BEYOND DISPENSING: THE EXPANDING ROLE OF NURSES IN ANTIMICROBIAL STEWARDSHIP AND PHARMACOTHERAPY SAFETY

Abstract

Antimicrobial resistance (AMR) represents one of the most pressing threats to global health, with hospital-based Antimicrobial Stewardship Programs (ASPs) traditionally governed by physician- and pharmacist-led models that overlook nursing's structural position within healthcare delivery. This commentary argues that nurses, who constitute the largest professional group in the global health workforce and maintain near-continuous bedside presence, are uniquely positioned to contribute to antimicrobial stewardship and pharmacotherapy safety, yet remain systematically underutilized due to the persistence of task-oriented practice models, hierarchical team dynamics, and educational gaps in pre registration curricula. Drawing on international evidence from hospital and community settings, the commentary demonstrates that nurse-integrated stewardship models—including bedside surveillance, IV-to-oral antibiotic conversion prompting, penicillin allergy de-labeling, and patient education initiatives—produce measurable reductions in antimicrobial consumption, healthcare-associated infections, and medication errors. Specialist nurse champion programmes from the United Kingdom, Australia, and other national health systems illustrate replicable implementation pathways, although barriers including understaffing, inconsistent competency frameworks, and regulatory limitations on prescribing authority constrain scalability. The commentary further examines the ethical dimensions of expanded nursing roles, emphasizing professional accountability, advocacy obligations under the International Council of Nurses' Code of Ethics, and equity considerations for resource-limited settings. We conclude with a call to action for institutions, policymakers, educators, and nursing professional bodies to formally integrate nurses into ASP governance structures, reform nursing curricula, and recognize nursing as an indispensable asset in the global response to AMR as a health security imperative.