California Insider

My column Tuesday on nurse-patient ratios prompted a lot of reaction, including a few from nurses who pointed out the unintended consequences of a state edict requiring a certain number of RNs per patient in various wards. One hidden effect: hospitals are using relatively fewer licensed vocational nurses and nurses aides, leaving the RNs, while better staffed, to do more of the work, including work that is not directly related to the medical care of patients. Here's how one nurse sees it:

"I've worked as an RN since 1977, and these ratios are a mixed bag, at best. They give newer nurses a false sense of security. The nurses talk of how much they look forward to the ratios being lower, not realizing there is simply no way hospitals will be able to staff LVN's and nurses aides at the same levels they do now. I know of one hospital in Santa Monica that layed off all of its LVN's. The ratios encourage tunnel vision, and discourage teamwork and an attitude of everyone helping out wherever needed on the floor. If a nurse has one or two patients doing poorly--it doesn't matter what her ratio is. What will matter is the other nurses pitching in and helping out--which they can't do without violating the ratios..."

I got this email from a critic of the Berkeley study on Florida e-voting. It raises some interesting points:

I have just read through the UC Berkeley paper you linked about e-voting. There is a pretty significant pair of errors in it.

The assumption is made (but never disclosed) that in an honest election, e-voting patterns would mirror those of paper voting. But in fact, there is no way to know this. For example, marginal Democratic voters -- and since the error they purport to find is about 2.5%, we are talking about the margins -- in the Democratic counties could well be older retirees from New York and more frightened by electronic voting, while Republican voters in those Democratic counties could be younger and actually attracted by e-voting; even younger Democratic voters could have been more moved by 9/11 than older Democrats, and might also be less afraid of e-voting.

The second assumption is that if there is an actual discrepency between the results as obtained by the e-voting=1 model (use of electronic voting machines) and the e-vote=0 model (no e-voting), that the correct way to interpret this is that there were between 130,000 and 260,000 "excess votes" for Bush. But mathematically, it's equally valid to suppose that there was a Republican suppression factor in the 2000 and 1996 elections -- that is, that the Democrats cheated in counting punchcards in heavily Democratic districts in past elections -- which they were unable to do in 2004 with the electronic voting machines.

In fact, it is easier to cheat with punch cards: for one easy example, if you take a stack of ballots and push a long stylus through the "Gore" hole, this will have the effect of turning Bush votes into uncountable Bush and Gore double votes, while leaving Gore votes undisturbed. This requires no computer sophistication at all (or even a high-school diploma) and can be done by the lowest level of poll worker, long before the cards even leave the individual precinct.

All that the study actually found was that Bush's support in Democratic counties of Florida increased more than the level one would have expected from projecting Republican support in 1996 and 2000, and that this increase seems correlated to electronic voting. It does not and cannot tell us whether those "excess" votes are in fact legitimate or a result of fraud... for all that the authors pretend that's what they have found.

Rick Hasen at the Election Law blog has some additional analysis of this at his site.