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Outpatient Antimicrobial Stewardship -

Nurse Practitioner

U.S. Antibiotic Awareness Week is November 18th-24th. During this observance, SIDP is highlighting members who promote optimal antibiotic use and combat the threat of antibiotic resistance in impactful and innovative ways. This blog features Dr. Elizabeth Miller Walters and her role as a pediatric nurse practitioner and an antibiotic steward. 

I am a pediatric nurse practitioner and an antibiotic steward. In my everyday work, I practice in a variety of settings including juvenile justice, adolescent medicine, and primary care. As an antibiotic steward, I ensure that I prescribe antimicrobials only when necessary and utilize the most recent evidence for diagnosis and treatment of infections. Beyond my day-to-day work, I am an Advanced Practice Registered Nurse (APRN) leader and work on antimicrobial stewardship at a local and national level. APRNs are an important group to target for antibiotic stewardship and I have been working diligently for APRNs to be a voice in the stewardship arena.

Some of the stewardship initiatives that I am most proud of include mentoring Doctor of Nursing Practice (DNP) Students through stewardship related doctoral work. My students and I implement practical approaches to antimicrobial stewardship, often focused on guideline implementation. For example, I have designed and implemented a pediatric UTI algorithm for our system’s pediatric emergency department that focuses on both provider actions and nursing actions to improve test acquisition and appropriate treatment for pediatric UTI. A DNP student under my mentorship implemented a nurse triage algorithm for signs and symptoms of strep throat during the pandemic. One of the most important aspects of this work is that we ensure that the projects are interdisciplinary and work with all the relevant team members including nursing, pharmacy, providers, microbiology, infection prevention and healthcare leadership in the design and implementation of these projects. I am honored to be working at the front lines of antimicrobial stewardship along with the DNP students that I mentor.

Another initiative that I am very proud of is bringing national societies together to work towards getting the word out to APRNs about antimicrobial stewardship and the importance of every APRN being an antibiotic steward. Currently, I am working with the Pediatric Infectious Diseases Society and the National Association of Pediatric Nurse Practitioners on a series of educational modules focused on antimicrobial stewardship principles for pediatric nurse practitioners.

“Being Antibiotics Aware” is an important concept to me. Nurses are seen as the most trusted profession. As a nurse, I often have family and friends ask my opinion on their illness and when to seek treatment or antibiotics. Many times, antibiotics are not necessary for common illnesses, and I am proud to share the message from the CDC about when antibiotics are not recommended.

One pearl for clinicians that I have is that antimicrobial stewardship must be an interdisciplinary effort that includes APRNs and nurses. On your stewardship teams and committees, actively seek out nurses and APRNs to help. There are several excellent tools for nurses to utilize for antimicrobial stewardship including the Johns Hopkins Antibiotic Stewardship Nursing Tool Kit. Nurses can examine their nurse triage protocols to find opportunities to improve the use of antimicrobials. Nurses and APRNs are key team members in the fight against antimicrobial resistance, invite them to the table for antibiotic stewardship work.

Elizabeth Miller Walters DNP, CPNP, RN

Assistant Director of Operations of Advanced Practice Initiatives and Certification Outreach at the American Nurses Association

Adjunct Faculty at University of North Carolina, School of Nursing

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