RNs' Interactions With Industry Fly Under Disclosure Radar

Marcia Frellick

April 05, 2016

Interactions between nonprescribing nurses and industry are common and may influence care, but they are "invisible" under the current disclosure policies and guidelines, which focus on physicians, authors of a new study say.

Quinn Grundy, PhD, RN, from Charles Perkins Centre, the University of Sydney, Australia, and colleagues purposively recruited 72 participants with direct experience with nurse–industry interactions. Participants included advanced practice nurses with prescribing authority, nonprescribing staff nurses, administrators, and industry and supply chain professionals at four acute care hospitals in a US western metropolitan area and at an annual nursing conference.

All 56 registered nurses (RNs) in the study reported they had interacted with industry in the past year, according to results published online April 5 in the Annals of Internal Medicine.

The researchers used four forms of data collection to characterize the encounters: targeted observation of nurse–industry interactions, focus groups with RNs, one-on-one interviews, and analysis of hospital policies.

Most Common Interactions

The most common interactions were one-on-one meetings with sales representatives, which happened on average 13 times in the previous year. Other common interactions were sponsored meals or events (n = 39), gift offers (n = 40), product samples (n = 34), and payments related to speaking, consulting, or participating in market research (n = 15).

Most of the interactions were with the medical device industry (n = 47 RNs), as well as with the pharmaceutical (n = 31), health technology (n = 12), and infant formula (n = 2) industries. About one third (20 of 56 nurses) of the participants were standing members of their institutional purchasing committees.

Potential for Conflict Misunderstood

Almost half the nurses (n = 25) described the blurring of boundaries between service and marketing. However, aspects of these relationships were largely unknown to administrators.

Hospitals often rely on the relationships between RNs and industry but are unaware of the potential conflicts, the researchers note. Responses in the study included that because RNs do not prescribe, there would be no point to marketing, so conflicts do not exist.

In addition, "[m]arketing to nurses was widely considered innocuous because it was difficult to link it to a particular decision, as is the case with pharmaceutical marketing and a prescription," the authors write.

Some aspects of the interactions may be beneficial, but others could pose financial risks to hospitals and safety risks to patients, according to the authors.

They acknowledge that the study was small and not representative because participants had direct experience or interest in the subject being studied, but they say the data warrant a call for changing regulations of industry relationships to include all nurses to keep boundaries between sales and care.

Such a bill to expand the Sunshine Act has been proposed to include prescribing nurse practitioners and physician assistants, but not RNs, who number nearly 3 million in the United States and make up the largest proportion of health professionals.

More Evidence Needed

Connie M. Ulrich, PhD, RN, from the University of Pennsylvania School of Nursing and Perelman School of Medicine in Philadelphia, and Christine Grady, PhD, RN, from the National Institutes of Health Clinical Center in Bethesda, Maryland, note in an accompanying editorial that they were glad the study spotlighted the issue, but warned against making sweeping changes in light of one study.

"Unfortunately, the small sample size and qualitative nature of the study does not help us fully understand the reality — it only tells us that a problem may exist within the institutions sampled," they write.

They say there is some guidance in the 2015 Revised Code of Ethics, which "broadly identifies conflicts between nurses and patients as well as conflicts in 'any domain of nursing activity.' This would include incentives, bonuses, and gifts from industry."

Balancing the benefits and potential harms in these relationships is important. For instance, nurses benefit from outside expertise and resources when they introduce new technologies and when devices and systems break down.

However, the editorialists acknowledge potential risks in relationships with industry that could damage the nurses' reputation.

"As the authors correctly point out," they write, "the public and patients have long identified nurses as the most trusted professionals."

The study was funded by the Canadian Institutes of Health and the Agency for Healthcare Research and Quality. Dr Grundy was supported by the University of California, San Francisco. Dr Grundy also reports receiving grants from the Agency for Healthcare Research and Quality and the Canadian Institutes of Health Research and a fellowship from the University of California, San Francisco, during the conduct of the study. The remaining authors and the editorialists have disclosed no relevant financial relationships.

Ann Intern Med. Published online April 5, 2016. Article abstract, Editorial extract


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