04 Apr Nurses Financial Relationships With Industry May Not Be Transparent
Dr. Quinn Grundy
MedicalResearch.com Interview with:
Quinn Grundy, PhD, RN
Postdoctoral Research Associate
Charles Perkins Centre
Faculty of Pharmacy
The University of Sydney
MedicalResearch.com: What is the background for this study?
Dr. Grundy: In 2010, United States (US) lawmakers passed the Physician Payments Sunshine Act as part of the Affordable Care Act. The goal of this legislation was to make publicly transparent the financial relationships between physicians and pharmaceutical and medical device companies. These relationships are associated with increased prescribing of high cost, brand name medications with limited track records for safety. Policymakers hoped that increased transparency would help to deter relationships between physicians and industry that could bias treatment decision-making in this way.
What caught our attention was that nurses, though they represent the largest proportion of health professionals, are omitted from the US Sunshine legislation. We questioned whether policymakers believed that nurses did not have the same kinds of relationships with industry as their physician counterparts, or, whether they did not believe that the consequences of nurse-industry interactions would warrant regulation.
Rather than assuming that nurses interacted with industry in the same way that physicians do, we conducted an exploratory, in-depth qualitative study of nurses’ interactions with industry representatives in day-to-day clinical practice. At 4 hospitals in the western US, we interviewed 72 nurses, hospital administrators, supply chain professionals and industry representatives. Over a period of 2 years, we also directly observed nurses’ interactions with what we call “medically-related” industry, including pharmaceutical, medical equipment and device, infant formula, and health technology companies.
MedicalResearch.com: What are the main findings?
Dr. Grundy: All of the 56 nurses we interviewed had interacted with industry representatives in the past year and the majority interacted largely with the medical device industry. Nurses reported having financial relationships with medically-related industry that were similar to those reported by physicians such as attending pharmaceutical company-sponsored dinners or serving as paid speakers for industry. However, the focus of the interviews conducted with nurses was their daily interactions with industry representatives that took place as part of their jobs.
However, when we approached hospital administrators, most asserted that nurses did not interact with industry at all. This sharply contrasted with nurses’ experiences of day-to-day contact with industry representatives conducting product in-service education, providing device support in the operating room or negotiating the purchase of medical products and equipment.
Nurses described these interactions as essential to their jobs, but that often the boundary between service and sales was blurred.
Thus, many nurses were ambivalent about their interactions with industry – they welcomed product support and information, but struggled to ensure sales reps adhered to hospital policy, biased information sources, introduction of unapproved devices, lack of accountability for product failure, and threats to patient safety and privacy.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Grundy: We identified some deeply held assumptions about nurses that serve to keep nurses’ interactions with industry “under the radar” for policymakers and the general public. One such assumption is that marketing to nurses either does not happen or that if it does, it is of no consequence because nurses do not prescribe.
What is generally unknown to the public is that nurses are responsible for many of the purchasing decisions within hospitals and frequently recommend treatments to prescribers and to patients. Thus, they are increasingly a valuable marketing target for medically-related industry. This may result in the introduction of higher cost devices and treatments into clinical practice that may be unsafe or ineffective if decisions are based on the best marketing rather than the best evidence.
Hospital policies and legislation such as the Sunshine Act need to be inclusive of all health professionals in order to truly achieve the goal of transparency. But to curb rising healthcare costs and to ensure patient safety, we need to take further steps to separate industry’s service role from its sales function. For example, sales representatives that provide product support in operating rooms work largely on commission, which creates clear incentives to push increased product use or the use of more expensive products.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Grundy: As this was an exploratory study, researchers need to further investigate the extent to which nurses interact with medically-related industry across specialties, in different regions and in the different kinds of facilities in which nurses work.
Further research is needed to understand the impacts of interactions between nurses and medically-related industry on purchasing decisions, treatment decisions and nursing practice to better understand the risks and benefits of these interactions.
Nurses are important end-users of many medical products and equipment and have particular expertise to offer manufacturers towards improving their effectiveness and safety. Future work should explore how interactions between nurses and industry can further these goals in an ethical and transparent manner.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Grundy: The public consistently rates nurses as the “most trusted” profession, suggesting they are a key part of the healthcare team. In order to minimize the impact of marketing on decisions around patient care, policies that seek to manage the relationships between health professionals and medically-related industry need to be inclusive of all health professionals, including nurses.
Citation:
Grundy Q, Bero LA, Malone RE. Marketing and the Most Trusted Profession: The Invisible Interactions Between Registered Nurses and Industry. Ann Intern Med. [Epub ahead of print 5 April 2016] doi:10.7326/M15-2522
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Quinn Grundy, PhD, RN (2016). Nurses Financial Relationships With Industry May Not Be Transparent
Last Updated on April 5, 2016 by Marie Benz MD FAAD