Iranian Nurses’ Authority to Prescribe Medications; A Letter to the Editor

Abstract

Nurses are the largest group of health care providers spending most of their time in touch with patients and are often present at patient bedside immediately when a problem arises (1,2). In many countries around the world, nurses are allowed to prescribe some medications, but this is not the case for nurses working in Iran for some reasons (3) and although nurses are aware of medications used in emergency situations, in Iran, nurses have no legal right to prescribe medications without taking physicians permit and agreement (4,5). In this letter, we argued whether or not nurses should have the authority to prescribe medications for patients. Forty nurses working in Iran hospitals with various academic degrees were interviewed. The interview consisted of 4 domains including qualification, legal authorization, modification, and promotion. The aim was to find out whether Iranian nurses, considering the status quo, can prescribe medications or not (3-6). The results showed that in terms of the qualification, the number of educational courses passed by medical students is slightly higher than that passed by nursing students. The same subjects are included in the curriculums of both groups, but the subjects are more expanded for medical students. Therefore, based on such minor differences, physicians, but not nurses, are allowed to prescribe medications. In terms of legal authorization, insurance companies only approve and accept physicians’ seals. Even in case of prescribing medications by midwives, insurance companies do not accept their prescriptions and refuse to provide services for medications prescribed by them. Therefore, it seems that medical education approaches and health care management systems in Iran should be substantially and structurally reviewed. Before implementing such modifications, however, it is suggested to determine the strengths and weaknesses of the current condition. Moreover, motivation and selfconfidence of nurses, as well as people attitude and view towards nurses should be improved. Such fundamental evolutions can augment patients’ and their relatives’ trust in nurses and finally improve therapeutic outcomes. Some comments proposed by the interviewees were actually appealing and applicable. Most of the participants proposed developing master educational program for nurses who have adequate clinical experiences. This strategy can compensate the shortage in nursing educational curriculum and finally nurses who are adequately proficient to prescribe medications. Organizational supports should be implemented to encourage insurance companies to approve medications prescribed by nurses. Nurses should also legally protected and given the authority to prescribe some specific medications. Finally, the interviewees believed that prescribing medications by nurses can enhance their motivation, confidence, and working proficiency. It seems that substantial modifications are inevitable to meet Iranian nurses’ needs. This requires correct and principled decisions. Some challenges and barriers for implementing such modifications include the low ratio of nurses to patients, inadequate pharmacology credits in nursing filed curriculum, and relatively short period of nursing academic program. Although nurses can alert physicians by phone calls in emergency situations, this cannot be a surrogate to the actual presence of a health care provider at the patient’s bedside and concise physical examinations.