Everyone knows the bad news: Bacterial resistance to antibiotics is common. The good news is that healthcare providers, public health organizations like the Centers for Disease Control and Prevention (CDC) and the World Health Organization, and nations and governments recognize this reality and are taking steps to address the looming crisis. This campaign involves a thoughtful approach to using antimicrobial agents against infections of all types and has led to the development of antimicrobial stewardship programs (ASPs).
Additional bad news is that despite antimicrobial stewardship, the misuse and overuse of antibiotics persists globally. The good news is that multidisciplinary ASPs have become widespread and are working to limit antibiotic resistance and find the best approaches for these valuable medications. Sadly, nurses frequently were left out of ASP designs, and they previously had been undereducated about antibiotic use, uninformed about the risks of multidrug resistance, and omitted from programs designed to address both.
Even after the American Nurses Association (ANA) and CDC collaborated in 2017 on a white paper describing the breadth of antimicrobial resistance and delineating areas of nurse contribution to ASPs, publications on the subject rarely reflected nursing functions. In addition, articles with nurse coauthors were published in medical rather than nursing journals, and no shift occurred in nursing curricula or nurse education. A concern was that nurses would view antimicrobial stewardship participation as an additional responsibility on their already full work plate.
But more good news is emerging. At national conferences and in medical publications, nurses’ contributions to daily antimicrobial stewardship functions are acknowledged. The success of nurse-directed programs to decrease central line–associated bloodstream and catheter-associated urinary tract infections are undeniable and universally praised. The accreditation standards of The Joint Commission and DNV-GL to encourage ASPs frequently are mediated through nursing departments, and the recent addition of ASPs as a Centers for Medicare and Medicaid Services hospital requirement will heighten interest in stewardship and efforts to engage nurses. The CDC is updating its Core Elements of Hospital Antibiotic Stewardship Programs with an expanded discussion of nurses’ participation, and the Agency for Healthcare Research and Quality includes nurses in their research efforts to change antibiotic prescribing practice. The ANA and CDC’s call for more nurse education was addressed with the development of international core competencies for prelicensure nursing education in first-world and middle-income countries.
A recent report by Ha and colleagues documented improvements in antimicrobial stewardship results after including bedside nurses into existing ASPs. The authors found that their nursing staff’s ASP education and participation enabled them to “work smarter and work better rather than work harder,” an attitude that nurses on other units quickly embraced. This disabused the notion that nurses would view antimicrobial stewardship as a burden.
To paraphrase Charles Dickens’ A Tale of Two Cities: Is it the best of times, or the worst of times? Microorganisms are still resistant, but some progress has been made. Nurse competencies have been published, and nurse contributions to successful antimicrobial stewardship are being recognized. We’re moving toward accepting that “Good antimicrobial stewardship is good nursing, and good nursing is good antimicrobial stewardship.”
Rita Olans is an assistant professor at MGH Institute of Health Professions in Boston, Massachusetts.