Evaluating nurses’ adherence to antimicrobial administration principles and associated factors in Eastern Uganda: a hospital-based cross-sectional study

Background Antimicrobial resistance (AMR) is a severe global public health threat demanding robust antimicrobial stewardship (AMS), where nurses play a critical execution role. This study evaluated nurses’ adherence to the Five Rights of antimicrobial administration and identified the professional and institutional determinants affecting their practice at Mbale Regional Referral Hospital (MRRH) in Eastern Uganda. Methods A descriptive cross-sectional institutional study employing quantitative approach to data collection was conducted among 92 qualified nurses from November to December 2024. Data were collected using a validated, semi-structured paper questionnaire. Inferential data analysis was performed using STATA version 15.1, employing Pearson’s chi-square tests to determine statistically significant associations between independent factors and adherence, with significance set at p< 0.05. Results Out of 92 nurses, 57 (61.96%) adhered strictly to all Five Rights of antimicrobial administration. Adherence was significantly higher among nurses with 6 years of professional experience (70.83% versus 52.27%, p = 0.041) and those with positive attitudes towards patient education (83.08% versus 44.44%, p = 0.0003). Adherence was significantly compromised by institutional factors, notably heavy workloads (65.22% adherence, p = 0.012) and acute time constraints (33.33% adherence, p = 0.008). Conclusion Nearly two-thirds of the qualified nurses fully adhered to the Five Rights of antimicrobial administration at MRRH. Adherence behaviors are strongly driven by clinical experience and positive educational attitudes, but heavily undermined by operational pressures like high workloads and time limitations. To close remaining compliance gaps and strengthen institutional AMS, hospital management must optimize staffing levels and integrate continuous AMS education into nursing workflows.