“They want your buy-in”: Nurses' interactions with industry in clinical practice

Background: Recent legislation, passed as part of the Patient Protection and Affordable Care Act, will require manufacturers of products covered under federal health programs to disclose payments and gifts made to physicians. This legislation aims to curtail rising healthcare costs and threats to clinician integrity through the disclosure of potential conflicts of interest. Notably, this “sunshine” legislation does not include nurses, even nurses with prescriptive authority. Very little work has explored nurses' interactions with industry in clinical practice; this pilot study sought to explore this multifaceted phenomenon. Methods: Audiotaped interviews with Registered Nurses (n=5) in clinical practice were analyzed qualitatively, utilizing a phenomenological approach to understand nurses' taken-for-granted perspectives about industry interactions. Results: Nurses frequently interacted with a variety of industries, including the pharmaceutical, pharmacy services, medical device, and information technology industries. Nurses relied on these interactions for continuing education and mentorship, for resources used in patient care, for product support, for provision of patient support and teaching, and for social outlets; and they acted as gatekeepers for industry access to patients and to other nurses. One nurse explained, industry “understand[s] that the nurses, that you know, the intensity of the care is as it is and you're the one that's constantly there at the bedside, so, they want your buy-in.” Nurses described frequently influencing treatment decision-making or being responsible for purchasing decisions and, thus, perceived industry to have vested interest in these interactions. Implications: These pilot findings suggest that further research exploring nurses' interactions with industry could inform cost containment and conflict of interest policy initiatives.