The Role of the Nurse in Antimicrobial Stewardship

Monday, 22 July 2013

Rita Drummond Olans, MSN, BA, APRN-BC, CPNP
Department of Nursing, MGH Institute of Health Professions School of Nursing, Charlestown, MA

Learning Objective 1: The learner will identify the scope and implications of antimicrobial stewardship programs and role for a nurse in antimicrobial stewardship models.

Learning Objective 2: The learner will be able to recognize the content and skills needed for a nurse to participate in antimicrobial stewardship activities.


Antimicrobial Stewardship (AS) is an interdisciplinary approach to the optimal use of antibiotics in order to achieve improved clinical outcomes in hospitals. It is driven by the awareness of the worldwide crisis in microbial antibiotic resistance and the negative consequences of imprudent antibiotic use. Proponents of AS all stress the value of this coordinated approach, identifying pharmacy, microbiology and infectious disease specialists as team members.  Surprisingly, nursing is not recognized as having an important role in the AS collaborative model.  Nurses are at the center of coordinated patient care and could play a valuable role in achieving the goals of successful AS.  Yet to fully realize these benefits, the nursing profession must be educated about this model of quality care.  An extensive literature review identifies only one article that mentions a possible role for the nurse as a participant in AS activities, and this article asks, “Where is the nurse?” The purpose of this study was to gather data on nurses’ knowledge and teaching of basic precepts, skills, and techniques of AS.


Nurse educators were asked to define, refine, and prioritize key constructs of AS using a quasi-Delphi method. This structured approach elicited expert opinion of role, content, and skills necessary for staff nurses to participate in AS activities.


Greater than 85% consensus was achieved by round 2 in the quasi-Delphi approach. Although nurses indicated that they may not be recognized as members of the interdisciplinary team, they currently perform many critical functions in the realm of AS.


Although nurses are currently participating in AS activities, nurse educators identified seven areas for further staff development to maximize the nurse’s role in that interdisciplinary team. Educational priorities identified in this study set a framework for expanded education for nurses in successful AS.