title: Nurses as Antibiotic Brokers: Institutionalized Praxis in the Hospital.
abstract: We are likely moving rapidly toward a post-antibiotic era, as a result of escalating antimicrobial resistance, rapidly declining antibiotic production and profligate overuse. Hitherto research has almost exclusively focused on doctors' prescribing, with nurses' roles in antibiotic use remaining virtually invisible. Drawing on interviews with 30 nurses, we focus on nurses as brokers of doctors' antibiotic decisions, nursing capacity to challenge doctors' decisions, and, "back stage" strategies for circumnavigating organizational constraints. We argue that nurses occupy an essential and conscious position as brokers within the hospital; a subject position that is not neutral, facilitates (short-term) cohesion, and involves the pursuit of particular (preferred) nursing outcomes. Illustrating how authority can be diffuse, mediated by institutionalized praxis, and how professionals evade attempts to govern their practice, we challenge the reification of physician prescribing power, arguing that it may work against the utilization of nurses as important stakeholders in the future of antibiotics.
authors.affiliation: 1 The University of New South Wales, Sydney, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Broom
authors.affiliation: 2 Sunshine Coast Health and Hospital Service, & The University of Queensland, Brisbane, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Broom
authors.affiliation: 1 The University of New South Wales, Sydney, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Kirby
authors.affiliation: 3 University of Surrey, London, United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: Scambler
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000066491:Clinical Decision-Making / Q000379:methods*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D010344:Patient Advocacy; D010818:Practice Patterns, Physicians'; D024382:Professional Role
chemical_list: D000900:Anti-Bacterial Agents
keywords: Asia-Pacific; Australia, Australians; health care; health care professional; interprofessional; interviews; qualitative; sociology