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Main attraction

Nurses are a new audience for pharma, but can it catch and retain their attention?

Nurses are a new audience for pharma, but can it catch and retain their attention?

Over the last year or two a new term has been doing the rounds; 'maxi-nurse'. From seminars to surgeries and right across the healthcare world you can hear it being used to talk about a major trend.

Where did this term come from? Just who are maxi-nurses and what does it all mean for the pharmaceutical industry?

It is important to know the answers to these questions, so that the next time you hear the phrase `maxi-nurse' you are not simply nodding meaningfully, while secretly thinking of some new kind of nursing super-hero.

Maxi-nursing looks set to stay and will have a major impact on how the pharma industry manages its communication with these healthcare professionals.

The history
The term maxi-nurse can be traced back to a national survey commissioned by the Department of Health and the Royal College of Nursing (RCN) in the autumn of 2004. The aim of the survey was to gain a better understanding of nurses working in advanced and extended roles throughout the NHS.

The survey, entitled Maxi-Nurses: Nurses Working in Advanced and Extended Roles Promoting and Developing Patient-Centred Healthcare, was duly launched by Chris Beasley, chief nurse for England. Over time, the somewhat more snappy term maxi-nurse has remained.

One outcome of the survey was a clear message that nurses in advanced and extended roles were reliant upon their nursing background and experience to operate effectively and have a positive impact on patient care. These were, essentially, nursing roles at the furthest reaches of knowledge and experience.

What do they do?
As part of the survey, the RCN and Department of Health survey asked its 500-plus respondents to describe the work they were actually undertaking in their role, as well as the job titles that they were operating under.

The five main job titles that came out of the survey were: nurse practitioner, clinical nurse specialist, nurse consultant, specialist nurse and advanced nurse practitioner.

While the survey revealed a wide variation in job title, when asked in more detail about what their jobs entailed, there was a good deal of similarity between the respondents. What these nurses had in common was that their roles involved acting with a great deal of autonomy
in three main areas: diagnosis, case management and organisational activity.

Activities in diagnosis include undertaking physical examinations, ordering investigations, screening and using information received to make a diagnosis, while case management includes such things as collaborating with others to develop care plans, coordinating programmes of care across different units and admitting or discharging patients.

In addition, organisational activities include leading and educating staff, and initiating research.

It is important to recognise, though, that different roles will undertake different activities to a greater or lesser degree. For example, clinical nurse specialists and specialist nurses will tend to focus on case management, while nurse consultants would spend more time on diagnostic and organisational activities.

The main point to note, however, is that these are nurses in advanced and extended roles, carrying out activities with a good deal of autonomy. They are making crucial decisions that will affect health outcomes for patients.

Where are they?
One of the biggest challenges for pharma is locating this new customer base - a task made more difficult by the use across the NHS of inconsistent job titles. It is not as simple as just counting the number of nurses in specific posts in any given NHS Trust.

To get a better idea of where maxi-nurses can be found, we can look again at the 2004 RCN and Department of Health survey. Of the 500-plus respondents, around half stated that they were hospital-based and mainly in a specialist unit of some sort. Of the rest, 10 per cent were in GP practices, 20 per cent in the community.

It is interesting to note that the final 20 per cent of respondents stated that they did not see their role as fitting into any special area; they were acting across a number of the traditional NHS boundaries.

The extension of nurse prescribing rights can be seen as a clear sign of intent from government that it believes in the benefits of extended and advanced roles for nurses. After all, the Department of Health worked with the RCN on the maxi-nurse survey and also on a document called Freedom to Practice: Dispelling the Myths in November 2003.

This publication went a long way to exposing the real need for nurses to take on advanced roles and battle the existing myths concerning the traditional boundaries of their jobs.

Put simply, the government is well aware that maxi-nursing is good for patient care, good for nurses and good for the NHS. But what effect will this new trend have on the pharma industry?

Impact on industry
The most obvious implication is that it creates an emerging new audience for communication.

This is an audience that the industry must communicate with simply because maxi-nurses are not only making key decisions that affect patient care but also decisions that affect the goods and services that are used to deliver that care.

The pharma industry has well-established communication channels with doctors, which are seen by many (healthcare professionals and industry alike) as a vital way to ensure that information relating to product developments and characteristics is shared with those who prescribe them. Ultimately, this information can then be shared with the patient.

It is clear that this level of communication needs to be replicated with nurses in advanced and extended roles: the need for communication is no different.

If maxi-nurses are increasingly involved in diagnosis, case management and organisational activities, then they need the same information as doctors.

The way ahead
The first job for a pharmaceutical company that wants to engage with these nurses is to find them.

The best solution is to get out there; attend the right senior-level nursing conferences, be seen in the right journals and make sure that reps are asking to speak to the practice nurse, as well as the GP.

If the industry really is serious about communicating with this emerging group of key opinion leaders, it must first increase its exposure to them.

On top of this basic exposure, a company must develop a profile and networks within the nursing community through working in partnership with organisations, such as the RCN. With familiarity, comes understanding and, over time, a trusting relationship is more likely to develop.

The next task is to ensure that they are developing appropriate messages. While the need for communication is the same as with doctors, it is not possible to assume that the mode of communication should also be the same. This is where the difficulty lies.

If a pharmaceutical company wants to be successful in communicating with maxi-nurses, it has to ensure that it talks to them in the right way and is able to listen to what they have to say.

One of the most effective ways of communicating to nurses that I have seen has been through consultation groups. One recent initiative saw a major pharma company bring together a group of maxi-nurses involved in nutrition to discuss case management.

The meeting was handled in such a way that participants felt that their input was highly valued, that they were listened to and that they would be involved in producing something that made a significant contribution to improving patient care.

It seems that the most important thing was that the participants were keen to be involved, despite their increasing work pressure, because they felt it would make a significant impact.

Compare this to a recent publication I saw. A company was looking to invite a group of senior nurses to a seminar identifying best practice in their field. While the content of the seminar was fine, the football-based images and language just did not resonate with their intended audience: the nurses just felt that it was not for them.

Changing tack
Both the nursing community and pharma need to make changes to their thinking in order to build a relationship.

The nursing community for its part must develop its own understanding of the pharma industry and develop a framework in which it can comfortably build an appropriate relationship with the sector: a framework that suits its needs and sits within the Nursing Midwifery Council guidelines they all signed up to when they registered.

Although there are plenty of examples of firms already getting to know nurses, there are few that have added this audience into their long-term strategic thinking, either at a corporate or product level.

With maxi-nursing set to grow, the company that can develop its traditional view of the nurse as care-giver to that of care manager is the one that is best-placed for the future.

The author
Joel Rose is corporate sponsorship manager at the RCN

2nd September 2008

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