Table 3 Characteristics of antimicrobial stewardship nursing models
Domains | |||||||
|---|---|---|---|---|---|---|---|
Antimicrobial stewardship nursing model | Interprofessional working | Strategic influence- Relation with other structures | Clinical outcomes (What measure of impact? Process?) | Individual identity | Funding/ Managerial structures | Setting of practice (hospital, community …) | Role components (clinical, educational, quality, policy, managerial) |
Vertical (i.e. nurse consultant) | Yes | High strategic influence; focal relation with comparable figures/ roles within own profession (i.e. nurse consultant) or others (i.e. pharmacy consultant); collaboration/leadership across aligned areas (i.e. AMS & IPC/AMS & sepsis etc) | May be difficult to robustly attribute impact or clinical improvements to the role in view of indirect work (i.e. influencing others) Feasible to attribute process improvements | Novel professional figure/role, supported by similar professionals in other clinical areas, or professionals from other disciplines | Mainstream human resources funding May be difficult to evaluate value-for-money Appointed by board-level managers from own or other professions | Hospital or community, but most likely hospital | All, with emphasis on planning/ evaluation/ management of organisational practice |
Hybrid (i.e. nurse specialist) | Yes | Some strategic influence as part of specialist services; advisory relation with own and other professions across multiple areas | Easy to attribute impact or clinical improvements due to focus on planning and delivery of clinical services, education. | Traditional role with some expanded or novel skills/ responsibilities which may have been jurisdiction of other professionals or disciplines | Funding may be short-term or pilot before substantive, based on results. Appointed by manager or lead of specialist team, which may not be a nurse (i.e. consultant pharmacist or physician in AMS) | Hospital or community | All, with mixture of planning, evaluation and delivery of services |
Horizontal (i.e. staff nurse) | No | Limited or minimal strategic influence; most relations within own ward/team, with frequent contact with specialist/advisory roles (i.e. IPC specialists) | Feasible to attribute impact or clinical improvements in antimicrobial stewardship interventions deployed | Traditional role, supported by similar professionals in same or other clinicals areas | Mainstream human resources funding. Appointed by ward manager/nurse in charge | Hospital or community | Mainly clinical, educational, quality and managerial service delivery |