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Dan Long has been vice president of integrated healthcare markets (managed care) for GW Heritage Products at Research Triangle Park, NC-based GlaxoSmithKline since January 2001. Prior to this, he was the group director of strategic operations for managed healthcare, responsible for directing marketing and contracting strategies for managed markets. Long joined Glaxo in 1988 as a sales representative and has also been an account manager and the director of managed care for the Pacific region. Before joining Glaxo, he was a registered nurse and the manager of a variety of emergency departments, including Children's Hospital and Kaiser Permanente. Long is also a member of the Pharmaceutical Representative editorial advisory board.
Nurses can be powerful advocates.
The pharmaceutical representative's job just keeps evolving. Many factors can be identified as catalysts to change, but two large drivers are readily identifiable: Improved information systems allowing for the percise identification of key prescribers and the sheer volume of reps have changed the landscape. Twenty percent of doctors write 80% of scripts, and everybody wants to see them! These dynamics can make it difficult to provide the important clinical information you have to deliver to be effective in your territory.
It's a given that you will work hard, but working smart is what separates the highly successful from those in the middle of the rankings. Coming from the perspective of being a nurse for many years, I know that selling to nurses presents a great opportunity, but you have to work smart to be effective. Some homework is needed to understand which nurses have an impact on the therapeutic areas near and dear to your heart. Your time is your biggest asset, and targeting is still the name of the game.
Registered nurses represent the nation's largest healthcare profession, actively employed in 2.1 million jobs in 1998. Sixty percent are employed in hospitals. Most general-practice offices use nursing assistants or other non-professional staff. Registered nurses may be prepared for practice in associate degree, nursing; bachelor of science, nursing; or master's degree programs. They may progress in clinical scope in a variety of manners (specifically, as a clinical nurse specialist, nurse practitioner, certified nurse midwife or nurse anesthetist). As a result of healthcare reform and managed care influence, more sophisticated procedures are being done in outpatient settings such as surgery centers, cancer treatment centers and other specialized, freestanding facilities, so specialty nurses are frequently involved outside of traditional hospital environments.
How do these demographics impact your planning and activity? I'll use some broad brush-strokes to identify three different brands of RNs: generalists, specialist RNs and nurse practitioners.
Generalists probably have the least influence on prescribing habits. They can, however, be important to raise the level of awareness of new products, and can be advocates for products that really improve the quality of their patients' lives. Additionally, they can be a great conduit for information regarding managed care formulary status and mechanisms for reimbursement if there are challenges to access.
Specialty RNs may be credentialed formally or may be RNs who work very closely with specialty physicians. These RNs have a very high degree of clinical knowledge, and their advice to physicians is frequently viewed more as the opinion of a coworker than that of a subordinate. For example, nurses in allergists' offices understand causes and treatment modalities for all types of asthma and rhinitis. They frequently get more details related to a patient's symptoms and response to treatment than the physicians do. Should the patient be awakened with nocturnal asthma that disrupts sleep patterns, the RN frequently gets that history rather than the physician.
Nurses are advocates for quality of life and are very interested in medications that will allow their patients a good night's sleep. Sound like a selling opportunity? It's also an opportunity to make a contribution to better patient care and a way to be a resource to a medical practice. I'm sure other examples leap to mind. Which products offer total symptom relief to migraine patients? Does the ergotrate work for their headache, but cause symptomology that interferes with the family's quality of life? The physician might believe the patient is getting a good result when there are options that may be much more effective. Nurses are great advocates for a holistic approach to their patients.
Specialty nurses also work in an area that focuses on a smaller number of disease states. They are likely to be a conduit to key prescribers in therapeutic areas in which you already have an intense focus. These offices or centers often organize their schedules around specific times that procedures are done, when physicians make rounds at the hospital or other obligations of the physician. Making a total office call that revolves around multiple healthcare professionals requires an understanding of office patterns. Para-medical staff and nurses can help you gain insight to maximize your timing.
At the advanced level, nurse practitioners deliver primary patient healthcare. Their scope of practice allows the diagnosis and treatment of garden-variety acute illnesses and inquiries. These RNs have prescribing authority in all states and the District of Columbia. The American Nurses Credentialing Center offers the following nurse practitioner certifications: acute care NP, adult NP, family NP, geriatric NP, prenatal NP, and psych mental health (adult and family) NP.
These RNs can practice in a wide variety of settings, including office practices, emergency departments, home health, nursing homes or ambulatory emergency centers. This area of nursing practice is growing â especially with managed care forces driving down healthcare spending.
My personal experiences demonstrate the untapped opportunities presented by nurse practitioners. As a nurse manager, I supervised an emergency pediatric and urgent care center that treated large volumes of patients. Each of the pediatric nurse practitioners I managed would see 40 to 50 patients per shift. Virtually every patient left the department with an Rx in hand. Were we open to better therapies for the kids? Absolutely!
Nurse practitioners are required to function under written guidelines and with some supervision from a physician. States vary significantly on how this is managed, as well as the scope of prescribing ability. Clearly, you have to understand how the NPs' prescribing authority extends to your products and any protocols they may operate within.
The busier the provider, the more difficult access can be. So work smart. Most RNs are members of local associations that meet regularly or attend their own group meetings. Education updates are almost always part of these meetings. Offers to provide access to quality information on medicines that can improve care (especially if continuing education credits are involved) can meet with a warm reception. This is frequently a better setting in which to provide information than a hectic environment at the hospital or office.
An important caveat to this article is that any detailing of your company's products must be within company-approved guidelines. All promotional activities must comply with Food and Drug Administration standards. Shortcuts undermine our credibility in the eyes of healthcare professionals and regulatory agencies. Detailing RNs represents no variance in these standards.
Your targeting of calls depends on the life cycle of the products (early launch versus broad recognition of a product), access to the physicians who are most important in your territory, and the therapeutic areas your products represent.
There are many great opportunities to provide support to registered nurses who can influence the choices made to optimize patient care. Careful targeting and judicious use of your time are critical. This group doesn't appear as "high-decile writers," but if you understand the dynamics of your territory, there are real opportunities to sell your product and improve nurses' ability to be powerful advocates for their patients. Nurses view healthcare differently than physicians do, and they are a powerful force. Work smart and they can be a great ally to you. PR