The quicksand of stewardship: A qualitative study of antimicrobial learning during clinical placements in European nursing education.

Abstract

AIM Investigate how undergraduate nursing students experience antimicrobial stewardship learning during clinical placements in two European countries. BACKGROUND Nurses are vital but underused actors within antimicrobial stewardship interventions. Prior research has identified major gaps in undergraduate, university classroom-based antimicrobial stewardship education, yet how nursing students translate this learning during clinical placements remains unexplored. DESIGN Qualitative design. METHODS Semi-structured interviews conducted with 17 undergraduate nursing students (ten from the United Kingdom and seven from Spain) between 2023-2025. Data were analysed using reflexive thematic analysis. Rigour was enhanced through bilingual coding, peer debriefing and ongoing interpretive reflection. RESULTS Students, across multiple educational and clinical contexts, found themselves navigating what we describe as an 'educational quicksand', a shifting terrain shaped by hidden curricula and systemic opacity, a disorienting and fragmented learning space marked by unclear roles, minimally structured teaching, workload-driven deviations in practice and sparse opportunities for reflection or interprofessional learning. Overall, four interconnected themes emerged: (1) antimicrobial stewardship is marginalised in both practice and pedagogy; (2) learning is self-directed and fragmented; (3) embodied learning and the role of modelling: between hesitation and enactment; and (4) students aspire to stewardship roles despite systemic constraints. CONCLUSION Across the two study settings, nursing students hover at the threshold of stewardship, constrained by comparable structural gaps, implicit curricula and unclear role boundaries. Embedding antimicrobial stewardship within mentorship, interprofessional dialogue and assessment frameworks could help students move more confidently through this 'quicksand' and support the development of antimicrobial stewardship as a core nursing competency.