They appear similar to their film counterpart, the Dark Nurses (which borrowed elements from the Bubble Head Nurse), with very deformed and rather featureless faces, short, revealing dresses made of skin, and feet marked by pointed-toe, white heels. As well, the nurses engage in twitchy movements and an attraction to any source of light or a considerable level of sound, remaining frozen until alerted.
When illuminated by a light source (not the flashlight), a fetus can be seen growing inside their wombs.
Nurses are initially rather easy enemies to overcome and can be defeated using melee combos with the knife. Later in the game however, they become significantly more dangerous, being able to use incredibly quick slashes in rapid succession, which makes approaching or even escaping them difficult. If a Nurse is allowed to continue slashing in this manner, they will relentlessly attack until Alex is dead, even if the player has full health at the beginning of this encounter. Utilizing Alex's mobility (namely dodging) makes Nurse encounters easier to deal with. If combat needs to be avoided altogether, turning off the flashlight will lower the chance of being attacked by a nurse provided he moves slowly and maintains a reasonable distance. A drawback of this is that it also hinders Alex, as without the illumination it provides, he is often plunged into complete darkness. Normally, they are found in groups of three or more, making direct confrontation all the more dangerous.
If the Nurse is stunned and Alex is wielding his knife, the finishing move shows Alex stabbing her twice in her breast and throwing her down to a pool of her own blood. If with the fire axe, Alex will decapitate her from behind.
They may represent Alex's institutionalization in the mental hospital for four years and his possible suppressed libido and lust. As a young man in a mental hospital, Alex would be prone to no sex life, instead resorting to fantasies.
In Alex's diary, Alex writes that he believed that the nurses in the military hospital were sexualized to comfort the wounded soldiers. However, because Alex was never actually in the military, these nurses are likely his wishful fantasies to help him cope with his predicament. It is also possible they were the real nurses who nursed him at his mental hospital (presumably Alchemilla).
|“|| The food here is terrible. My bed is stiff. There's only one thing that makes it bearable: The nurses. These girls are incredible. They have these pristine white uniforms cut right above the knee, their breasts spilling out from their shirts. Look, I don't want to sound like a dirtbag or anything, I'm just saying I appreciate the military providing us with this one thing to brighten our days. Maybe it's sort of like payback for getting us stuck in this place to begin with. I don't know. All I can say is, "thank you."
Alex also writes that he was once sedated by the nurses, possibly explaining their hostility:
|“|| When I woke up, I was screaming. I wasn't sure if I was awake or not, because I was still in the hospital and it was dark. But then the nurses ran in. I couldn't calm down, so eventually they stuck me with a needle and sedated me. That's why all of this is kind of a blur. I'm still a little loopy from the drugs.
The fetuses they carry inside could also symbolize Joshua's birth. Whenever Alex kills a nurse, he is also killing the fetus inside. This may be a subconscious foreshadowing of the repressed memories of Alex killing his brother.
Their pregnancy could also be a symbol of Alex's lineage (to put it bluntly, a possible desire to impregnate a woman) and his consignment to sacrifice from birth, adding to the game's themes of "family", "lineage", and "tradition".
The nurses may also take on differing meanings depending on where they are in the course of the story. During the nightmare sequence at the beginning of the game, they likely represent the aforementioned hospital delusion as well as Alex's stay in an asylum. Nurses are also seen in the Grand Hotel, representing Clayton Doyle's terminal illness and deteriorating condition. Later, they are seen in Dr. Fitch's clinic, an appropriate setting.
- The Nurses are equipped with jiggle physics, adding to Alex's possible sexual frustration.
- When the player kills the first nurse on the Xbox 360 version in the hospital, they will receive the achievement "Alchemilla's Finest."
- This nurse also made an appearance in Anne's Story, representing Anne Marie Cunningham's refusal to put her father, Frank Coleridge, in a nursing home after he wound up in a persistent vegetative state. Anne approaches a nurse and says, "I'M taking care of him. He doesn't need a goddamn... nurse." Anne calls her a "goddamn whore" and a "crazy bitch".
|Anne Marie Cunningham - Murphy Pendleton - George Sewell - Frank Coleridge - Bobby Ricks - Howard Blackwood - John P. Sater - M. Koons - Freddie Gates - Mark Cunningham - Leonard B. Trent|
|Bogeyman - Doll - Leonard B. Trent - Nurse - Prisoner Minion - Screamer - Tormented Soul - Weeping Bat - Wheelman|
|Centennial Building - Devil's Pit - Lakeview Hotel - Overlook Penitentiary - Room 302 (South Ashfield Heights) - Ryall State Prison - Silent Hill - Toluca Lake|
|Fog World - Monster - Otherworld - Real World|
|Tom Waltz - IDW Publishing|