Development of antimicrobial stewardship competencies: A pan-Canadian framework for nurses

Background: Recent evidence highlights the critical influence nurses may have in antimicrobial stewardship (AMS). However, nurses’ express knowledge gaps and a lack of confidence in leading AMS interventions. The AMS competencies framework was developed to address these challenges by providing a foundation for optimizing AMS-related nursing interventions with guidance and expected competencies that can be adapted to different practice settings and nursing categories. Methods: The framework development began with a literature review of nurses’ role in AMS across all nursing practice settings and was followed by a cross-Canada survey that involved 261 nurses, with 94% of respondents in non-prescribing roles and 6% in prescribing roles (nurse prescribers). Key survey findings were explored in virtual focus groups. Findings from the literature review, survey, and focus groups informed the initial draft of the AMS competency framework. The draft underwent internal review, and external validation through a Delphi Method with 33 reviewers and achieved high agreement (over 90%) on competency statements. Results: The AMS competency framework is organized within a matrix of seven AMS domains, nurses’ roles, and the competencies (knowledge, skills, attitudes) that nurses and nurse prescribers require to participate in AMS within their practice setting. The competencies are broadly divided into three types: Core, additional, and optional competencies. Additionally, an evaluation framework provides individual nurses and partners with potential guidance and approaches to measure outcomes associated with the achievement of the AMS competencies. Conclusion: Nurses’ impact on antimicrobial resistance (AMR) and involvement in AMS activities can have far-reaching benefits because nurses are at the forefront and interface across numerous care and practice settings. However, nurses’ engagement in AMS varies greatly and can be impacted by both individual factors (e.g., knowledge level, confidence, engagement) and contextual influences (e.g., workload, resources, leadership support, and advocacy to support nurses’ role in AMS). Coupled with contextual supports, the AMS competency framework represents an evidence-informed approach to define and support the knowledge, skills, and attitudes needed to maximize nurses’ role in AMS.