Nursing diversity

May 1, 2006
Michelle Nolin Flewell

Pharmaceutical Representative

Volume 0, Issue 0

You can tailor your approach if you are able to recognize the diversity in the field of nursing.

Whether you're promoting within a hospital, a physician's office or a specialty clinic, do you employ a one-size-fits-all sales approach to nurses? There are actually many kinds of nurses, all with their own interests and concerns. So if your answer to the opening question is yes, you may want to reconsider your approach and begin to focus on the different nurses in the field, challenges facing the nursing profession, and strategies for communicating with and bringing value to this vital member of the healthcare team.

Different needs

Nurses can be valuable allies, no matter what type of nurse you are working with. However, you will be more able to tailor your approach if you can recognize the diversity in the field of nursing in terms of experience, education and responsibilities.

Registered nurses. Registered nurses represent the largest segment of the nursing workforce. According to the Department of Health and Human Services, there are approximately 2.9 million licensed registered nurses living and working in the United States today, of which about 83% (2.4 million) are employed in a direct care or nursing capacity. Registered nurses are able to administer prescribed medications, in addition to their countless other clinical management responsibilities.

There are three paths to R.N. licensure: a two- or three-year diploma program, an associate's degree in nursing (A.D.N.) from a junior or community college, and a four-year bachelor's degree in nursing (B.S.N.) from a college or university. In recent years, the number of registered nurses entering the field from a diploma program has decreased, while the number entering the field with an A.D.N. or B.S.N. has increased.

Many registered nurses choose to receive advanced training and certification in various specialty areas. For example, a registered nurse with a B.S.N. may be certified in cardiology, gerontology, pediatrics, psychiatry, perinatal, medical-surgical (or "med-surg") or other specialties. A registered nurse with an A.D.N. may also be certified in similar categories.

A nurse practitioner at a MinuteClinic inside a CVS/pharmacy in Eagan, MN, administers a blood-pressure test.

Advanced practice nurses. Nearly a quarter of a million nurses practicing today fall into the category of advanced practice registered nurses, many of whom have master's degrees or advanced clinical training beyond that required for a registered nurse.

Nurse practitioners. The largest segment of advanced practice nurses is composed of nurse practitioners, who can further specialize in adult or family practice, pediatrics and other areas of medicine. Nurse practitioners have prescribing authority in all states, as well as considerable clinical autonomy. Experts estimate that the number of nurse practitioners in the United States will soon approach 125,000 — roughly the same as the number of primary care physicians. Each state has its own Nurse Practice Act or similar legislation that defines what an advanced practice nurse can do. With growing demands in healthcare, the role of these "physician extenders" will likely continue to increase.

Other kinds of advanced practice nurses include:

Certified nurse midwives. Certified nurse midwives provide care for women throughout pregnancy and childbirth, and in some cases they provide primary care services as well.

Clinical nurse specialists. Clinical nurse specialists, most of whom hold a master's degree in a particular specialty, may practice independently and/or in hospitals, long-term care settings and healthcare agencies.

Certified registered nurse anesthetists. These nurses provide anesthesiology services to surgical patients under the supervision of an anesthesiologist.

All types of advanced practice nurses may be found in administrative and supervisory roles as well, and as such, they may oversee aspects of the delivery of care and may serve on pharmacy and therapeutics committees.

Licensed practical nurses. Another type of nursing professional is a licensed practical nurse. These nurses typically have one year of training from a community college or trade school and must pass a licensure exam. Licensed practical nurses do not administer medications.

There are a number of other types of healthcare workers who may, at first glance, appear to be nurses in the healthcare settings you call on. These may include nurse's aides, personal care assistants, nurse technicians and caregivers, all of whom fall into the category of "unlicensed assistive personnel" (UAPs). The Silver Spring, MD-based American Nurses Association defines UAPs as "individuals who are trained to function in an assistive role to the registered professional nurse in the provision of patient/client care activities as delegated by and under the supervision of the registered professional nurse."

The role of non-registered nurse caregivers and UAPs has grown in complexity in recent years, fueled in part by a recent shortage of registered nurses that is only expected to get worse in the future. The American Nurses Association has projected that the need for nurses will increase 21% from 1998 to 2008, outpacing needs growth in other occupations, which averages 14%.

Reasons for the current and growing nursing shortage include an overall aging of the nursing workforce and an inadequate number of slots for qualified candidates in nursing schools across the United States. In addition, many nurses cite unsatisfactory and deteriorating work conditions, stress, overwork, burnout, and lackluster salaries — all of which have contributed to the shortage.

Strategies for calling on nurses

Depending on the area of medicine in which your products are used, it makes good sense to determine which types of nurses practice and are influential in that area. Keep in mind that nurse practitioners can prescribe medication and registered nurses can administer medication, but licensed practical nurses and UAPs cannot do either. Thus, your focus needs to be on nurse practitioners and registered nurses.

When calling on registered nurses, avoid making assumptions about their educational background or advanced training. Ask them, and tailor your message to their appropriate level of training if possible. For example, a registered nurse with a B.S.N. or specialty certification might be interested in hearing details about the pharmacologic basis for the dosing of your product in addition to general information about administration.

Anything you can do to make nurses' jobs easier will most likely be welcome, including providing resources and information they can immediately put into practice. In addition to clinical information about your product, nurses may find the following helpful:

  • Prescribing information (for healthcare providers and patients).

  • "Reminder" devices they can use with their patients to improve compliance.

  • Copies of clinical studies.

  • Patient education materials, including posters, wall charts, anatomical models, fact sheets, educational brochures, disease management tools and body mass index calculators.

  • Information about pharmaceutical patient access programs for patients with limited financial means.

  • Managed care and drug coverage/reimbursement information, including formulary status details for the various health plans their practice accepts and information about Medicare Part D and the new prescription drug plans.

Regardless of their background or advanced training, nurses have an overarching focus on patient care and are on the front lines of clinical management. Nurses can be a source of valuable information, so allow them to talk about their clinical experiences with your product and your competitors'. Nurses have their finger directly on the pulse of what's happening in the day-to-day clinical management of patients. Forming relationships with these professionals can pay off, both for you and for the nurses you call on.