care from nurses. Usually we are at our most vulnerable at such times – in all senses of the word.

We have to trust the nurses. We need to be able to trust them. And overwhelmingly, we can trust them. So let us, as members of the public, not overreact in response to this case. Let us get the facts first – and not media characterisations of the case. And let us ask our media to treat this case for what it is. It is a tragic case. People have died. They may have been murdered, but that is yet to be established. They may have been murdered by a registered nurse, but that too is yet to be established. If it proves to be the case, it will still not amount to an indictment of nursing as a profession. It will mean that one aberrant individual slipped through the system. That individual might have acted in a moment of madness – and if guilty as charged, that might be best for all concerned. However, it is equally possible that if guilty as charged, the individual was just plain bad.

We need to be able to accept that such individuals exist and that they might just find their way into nursing, but so rarely that it should not change our view of nursing and nurses who will continue to provide superb care to highly vulnerable people, often in very difficult circumstances.

What is certain is that virtually every one of us will need a nurse at some time, so let us be careful about how we react to the charging of this nurse with multiple counts of murder.

Dr John Field is a lawyer and a nurse. He is currently Associate Professor of Nursing, Associate Head of School and Director, Research and Higher Degrees in the School of Nursing and Midwifery at the University of Tasmania. In 2008 he completed one of the world’s first academic studies on nurses who deliberately kill their patients.

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