Estimating the Effect of New Jersey’s 2005 Administrative-Nurse Mandate on Mortality and Availability of Care for Hemodialysis Patients
Estimating the Effect of New Jersey’s 2005 Administrative-Nurse Mandate on Mortality and Availability of Care for Hemodialysis Patients

January 8, 2020

Project Summary

In the United States, over 660,000 people are affected by kidney failure or End-Stage Renal Disease (ESRD). ESRD is an irreversible condition that requires a kidney transplant or treatment through dialysis to prevent death. An aging population coupled with increasing rates of obesity and diabetes has resulted in growing instances of ESRD since the 1980s. As a result, lawmakers in some states have become concerned that existing hemodialysis clinics, which provide treatment for ESRD, may not provide adequate care to patients due to strains on nursing staff.

In 2005, New Jersey regulators enacted a rule requiring hemodialysis clinics to keep an administrative nurse on-site at all times and prohibits that nurse from participating in patient-care activities. This regulation was intended to reduce the administrative burden felt by patient-care nurses at hemodialysis clinics and free up the nurses’ time to focus more on patient needs. The requirement to keep an additional nurse on-site for administrative purposes, however, also creates a financial burden for clinics.

For the 2005 law to be effective, there should be some evidence of improved health outcomes at hemodialysis clinics in New Jersey since its passage. To identify whether or not health outcomes have improved, this paper uses a synthetic control method to compare patient outcomes in New Jersey to a control group of states meant to mimic what would have happened in New Jersey if the nurse-staffing rule had not been enacted.

After comparing New Jersey’s results to the synthetic state, the authors find the following:

  • There is no evidence that the mandate reduced the death rate of Medicare patients, despite increasing costs through mandatory staffing requirements.
  • There is no evidence that the rule reduced the number of hospitalizations of dialysis patients with Medicare.
  • There is suggestive evidence that the law reduced the number of hemodialysis clinics in the state.

These findings have important implications for all states working to improve health outcomes at clinics. Increasing staffing mandates may not have the intended result of improving health outcomes. Instead, by increasing the costs of operating clinics the policy may actually reduce the availability of care for those in need of dialysis treatment.