The acute shortage of doctors in the country has been compelling nurses to prescribe medicines, often leaving patients unsatisfied. A recent study revealed that over 61 per cent of the Bhutanese nurses are unlawfully prescribing medicines. According to the Bhutan Medicines Rules and Regulations 2019, only doctors are permitted to issue prescriptions.
Bhutan Medicines Rules and Regulations 2019 states that individuals registered as “Competent Persons”, including nurses, are not allowed to prescribe medicines.
The study titled “Prevalence and Perspectives of Nurses Prescribing Medicines: A Cross-sectional Mixed-method Study in Bhutan,” published in the Journal of Medical Evidence last month, was conducted by four Bhutanese nurses. 312 nurses from hospitals across the country participated in the study.
One of the researchers says prescribing medicine requires well-qualified and properly trained professionals to prevent avoidable harm, disability, and death to patients.
Despite the regulations, the study found that many nurses, especially in district hospitals without doctors, are seen prescribing medicines.
The study also revealed that it sometimes happens when patients visit Emergency Units during holidays and weekends asking for medicines.
“In the bigger hospitals, there is no problem. In those hospitals, there are doctors available 24 hours in the emergency units where as in the district hospitals, there is a shortage of doctors. Our nurses are compelled to prescribe due to the shortage of prescribers,” said Krishna Singh Mongar, one of the researchers who currently serves as a specialist nurse at the National Referral Hospital.
The study also found out that nurses with one to ten years of experience are more likely to prescribe medication. Senior nurses tend to avoid the responsibility unless they receive a formal directive from the hospital.
The Medical and Health Professionals Council has not received any formal complaints from patients regarding incorrect prescriptions so far. Many nurses who participated in the study were found to lack confidence in taking up the responsibility.
The study highlighted that nurses who had to prescribe medicines felt stressed and anxious due to fear of making mistakes and the absence of legal protection.
Moreover, the added responsibility also compromised their ability to provide quality nursing care.
Krishna Singh Mongar said, “They are qualified, but due to our regulation, they are not allowed to prescribe. If there are opportunities advancing studies in prescribing, they are competent enough to write a prescription.”
According to the Medical and Health Professionals Council, there are currently no legal provisions allowing nurses to prescribe. The council also says if nurses are caught prescribing medication without legal authority, it may take disciplinary actions.
However, the council recognises the need for task sharing, especially given the shortage of healthcare workers in remote and rural areas.
The council is also exploring international models that allow qualified nurses with advanced clinical training to prescribe medications under supervision.
Kelzang Chhophyel
Edited by Sangay Chezom
