Nurses in the Pharmaceutical Industry: Part 3:
SummaryWe have already considered in previous articles the role of the nurse adviser and how nurses cope with the transition from NHS into a commercial environment. This month we look at how nurse advisers a
Nurse adviser teams are still a fairly new concept. Many representatives still have little or no direct experience of working for a company that sponsors such a team. This means that there is often a lack of understanding of how these teams work, particularly in terms of the relationship with the representative. This lack of understanding can lead to misconceptions and concerns about the impact of the nurse on the representative’s territory. Some representatives are concerned that the nurses may upset their customers and ruin their established relationships. Some may see the nurse as being in competition with them. Other representatives may welcome the nurse with open arms, believing that they will be a great source of information on individual doctors and clinics. This group rapidly become frustrated when they discover that ethical and confidentiality constraints prevent this. For many projects, particularly when they are first set up, it is down to the representatives to refer practices/departments that are interested in the nurse adviser service. Often representatives do not see the value in this additional work, particularly if customers are resistant to the idea, so they may not make sufficient referrals to allow the nurse to work to her fullest capacity. In fact, the thought of working with a nurse adviser team can leave the representative thinking ‘All this extra work and what is in it for me? How is this going to help me achieve my territory objectives?’ The Nurse Adviser Perspective If we then consider the nurse’s perspective, they have a completely different set of concerns. One of their highest priorities is that they do not compromise their ethics. As healthcare professionals, working within the pharmaceutical arena, nurse advisers are keen to ensure their independent status conforms to the statutory requirements of their regulatory body, the UKCC code of conduct. Nurse advisers are very clear about their non-promotional status (they do not promote any product or provide a "service for products" i.e. they do not provide a service in exchange for product usage, they provide it for the purpose of improving patient outcomes). In fact, they are so clear on this point that some may see no possible need to have a relationship with the wholly promotional sales representatives. One of their other concerns is the impact on their credibility with customers if they are seen with or linked to a representative. Nurses tend to approach the situation from a different angle to the representatives. They have a different relationship with clinicians in that they are able to work with the clinicians peer-to-peer, providing advice and assistance in implementing best practice. Unsurprisingly, nurse advisers are keen to preserve this relationship. All these factors can lead to a nurse adviser expecting the representatives to provide the centres that they will work in and then leave them to it. For some nurses this is as much of a relationship as they see necessary. Maximising the Relationship Looking at it from the 2 perspectives, both groups appear to have quite divergent agendas. However, by maximising their working relationship, within clear ethical boundaries, each party can gain significant help in the achievement of their own quite separate goals. The representative can ensure that the nurse adviser service is sold as a concept, to enough customers, to maintain the level of throughput of centres/practices that the nurse requires. They can also ensure that the introductions are appropriate so as not to waste either the customer’s or the nurse’s time. Once in the practice the nurse can ensure that the relationships that they build and the service that they provide further enhances the reputation of the sponsoring company as being experts in a particular arena. Their positive experience and the positive feedback from their patients, as well as the measurable improved patient outcomes, can only assist the representative in their future dealings with the practice. It is up to the representative to then capitalise on this. The key to maximising the relationship is, as with many things, communication. Both parties need to have a clear understanding of and mutual respect for each others roles, objectives and boundaries. This enhanced understanding can be facilitated through meetings. Meetings between nurses and representatives can aid the situation, provided there are very clear guidelines for these meetings so that their independent status and other ethical boundaries are not compromised. On some occasions it may even be appropriate for the representative to be involved in the introduction of the nurse, to facilitate the process, but both parties need to understand that once the nurse is introduced they need to be left to work independently. In addition communication between the two groups can be enhanced by the Nurse Managers, part of whose remit is to balance the commercial and ethical issues. By attending regional, national meetings and initial training courses the manager can provide feedback on the team’s achievements and the do’s and don’t’s of how the two groups can work together. Once good communication and understanding are in place, everyone involved starts to see the benefits of the programmes. One representative described her expectations of working with nurse advisers when she first joined her current employer, ‘my initial expectations were quite high because when I joined the team, my first day was a regional meeting where there was an update on the nurse team. Three of my colleagues were already using the service. I was listening to the feedback from them about a professional service with well trained nurses who are adaptable and really try to help the surgeries as much as possible’. Having now worked alongside her local nurse for some time her personal experience has only served to enhance this position, ‘I am proud to discuss the nurse adviser’, she says, ‘what a wonderful service, what a wonderful team’. So although the relationship between nurses and their sponsoring company’s representatives can be a tricky balance and whilst it does not always get off to a good start, with a clear understanding of each other’s aims and the benefits for both, a positive working relationship can be established which leads to positive outcomes for all.