They always wield pipes in their hands, with which they use to attack victims. They move very fluidly and lack the twitching movements common to nurses, and are considered by many to be unrelated to nurses.
They have mottled grey skin with chunks missing from their bodies and wear bloody grey hospital gowns as well. They are large humanoid, nurse-like creatures, standing well over six feet in height and towering over Henry Towshend. The Patient is a type of enemy found in Silent Hill 4: The Room. In Silent Hill 3, the nurses are manifested from the mind of the protagonist, Heather, who is in actuality the now-grown Alessa Gillespie as such, like the first Silent Hill, the nurses' appearance here comes from Heather's hatred of hospitals and her memories of her painful hospitalization. Those with revolvers should be dealt with immediately, as they can attack from quite a ways away and deal a large amount of damage. Those armed with pipes swing away at Heather Mason when she comes close enough, limping towards her until they're in range. They are generally more dangerous than other creatures at the time, particularly those with the handgun.
If the Perfume is equipped while in the hospital, then they will attack in much greater numbers. They carry weapons as well, either the steel pipe or revolvers. They make heavy panting noises and, when injured, they utter bloodcurdling screams. Their hair is all uniformly cut into black bob cuts and they share the Bubble Head Nurses' busty appearance. It appears as though they have either coughed up blood or have been feeding on a bloody carcass, as blood is visibly splattered all around their mouths. Unlike in Silent Hill 2, the nurse creatures in Silent Hill 3 have a more "human"-like appearance, despite the fact that their faces are still rather distorted and deformed. The highly sexualized figures of the nurses are created to further James' anxiety. The Bubble Head Nurse is a result of severe anxiety in James over his wife Mary's terminal illness, along with the sexual deprivation that resulted and James' difficulty in dealing with both. It is here that the Nurses obtain their trademark character designs. They attack with melee weapons, and will swarm James if he finds himself trapped in an area with several of them. Here, the nurses wear low-cut blouses with the first several buttons undone to display their breasts their heads face backwards and are swollen and bloated, and they twitch and convulse violently, as if about to burst. The nurses of Silent Hill 2 are called Bubble Head Nurses, and are manifested from the mind of protagonist James Sunderland, combining his anxieties surrounding his wife's terminal illness and the sexual deprivation that came with it. Although they weren't necessarily members themselves, they were acting as puppets of the Order by keeping her alive. These monsters are created from Alessa's memories of her hospitalization and of the nurses that worked there, including Lisa Garland. They also have a male counterpart, Puppet Doctors, who appear in this game only. They carry scalpels which they use to attack the player.
It is thought that they are the nurses who worked at Alchemilla Hospital, but became controlled by parasites (the same parasite that later attacks Cybil Bennett) due to Alessa Gillespie's powers, giving them a humpbacked appearance. They are dark or blond-haired women, and are seen wearing blue or green cardigans and white blouses with matching skirts, to resemble the attire worn by nurses before the adoption of scrubs. In the original Silent Hill they are called the Puppet Nurses.
Generally these monsters wear uniforms that reflect those of contemporary nurses, though in the first game the Nurses wear a much older form of attire, such as cardigans, rather than modern day scrubs. The Nurses in general share many common traits across the entire series, with a few alterations both large and small that reflect the mentality and personality traits of the protagonist, (and in some cases, such as the original Silent Hill, the antagonist). Invariably, once inside the hospital, the player will encounter monsters manifested by the town which resemble deformed nurses. Due to the recurring themes of hospitalization, insanity, and death, each game features, at some point, a trip to one of Silent Hill's two hospitals, Alchemilla Hospital (which houses the town's emergency room) in Old Silent Hill and/or Brookhaven Hospital (which houses long-term patients and the mentally ill) in South Vale. In the Silent Hill franchise, monsters are manifested by the town of Silent Hill, which acts as a mirror of individuals' anxieties and fears.