**Chapter 10** Nurse Prescribing

*Hamidreza Haririan*

## **Abstract**

Nurses, as the most numerous human resources in the field of health, have many roles and responsibilities. The number of countries where nurse prescribing is common is increasing. Also, the legal, educational, and organizational conditions in which a nurse prescribes medication vary greatly from country to country, ranging from the fact that the nurse can only prescribe from a limited list and under the supervision of a physician to the case where the nurse is authorized to prescribe without any restrictions. In many countries, health policymakers have responded to increasing demand for care due to aging populations and the increasing prevalence of chronic disease, physician shortages, and budget constraints, through strategies such as modernizing roles and combining health professions, including the role development of nurses. Prescribing by nurses has been a historic move for the nursing profession and an important part of the health system solution in leading countries to improve access and reduce the waiting time for patients to receive medication. Other potential benefits of nurse prescribing are increased continuity of patient care and better access to medication, efficiency in drug delivery and patient comfort, and reduced patient waiting time.

**Keywords:** authority, cost effective, health service, nurse, prescription

## **1. Introduction**

Nurses have different roles in the health system and these roles can be changed or revised according to the needs of the society and increasing the ability of nurses [1]. Nurse prescribing is considered as the one of the new roles in the world, the implementation of which requires knowledge, skill, and clinical experience in nurses [2]. Written or oral prescribing requires complex and challenging skills. According to the Oregon Nurse Practice Act, nurse prescribing refers to the process in which a nurse recommends medication or dispenses medicines for patients [3].

Although nurse prescribing was first done in 1986 in the UK, in recent years, evidence of a significant development in the role of nurse prescribing has been seen in various countries, for example, in countries such as South Africa, Ireland, Canada, Norway, Netherlands, Sweden, Spain, and USA, nurses have the legal right to prescribe [4]. The legal, educational, and organizational conditions in which a nurse prescribes medication vary greatly from country to country. A nurse may only be allowed to prescribe from a limited list of medications under the supervision of a physician to being authorized to prescribe without any restrictions [5]. Nurses' ability to prescribe has been a historic development for the profession and an important part

of the solution in many health systems in leading countries to improve access and reduce the waiting time for patients to receive medication [6].

In England, for the first time in 1986, the nurse prescription was proposed by the British Health Department, in such a way that nurses assessed the patients and after diagnosing the problem, they waited for the physician to confirm and stamp the diagnosis and prescription taken by the nurse. In 1989, in the first report of the Crown, the prescription of nurses within a specific pharmaceutical range was supported, and in 1998, the nurse prescription from the list of drugs (Nurse prescribers formulary) was approved nationally in the United Kingdom, and based on the opinion of the government, in 2000, nurse prescription was developed and the drug list with more scope became official with the title (Extend nurse prescribers formulary) [7]. And finally in 2006 the independent prescription of drugs from the British national formulary became official and the registered nurses who had at least 3 years of work experience were allowed to participate in prescription training courses. According to the drug list of 2002, nurse prescribers in the United Kingdom prescribed 180 drugs for about 80 clinical conditions, which reached 240 drugs for 110 different clinical situations in 2005, and since 2006, nurse prescribers could prescribe all authorized drugs except for some restricted drugs including special narcotics [8].

In some countries, prescription laws are exclusive and include physicians and nurse practitioners. The United States of America is one of these countries, and in some states, optometrists, psychologists, and nurses with special clinical experience can also prescribe within the specified limits. Nurse Practitioners were able to obtain a prescription license for the first time in 1969 in the United States, and in 2004, they started prescribing drugs in about 40 American states [7]. It should be noted that in some countries, nurse prescription is being implemented in clinical areas such as chronic diseases, cystic fibrosis, diabetes, cardiovascular disease, general surgery and pain control, renal failure, and substance abuse [9].

There are many reasons for endorsing prescribing rights to nurses including the following: improving the quality of medical care delivery, reducing treatment time and expense, increasing nurses' job independence, and helping nurses to make better use of their professional skills [2]. The right to prescribe can enhance nurses' sense of independence, usefulness, and professionalism [10]. The purpose of prescribing in nursing is not to turn a nurse into a physician, but to increase health in the community, especially in basic and primary care, which can enable the level of access and cheaper services. Nurse prescribing can bring the following advantages: timely, rapid, and convenient access of patients to medication, treatment, and care (especially in chronic diseases), reduced patients waiting time, improved efficiency of care and medical services, constant and extensive prescriber-patient communication, optimal use of nurses, patients, and physicians' time, engagement of nurses in non-repetitive and non-routine tasks, better control of disease symptoms, reducing the number of admissions and length of stay, and reduced health costs [2, 11]. Since cost containment is one of the main policies of health systems in countries, the government officials consider changing duties and roles and assigning some tasks from physicians to nurses as one of the important ways. In addition, the nursing profession has developed strategies to increase the advancement of the nursing profession, increasing autonomy with introduction of specialized roles that include nurses having prescribing rights [4].

In specialist wards, such as the Intensive Care Unit (ICU) and the Cardiac Care Unit (CCU), due to the nature of the ward and the acuity of the patients, nurses have more scientific and practical capabilities that lead to clinically competent nursing staff. Also, due to the critical condition of the patient, it is sometimes necessary for

### *Nurse Prescribing DOI: http://dx.doi.org/10.5772/intechopen.110744*

nurses to make quick and sudden decisions to save the patient's life, among which one of these decisions may be prescribing medication or other life-saving care measures that ultimately improve patient outcomes [12].

The World Health Organization (WHO) discussed the role of nurses and their performance in prescribing in different countries in the consultative panel of the Eastern Mediterranean Region Nursing Forum in 2001 and considered them ready to prescribe medicine. However, the prescription by the nurse, like the prescription by the physicians, can include drug side effects, wrong diagnosis, or incorrect prescription [13].

Nurse prescribing in some countries for example in Iran is in its infancy, because there have only been discussions in this regard and no executive action has been taken so far, and it is clear that giving this duty to nurses in these countries requires providing the necessary conditions such as creating preparation and increasing the authority of nurses [10]. Darvishpour [14] conducted a qualitative study entitled nurse prescribing in Iran and abroad. She reported that, despite the public assumption that nurse prescribing is not practiced in Iran, it is carried out in most wards, especially in emergency departments and intensive care units. In addition, like other countries, there are independent and dependent prescribing practices, but the quality and manner of prescribing is greatly different in Iran because nurse prescribing is carried out illegally and, in some cases, secretly [14]. In the study by Babaie et al. [15] that aimed to determine the attitude and readiness of Iranian nurses toward nurse prescribing, the results showed that nurses had a good preparation and attitude toward nurse prescribing [15].
