ESNO, Specialist Nurses Position Statment on AMR

Brussels, 08-11-2018

‘Specialist Nurses with key roles in tackling AMR’

Antimicrobial resistance (AMR) represents a serious public health threat, with an estimated 10 million people predicted to die globally from multidrug-resistance infections every year by 2050 if urgent action is not taken[1]. As caregivers for an increasing number of patients with multidrug-resistant infections, health care professionals play a crucial role in addressing AMR[2]  with nurses both in Europe and worldwide who are on the frontline of the AMR crisis. Nurses observe first-hand how multidrug-resistant infections lead to longer hospital stays, higher health care costs and increased mortality.

Nurses play several central roles in tackling AMR: infection control and prevention, advocating for rational antibiotic use and educating patients and their families on the responsible use of antibiotics. Firstly, nurses are involved in the preparation, administration and prescription of antimicrobials along with monitoring their effects.

Nurses, especially Infection Prevention and Control Nurses, are heavily involved in preventing the acquisition and spread of infections in hospitals and other healthcare settings. Hand hygiene compliance and the use of specific contact precautions are paramount in controlling transmission. Nurses are also essential in promoting awareness of AMR amongst other health care workers, patients and the general public. Due to their close relationship with patients, nurses are ideally placed to support adherence to treatment and the appropriate use of antibiotics in everyday practice. Misconceptions around drug resistance still exist, for example, some people believe that they can stop taking a prescribed course of antibiotics as soon as they feel better, and nurses play a key role in altering public perceptions and behaviour.

Despite their manifold roles in combatting AMR, nurses have been under-recognised and underutilised in antimicrobial stewardship[3]. EU and National AMR Action Plans have not previously emphasised the role of nurses. Initiatives promoting prudent antimicrobial prescribing and management have generally lacked nurses’ involvement. However, with relevant training, nurses have the potential to play an even more important role in combatting AMR, through influencing clinical decision making related to monitoring prescription decisions. With their consistent presence as patient advocate, nurses play an invaluable role in monitoring and communicating daily patient progress to ensure that antibiotics are being given in an appropriate manner. Through empowerment, nurses can play a larger role in advocating prudent use of antimicrobials within the multidisciplinary team. This is particularly true since nurses are becoming increasingly involved with prescribing in Europe. Hence, ESNO endorses the engagement of nurses in policy designs. In addition, ESNO supports further involvement of nurses in AMR surveillance. Through collaborating with data collection, nurses could help to provide the evidence base for action and advocacy on AMR.

To ensure that nurses and other healthcare workers are engaged in tackling AMR, training and educational resources on AMR need to be made available. ESNO therefore promotes the creation of tailored resources on AMR, specifically designed for nurses. Throughout Europe, undergraduate training should place a greater emphasis on AMR and how nurses can contribute to combatting it. Furthermore, ESNO supports the integration of AMR courses into the continued professional education of nurses, particularly accredited courses.

Accordingly, ESNO is currently working on the production of an Information and Communication Guide on AMR to ensure that nurses across Europe can access accurate, consistent information on drug resistance to be published April 2020. It is our belief that if all nurses throughout Europe were to receive specific education on AMR, a huge difference could be made.   

[1] Tackling Drug-Resistant Infections Globally: final report and recommendations (2016) UK Review on Antimicrobial Resistance.
[2] Communicating to professionals in hospitals and long-term care facilities,


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