Nurse ‘Ambassador’ Programs Pose Significant Ethical Concerns
Some pharmaceutical companies offer “nurse ambassadors” to assist patients on complicated medication regimens. The authors of a recent paper examined ethical issues posed by these programs.1 “Nurses, including nurse practitioners, need to pay attention to the fact that they are becoming targets of pharmaceutical marketing,” says Diana J. Mason, PhD, RN, FAAN, the paper’s co-author and a senior policy service professor at the George Washington University’s Center for Health Policy and Media Engagement.
Nurses who are approached by a drug company for this kind of position should think twice about becoming involved in this new role. “Consider the ethical challenges that may present. Discuss with the company how to handle these,” Mason says.
The goal is to define ahead of time the ethical lines that will not be crossed. “Be mindful that you must always act in the best interests of the patient,” Mason offers.
There is evidence indicating doctors who received payments related to specific drugs prescribe that drug to patients more often than doctors without those financial ties.2,3 Mason says the same ethical concerns hold true for nurses. However, since nurses previously were not prescribers, they were seldom targeted by pharmaceutical companies. “Discussion of the ethical issues related to pharmaceutical marketing has seldom been included in nursing curriculums,” Mason notes.
This changed after nurse practitioners gained prescriptive authority. It is particularly relevant in states that provide nurse practitioners with full practice authority, meaning nurses can prescribe with no physician supervision or mandated collaboration.
“Nurse ambassador programs are an example of the way pharmaceutical companies are using nurses, who may not be aware that the practice really has them straddling a line in terms of unethical behavior,” Mason observes.
One of Mason’s colleagues took a position with a major pharmaceutical company and became a top seller. “Physicians trusted her because she was a nurse, smart, and knowledgeable. She also knew how to talk with physicians,” Mason says.
When Mason noted the nurse was promoting a medication that was quite controversial, the nurse replied, “I’m a sales rep, not a nurse.”
“But she was still a licensed RN, and used her knowledge, skills, and reputation to be successful at her job,” Mason says.
Another colleague was making a lot of money working for pharmaceutical companies as a consultant. “She spoke for them and noted that they prepared her slides and drafted papers for her, making it easy work. She hadn’t thought that this was wrong,” Mason recalls. After reflecting on this marketing strategy that pharmaceutical companies used, the nurse quit speaking for the companies. One issue is the nurse ambassador programs are largely unregulated at the federal level. “It may be up to the nursing profession itself, and state licensing boards, to convey to nurses that the programs may violate professional ethics,” Mason says.
Ideally, Mason says the National Council of State Boards of Nursing would issue some guidelines to answer the question: What constitutes unethical practice as a nurse ambassador? “Perhaps they could partner with some nurse ethicists to develop guidelines,” Mason suggests.
Nurse ambassador programs have been successful for pharmaceutical companies. “But there is a dearth of discussion within the nursing community about them,” Mason reports.
The overarching issue is nurses sometimes are used wittingly or unwittingly by pharmaceutical companies to increase their profits. “And it’s not always in the best interest of patients,” Mason adds.
- Yang YT, Mason DJ. Problematic promotion of medications by nurse ambassadors: Legal and ethical issues. JAMA 2021;325:345-346.
- DeJong C, Aguilar T, Tseng C, et al. Pharmaceutical industry-sponsored meals and physician prescribing patterns for Medicare beneficiaries. JAMA Intern Med 2016;176:1114-1122.
- ProPublica. Dollars for doctors: How industry money reaches physicians.
Nurses who are approached by a drug company for this kind of position should think twice about becoming involved in this new role. Consider the ethical challenges that may present. Discuss with the company how to handle these.
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