Advancing antimicrobial stewardship through the One Health Stewardship Competency Model for Nursing

Antimicrobial resistance is a critical global health threat that compromises the effectiveness of essential medical treatments and procedures. A significant yet under-recognised contributor to antimicrobial resistance is the improper disposal of antibiotics, which introduces pharmaceutical residues into ecosystems. These residues exert selective pressure on microbial communities, facilitating the emergence of multidrug-resistant organisms, often referred to as silent superbugs. The environmental dimension of antimicrobial resistance aligns closely with the principles of One Health, which emphasise the interconnectedness of human health and the health of natural systems.

Despite the growing urgency of antimicrobial resistance, nursing education has yet to fully integrate a One Health approach into its curricula. We pose a conceptual framework that the nursing profession may adopt to guide a more ecologically informed approach to healthcare education and practice. Nurses, as the largest and most trusted global health workforce, are uniquely positioned to lead efforts in antimicrobial stewardship, sustainable healthcare delivery, and public education. However, without formal training in environmental health and sustainability, their capacity to address antimicrobial resistance holistically remains limited.

This paper calls for the integration of a One Health approach into nursing education, outlining strategic actions for educators, clinicians, and policymakers. These include interdisciplinary collaboration, culturally responsive community engagement, and the use of digital technologies to support stewardship and education. The discussion is framed within international policy contexts, including the World Health Organization's Global Action Plan on antimicrobial resistance and the One Health approach. By embedding sustainability and environmental literacy into nursing education, the profession can play a transformative role in mitigating antimicrobial resistance and protecting the efficacy of antibiotics for future generations. This call-to-action urges nurse leaders to embrace their role in shaping a resilient, ecologically responsible healthcare future.