Nurse Interactions with Medical Industry are Common but Need Regulation, Study Shows

Nurse interactions with pharmaceutical and device companies are commonplace and beneficial, but they also can lead to conflicts of interest regarding drug treatment and purchasing decisions, according to researchers at UC San Francisco. Safeguards must be added, they say, to ensure the boundary between service and sales remains intact.

The study appears in the April 5, 2016, issue of Annals of Internal Medicine.

“We found that, contrary to popular opinion, nurses are highly influential targets for marketing, and they likely interact with sales representatives on a daily basis,” said lead author Quinn Grundy, RN, PhD, a recent graduate of the UCSF School of Nursing and now a postdoctoral research associate at the Charles Perkins Centre at the University of Sydney. “The assumption that because nurses do not prescribe medications, marketing to them must not really matter, serves to make these relationships entirely invisible to the public eye.”

While not able to prescribe medications, nurses still influence patient treatment through physician consultation and patient teaching. Nurses also research, evaluate and select medical products, devices and equipment for hospital purchase.

The disclosure of physicians’ personal financial ties to industry has become the standard for addressing health care conflicts of interest. Legislation has brought transparency to these relationships in an attempt to restore public trust and deter conflicts of interest associated with the increased prescribing of brand name, high-cost medications and devices and the underuse of older, still high-quality medications.

However, payment disclosures largely fail to capture the complexity of daily interactions between industry representatives and health professionals that are built into clinical practice and are often part of the job, the researchers report. In addition, the disclosures focus only on physicians, not registered nurses, the largest proportion of health professionals.

Nurse Relationships Similar to Prescribers

In their study, Grundy and her colleagues interviewed 72 participants with direct experience with industry – staff nurses, administrators, and industry and supply chain professionals – between January 2012 and October 2014 at four acute care hospitals in the metropolitan area of a large western U.S. city and at the annual conference of the American Association of Critical Care Nurses. The study included observations (shadowing and attendance at meetings and sponsored events), in-depth individual interviews, four focus groups, and content analysis of marketing materials and hospital policies.

The researchers found that all 56 nurses in the study interacted with industry in the past year, on average 13 times. One-on-one meetings with sales representatives were the most common interaction, along with sponsored lunches, dinners or events; gift offers; product samples; and paid participation in market research, speakers’ bureaus or consulting. Most interactions were with the medical device industry, followed by the pharmaceutical, health technology and infant formula industries.

Of the 56 nurses, 33 acknowledged benefits of working with representatives, and more than a quarter (16) said it would be impossible to do their jobs without industry resources. Thirty-nine (39) reported challenges with these relationships.

For the overall study, administrators at eight institutions initially were approached to participate. However, most asserted nurse-industry interactions did not occur at their hospitals and nurses did not have much interface with industry.

Further bolstering the belief that marketing to nurses does not occur is the sense that there is no point marketing to clinicians who cannot prescribe. But 46 of the 72 participants evaluated provided concrete examples where nurses had influenced treatment and purchasing decisions.

Overall, Grundy and her colleagues found nurses’ external financial relationships with industry were very similar to those reported by prescribers, but the most significant interactions occurred in daily practice, such as patient care and continuing education. The current policy environment makes these interactions “invisible,” leaving nurses with little guidance to ensure the boundary between service and sales stayed intact.

Changes Needed in Policy, Professions

To remedy these invisible interactions, the researchers in this study recommended amending current institutional policy to include all disciplines, ensuring a more comprehensive approach to controlling marketing influence within clinical settings. Nurses should be included in development of university and hospital industry relations policy to ensure it is relevant to their practice. Hospital administrators also need to recognize and support nurses’ work with industry.

Further, the nursing profession should take a leadership role in supporting nurses’ work with industry by incorporating it into a professional code of ethics, adopting a conflict of interest policy in nursing schools and professional associations, and incorporating preparation for interacting with industry in teaching curricula.

For industry, the roles for support personnel must be clearly defined, and staff need regular training to ensure boundaries are maintained, especially around patient care. Industry-delivered education should be supervised by hospital staff.

Additional research is needed to determine the frequency and prevalence of nurse-industry interactions; the impact at non-academic, private, not-for-profit hospitals; and whether these nurse-industry interactions occur globally.

“Nurse-industry interactions may be commonplace and influential, but they remain invisible in this policy climate,” Grundy said. “While some aspects of these interactions may be beneficial, others may pose financial risks to hospitals or safety risks to patients. Disclosure strategies alone will not provide health professionals with adequate support to manage day-to-day interactions. Management of industry interactions must include nurses’ interactions with industry.”

Other contributors to the Annals of Internal Medicine study were senior author Ruth Malone, RN, PhD, FAAN, professor and chair of social and behavioral sciences in the UCSF School of Nursing; and Lisa Bero, PhD, of the Charles Perkins Centre at the University of Sydney. Funding was provided by the Canadian Institutes of Health Research Doctoral Research Award and grant R36HS022383 from the Agency for Healthcare Research and Quality. Grundy was supported by the UCSF Graduate Dean’s Health Science Fellowship.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and UCSF Health, which includes two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco, as well as other partner and affiliated hospitals and healthcare providers throughout the Bay Area.