Nurses as antimicrobial stewards: Recognition, confidence, and organizational factors across nine hospitals

Background: There are national calls to engage nurses as antimicrobial stewards, but it is unknown how patient safety culture influences nurses' antimicrobial stewardship (AS) involvement.

Methods: Cross-sectional survey to determine bedside nurses' recognition and performance confidence in AS. Nine hospitals ranged in size from 42 to 562 beds serving pediatric and adult populations in 2 different metropolitan areas. Composite scores for nursing practices, performance confidence, and organizational factors were developed and correlated. Analysis of variance (ANOVA) with Tukey HSD post-hoc tests and nonparametric (Kruskal-Wallis) tests with Bonferroni adjusted P values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience. Free text comments were categorized by theme.

Results: A total of 558 nurses participated (13% response rate). A significant positive association r_s = 0.454, P < .001 was found between nurses' beliefs about nursing practices that contribute to AS processes and their confidence to perform. Ninety one nurses provided comments with 50 statements indicating the primary barrier to stewardship were organizational factors including perceived lack of a safety culture.

Conclusions: Nurses identified a professional role in AS processes, though safety culture inhibited their involvement. These findings can help enhance the inclusion of nurses in AS efforts.