School Nursing

The Relentless School Nurse: UPDATE #NoJournalsNoEBP – Access to the Research Behind Evidence-Based Practice Must Not End at Graduation

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The hashtag #NoJournalsNoEBP began trending on Twitter after Melanie Rogers, MPH, BSN raised a valid concern about being frustrated that her access to professional nursing journals ended after she graduated from her Master’s program. With the encouragement of Media Strategist, Barbara Glickstein, Melanie created the hashtag and the response was immediate. I invited Melanie to write a blog post to explain her concerns and look to social media, #NursesWhoTweet for reactions, suggestions and next steps.

Even before this blog post was published: The Relentless School Nurse: Access to the Research Behind Evidence-Based Practice Must Not End at Graduation, the suggestions, comments, and recommendations were shared on Twitter. One that really caught our attention was from nurses in Washington state. All healthcare providers have access to professional journals through a joint partnership between the Washington Department of Health and the University of Washington. Funding for this innovative initiative is through license renewal fees. Here is more information about this program called HealWA.

Read about the Mission and Vision of Heal WA – the On Call Library for Washington State Practitioners:

 

Melanie Rogers, MPH, RN, the curator of #NoJournalsNoEBP, shares a comprehensive view of the feedback received since the original #Tweet she shared to express her distress at not having access to professional journals.  Melanie’s voice has agency:

#NoJournalsNoEBP has taken off on Twitter as colleagues in practice from various health professions chimed in on how lack of access to quality scientific journals has impacted their ability to maintain evidence-based practice (EBP). There were stories similar to my original recounting of the challenges in nursing, chronicled in the first #NoJournalsNoEBP blog post in the Relentless School Nurse: https://relentlessschoolnurse.com/2019/03/25/the-relentless-school-nurse-access-to-the-research-behind-evidence-based-practice-must-not-end-at-graduation/

Nurses who worked acute care in hospitals spoke to the challenges of maintaining EBP in an environment with either shrinking or no access to journals, particularly those who worked in places without an academic affiliation. One nurse studying in her nurse practitioner program noted that when she graduated, she planned to work in her rural area, and anticipated that she would not have any access to journals at all because of her practice setting in a low resource area. Another long-term care facility nurse said the only hope she had of accessing scientific literature was in open access journals online, as her workplace provided nothing. Pharmacists told us how the occasional continuing education opportunity was helpful but did not meet their needs in the way that library access would. Colleagues in public health spoke to their frustration of needing access to current peer-reviewed literature to do their jobs, but being thwarted with no institutional provision of such resources nor access via the universities attended for their public health training. We even had athletic trainers reach out to tell us #NoJournalsNoEBP affected their workforce. Colleagues from across the United States, Canada, England, and Australia reached out on Twitter to tell their stories, and their ideas for solutions.

Our initial focus on #NoJournalsNoEBP was how it affected nurses, but it was quickly apparent from the information our interprofessional conversations over Twitter provided us that we must expand our viewpoints. We thank everyone that has chimed in to help us examine how we might address this problem in a holistic way for all affected health professionals.

#NoJournalsNoEBPAction Steps:

Academic Programs
The colleges and universities that train the workforces of nursing, medicine, pharmacy, public health, and other health professions can make a difference by providing support to their graduates to be lifelong learners in their professions. Provide continued full online access to the academic library that is accessible off-campus to graduates of your programs. It does little good for the nurse on the hospital floor to have to go across country to his alma mater campus to do a literature review.

We know that an essential part of any school of medicine, nursing, pharmacy, or other health profession is for their students to learn from professionals in practice. Any reputable program wants its students learning from preceptors that are up to date with their clinical knowledge and evidence-based practice. Academia should provide free online institutional logins for the library to the community partners their students are sent to in order to ensure quality learning for their students, especially if the community partner does not provide such access to their employees internally.

If you are in academia and your institution does these things already, we applaud you. If your institution does not, advocate for these things to your leadership. In the interim, please teach your students about databases that can be accessed without an institutional affiliation or subscription, such as those found at this Rutgers University Library web page: https://libguides.rutgers.edu/c.php?g=337224&p=2269241 Help them find quality open access journals, such as those found on the Directory of Open Access Journals here: https://doaj.org/ Such resources will be helpful if students lose their library access after graduation.

Hospitals, Health Departments, & Other Practice Settings

We encourage the practice settings of health professions to provide their employees with access to scientific literature to help them maintain their evidence-based practice. Workplaces with an academic affiliation may do this already, but everyone is not so lucky. Explore creative strategies to provide your employees with the scientific literature they need. As an example, public health departments can explore a partnership with the National Network of Libraries of Medicine to participate in the Public Health Digital Library program, which provides over 270 e-journals, 70 e-books, and other digital resources relevant to evidence-based public health practice: https://nnlm.gov/nphco

Professional Organizations

Professional organizations often provide access to one or two journals as a membership benefit. We challenge professional organizations to go further and maintain digital libraries that are open to everyone in the profession, not just those who are able to afford membership. We applaud the example set by Sigma, the international honor society of nursing, which maintains the Virginia Henderson Global Nursing e-Repository. This open access collection of journal articles and papers is open to all nurses, whether they are members of Sigma or not. https://www.nursingrepository.org/

Societies and professional organizations also influence the science of the professions they represent. Encourage the researchers in your profession to practice open science in the name of collegiality, especially as they publish. More information can be found on the precepts of open science and resources can be found here: https://osf.io/

Researchers and Scientists

We encourage researchers and scientists to take steps to publish their work as open access papers where possible. When applying for grants to fund your work, include a line item for the open access fees that journals may charge. Try to select quality open access journals for submission of your work. Where that is not feasible, look into publication with journals that will allow you to issue pre-prints of your work on your personal website or another open science framework. One Twitter colleague provided this resource for fellow researchers looking for which journals allow pre-prints at which stage of publication: http://www.sherpa.ac.uk/romeoinfo.html  Remember to advertise frequently that researchers can email PDFs of their papers if an individual contacts them directly – the public does not know this widely! 

Further nuance in the #NoJournalsNoEBP discussion deepened as researchers and academics chimed in about the larger upstream problems of the publishing industry that drive the downstream problems at the individual health professional level. While the need for open access papers is a valid complaint from those in practice, we must be aware that not all journals are created equally. Predatory publishers and low-quality journals exist, which may be open access and tempting to the unsuspecting researcher to publish within or reader to peruse.  Several researchers raised the concern that shifting the additional cost of making their research papers open access in quality journals would restrict the ability of researchers without significant financial backing from institutions to publish their work. Early career researchers or those without institutional support might not be able to afford from their own pockets the fees to publish open access papers. However, researchers and scientists at any point in their careers can avoid publishing in predatory journals, and can steer their colleagues and students they may work with away from such publications. One resource to assist in identifying predatory journals is Beall’s List https://beallslist.weebly.com/. For nursing research specifically, the Directory of Nursing Journals exists to provide a list of vetted quality publications. https://nursingeditors.com/journals-directory/

You

Everyone has a role to play in addressing #NoJournalsNoEBP. We encourage you to continue the discussion of #NoJournalsNoEBP with your colleagues in person and on social media platforms. It is conversations on Twitter that allowed us to pull together these ideas – imagine how much more we can do if we keep talking with each other! But we must also talk with the public, policy makers, and politicians to inform them of the problems we face in our professions. Someone in the state of Washington realized years ago the challenges health professionals face in accessing peer-reviewed literature and spoke with their representative, because the innovative solution of HEALWA was legislated into existence as mentioned in the intro of this post: https://heal-wa.org/ We would love to see similar resources across the United States (and the rest of the world!) for everyone in a health profession.

Upstream Problems

Some of our ideas, such as universities providing continued library access to graduates of their programs and for community partners, their students train at, may work less well in the face of rising costs of journal subscriptions. We learned from a colleague on Twitter that the University of California has declined to renew their subscription to Elsevier, which is a publishing firm of some enormity that holds publication rights to hundreds of journals of nursing, medicine, and other health professions. As much as we focused on the impact of #NoJournalsNoEBP on the individual worker who cannot afford to pay $30 for every paper they wish to read, institutional access to journals may shrink if other academic institutions or health systems decrease the number of subscriptions they can purchase each year.

There is no one solution to #NoJournalsNoEBP, and indeed the problem is not just a lack of access to journals by health professionals who work in practice rather than academia. There are problems of predatory journals, low-quality science, and the ever-looming challenge of actually translating research into practice so that evidence-based practice exists at all. Those conversations are worth having as well, but for now, we must all do our part in at least tackling the lack of access to peer-reviewed literature by health professionals in practice.

Join us, and rally up!

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