Originally published here.

Any form of unfair treatment may negatively impact health, and diverse groups may be vulnerable to adverse health outcomes (Lewis et al., 2015; Williams et al., 2019). As a part of health professionals, nurses are one of the most strategic resources that play an important role in health and medical issues. However, physicians regard nurses as their helpers rather than as professional peers, and a hierarchical structure exists between them (Farsi et al.,2010).

However, some increase in the number of male nurses has caused the dissatisfaction of nurses to be reflected in a part of mass media, but still, nursing is seen as an inferior job in the hospital (Nikbakht-Nasrabadi et al., 2003). Although the Healthcare Reform in 2014 was to expand insurance coverage and improve access to health care, it has led to some unintended drastic consequences (Heshmati & Joulaei, 2016).

On the other hand, evidence from different resources suggests an increased rate of discrimination against nursing professionals in Iran. Meanwhile, except for a few that had a qualitative study on violence, sexual harassment, and job dissatisfaction (e.g., Najafi et al., 2017; 2018; Atefi et al., 2014), there is a dust of scarcity on this subject (Valizadeh et al., 2015). Therefore, part of the background study in this research was based on newspaper articles and news. Under the title “Nurses have always been despised”, Salamat News Agency, an Iranian newspaper (TABANA, July 2022), reported that medical service organisations in Iran have been engaged in injustice and discrimination in which human beings in pain and in need of humanitarian services have become a commercial and economic source.

Sadaghaini (1998) also argued that the implementation of a mechanism in which public hospitals are expected to generate revenues has negatively affected the medical professions, causing a change in the values from the core objectives of disease prevention and effective treatment to wealth creation (Arredondo & Orozco, 2008).

Therefore, most of the programs focus on increasing income by establishing hospitals and providing hospital beds and equipment. As a result, resources have been placed in the pockets of a particular group and the double increase in payments has led to the emergence of self-centred doctors who look down on the patients and other hard-working hospital staff (Jafari et al., 2011).

The findings of the study conducted by Jafari et al. (2011) also claimed that there seems to be some sort of informal and unwritten agreements that allow physicians to hospitalise their private clinic patients in public hospitals to reduce the patients’ hotelling and facility costs while physicians receive their fees as in private sector that comes out-of-pocket and is known as under-the-table payments. According to the Salamat News Agency, an Iranian newspaper (TABANA, July 2022), due to organisational injustice, nursing professionals who are 70% of the body of the medical staff have been at the service of doctors to generate more and more money, whilst being abused and oppressed.

Whenever they demand equity, recognition, and a sense of worthiness, they are subjected to criticismo by the authorities who are again doctors (Rezazadeh, 2021). An article in another newspaper pointing out the results of a comparison between the income of nurses and doctors in 14 countries of the world, claimed that in no country in the world, the income of doctors is sometimes a thousand times that of nurses as is in Iran (Naseri, 2018). In line with it, some studies and many other newspaper articles, referring to the sufferings of nurses from the surprising difference between their incomes with doctors, wrote that the ignorance of the important role of nurses as members of health and treatment groups is related to the implementation of the self- governance plan of hospitals and the unfair distribution of the income leading to a deep inequality between doctors and nurses (e.g., Heshmati & Joulaei, 2016; Hatamizadeh et al., 2019; Rezazadeh, 2021;

Salary, 2015; Sharifi-Moghaddam, 1995; Breaking News, Sep. 2019). The present research aimed to investigate the concerns of Iranian nurses about inter- professional collaboration, and the purpose of this correlational mediation study was to explore the effect of workplace discrimination on job stress and depression among the nurses in Iran, and to find out whether job stress mediates the relationship between workplace discrimination and depression among nurses in Iran.

The present study showed the nature of workplace discrimination and emphasised nursing professional staff’s interpretation of their organisational setting in relation to their own well-being. The findings of this study are underpinned by the resource-based view (RBV) theory that provides a greater focus on nurses as the strategic human capital in the hospitals and suggests the capitalisation of these professional employees as knowledge assets of the hospitals (Barney, 2001). This study suggests that nurses need equity and psychological and emotional support to be provided for them.

In turn, hospitals can benefit from happy and healthy professionals that are effectively committed and engaged with their job as supported by RBV theory. Considering the fact that discrimination and a severe class divide are more annoying and painful than poverty (Grusky & Szelenyi, 2018; Adams, 1965; Al-Zawahreh & Al-Madi, 20120; Cohen, 2019), a salary increase is not always recommended as a solution for dissatisfaction with a root of discrimination and may only lead to na increase in the costs of production or service and therefore to a rise in prices (Necșulescu & Șerbănescu, 2013).

Increasing the salary of nurses, on the other hand, may again result in salary discrimination (Holmes, 2011). Instead, changing the organizational culture and the perspective of doctors to nursing professionals from vertical to horizontal through facilitating the work of nurses in managerial and decision-making positions is recommended. Meanwhile, an effective monitoring system for the prevention of using resources for personal gain and implementing a tiered tax arrangement can also be quite effective in reducing income gaps (García‐Sánchez, 2020; Fremstad & Paul, 2019).

Since trends associated with healthcare system reform may become evident only over time, a comprehensive Difference-In-Differences (DID) and Strengths, Weaknesses, Opportunities, and Threats (SWOT) analyses are strongly recommended to evaluate its broader effects on healthcare delivery, efficiency, equity, and effectiveness (Xu et al., 2018).

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