Quinn Grundy, PhD, RN; Lisa A. Bero, PhD; Ruth E. Malone, PhD, RN
Financial Support: This work was funded by the Canadian Institutes of Health Research Doctoral Research Award and grant R36HS022383 from the Agency for Healthcare Research and Quality. Dr. Grundy was supported by the Graduate Dean's Health Science Fellowship, the University of California, San Francisco.
Disclosures: Dr. Grundy reports 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. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2522.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available from Dr. Grundy (e-mail, firstname.lastname@example.org). Statistical code and data set: Not available.
Requests for Single Reprints: Quinn Grundy, PhD, RN, Charles Perkins Centre, The University of Sydney, D17, The Hub, 6th Floor, Sydney, NSW 2006, Australia; e-mail, email@example.com.
Current Author Addresses: Drs. Grundy and Bero: Charles Perkins Centre, The University of Sydney, D17, The Hub, 6th Floor, Sydney, NSW 2006, Australia.
Dr. Malone: University of California, San Francisco, 3333 California Street, Laurel Heights, Room 455P, San Francisco, CA 94118.
Author Contributions: Conception and design: Q. Grundy, L.A. Bero, R.E. Malone.
Analysis and interpretation of the data: Q. Grundy, L.A. Bero, R.E. Malone.
Drafting of the article: Q. Grundy, R.E. Malone.
Critical revision of the article for important intellectual content: Q. Grundy, L.A. Bero, R.E. Malone.
Final approval of the article: Q. Grundy, L.A. Bero, R.E. Malone.
Obtaining of funding: Q. Grundy.
Collection and assembly of data: Q. Grundy, R.E. Malone.
Grundy Q, Bero LA, Malone RE. Marketing and the Most Trusted Profession: The Invisible Interactions Between Registered Nurses and Industry. Ann Intern Med. 2016;164:733-739. doi: 10.7326/M15-2522
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Published: Ann Intern Med. 2016;164(11):733-739.
Published at www.annals.org on 5 April 2016
The mainstay for addressing conflicts of interest in health care is disclosure of personal financial ties to industry. However, this approach fails to capture the complexity of industry interactions that are built into clinical practice. Further, the policy climate focuses on physicians and traditional pharmaceutical marketing.
To describe industry activities targeted at registered nurses.
Qualitative, ethnographic study conducted from January 2012 to October 2014.
Four acute care hospitals in a western U.S. city.
A purposive sample of 72 participants with direct experience with industry, including staff nurses, administrators, and industry and supply chain professionals.
Fieldwork, including observations (102 hours), semistructured in-depth interviews (n = 51), focus groups (n = 4), and documents analysis.
Nurses' reported financial relationships with industry were similar to those reported by prescribers. However, nurses reported that their most significant interactions with industry occurred in daily practice. The current policy environment rendered these interactions invisible, leaving nurses with little guidance to ensure that the boundary between service and sales remained intact.
This study could not determine the frequency or prevalence of nurse–industry interactions. The sample is not representative.
Nurse–industry interactions may be common and influential, but they remain invisible in the current policy climate. 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.
Agency for Healthcare Research and Quality; Canadian Institutes of Health Research; and University of California, San Francisco.
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