Enrique Castro

Rising racism blamed for collapse in number of foreign nurses coming to UK Number of overseas nurses and midwives registered between April and September was half that of a year ago

www.theguardian.com/society/2025...

If your AMS role vanished tomorrow… what would your ward, facility, health system lose?
And how would you prove it, in numbers, not just narratives?

Full reflection here: open.substack.com/pub/theamsnu...

#AMR #Nursing #Stewardship #HealthEconomics #AMS #IPC #PatientSafety

AMS programmes save money. But unless nursing contributions are made visible, they risk disappearing at budget time.

From COM-B–based engagement tools to nursing-sensitive stewardship outcomes, we now have ways to show what nurses already do, and what their work is worth.

My new The AMS Nurse Substack post asks a simple question with big consequences:
If we don’t measure the value of AMS nursing, how can we argue for sustainable funding?

We talk a lot about “empowering nurses” in stewardship, but not enough about securing the roles themselves.

Why antimicrobial stewardship (AMS) nursing needs an economic story…

AMS nurses are doing some of the most safety-critical work in the hospital… yet many posts are temporary, seconded, or funded year-to-year.

Between Admiration and Authority: How Far Does Nursing Partnership in Antimicrobial Stewardship Really Go? When the pharmacist calls for collaboration, but the system still resists it.

My post on The AMS Substack sits in that uneasy space between praise and permission, asking what real partnership in stewardship might look like, and what it costs to keep showing up when the system still doesn’t always listen.
open.substack.com/pub/theamsnu...

Yet, in the quiet moments of practice, during the IV review that went unnoticed, or the hesitant suggestion that gets waved away, admiration starts to sound a little hollow.

There’s a particular kind of melancholy that comes with being admired but not quite trusted.

Often, colleagues from other professions say that nurses are essential. The evidence agrees.

The Stigmatisation of Men Who Have Sex With Men in the Spread of Mpox: Are We Repeating the Mistakes of HIV? The 2022 mpox outbreak disproportionately affected men who have sex with men (MSM), leading to targeted public health interventions. While data supported prioritising MSM, this focus risks reviving s...

Epidemics test our values as much as our systems.

When fear rises, will we choose compassion or blame?

Our editorial argues for solidarity, because dignity is a public health intervention.

doi.org/10.1002/nop2...

Nurses are at the frontlines of inclusion. We listen, educate, advocate, often when others won’t.

In mpox, as in HIV, nursing leadership can rebuild trust and confront stigma.

HIV taught us that solidarity and empowerment save lives.
Mpox reminds us that stigma still shapes outbreak response.

Let’s not repeat history, let’s rewrite it with empathy and evidence.

Stigma doesn’t stop infection, but it fuels it.

When communities feel blamed, they disengage from prevention, testing, and care.

Public health language matters.

The 2022 mpox outbreak hit MSM communities hardest. But focusing only on risk groups risks repeating old narratives.

Epidemiology can’t justify stigma. Public health must protect people, not just populations.

The Stigmatisation of Men Who Have Sex With Men in the Spread of Mpox: Are We Repeating the Mistakes of HIV? The 2022 mpox outbreak disproportionately affected men who have sex with men (MSM), leading to targeted public health interventions. While data supported prioritising MSM, this focus risks reviving s...

Our new Nursing Open editorial is out: “The Stigmatisation of Men Who Have Sex With Men in the Spread of Mpox: Are we repeating the mistakes of HIV?"

doi.org/10.1002/nop2...
#Nursing #PublicHealth #Equity #Mpox

In the Crucible of Care: Why the Critical Care Nurse Is (another!) Unsung Hero of Antibiotic Stewardship Reflections from the European intensive care frontlines of antimicrobial resistance

My new The AMS Nurse reflection, written during #ESICM2025, asks what would change if we recognised critical-care nursing vigilance as leadership.

Read more theamsnurse.substack.com/p/in-the-cru...

Two decades of research show the pattern: when nurses prompt, question, and advocate, antibiotic use falls … but hierarchy and workload still silence those voices.

ICU nurses see antibiotics started, hung, reviewed, and stopped.

They are the 24-hour sentinels of antimicrobial stewardship; yet still one of the most overlooked leaders in the room.

The ICU is the crucible of care — where every decision can save a life … or feed resistance.

Involvement of community health workers in antimicrobial stewardship interventions and programmes: a scoping review Introduction Antimicrobial resistance (AMR) poses a global health threat, especially in low-income and middle-income countries. Community health workers (CHWs) are key actors in infection management a...

Looking ahead

Community health workers already save lives every day.
With the right systems, they can also protect the effectiveness of antibiotics for generations.

It’s time to see them as key agents of change in the work to prevent and address #AMR.

🔗 doi.org/10.1136/bmjg...

Policy implications

Our review calls for CHWs to be formally integrated into national AMS policies.

They need clear scopes of practice, fair pay, and ongoing learning opportunities.

Investing in CHWs means investing in equity and resilience. #CommunityHealth

Training & Support

Training makes the difference.

Where CHWs had structured AMS education, supervision & feedback tools, outcomes improved—better adherence to guidelines, fewer unnecessary prescriptions.

Without that support, progress stalls. #AMR #Stewardship

What we found

Across 8 studies in Uganda, Tanzania, Zambia, Pakistan, Bangladesh & Kenya, CHWs helped prevent, detect & treat infections—often reducing inappropriate antibiotic use.

But their stewardship role is rarely formalised or supported. #GlobalHealth

Why this matters

#AMR kills over 1.2 million people each year—mostly in low- and middle-income countries.

Yet those same health systems rely heavily on community health workers.

How can we harness their role in responsible antibiotic use? Our review explores just that.

Involvement of community health workers in antimicrobial stewardship interventions and programmes: a scoping review Introduction Antimicrobial resistance (AMR) poses a global health threat, especially in low-income and middle-income countries. Community health workers (CHWs) are key actors in infection management a...

Thrilled to share our new paper in BMJ Global Health:
“Involvement of community health workers in antimicrobial stewardship programmes: a scoping review.”
Community health workers (CHWs) are central to tackling #AMR globally.
🔗 doi.org/10.1136/bmjg...

Many congratulations!

Rewriting the Future of Nursing Leadership in Antimicrobial Stewardship Reflections on education, conferences, and diplomacy in action

We’ve learned to teach stewardship, now we need to learn to lead it.
My new The AMS Nurse post reflects on AMS nursing education, leadership, and diplomacy, and why it might be time for a Nursing AMS Policy & Diplomacy Summit.
Read it: open.substack.com/pub/theamsnu...

#Nursing #AMS #Diplomacy

On the edge My week in the NHS

On the edge
open.substack.com/pub/samf/p/o...

‘Frightened to get out of their cars’: Britain’s toxic race debates threaten overseas care workers Staff are being advised to travel in mixed groups and carry panic alarms as incidents of intimidation spread

‘Frightened to get out of their cars’: Britain’s toxic race debates threaten overseas care workers