The role of nurse in antimicrobial stewardship- an integrated review

Sarah Thomas1, Dr Thea F van de Mortel2, Dr Peta-Anne Zimmerman2

1Gold Coast Health

2Griffith University



Antibiotic resistance is a global problem that can be effectively controlled by appropriate antimicrobial stewardship (AMS) strategies. Nurses should be involved in AMS as they comprise a huge proportion of the health care force however, their current roles are unclear.


This study aimed to identify and discuss the role of nurses in AMS in various health care settings.


An integrative review using a systematic search of available literature was performed in MEDLINE, CINAHL Plus with full text, Scopus, and Web of Science for studies published from 2013-2018 in English and among humans. Results:

  • Thirteen studies that met the inclusion criteria were included in the review.
  • Five were qualitative, seven were quantitative, and one used mixed method.
  • All identified the role of education in preparing nurses to be antibiotic stewards.
  • A barrier to the involvement of nurses in AMS activities included professional role perceptions within organisations.
  • Nurses were willing to participate in an antimicrobial stewardship programme (ASP) as it was considered as an extension to their role as patient advocate.


  • Educating nurses pre- and post-registration on antimicrobial stewardship principles is required to empower them to support the correct decisions in relation to antimicrobial use.
  • Nurses need to be involved in ASPs and the related outcomes of their involvement should be monitored.
  • Nurse prescribers do have role in AMS.
  • More studies need to be done defining the role of nurses in AMS.


There was paucity in the literature in measuring the outcomes of antimicrobial stewardship associated with the nurse’s role. Antimicrobial resistance has been identified as a global threat. Though there is some role related ambivalence for nurses in AMS, the core value of nurses as patient advocates promotes them for active participation in AMS. Globally there are huge efforts done to tackle antimicrobial resistance hence nurses should join hands in AMS in their roles in various healthcare settings.


Sarah Thomas RN, MSc Infection Control, Nurse Immuniser, CICP-E. Currently working as Clinical Nurse in Infection Control, Gold Coast Health. Areas of interest include antimicrobial stewardship, staff health and device related infection.

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