Registered nurses’ antimicrobial stewardship roles: a qualitative descriptive exploratory study
Anecita Gigi Lim
1 * , Jennifer Woods 1 § , Brenda Waite 1
1
Abstract
Antimicrobial stewardship (AMS) is a global initiative aimed at promoting the responsible use of antimicrobials to combat antimicrobial resistance (AMR), a critical global health threat. In New Zealand, over 95% of antibiotics are prescribed in the community, with estimates suggesting that half of these prescriptions are for self-limiting respiratory infections, contributing significantly to AMR. Registered nurses (RNs), especially nurse practitioners and designated nurse prescribers, are well-positioned to play a pivotal role in AMS efforts due to their accessibility and broad skill set. However, their potential remains underutilised in AMS programmes.
This study aimed to explore the role of New Zealand Māori and non-Māori registered nurses as antimicrobial stewards within the New Zealand health care system.
The current knowledge and involvement in activities that mitigate the risks of infectious diseases and AMR of registered nurses was assessed. The educational and organisational support needed to enhance their leadership and engagement in AMS initiatives were identified.
Findings highlight the need for targeted AMS education, greater participation in stewardship activities, and clarity in RN roles in collaboration with other health care professionals. This research underscores the importance of empowering registered nurses through education and organisational support to strengthen AMS and mitigate the growing threat of AMR.
This study provides key insights into the leadership potential of RNs in AMS and offers recommendations for future policy and education strategies to optimise their role in New Zealand’s health care.
Keywords: antimicrobial resistance, antimicrobial stewardship, care, clinical practice, health system, leadership, registered nurses, role, safety, support.
| WHAT GAP THIS FILLS |
| What is known about this topic: Judicious, appropriate antimicrobial stewardship (AMS) is crucial to reduce the development and spread of antimicrobial resistance. Registered nurses are ideally placed to enhance AMS activities due to their broad skillset and accessibility. Registered nurses, as a major component of the health workforce, are often significantly underutilised in health systems to promote AMS. |
| What gaps this paper adds: This exploratory qualitative study found that registered nurses were clearly engaged in activities contributing to antimicrobial resistance reduction. To increase and enhance registered nurses’ AMS leadership roles throughout the health system they need greater support, increased collegial collaboration, and targeted education in this role. |
Introduction
Antimicrobial resistance (AMR), a current plague in our health care systems, is a serious global threat.1 Antimicrobial stewardship (AMS) is a coherent set of actions that promote the responsible use of antimicrobials to counteract AMR. AMS programmes decrease unnecessary exposure to antibiotics, improve cure rates, reduce adverse drug reactions, slow the emergence of antibiotic resistance, and reduce hospital costs.2–4 Judicious, appropriate AMS is crucial to reduce the development and spread of AMR.5 Community antibiotic use is a strong driver of AMR and in New Zealand (NZ) over 95% of antibiotics are dispensed and consumed in the community.6 It is estimated that at least half of the antibiotics prescribed in NZ are inappropriately used to treat self-limiting (often viral) respiratory tract infections.7
Certain infections, such as rheumatic fever and skin sepsis, disproportionately affect Māori and Pacifica People7 and these are often treated with antibiotics. In these communities registered nurses (RNs) are the first point of contact for patients seeking advice in the management of medicines (eg antibiotics) and are best positioned to promote, teach, and support appropriate use of antibiotics and engage in AMS activities to reduce AMR. However, they are underutilised.8
Background
Nurses comprise most of the health care workforce9 but are significantly under-utilised in AMS.10 RNs are central to infection prevention and control (IPC) teams and are ideally placed to enhance AMS activities due to their wide skillset and accessibility.6 However, to succeed in this role RNs require specific AMS education, increased participation in AMS activities, and organisational support.10,11 In addition, further clarity is required on how RNs should enact this role in a complex environment where engagement and collaboration with other health professionals is essential.
This study aims to investigate the roles that RNs currently have in AMS, and to explore how to enhance their involvement in future AMS activities. Two important research goals were completed during the period of this research activity; engagement and collaboration with clinical partners, Māori nursing leaders and RNs (including nurse practitioners (NPs) and registered nurse designated prescribers (RNDNPs)), to determine strategies that can be implemented to enhance and promote RN’s leadership roles in AMS. Secondly, this research has contributed to our understanding of the approaches that RNs (prescribers and non-prescribers) require to develop and enhance skills and capability to work in a collaborative environment with other health professionals in promoting AMS activities.
Our specific aims of the study were: (1) To explore RNs views on how they engage and participate in AMS activities, (2) To determine gaps in their knowledge and skills, and (3) Identify the education needed to enhance leadership and management skills in the promotion of AMS activities.
Methods
This study utilised an exploratory descriptive qualitative approach12 and the consolidated criteria for reporting of qualitative research (COREQ) guided the reporting of this study’s methods and findings.13
Study participants
Thirty-two RNs were recruited for the study through a purposive sampling method, five were unable to participate. Twenty-seven (N = 27) RNs were interviewed of whom six were Māori RNs. Of the 27 RNs, seven were NPs and three were RNDNPs. Two NPs and one RNDNP were Māori. The majority were RNs in primary and secondary care working in infection control and in clinical roles (see Table 1).
| Registered nurses (RNs) | Non-Māori | Scope of practice | Māori | Scope of practice | |
|---|---|---|---|---|---|
| Nurse practitioner (NP) | 5 | Primary care (2) | 2 | Primary care | |
| Older Adults | |||||
| Paeds | |||||
| Diabetes | |||||
| RN designated nurse prescriber (RNDNP) | 3 | Diabetes | 1 | Primary care | |
| Primary care (2) | |||||
| Clinical nurse specialist (RN) | 5 | Secondary setting | 2 | Secondary setting | |
| Educator (RN) | 1 | RN educator for Designated nurse prescribers | |||
| Infectious disease registered nurse (RN) | 7 | Secondary settings | 1 | Secondary setting | |
| TOTAL (n = 27) | 21 | 6 |
Data collection
Individual semi-structured interviews were conducted by all co-authors (GL, BW), with JW completing interviews specifically for Māori RN participants. The interviews followed a guide and were conducted either in person, by phone, or via videoconferencing (Zoom). These interviews took place between January and April 2022 and were transcribed verbatim by the lead investigator (AGL). The interview guide included questions regarding the RNs’ knowledge of AMS and their perspectives on the role of RNs in promoting stewardship activities.
Ethical approval was sought with the Auckland Health Research Ethics Committee (AHREC approval Ref. AH23218 – 18 November 2021).
Data analysis
Thematic analysis, using an inductive process, was conducted by all authors (AGL, BW, JW). This process involved reading and re-reading the transcripts, identifying initial codes, collating these codes, and then developing initial themes, following the approach outlined by Braun and Clarke.14 Further analysis refined and finalised the themes, along with the identification of illustrative quotes.
Thematic analysis was employed to analyse the data, suitable for our exploratory work in an area where little is known. According to Braun and Clarke,14 thematic analysis offers a purely qualitative, detailed, and nuanced account of the data.
The identified themes were analysed both within and across cases. The across-case and within-case15 approach is valuable when the research goal is to develop generalisations that represent multiple perspectives. We also distinguished between information relevant to all participants and aspects that may be specific to Māori RNs. Within-case analysis refers to non-Māori and Māori RNs separately, while across-case analysis includes both groups. This distinction is crucial, as we aim to ensure that the voices and perceptions of Māori RNs are heard. We sought to identify any cultural issues that may be unique to Māori.
Results
Four themes were identified related to registered nurses’ views of AMS: limited familiarity with AMS/AMS activities, knowledge of antimicrobials, advocacy roles, and leadership roles in the clinical setting.
Theme 1: limited familiarity with AMS/AMS activities among RNs
Our findings across both Māori and non-Māori RNs indicate a general lack of familiarity with AMS activities in their clinical settings. While most participants are aware of AMR, they often lack a clear understanding of AMS approaches or are unfamiliar with specific AMS activities. Many RNs expressed the view that, if such activities do exist, nurses are not typically involved. Some participants mentioned that larger District Health Boards (now Te Whatu Ora Health New Zealand) may have established AMS groups and developed formal AMS plans. However, they noted that while the concept of AMS is acknowledged, full implementation has yet to occur, with doctors and pharmacists usually being the primary stakeholders in these efforts.
… conception of the idea definitely exists, but has yet to happen. (P6)
Across the board, RNs indicated a lack of knowledge and education around AMS activities. There was a strong desire for more education on the topic, as reflected by one clinical nurse specialist (CNS) who identified a link between their infection control role and AMS:
… link between infection control role and AMS. My role is probably more about sharing that information and explaining the implications of overuse of antimicrobials and multidrug-resistant organisms. (P10 RN)
Māori RNs, particularly in primary care, showed a strong understanding of antimicrobial resistance (AMR) but did not identify formal AMS activities. Instead, they focused on safe and effective prescribing practices. One Māori RN described this responsibility as follows:
It is an individual responsibility to be a good evidence-based prescriber, to provide the appropriate treatment depending on my clinical diagnosis, and to make the best use of the antibiotics available to me. (P2 NP)
Māori RNs place high value on clinical reasoning and individual responsibility in their prescribing practices. Māori RNs further reported engaging in weekly case discussions on best practices for antibiotic use. These discussions provided an informal AMS structure:
… we have weekly case discussions/round tables where we case manage and discuss … talk about best practice and keeping up to date with current research. (P3 NP)
Theme 2: knowledge of antimicrobials
A solid understanding of antimicrobials was seen as essential for confident engagement in patient education, particularly regarding risks and current information. This knowledge also bolstered RNs’ confidence when interacting with prescribers (eg doctors) and other health care professionals (eg pharmacists). RNs strongly suggest that being an effective antimicrobial steward will require good knowledge of antimicrobials.
They (RNs) need a level of knowledge around antimicrobial resistance and stewardship. (P15 NP)
RNs viewed good knowledge of antimicrobials as key to confidently educating patients about risks and providing up-to-date information. This knowledge also enhanced their interactions with prescribers (eg doctors) and other health professionals (eg pharmacists).
… challenging to explain to doctors and to introduce the topic gently and respectfully … there is an assumption that they know more than you. (P8 RN)
The quote above highlights the power dynamics between RNs and doctors in clinical settings. The RN faces the challenge of communicating AMS-related concerns to doctors, who are often seen as the dominant authority in prescribing decisions. This suggests the need for better interprofessional collaboration and education to empower RNs in AMS activities.
A notable theme across all groups was the lack of knowledge and the need for further education on AMS. RNs expressed a need to strengthen their understanding of AMS activities.
RNs demonstrated a good overall understanding of AMR, particularly the challenges associated with antibiotic overuse and misuse. The findings across cases indicated that NPs have a solid awareness of how their prescribing practices may contribute to AMR.
… it’s about encouraging the best use of narrow spectrum rather than broad-spectrum … making sure you keep in mind the potential for resistance and tolerance. (P19 NP)
This reflects a conscious effort by NPs to promote the judicious use of antibiotics, aligning with AMS principles. The focus on narrow-spectrum antibiotics highlights an understanding of minimising the impact on microbial resistance, showcasing a practical application of AMS in clinical practice.
While RNs had a foundational knowledge of antibiotics and their appropriate use, some participants questioned the depth of this understanding. Several RNs expressed a need for deeper knowledge in areas such as the mechanisms of resistance and the effectiveness of antibiotics for specific bacteria. Their work in medication management and patient education demonstrates practical engagement in AMS, but the feedback suggests that deeper scientific understanding would enhance their efficacy and confidence in these roles.
… strong knowledge of the pathology of infectious diseases, biosciences, and applied microbiology principles, like the difference between viruses and bacteria. (P18 RN)
This highlights a significant knowledge gap that could hinder RNs’ full participation in AMS programmes. The basic understanding gained during undergraduate education was viewed as insufficient for the complex nature of AMR and AMS. To fill this gap, participants suggested enhancing education through continuing education programmes, postgraduate studies, and discussion forums to deepen their applied microbiology and pharmacotherapeutics knowledge.
Māori RNs agreed on the need for more detailed education. They also highlighted the importance of educating tauira (student nurses) and expressed that better education is crucial for Māori RNs, as it allows them to educate their patients in Te Reo Māori and respond to Kaupapa nurses:
For Māori, it is important to see the bigger picture, such as through Te Whare Tapa Whā, which looks at a holistic perspective. (P4 RN)
Their narratives underscore the cultural context in which Māori RNs work, emphasising the need for education that is not only technically sound but also culturally responsive. Incorporating holistic perspectives such as Te Whare Tapa Whā (Four Dimensions of Life) into RN education can help Māori nurses engage more effectively with whānau, promoting preventative measures and appropriate antibiotic use within their communities.
Māori RNs emphasised the importance of strengthening undergraduate education, particularly in pharmacology. This is especially relevant for Māori RNs, as better education would enable them to educate patients in Te Reo Māori and respond to Kaupapa nurses. Māori RNs also stressed the importance of incorporating holistic models like Te Whare Tapa Whā to offer a comprehensive view of healthcare.
… it’s important to engage with whānau about preventative measures … (P6 RN)
These insights underline the need for culturally responsive education, especially for Māori RNs who play a unique role in advocating for patients in their communities.
While RNs demonstrated a good foundational understanding of AMR, there is a clear need for deeper scientific knowledge and more targeted education, particularly in applied biosciences and pharmacology. Continuing education programmes and postgraduate studies were viewed as necessary steps to equip RNs with the skills needed to engage fully in AMS activities. For Māori RNs, culturally responsive education that integrates holistic frameworks, like Te Whare Tapa Whā, is essential for effective patient and whānau engagement.
Theme 3: advocacy role
RNs play a pivotal advocacy role in promoting the appropriate use of antimicrobials, contributing significantly to AMS efforts. As frontline health care providers, RNs are uniquely positioned to educate patients on the safe and effective use of antibiotics, emphasising the importance of adhering to prescribed regimens and the risks of misuse, such as contributing to AMR.
Through patient education, monitoring antibiotic use, and promoting evidence-based guidelines, RNs act as crucial advocates for reducing AMR and ensuring safe, effective antimicrobial use within both hospital and community settings. Empowering RNs with continuous education and the tools needed for this role strengthens their role in AMS. Māori RNs also expressed caution regarding the overuse of antibiotics. One clinical nurse specialist (CNS) remarked:
The nurses are in favour of being careful with antibiotic use. We don’t want to overuse them. We need the patients to come into the office, not just prescribing over the phone. (P3 CNS)
This reflects the nurses’ awareness of the dangers of antibiotic overuse, a key concern in AMS. Their preference for in-person patient consultations rather than over-the-phone prescriptions demonstrates their commitment to ensuring appropriate antibiotic use and thorough clinical assessments before prescribing. This careful approach aligns with AMS goals, even though it is implemented informally in their practice.
Māori RNs also identified their role as community advocates, focusing on preventing unnecessary antibiotic use. Māori RNs stressed the importance of advocating for Māori patients when doctors prescribe unnecessary antibiotics:
… nurses will speak up about concerns, but the reality is we are so busy. Doctors do get questioned about the appropriateness of antibiotics. (P10 RN)
These reflect the informal but meaningful AMS efforts by Māori RNs, particularly in community settings where formal programmes may not be available. The argument could be strengthened by highlighting the need for formal recognition and support of these informal practices to ensure that Māori RNs can continue their vital advocacy work effectively.
Theme 4: leadership in AMS committees
RNs in the study recognised their role in AMS but felt they needed to be more confident in addressing overprescribing. The lack of confidence expressed by RNs points to both a gap in knowledge and a hierarchical barrier in health care settings. To address this, the argument should focus on empowering RNs through better education and clearer AMS guidelines, as well as promoting a culture of interdisciplinary collaboration where RNs can challenge overprescribing more confidently. NPS and RNDPs suggested that nurses need to take on leadership roles in AMS. Currently, RNs do not have a strong presence in AMS committees due to a lack of involvement in decision-making. RNs expressed the need for more active participation in AMS committees, particularly in collaboration with infectious disease (ID) and AMS groups. As one NP suggested:
… nurses should sit within AMS groups and collaborate with ID teams to provide advocacy and advice. (P18 NP)
This call for leadership indicates that RNs have both the skills and knowledge to contribute meaningfully to AMS initiatives. To strengthen this argument, there should be a push for more inclusive AMS committees where RNs can actively participate in decision-making processes and advocate for patient-centered care.
The absence of established antibiotic guidelines makes it challenging for RNs to advocate for appropriate antibiotic use. Many RNs expressed the need for prescribing guidelines to guide their practice effectively:
… strategies not just locally but nationally around the appropriate use of antimicrobials are needed to reduce adverse drug reactions and antimicrobial resistance (AMR). (P26 RN)
Referring to resources such as clinical guidelines or policies is essential for guiding RNs’ clinical decision-making, ensuring evidence-based antibiotic prescribing. This is critical for RNs to advocate effectively for the appropriate use of antibiotics. Establishing protocols or policies ensures consistency in practice, with everyone in the clinic adhering to current best practices. Staying updated with changes is also important, as regulations can shift every 3–6 months.
RNs felt that collaborative relationships with physicians, pharmacists, and ID specialists would help them build the confidence needed to take on leadership roles in AMS.
Discussion
AMR represents a significant threat to global health, particularly for vulnerable populations that rely on effective antimicrobial agents, such as antibiotics. Inappropriate use of antibiotics has been directly linked to antibiotic resistance and a range of adverse effects, including rashes, diarrhoea, and severe complications such as Clostridioides difficile infections and fluoroquinolone-resistant Escherichia coli infections.16 Given the grave risks posed by AMR, it is imperative for health care professionals, including RNs, to actively engage in AMS efforts.
AMS is a structured and coordinated approach aimed at promoting the appropriate use of antimicrobials to combat AMR and ensure the continued efficacy of antibiotics Effective AMS requires collaboration across a multidisciplinary team, which typically includes IDs physicians and pharmacists.17 However, RNs are often excluded from formal AMS teams, despite being directly involved in patient care and contributing to AMS-related practices in clinical settings. Our study highlighted several important findings regarding the role of RNs in AMS, structured around four key themes: lack of familiarity with AMS, lack of knowledge, the advocacy role of RNs, and their potential leadership role in AMS.
A notable finding from our study was that while RNs were generally aware of AMR and had engaged in related activities, there was a lack of familiarity with formal AMS programmes, particularly among those working in wards, aged care facilities, and primary care settings.11 RNs in these settings were less familiar with AMS programmes compared to NPs and designated RN prescribers, who were more actively involved in AMS activities. This lack of awareness may be due to the absence of AMS-specific training or structured programmes in these settings. Studies from Australia have similarly noted that while RNs are aware of AMS, they are not often familiar with the activities and protocols associated with AMS programmes. Increasing awareness and formal involvement of RNs in AMS initiatives could bridge this gap and enhance their contributions to combating AMR.18
Another critical finding was the perceived lack of depth in RNs’ knowledge regarding antimicrobial use. Although RNs in this study demonstrated a basic understanding of antibiotics and AMR, many acknowledged that their knowledge was limited, particularly in areas such as microbiology, mechanisms of resistance, and pharmacology. This gap in knowledge hindered their ability to engage confidently in AMS practices.19 Studies from Australia also underscore similar challenges, where RNs reported a lack of confidence due to insufficient knowledge of antimicrobials.20
To address this, there is a clear need for continuing education programmes that focus on AMS, microbiology, and pharmacotherapeutics. Educational programmes that enhance RNs’ understanding of the science behind antibiotic use could increase their confidence and ability to engage in AMS activities. Furthermore, integrating AMS principles into undergraduate and postgraduate nursing curricula, as seen in some international contexts, would provide nurses with the foundational knowledge needed to participate in AMS initiatives.21 Our study suggests that both formal education and practical experience are necessary to equip RNs with the knowledge required to be effective stewards of antimicrobial use.
A key finding from our study was that RNs overwhelmingly recognised their role as patient advocates in antimicrobial use. Advocacy is a core component of nursing practice, and RNs frequently found themselves advocating for appropriate antibiotic use, particularly when educating patients on the risks of overuse and the importance of adherence to treatment regimens. RNs also acted as intermediaries between patients and prescribers, relaying important information such as laboratory results and expressing concerns about antibiotic overuse. Despite their crucial role, RNs felt underutilised in decision-making processes regarding antibiotic prescribing. Many expressed frustration that they were seldom consulted in decisions about which antibiotics to use, despite their close involvement in patient care.
The role of RNs in AMS goes beyond patient education – it also involves advocating for evidence-based practices in collaboration with other health care providers.19 Our findings highlight that RNs need to be more integrated into AMS decision-making teams to fully exercise their advocacy role. By promoting shared decision-making tools, RNs can help reduce unnecessary antibiotic use and educate patients on when antibiotics are not needed, ultimately supporting AMS goals. RNs are well-positioned to be key advocates for AMS but to do so effectively, they need to be empowered through better integration into multidisciplinary AMS teams.
Finally, our study revealed that RNs are willing to take on leadership roles in AMS, but they require greater confidence and support to do so effectively. Many RNs in our study expressed a desire to be more actively involved in AMS initiatives, but they felt constrained by their perceived lack of knowledge and by hierarchical structures that placed physicians and pharmacists in leadership positions.
RNs working in aged care and primary care settings are particularly well-placed to lead AMS efforts22 as they are often involved in practices like switching from intravenous to oral antibiotics and managing antibiotic use in community settings.23 However, as noted by participants, AMS practices in primary care have been neglected. To realise the potential of RNs as leaders in AMS, health care systems must foster collaborative environments where RNs are encouraged to take leadership roles, supported by ongoing education, and included in AMS decision-making processes.
The findings from this study highlight the essential role RNs play in AMS, from patient advocacy to leadership in antimicrobial use. However, significant barriers – such as a lack of familiarity with AMS, gaps in knowledge, and underutilisation in decision-making – must be addressed to fully integrate RNs into AMS programmes. Improving education, fostering interdisciplinary collaboration, and promoting RNs to leadership roles within AMS teams are critical steps toward enhancing the effectiveness of AMS and reducing the threat of AMR. Furthermore, ensuring that culturally tailored AMS activities are developed for Māori communities will be vital in addressing health care inequities and supporting Māori RNs in their unique advocacy and leadership roles.
Limitations
Limitations of this study were its small sample size, and none of the RNs interviewed were currently employed in private hospital settings. It was also a qualitative study based on interviews. This approach was chosen as there is little information on the role of RNs in AMS in New Zealand. Further research, such as a survey of more RNs, would also offset a possible selection bias as participants self-selected to participate in this study.
Conclusion
AMR is increasing in New Zealand. AMS is one approach to reducing AMR. AMS culture is still evolving in New Zealand. An intended outcome of this research is to explore the role of RNs as AMS stewards and to show nursing’s current involvement in clinical work that mitigates the risk of infectious disease and AMR for NZ. This study is responding to a call for action to reducing AMR through AMS approaches. RNs are positioned well to help with the implementation of AMS programmes and activities in NZ, as RNs are already engaged in activities contributing to AMR reduction. Greater support and targeted education, and clarification of the specific roles for nurses in AMS, are required to incorporate AMS into their daily tasks and to apply AMS principles to their care of patients.
Data availability
The data that support the findings of this study are available on request from the corresponding author (AGL). The data are not publicly available due to some cultural sensitivity of information and may compromise the privacy of some research participants.
Declaration of funding
This work was supported by the Health Research Council Activation Grant HRC Ref ID#: 21/980.
Acknowledgements
Dr Bobbi Laing is acknowledged as the research assistant for the project and for preparing the manuscript for submission.
References
1 World Health Organization. Global Action plan on antimicrobial resistance. 2015. Available at https://www.who.int/publications/i/item/9789241509763
2 Abbo L, Smith L, Pereyra M, et al. Nurse practitioners’ attitudes, perceptions, and knowledge about antimicrobial stewardship. J Nurse Pract 2012; 8(5): 370-376.
| Crossref | Google Scholar |
3 Carter EJ, Greendyke WG, Furuya EY, et al. Exploring the nurses’ role in antibiotic stewardship: a multisite qualitative study of nurses and infection preventionists. Am J Infect Control 2018; 46(5): 492-497.
| Crossref | Google Scholar | PubMed |
4 Khan F, Arthur J, Maidment L, et al. Advancing antimicrobial stewardship: summary of the 2015 CIDSC Report. Can Commun Dis Rep 2016; 42(11): 238-241.
| Crossref | Google Scholar | PubMed |
6 Thomas MG, Smith AJ, Tilyard M. Rising antimicrobial resistance: a strong reason to reduce excessive antimicrobial consumption in New Zealand. N Z Med J 2014; 1394 127: 72-84.
| Google Scholar | PubMed |
7 Duffy E, Ritchie S, Metcalfe S, et al. Antibacterials dispensed in the community comprise 85%-95% of total human antibacterial consumption. J Clin Pharm Ther 2018; 43(1): 59-64.
| Crossref | Google Scholar | PubMed |
8 Mostaghim M, et al. Nurses are underutilised in antimicrobial stewardship – Results of a multisite survey in paediatric and adult hospitals. Infect Dis Health 2017; 22(2): 57-64.
| Google Scholar |
10 Office of the Prime Minister’s Chief Science Advisor. Kotahitanga: Uniting Aotearoa against infectious disease and antimicrobial resistance - A report from the Prime Minister’s Chief Science Advisor, Kaitohutohu Mātanga Pūtaiao Matua ki te Pirimia. Key messages, O.o.t.P.M.s.C.S. Advisor, editor. Auckland: The University of Auckland; 2022
11 Padigos J, Ritchie S, Lim AG. Nurses have a major role in antimicrobial stewardship. Kai Tiaki Nurs N Z 2017; 23: 16-45.
| Google Scholar |
13 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19(6): 349-357.
| Crossref | Google Scholar | PubMed |
14 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
| Crossref | Google Scholar |
15 Ayres L, Kavanaugh K, Knafl KA. Within-case and across-case approaches to qualitative data analysis. Qual Health Res 2003; 13: 871-83.
| Crossref | Google Scholar | PubMed |
16 Avent ML, Cosgrove SE, Price-Haywood EG, et al. Antimicrobial stewardship in the primary care setting: from dream to reality? BMC Fam Pract 2020; 21(1): 134.
| Crossref | Google Scholar | PubMed |
17 Olans RD, Olans RN, DeMaria A, Jr. Florence Nightingale and antimicrobial stewardship. Florence Nightingale J Nurs 2022; 30(1): 106-108.
| Crossref | Google Scholar | PubMed |
18 Rout J, Essack S, Brysiewicz P. Guideline recommendations for antimicrobial stewardship education for clinical nursing practice in hospitals: a scoping review. South Afr J Crit Care 2021; 37(3):.
| Crossref | Google Scholar | PubMed |
19 Courtenay M, Hawker C, Rose G, et al. The application of antimicrobial stewardship knowledge to nursing practice: a national survey of United Kingdom pre-registration nursing students. J Adv Nurs 1: 12.
| Crossref | Google Scholar | PubMed |
20 Kirby E, Broom A, Overton K, et al. Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study. BMJ Open 2020; 10(10): e042321.
| Crossref | Google Scholar | PubMed |
21 Danielis M, Regano D, Castaldo A, et al. What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review. Antimicrob Resist Infect Control 2022; 11(1): 153.
| Crossref | Google Scholar | PubMed |
22 Jokanovic N, Lee SJ, Haines T, et al. Pilot study to evaluate the need and implementation of a multifaceted nurse-led antimicrobial stewardship intervention in residential aged care. JAC Antimicrob Resist 2024; 6(1): dlae016.
| Crossref | Google Scholar | PubMed |
23 Dowson L, Friedman ND, Marshall C, et al. The role of nurses in antimicrobial stewardship near the end of life in aged-care homes: a qualitative study. Int J Nurs Stud 2020; 104: 103502.
| Crossref | Google Scholar | PubMed |
