DNP Scholarly Projects


Background: The World Health Organization stated that antimicrobial resistance is one of the top 10 threats to global health. To combat antimicrobial resistance, antimicrobial stewardship (AMS) programs were developed. Efforts to engage nurses in stewardship efforts have been limited. Bedside nurses are in an optimal position to help decrease antimicrobial use, which is especially relevant in long-term care facilities where up to 75% of antibiotic use is deemed unnecessary or inappropriate. The purpose of this Doctor of Nursing Practice scholarly project was to examine factors that influence nurse engagement in AMS at long-term care facilities in Tennessee. Methods: A mixed-method, cross-sectional survey design was used to assess knowledge, attitudes, and behaviors of nurses working in 30 long-term care facilities in Tennessee. Descriptive statistics, qualitative thematic analysis, and Kruskal-Wallis H tests were used for statistical analysis. Results: 107 (N = 107) nurses participated. Overall, nurses provided appropriate definitions of antimicrobial stewardship. While 88.7% of nurses agreed that antibiotics were overused nationally, only 33.3% agreed that antibiotics were overused in their setting. Approximately 72.6% of nurses were interested in learning about the current status of antibiotic resistance in their setting. Nurses were confident in performing most behavioral skills, except for antibiotic dosing and de-escalation and IV to PO antibiotic conversion. Nurses listed lack of education, communication, time constraints, and patient and family knowledge as common barriers to engaging in AMS. Conclusion: Overall, nurses had positive knowledge and attitudes, which indicated a strong potential to engage in stewardship behaviors. After identifying barriers to nurse engagement in AMS, long-term care facilities should implement interventions to overcome the barriers. Further research should assess the effect of interventions, such as formal and informal education, on nurses' knowledge and attitudes and evaluate interventions to counteract barriers to engagement. Recommendations include providing nurses with current antimicrobial resistance and utilization patterns in their facility and engaging them within the institution's antimicrobial stewardship team.


Spring 4-19-2022

First Advisor

Kathryn Dambrino

Scholarly Project Team Member

Olivia Bahemuka

Scholarly Project Team Member

David Phillippi


Nursing, School of


Health Sciences & Nursing, Gordon E. Inman College of

Document Type



Doctorate of Nursing Practice (DNP)

Degree Level


Degree Grantor

Belmont University


antimicrobial stewardship; nurses; antibiotic resistance; long-term care; attitudes; behaviors; knowledge

Included in

Nursing Commons