Are You a Nursing Thought Leader?

Traditionally, nurses, academicians, and association leaders have been used as thought leaders to provide insight into nursing practices for the pharmaceutical industry. However, with the emergence of the nurse prescriber, clinician and business owner, has the industry adjusted its expectations of the nurse thought leader to address the emerging new stature of nurse prescribers?

No provisions have been made to break out the prescribing data from the more than 200,000 nurses in advanced practice with authority to prescribe (NPs, CNS, CRNAs and CNMs); therefore, prescriptions written by these providers are often ascribed to the physicians with whom they work, or the providers are erroneously classified as physicians. As a result, NP and PA prescribing activities are consistently underestimated, whereas physician prescribing is artificially inflated by these invalid data collection methods. In the 2005 American Academy of Nurse Practitioners survey, it was noted that only 37.1% of NPs said that they were not billing at least some of their patient encounters and 33.9% were billing 76% to 100% of their patient charges in their own names. And, in the Nurse Practitioner 2006 survey, nurse practitioners indicated that only 70% typically prescribe under their own Drug Enforcement Administration (DEA) number (70.3%) (reasons for not using one’s own DEA number were not collected in this survey). Even though the data was takev via different sources, surveys and different groups of nurses, it clearly reflects the dichotomy between nurses who prescribe under their own name and nurses who do not, although 49 states authorize some type of nurse prescribing authority.

CarsonCompany’s own observation has been that, on the few occasions that industry has attempted to collect data about NP prescribing, a small, underpowered sample has been used and the results then generalized to the entire NP universe without recognition of the vast differences in prescribing patterns necessary for NPs who practice in different practice settings, nursing specialties or regions. This and other practices, including, but not limited to, the illegal practice of using physician pre-signed scripts, combined with the continued failure to develop comparable methods of compiling data on nurse prescribers, tends to indicate that nurse prescribing patterns, practice and numbers are grossly underreported.

Nurses practicing independently represent the new paradigm of independent practice; and whether it be the challenge of insurance reimbursement rules, network credentialing or concerns about whether medicare will understand their prescribing and reimbursement practices, many of these nurses have unique perspectives which factor into their prescribing process (which are not being heard).

The traditional dean or nursing professor as a thought leader reflects an outdated approach to nursing’s role in the purchase and use of drugs by patients. While there is value in using academia to explain nurse prescribing, we now have close to thirty years of regulated advanced practice. The nurse business owner, nurse clinical manager who supervises care or nurse practitioner students, or, alternatively, the clinical nurse specialist or nurse practitioner responsible for care management in private practice tends to have more knowledge and influence over pharmaceutical prescribing. Advanced practice nurses, unlike physicians, tend to study medications and are less apt to rely on pharmaceutical representatives when making prescribing decisions, and many nurses have had less than favorable experiences with drug reps who continue to ignore nurse prescribers by: 1) going to physicians to sign off on nurse sampling, although the nurse prescribes independently and has an independent DEA number; 2) refusing to meet and/or leave samples with nurse prescribers; 3) using the combined prescribing numbers of the practice to justify physician continuing education services, without providing complementary services to nurse practitioners; and/or 4) limiting the use of nurse speakers to a marginal number of nurses, who are typically national leaders in specialty practice, without assessing the regional needs and prescribing patters of nurses. A review of the literature reflects a different approach to pharmaceutical knowledge and influence that should be embraced by the industry and would improve relationships with nurses. If you are interested in helping us change the paradigm for thought leaders in advanced practice, join us.