Registered nurses’ antimicrobial stewardship roles: a qualitative descriptive exploratory study

Anecita Gigi Lim; Jennifer Woods; Brenda Waite

doi:10.1071/HC24080

RESEARCH ARTICLE (Open Access)

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Registered nurses’ antimicrobial stewardship roles: a qualitative descriptive exploratory study

Anecita Gigi Lim

¹ ^* , Jennifer Woods ¹ ^§ , Brenda Waite ¹

+ Author Affiliations

- Author Affiliations

¹ School of Nursing, University of Auckland, Building 502, Grafton Campus, Auckland, New Zealand. Email: jennifer.woods@auckland.ac.nz, br-enda.waite@auckland.ac.n-z

^* Correspondence to: g.lim@auckland.ac.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care 16(4) 382-389 https://doi.org/10.1071/HC24080

Submitted: 11 June 2024 Accepted: 5 October 2024 Published: 29 October 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

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.

Aim

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.

Methods

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.

Results

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.

Discussion

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.

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 |

5 World Health Organization. Antimicrobial resistance: global report on surveillance. WHO, 2014.

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 |

9 Nursing Council of New Zealand. Te Ohu Mahi Tapuhi o Aotearoa he New Zealand:Nursing Workforce: A profile of Nurse Practitioners, Registered Nurses and Enrolled Nurses 2018 – 2019. Wellington: Nursing Council of New Zealand; 2019

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 |

12 Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice, 8th edn. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.

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 |