Background
Health care services must engage all relevant healthcare workers, including nurses, in
optimal antimicrobial use to address the global threat of drug-resistant infections. Reflecting
upon the variety of antimicrobial stewardship (AMS) nursing models already implemented in
the UK could facilitate policymaking and decisions in other settings about context-sensitive,
pragmatic nurse roles.
Methods
We describe purposefully selected cases drawn from the UK network of public sector nurses
in AMS exploring their characteristics, influence, relations with clinical and financial
structures, and role content.
Results
AMS nursing has been deployed in the UK within ‘vertical’, ‘horizontal’ or ‘hybrid’ models.
The ‘vertical’ model refers to a novel, often unique consultant-type role ideally suited to
transform organisational practice by legitimising nurse participation in antimicrobial
decisions. Such organisational improvements may not be straightforward, though, due to
scalability issues. The ‘horizontal’ model can foster coordinated efforts to increase optimal
AMS behaviours in all nurses around a narrative of patient safety and quality. Such model
may be unable to address tensions between the required institutional response to sepsis and
the inappropriate use of antibiotics. Finally, the ‘hybrid’ model would increase AMS
responsibilities for all nurses whilst allocating some expanded AMS skills to existing teams of
specialists such as sepsis or vascular access nurses. This model can generate economies
of scale, yet it may be threatened by a lack of clarity about a nurse-relevant vision.
Conclusions
A variety of models articulating the participation of nurses in antimicrobial stewardship efforts
have already been implemented in public sector organisations in the UK. The strengths and
weaknesses of each model need considering before implementation in other settings and
healthcare systems, including precise metrics of success and careful consideration of
context-sensitive, resource dependent and pragmatic solutions.