WOODSTOCK, Ont. -- A former Ontario nurse angry with her career and personal life believed she was an instrument of God as she used insulin to kill vulnerable seniors in her care over the course of nearly a decade.

About seven months after her arrest last fall, Elizabeth Wettlaufer pleaded guilty Thursday to eight counts of first-degree murder, four counts of attempted murder and two counts of aggravated assault.

The crimes -- which took place in three Ontario long-term care facilities and at a private home -- make Wettlaufer one of Canada's most prolific serial killers.

Emotional family and friends of her victims packed a Woodstock, Ont., courtroom as the 49-year-old quietly said the word "guilty" 14 times and admitted to a judge that she used insulin in every case.

"There was always that red surging that I identified with God talking to me," Wettlaufer told a detective calmly in a confession video played in court. "Then I'd go get the insulin."

Prosecutors laid out the details of each incident in an agreed statement of facts that included chilling revelations Wettlaufer made to authorities. Later, the crowded courtroom watched the video of the former nurse confessing to Woodstock police last October, saying she had told others about some of her crimes more than three years earlier.

In many cases, a growing rage over her job and her life built up until Wettlaufer felt an "urge to kill," believing she was helping God, court heard. She said the feeling would only abate after she overdosed her victims.

"Then I'd get that laughing fit, like a cackle," she told police.

Court heard that Wettlaufer was not intoxicated on drugs or alcohol when she killed or tried to kill. Many of her victims lived with dementia.

She told police she knew that "if your blood sugar goes low enough, you can die." She also told police she refrained from logging her use of insulin in order to avoid detection, court heard.

In Aug. 11, 2007, Wettlaufer deliberately injected James Silcox, an 84-year-old man with diabetes and Alzheimer's disease, with insulin, "hoping he would die," the Crown said.

"It was his time to go because of the way he acted," she told police, according to the agreed statement of facts.

Silcox was later found without vital signs by a personal support worker, court heard. That was Wettlaufer's first "successful" kill after two previous attempts failed.

Wettlaufer told investigators that afterwards, she felt "like a pressure had been relieved from me, like pressure had been relieved from my emotions."

There were religious undertones to many of the killings, court heard, and in some cases, there was no motive other than "returning them to God."

"I honestly felt that God wanted to use me," Wettlaufer told investigators at one point.

Wettlaufer would even comfort some of her victims' families after her crimes. In one incident, court heard that she hugged the niece of a 90-year-old woman she had murdered.

The former nurse may have gotten away with the killings if she kept quiet. But, court heard, Wettlaufer told her pastor about some of the people she had killed.

"He prayed over me," she told police. "He said if you ever do that again, we'll have to tell police."

Wettlaufer also told a lawyer about everything in 2014, who advised her it was in her best interests to stay silent, court heard.

The former nurse also told other friends and acquaintances about killing patients with insulin, some took her seriously and told police, but most didn't tell authorities, or believed she was lying, court heard. Many of those confessions came last fall.

Then, last September, Wettlaufer admitted herself to a psychiatric hospital in Toronto.

There she repeatedly confessed to the killings to doctors and staff, who told police. At the hospital she wrote a four-page confession.

"She insisted she wanted to be treated seriously," said Crown attorney Fraser Kelly.

Wettlaufer jumped at the chance for an interview with Toronto police, where she confessed again. Then she told the story, "with great recall and in great detail," to Woodstock police, Kelly said.

In that confession, Wettlaufer apologized to the families of her victims.

"I am sorry," she said without emotion. "I am extremely sorry."

"What would you say to the families?" the detective asked.

"I'm sorry isn't enough," Wettlaufer said. "I should have gotten help sooner. I took something from you that was precious and taken too soon. I honestly believed at the time that God wanted to do it, but now I know it's not true. If I could take it back, I would."

Some family members of Wettlaufer's victims broke down in the courtroom as the proceedings unfolded.

At one point, a close friend of a man Wettlaufer killed walked by the prisoner's box and yelled expletives at the former nurse.

Susan Horvath, whose father was killed in 2014, called Wettlaufer a monster.

"It tore me apart. Tore me apart to hear how she killed my dad," she said outside court. "And she's sitting there, no expression on her face."

Horvath said she could not forgive the former nurse and called for better oversight at the province's long-term care facilities.

"I don't want my dad's death, and everybody's death, to just be wasted," she said. "Let's make a change."

The Registered Nurses' Association of Ontario called for a public inquiry into the deaths of Wettlaufer's victims.

"We need to get to the bottom of what happened, how it happened and what we can learn from an organizational, regulatory and system perspective to ensure nothing like this ever happens again," Doris Grinspun, RNAO CEO, and the group's president, Carol Timmings, said in a statement. "We want no stone unturned in this effort."

Records from the College of Nurses of Ontario show Wettlaufer was first registered as a nurse in August 1995 but resigned Sept. 30, 2016, and is no longer a registered nurse.

Court heard Wettlaufer stopped nursing because she was transferred to a different job where she would be dealing with diabetic children. She didn't trust herself around children and insulin, court heard. Wettlaufer still faces a disciplinary hearing with the nurses college, court heard.

Sentencing hearings for Wettlaufer will take place on June 26 and 27, with both the Crown and her defence lawyer suggesting she serve her sentences concurrently.

CTVNews.ca provided live updates from the court, replay the live blog below:

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