Marketing and the Most Trusted Profession: The Invisible Interactions Between Registered Nurses and Industry

Ann Intern Med. 2016 Jun 7;164(11):733-9. doi: 10.7326/M15-2522. Epub 2016 Apr 5.


Background: The mainstay for addressing conflicts of interest in health care is disclosure of personal financial ties to industry. However, this approach fails to capture the complexity of industry interactions that are built into clinical practice. Further, the policy climate focuses on physicians and traditional pharmaceutical marketing.

Objective: To describe industry activities targeted at registered nurses.

Design: Qualitative, ethnographic study conducted from January 2012 to October 2014.

Setting: Four acute care hospitals in a western U.S. city.

Participants: A purposive sample of 72 participants with direct experience with industry, including staff nurses, administrators, and industry and supply chain professionals.

Measurements: Fieldwork, including observations (102 hours), semistructured in-depth interviews (n = 51), focus groups (n = 4), and documents analysis.

Results: Nurses' reported financial relationships with industry were similar to those reported by prescribers. However, nurses reported that their most significant interactions with industry occurred in daily practice. The current policy environment rendered these interactions invisible, leaving nurses with little guidance to ensure that the boundary between service and sales remained intact.

Limitations: This study could not determine the frequency or prevalence of nurse-industry interactions. The sample is not representative.

Conclusion: Nurse-industry interactions may be common and influential, but they remain invisible in the current policy climate. Although some aspects of these interactions may be beneficial, others may pose financial risks to hospitals or safety risks to patients. Disclosure strategies alone do not provide health professionals with adequate support to manage day-to-day interactions. Management of industry interactions must include guidance for nurses.

Primary funding source: Agency for Healthcare Research and Quality; Canadian Institutes of Health Research; and University of California, San Francisco.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Conflict of Interest
  • Drug Industry*
  • Humans
  • Inservice Training / ethics
  • Marketing*
  • Nurses*
  • Nursing Staff, Hospital / ethics*
  • United States