Interaction between nurses and sales reps studied
The Physician Payment Sunshine Act threw a spotlight on how many payments and items of value vendors give to physicians and teaching hospitals. But a recent article in the Annals of Internal Medicine, the journal of the American College of Physicians, may turn a spotlight onto a hitherto unexplored relationship – that between industry reps and nurses.
“Nurse–industry interactions may be common and influential, but they remain invisible in the current policy climate,” write the authors of the article – Quinn Grundy, PhD, RN; Lisa A. Bero, PhD; and Ruth E. Malone, PhD, RN.
“Although some aspects of these interactions may be beneficial, others may pose financial risks to hospitals or safety risks to patients. Disclosure strategies alone do not provide health professionals with adequate support to manage day-to-day interactions. Management of industry interactions must include guidance for nurses.”
Under the radar
“[A]lmost nothing is known about the ways that RNs interact with industry, though research suggests they may have become an important ‘soft target’ for industry and a back door to prescribers in light of increasing restrictions on physician-industry interactions,” according to the authors. “This has been accompanied by a shift within the medical industry away from traditional marketing channels targeted at physicians, including a reduction in face-to-face marketing and an increase in marketing directed at non-physician clinicians, payers and patients.”
Yet administrators appear to be unaware of what’s going on.
To find out the true nature of nurse-sales rep interaction, the researchers surveyed and shadowed staff nurses, and asked questions of administrators, supply chain professionals and vendor representatives. “Administrators at eight institutions were initially approached,” write the authors. “However, most asserted that nurse-industry interactions ‘didn’t happen’ at their hospitals and that ‘nurses didn’t have much interface’ with industry.” None of the hospitals’ policies on industry explicitly referenced nurses or nursing practice.
Administrators often characterized reps’ in-service education to staff nurses as a “one-time, one-way, contracted event that was therefore outside the scope of industry relations policy,” according to the authors. “However, nurses who were responsible for in-service education experienced industry-delivered in-service education as a different phenomenon that was more akin to marketing.”
Although marketing to nurses was widely considered innocuous because it is difficult to link to particular decisions, nurses spoke of their ability to influence the distribution of resources and to affect patient care and institutional systems. For example, one infection control nurse served on all of the purchasing committees at her hospital. “She explained that for every product being considered for purchase, ‘my concerns have to be addressed before we make a final decision to go with a company or against a company.’ This nurse reported that she was heavily courted by sales representatives, who sought to form a relationship with her and to provide product information, gifts, and samples.”
Solutions
The researchers concluded that although some aspects of these interactions may be beneficial, others may pose risks “to the financial viability of hospitals, the safety of patient care, and the preservation of the public’s trust in the healthcare system.” What’s needed are policies that include all health care disciplines and aim to manage marketing and conflicts of interest, they say.
The researchers recommend that providers take the following steps.
- Include nurses at all levels in the development of university and hospital-industry relations policy to ensure that the policy is relevant to their practice.
- Allow the nursing profession to take a leadership role by incorporating nurse-industry interactions into professional codes of ethics, adopting conflict-of-interest policies in nursing schools and professional associations, and incorporating preparation for interactions with industry into curricula.
- Use industry representatives to augment clinical expertise, but don’t outsource that function to them. Industry-delivered education should be supervised by hospital staff.
- Vendors should compensate support personnel with salary, not commission. Nursing staff should receive regular training to ensure that the boundaries between sales and support are maintained.
- Hospitals should invest in in-house education and support to ensure unbiased, evidence-based continuing education and adherence to hospital policy.
- Hospital administrators need to recognize and support nurses’ work with industry. “Such work through purchasing and product evaluation committees should be supported with policies and tools to identify and manage conflicts of interest and to support independent, evidence-based and cost-effective decision-making.”
“Interacting with industry is a reality for practicing nurses in acute care hospitals,” conclude the authors. “This should be made visible and explicitly identified in job descriptions, should be part of staff orientation, and should be regularly supported through continuing education that addresses the ethical and practical aspects of industry relations.”
Source: “Marketing and the Most Trusted Profession: The Invisible Interactions Between Registered Nurses and Industry,” Annals of Internal Medicine, Vol. 164, No. 11, Jun 7, 2016.
Nurses agree: An issue worth studying
The study in the Annals of Internal Medicine “addresses an important issue, but more research is needed given its narrow scope,” said Cheryl A. Peterson, MSN, RN, senior director, nursing programs, American Nurses Association, responding to questions about “Marketing and the Most Trusted Profession: The Invisible Interactions Between Registered Nurses and Industry.”
“Conflict-of-interest issues arise in every practice setting,” she said. “However, the Code of Ethics for Nurses with Interpretive Statements makes it clear that the nurse’s primary duty is to the patient. The Code of Ethics also mandates that nurses in all roles must identify and, whenever possible, avoid conflicts of interest. Nurses must ethically address such conflicts in ways that ensure patient safety and promote the patient’s best interests.
“For the past 14 years, the public has voted nursing as the most honest and ethical profession in America, and with good reason. The public trusts nurses, and with that trust comes a responsibility to uphold the highest levels of quality and standards in our practice.”
Editor’s note: the Code of Ethics for Nurses with Interpretive Statements may be viewed at http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-2015-Part-1.pdf