How ProPublica Investigated Nurses & You Can Too

In July, I told you about a remarkable series of stories by ProPublica and the Los Angeles Times that investigated why so many nurses with legal problems were still licensed. It often took the state of California years to hold accountable nurses who stole drugs from patients or abused prescription drugs themselves.

Now, the Pulitzer-Prize winning reporters who wrote those stories are sharing their “reporting recipe” with you. Journalists Charles Ornstein and Tracy Weber will conduct a conference call Thursday at 2 p.m. ET. Just go here to sign up for the call.

I asked Ornstein some questions about the project. Here’s an edited version of our e-mail exchange.

Al Tompkins: These kinds of big database projects seem unrealistic for small newsrooms or even larger newsrooms that have lost a lot of folks. Are there ways to bite off smaller parts of this project and still come away with something worthwhile?

Charles Ornstein: This type of story can be as big or small as you want it to be, as long as you examine enough records to legitimately draw conclusions. We looked at all disciplinary records from the California Board of Registered Nursing from 2002 to 2009 to get a good historical look at trends, but a reporter could take a look at a shorter time window — six months or one year. I’d make two important points, though:

  1. Ask officials if anything significant happened during the window you’re studying to ensure it is not an aberration; and
  2. Compare your state’s performance to other similar states.

How important was the online multimedia to your project?

Ornstein: It was incredibly important. Five years ago, Tracy Weber and I worked on a project about a troubled hospital in South Los Angeles. Other than online photos, it had practically no multimedia components.

This story was designed so that readers and users could interact with it in the way they saw fit. We put our database online so that users could search for sanctioned nurses and review all of the examples we cited (i.e., when we said we found 80 nurses, our site offered links to all of them). Dan Nguyen of ProPublica did stunning work making the database user-friendly.

We also had two audio slide shows narrated by characters in our story (produced by L.A. Times photographer Liz Baylen). They can be found here and here.

These were incredibly powerful — allowing viewers to meet the characters and hear their experiences. Finally, L.A. Times graphic artist Raoul Ranoa created four interactive Flash graphics showing nurses’ journeys through the disciplinary system. You can see all of them here. They include “stops” at each problem job, along with every related disciplinary document. Allowing our readers to see as many — or as few — of these as they want took this story to another level.

Is there any real hope that state regulatory boards will someday talk to each other, the way the FBI’s NCIC, (National Crime Information Center) tracks criminals and stolen cars?

Ornstein: We can only hope so. Our final story of 2009 showed the deadly consequences when boards do not communicate with one another. A nurse who lost her license in Florida for lapses in the care of a child who died went on to get a job in Connecticut where she was later faulted for lapses in the care of another child who died. We found hundreds of examples of nurses disciplined by one state who had clear licenses in others.

Both The Texas Tribune and The (Allentown, Penn.) Morning Call used your recipe tips to track down stories of “errant nurses” near them. How surprised are you that the problem of drug-abusing nurses is so widespread?
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Ornstein: It was clear to us with California nurses that problems of addiction are serious and represent a big share of disciplinary cases. Some people read our stories as criticizing efforts to aid nurses in their recovery. This was not our intention. What our stories said is that nursing boards are created to protect the public first and assist the profession second. Often, California’s program did the reverse.

Not only did we show that the drug program didn’t work for many nurses (more than half of participants didn’t complete it), but we also showed that the public wasn’t protected when nurses did fail, often spectacularly. They were allowed to continue caring for patients for months and months while the board continued looking into their cases.

What is the one question you hope somebody will ask during Thursday’s conference call, and how will you answer it?

Ornstein: There’s no one question that we hope people will ask, but the best outcome would be greater scrutiny of nursing and other regulatory boards. We’re hoping that those attending the call will stay in touch afterward, and share further tips and suggestions. We’re committed on our end to continue shining a spotlight on this issue.

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