Nursing and Antimicrobial Stewardship: An Unacknowledged and Underutilized Focal Point

Abstract

Background: Nurses have the ability to play an important role in patient safety related to antibiotic use and overuse but are often not involved in antimicrobial stewardship programs (ASP). Therefore, nurses need to be educated and trained in antimicrobial stewardship (AS) so that they can more competently contribute to safe patient care. Lewin’s change theory may be utilized as a framework for understanding the integration of nurses into these efforts. Objective of the Study: This integrative review is intended to explore the role of nurses in AS and discuss the importance of nurses needing to be educated, trained, and competent in this so that they can become more actively involved in such programs. Methodology: Articles were gathered from the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Google Scholar from June 2015 to December 2019. A five-year time frame was implemented to ensure that the most current information was included. Seventeen peer reviewed, written in English, original research studies that met the inclusion criteria (from the original 107 studies) and conducted in Australia, Canada, Scotland, South Africa, and the United States were included in this review. Results: The identified 17 recent studies focused on nursing and AS. Six major themes emerged, including nurses’ competency requirements and training related to AS, antimicrobial knowledge and educational gaps, perceived role of the nurse, nurses’ attitudes toward antimicrobial use, nurse and provider perspectives on ASPs, and nurses’ valuable contributions to AS. Discussion: This integrative review found that including nurses in AS would benefit ASPs and that finding ways for facilities to organize and implement such efforts is vital. This ties into the first stage of Lewin’s change theory of “unfreezing” and recognizing that the current (or old) way of practicing is in need of change. The literature reviewed provides evidence that nurses have the capacity to be an integral part of any ASPs and that they can help combat antimicrobial resistance in myriad ways when provided the necessary training and education. All studies reviewed found positive aspects to having nurse representation. However, there are gaps in antimicrobial based knowledge on the part of the nurses. Limitations: The limitations of this integrative review include the fact that the publications used were limited to a five-year timeframe and came specifically from nursing journals or have at least one nurse author contributor. Also, the current review included five international studies where the nurses’ scope and standards of practice may be different from those in the United States. A search of the grey literature reports related to AS was not conducted and could have provided additional valuable information as well. Conclusion and Recommendations: Nursing participation is needed in all ASPs. Empowering and educating nurses to feel confident and competent in this role will help to mitigate the overuse and misuse of antimicrobials. The ASPs most likely vary from institution to institution and future research should provide a framework for how to best disseminate information to nurses. Keywords: Antimicrobial Stewardship, Antibiotic Training, Nurses