The “As-if” World of Nursing Practice: Nurses, Marketing and Decision-Making
We are currently featuring the article titled “The “As-If” World of Nursing Practice: Nurses, Marketing, and Decision-Making” by Quinn Grundy, PhD, RN and Ruth E. Malone, PhD, RN, FAAN. Based on an ethnographic study, the authors conclude that “nursing must deconstruct the “as-if” nondecisional myth by confronting conflicts of interest and owning fully its rightful clinical and advocacy roles.” This article is available to download at no cost while it is featured; I join the authors in inviting you to return here to share your responses and comments! Dr. Grundy shared this background about her work:
The Physician Payments Sunshine Act, passed as part of the Affordable Care Act, came into effect just at the time I was selecting an area of focus for my PhD dissertation. This legislation required pharmaceutical and medical device companies to publicly report all payments made to physicians and teaching hospitals and issued in a new era of transparency in United States healthcare. What surprised me, however, was that nurses were omitted from the mandate. This caused me to question whether nurses did not have these types of relationships with industry? Or, whether policymakers did not believe they warranted the same level of scrutiny?
Under the supervision of Dr. Ruth Malone, my co-author on this week’s featured article, I conducted an ethnographic investigation into the ways that registered nurses interact with industry in their day-to-day clinical practice at 4 hospitals in the western United States. What we found couldn’t have been more different than what the policy climate suggested.
Often on a daily basis, nurses interacted with industry representatives from multiple medically-related industries including
pharmaceutical, medical device, information technology and infant formula companies. These interactions including attending drug company-sponsored dinners, receiving payments for speaking or consulting, and receiving gifts at conferences or other sponsored events. Among physicians, these types of relationships have been associated with negative changes in prescribing habits including increased prescribing of brand-name, heavily marketed medicines with lower safety profiles.
However, to our surprise, nurses were mystified at the attention of sales representatives and wondered at their inclusion in marketing activities like drug dinners. They explained that as health professionals who cannot prescribe medicines, there was no decision-making for marketing to attempt to sway. Yet, these same nurses described their roles on hospital purchasing committees, narrated multiple instances where they had recommended treatments to providers, and described powerful influence over patient care within the hospital.
This article explores the conditions under which nurses’ considerable influence and power to affect change within clinical practice becomes invisible, even at times to nurses themselves. We call this the “as-if” world of nursing practice — a well-constructed, institutionally-preserved myth that nurses do not make decisions in the absence of doctor’s orders.
We hope this article will stimulate a conversation in the profession about the nature of conflict of interest in nursing practice and the need to recognize, and safeguard, nurses’ considerable decision-making power from marketing influence.