The insider

August 1, 2003
Julie E. Williamson

Julie Williamson is a freelance writer living in Arizona.

Pharmaceutical Representative

Make nurses your advocates.

Pharmaceutical sales representatives who place most of their detailing emphasis on physicians may very well be overlooking their best asset and ally – nurses.

Representing the largest healthcare occupation (with more than 2 million jobs), nurses are typically more visible and accessible than physicians, particularly in today's climate, where physicians are forced to see more patients in less time and are saddled with time-consuming paperwork. Beyond that, nurses spend more one-on-one time with patients and are often the first to hear complaints, requests and general feedback on prescription drugs, which makes them an increasingly vital resource for sales forces.

In light of such contributions, sales representatives who acknowledge nurses' overall value to the pharmaceutical industry and don't view them merely as physicians' gatekeepers will likely find the greatest success.

"More than ever, nurses are extremely vital to pharmaceutical sales representatives," says Tom Jones, marketing consultant for the American Association of Office Nurses in Montvale, NJ. "They are a great resource for information because they are the eyes and ears of both the patients and physicians. Sales reps need to be taking the time to build a rapport with nurses. Those who only see them as a means to an end are doing themselves and their companies a real disservice."

A growing number of pharmaceutical companies appear to be heeding that advice. The American Association of Office Nurses reports that the industry may be spending over a billion dollars of its annual sales force budgets talking to physicians' nurses. Similarly, a survey by Newtown, PA-based Scott-Levin reveals that drug representatives are placing a greater emphasis on detailing non-physician prescribers, such as nurse practitioners and physician assistants. The research firm also notes that some companies have "aggressive marketing strategies in place" to target such healthcare professionals.

NPs: A shot in the arm

Evolving healthcare dynamics have pushed nurse practitioners to the forefront of direct patient involvement, with many serving as front-line providers of primary and specialty care. Not only are they quickly becoming care leaders, they are also serving as critical resources for patients, physicians and the general public.

That lofty position in the patient care arena, coupled with the ability to prescribe medication, makes nurse practitioners an attractive resource in the drug detailing circuit. Studies have revealed that the quality of NP care is equivalent to that of physician care, and that few – if any – differences exist between the prescribing practices of NPs and physicians. Literature also reinforces the notion that NPs tend to have better communication, counseling and interviewing skills than physicians.

Sales reps' personal experiences also suggest that NPs can have a strong influence on physician prescribing practices and can even boost patient compliance with prescription drug use. In fact, the Scott-Levin survey "Expanding the Prescriber Base: Nurse Practitioners and Physician Assistants" reveals that 60% of nurse practitioners make recommendations to physicians to either expand usage rates or try new drugs.

One sales rep, who has been in the business for nearly six years, says the companies she has worked for stress the importance of building rapport with nurse practitioners and registered nurses.

"I have nurse practitioners on my call list just like physicians, because they are every bit as important," explains Rochelle Daniel, a sales representative for aaiPharma, a specialty pharmaceutical company based in Wilmington, NC. Daniel says the strong nursing focus was emphasized during her tenure at Indianapolis-based Eli Lilly and Co. – a practice that is also followed and encouraged at aaiPharma.

While NPs are highly beneficial to the pharmaceutical sales rep, the same can be said for registered nurses. Although they lack the ability to prescribe drugs themselves, they still can nudge physicians toward exploring new options, as one emergency department nurse notes.

"As an educator of the nursing staff, I can educate physicians based on what I learn from the sales rep and even make suggestions about trying a specific drug," says Pam Aitchison, a registered nurse at Evanston Northwestern Healthcare's Highland Park Hospital, Highland Park, IL. "You don't have to have prescribing capabilities to be heard. We also have a good rapport with the doctors."

Effective facilitators

Pharmaceutical representatives who build solid relationships with nurses may find the caregivers can also help squeeze them into a physician's busy schedule. Aitchison says reps often come in and briefly detail her on a product's benefits – information she can then use to track down the best doctor for the sales visit. Working with nurses can pay off big for reps in extremely busy, unpredictable environments like the emergency department, she says, "where there are more patients and nurses than physicians."

Of course, nurses are equally valuable in other settings, such as physician offices. Daniel says she works with numerous office nurses who carve out time with reps they respect, even if they are extremely busy. She says nurses also frequently go to bat for her with physicians who may otherwise be too busy for a sales visit.

"And in cases where the doctor just can't make the time, they are often willing to hear what you have to say and then pass the information on to the doctor later," Daniel notes.

Sources agree that there are times when nurses prove even more valuable than physicians, such as in providing reps with feedback – both positive and negative – from patients who are taking their drugs. One sales representative says nurses have the unique ability to feel out a patient's situation, ask specific questions, and learn more about that person's needs and complications.

"Nurses can bring more out of the patient, and they tend to find out ancillary issues that others may not," notes Patty Murray of Nutley, NJ-based Roche.

If there's a problem with side effects or dosing, she says, the nurse can pass that information on to the rep, who can then forward it to the pharmaceutical company. Having a reliable source who can alert them to such drug-related issues also prevents reps from being blindsided by physicians, and provides an advanced opportunity to improve quality and offer the doctor an effective solution.

Veto power

If improved drug usage and more productive face time with physicians aren't good enough reasons to develop positive working relationships with nurses, reps should consider that nurses have the ability to inhibit the use of a company's product and impede access to physicians.

One Phoenix, AZ-based nurse admits that when she comes in contact with reps who are pushy and disrespectful, she doesn't "put in a good word with doctors" and certainly makes little effort to boost prescribing of the rep's drug.

Brian Hommes, a pharmaceutical representative for aaiPharma, insists the same strategies reps use on physicians should also apply to nurses and other healthcare personnel.

"Like doctors, nurses don't want you to waste their time. Have a plan of attack in advance and know what it is you want to accomplish, whether it's just introducing yourself to the staff, providing literature on a new product or ultimately trying to get in to see the doctor," he says.

"Nurses have a lot of influence and doctors respect their opinions, so if you don't make an effort to educate them and provide them with useful [material], you'll not only be wasting their time, but yours as well." PR

Nature of the nursing profession

■ While state laws govern the tasks nurses may perform, it is usually the work setting that determines their daily job duties. The following are job descriptions for various types of nurses and care settings:

Hospital nurses form the largest group of nurses. Most are staff nurses, who provide bedside nursing care and carry out medical regimens. They may supervise licensed practical nurses and nursing aides. Hospital nurses usually are assigned to one area, such as surgery, maternity, pediatrics or emergency room. Some rotate among departments.

Office nurses care for outpatients in physicians' offices, clinics, surgicenters and emergency medical centers. They prepare patients for and assist with examinations, administer injections and medications, dress wounds and incisions, assist with minor surgery, and maintain records. Some also perform routine laboratory and office work.

Nursing home nurses manage nursing care for residents with conditions ranging from a fracture to Alzheimer's disease. Although they often spend much of their time on administrative and supervisory tasks, registered nurses also assess residents' health condition, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform difficult procedures such as starting intravenous fluids.

Home health nurses provide periodic services to patients at home. After assessing patients' home environments, they care for and instruct patients and their families.

Public health nurses work in government and private agencies and clinics, schools, retirement communities, and other community settings. They focus on populations, working with individuals, groups and families to improve the overall health of communities.

Occupational health or industrial nurses provide care at work sites to employees, customers and others with minor injuries and illnesses.

Head nurses or nurse supervisors direct nursing activities. They plan work schedules and assign duties to nurses and aides, provide or arrange for training, and visit patients to observe nurses and to ensure the proper delivery of care.

At the advanced level, nurse practitioners provide basic primary healthcare. They diagnose and treat common acute illnesses and injuries. Nurse practitioners also can prescribe medications (certification and licensing requirements vary by state). Other advanced practice nurses include clinical nurse specialists, certified registered nurse anesthetists and certified nurse-midwives.

Source: U.S. Department of Labor, Bureau of Labor Statistics, "Occupational Outlook Handbook," 2002-2003 Edition.

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