Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study

Abstract

ObjectivesThis study responds to calls for greater focus on nursing roles, and the need for nursing integration within the antimicrobial optimisation agenda. The objective of this study was to explore Australian hospital nurses’ views on antimicrobial resistance and antimicrobial stewardship (AMS) in a hospital setting, in order to better understand the opportunities for and challenges to integration of nursing staff in antimicrobial optimisation within hospital settings.DesignQualitative one-on-one, semistructured interviews. Interview transcripts were digitally audio-recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory.SettingFour hospitals (three public and one private), across metropolitan, regional and remote areas, in two Australian states.Participants86 nurses (77 females, 9 males), from a range of hospital departments, at a range of career stages.ResultsFindings were organised into three thematic domains: (1) the current peripheral role of nurses in AMS; (2) the importance of AMS as a collaborative effort, and current tensions around interprofessional roles and (3) how nurses can bolster antimicrobial optimisation within AMS and beyond.ConclusionNursing staff are central to infection management within the hospital and are thus ideally located to enhance antibiotic optimisation and contribute to AMS governance. However, without increased interprofessional cooperation, education and integration in the AMS agenda, as well as addressing organisational/resource constraints in the hospital, the nursing role in stewardship will remain limited.

Delivery of antimicrobial stewardship competencies in UK pre-registration nurse education programmes: a national cross-sectional survey

“…Only 63% of undergraduate nursing programmes include AMS teaching with only 12% reported to include all AMS principles [23]. This lack of integration has been cited as a factor that can limit nurses' knowledge of AMR and subsequent engagement in AMS implementation [24,25,26,9,14] The Standards of Proficiency for registered nurses [Nursing and Midwifery Council [27] (the nursing regulatory body in the UK) stipulate the skills, knowledge and attributes all nurses must demonstrate to be registered to practise in the UK. These standards are the same regardless of nursing field and whether pre-registration programmes are at degree or master's level.…”

Guidelines for the hospital role of the clinical nurse in antimicrobial stewardship: A scoping review

“…Healthcare professional organisations must recognise that stewardship reaches beyond the responsibilities of the prescriber, adding the efforts of the bedside nurse to those of infectious disease clinicians, pharmacists, microbiologists, hospital epidemiologists, and IPC specialists. [12 , 21 , 54 , 64 , 73 , 80 , 92 , 95] …”

“…[11,18,[75][76][77]88] AMR should be viewed by all healthcare professionals in all healthcare settings as relevant to their specific disciplines, 64 using a REVIEW multi-disciplinary collaborative approach between all members of the healthcare team to meet AMS goals. [1,8,9,11,18,19,73,88,[90][91][92] This is particularly important as global healthcare interrogates AMR within the added burden of COVID-19. [93,94] Failure to recognise those responsible for direct patient care is an oversight [12,14] that may impact the success of AMS.…”

Antimicrobial Stewardship for the Infusion Nurse

“…According to Kirby et al,31 efforts to control the global threat of antimicrobial resistance involve using nursing expertise. There is an expanding need for the multidisciplinary team to collaborate with nurses to promote effective antimicrobial stewardship 32.…”