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This could also not be a serial killer thing at all, and moreso be that the nurse was drugging patients to put them out. Which is still terrible, but not the same thing as intending to kill people even if some people died by malpractice of drugging them.
I would think if a nurse really wanted to be a serial killer and was a sole on-duty nurse there are probably slicker ways to have done so than using painkillers and sedatives that would turn up on an autopsy. Not to mention painkillers and sedatives arent really a surefire way to intentionally kill anybody, even if they can. But giving them in doses that are sure to stop someones breathing would also make them show up upon investigation quite clearly.
Sounds like this person was not a serial killer and was just drugging people to knock them out, which isnt necessarily intentionally lethal even if it can also kill. Realistically, as a palliative care nurse (even with him drugging people) some of them probably died more generally whether he happened to have drugged them or not. When dealing with people already dying I imagine it would be harder to concretely say he killed them without having massively overdosed them
Either way though, its certainly malpractice and people certainly died. So the verdict seems fair. He knew he was rolling the dice with their lives even if not trying to kill them