Twitter flows like a river of conversations, where you can step in or step out on any given day. The quality of these virtual discussions can be rich and actionable. One example is a discussion that was started by Melanie Rogers when she shared her frustration at no longer having access to evidence-based journals since finishing her graduate degree. This not only impacted Melanie’s nursing practice but also the nursing students that she precepted during their public health rotations.
Melanie raised a salient point, and her message has reverberated across social media. Why should access to professional journals end with graduation when it is needed the most? One remedy, joining our national organizations, does give access to the professional journals of that organization if they have one. However, not all nursing organizations have peer-reviewed research journals and it limits exposure to one sector of nursing when collaboration and innovation are keys to best health outcomes for our patients.
The power of social media, specifically Twitter, has now expanded to an international discussion about how access to research and evidence-based practice is handled around the globe. Melanie provides a comprehensive review of the responses that have been shared on Twitter using the hashtag #NoJournalsNoEBP.
I never imagined that a Twitter thread posted grumpily at 3 AM on a Sunday morning in a bout of insomnia would have resonated with so many, or been read so widely. The problem of lack of easy access to scientific journals is a barrier for health care and public health professionals in maintaining up-to-date knowledge of their respective fields to conduct evidence-based practice (EBP). The original guest blog post on the Relentless School Nurse detailed how this problem impacted me as an individual public health nurse:
As the topic of #NoJournalsNoEBP took off on conversations across Twitter, it quickly became apparent that this problem extended far beyond just nursing and public health, my own areas of experience. The discussions on Twitter provided us with insight on the impact of the problem on interprofessional colleagues, highlights of the ways #NoJournalsNoEBP is being addressed in some arenas, nuance into journal publication, and ideas for how we all can play a role in a #NoJournalsNoEBP call to action. The second guest blog post on Relentless School Nurse details these things:
How many are talking about #NoJournalsNoEBP?
Here we are, nearly four weeks from the original Twitter thread, and the #NoJournalsNoEBP conversations are still going. Julie J. Adams, a #NoJournalsNoEBP supporter from Sigma, the international honor society of nursing, was kind enough to provide us some statistics and graphics showing the length and breadth of #NoJournalsNoEBP on Twitter. From the first tweet to April 9, the #NoJournalsNoEBP hashtag has been seen over 404,700 times by Twitter users. A breakdown of the sorts of Twitter accounts tweeting about #NoJournalsNoEBP is displayed below, showing it is mostly individual healthcare providers (HCPs) who have been talking thus far.
We enjoy seeing that individuals are talking about #NoJournalsNoEBP, but we want to see more professional organizations, advocacy groups, academic institutions, and other organizations joining the conversations. We can’t solve this problem individually, after all. As individuals, the solutions we cobble together for our own journal access challenges are but piecemeal and patchwork, and we require systems-level changes to truly address this issue.
#NoJournalsNoEBP Goes to College
On April 4, a nursing professor from Mobile, Alabama shared with us on Twitter that she had incorporated #NoJournalsNoEBP into her course on evidence-based practice for undergraduate nursing students. She had her students complete tables on the differences between EBP, research, and quality improvement that had to include what they knew, why they needed each, how each should be used, and what tools were necessary. Showing the #NoJournalsNoEBP discussion during class led her students to progress their thinking under “tools needed” from nurse managers, administrators, and computers to include more robust things like databases, libraries, and professional nursing organizations.
We were also pleased to hear that the #NoJournalsNoEBP discussion prompted further thoughts from students on employee benefits beyond the immediately apparent of salary and health insurance to also think about resources employers might provide, such as journal access. We hope to hear about similar examples from other academics as they prepare their students to maintain evidence-based practice in their professions once they have finished their programs of study.
#NoJournalsNoEBP and the National Library of Medicine
One very exciting development in the reach of #NoJournalsNoEBP was when school nursing colleague Sheila Caldwell drew the attention of Dr. Patti Brennan, the Director of the National Library of Medicine, to the conversations on Twitter. Dr. Patti Brennan shared a message of support for the struggle of professionals to maintain access to scientific literature, and a request for us all to share ideas on addressing #NoJournalsNoEBP with her (@NLMdirector).
Dr. Patti Brennan also pointed out that over five million full-text articles are available on the PubMed Central database maintained by the National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/. The PubMed Central database is an excellent place for anybody to start looking for scientific literature relating to healthcare or public health discipline. Specific to the discipline of nursing, Dr. Patti Brennan provided a helpful link to the special collection of journals of nursing that participate in the PubMed Central database here: https://www.ncbi.nlm.nih.gov/pmc/journals/?term=nurse&titles=all&search=journals
Sheila Caldwell also informed us that there are National Institutes of Health funding opportunities available for projects to “improve access to health information, increase engagement with research and data, expand professional knowledge, and support outreach that promotes awareness and use of National Library of Medicine resources in local communities.” This is a very exciting prospect as we examine systemic ways we might impact #NoJournalsNoEBP – such things require funding after all. Learn more about the National Network of Libraries of Medicine program at NIH here: https://nnlm.gov/funding
#NoJournalsNoEBP Opportunities for Nurses in the United States
Nurses in the United States have upcoming opportunities to make an impact on #NoJournalsNoEBP.
The National Network of Libraries of Medicine is offering an upcoming webinar on April 25, 2019 2-3PM EST titled “A Nursing Liaison’s Role in Evidence-Based Practice,” which discusses the importance of evidence-based practice in nursing, the difference between EBP, performance improvement, and research, and identification of opportunities librarians can take advantage of to support the EBP of nurses. We ask that if you are a nurse in the United States and are available to participate in this webinar, please do! We need to bring the nursing voice and perspective to the vital partnerships with librarians to address #NoJournalsNoEBP. Register here: https://nnlm.gov/class/nursing-liaisons-role-evidence-based-practice/9605
We also encourage nurses in the United States to voice their thoughts on how lack of easy access to scientific journal affects our ability to do evidence-based nursing practice to the Future of Nursing 2020-2030 committee of the National Academy of Medicine. If you are not familiar with this study, a summary about it and the recording of the first public hearing is available here: www.nam.edu/FutureofNursing2030
There are three upcoming public hearings over the summer which may be attended in person or online.
Theme: Education, Research and Practice
Friday, June 7
8:30–12:30 pm CDT
Malcolm X College
Register to attend or watch online here.
Theme: Vulnerable Populations and Paying for Care
Wednesday, July 24
8:30 am–12:30 pm EDT
UPenn School of Nursing
Register to attend or watch online here.
Theme: High Tech, High Touch
Wednesday, August 7
8:30 am–12:30 pm PDT
University of Washington
Register to attend or watch online here.
We especially encourage nurses concerned about #NoJournalsNoEBP to register for the June 7th event focused on education, research, and practice. However, one need not wait for a scheduled event to provide input to the National Academy of Medicine. Testimony and commentary can be submitted anytime via email to email@example.com
#NoJournalsNoEBP Outside of the United States
Our initial perspective of #NoJournalNoEBP was centered on the United States, as that is where the writers live, work, and have familiarity with the systems. Colleagues from outside the United States graciously provided information on how access to scientific journals is or is not managed within their professional spheres in their locations, and how #NoJournalsNoEBP impacts them.
Healthcare professionals of the public health system in New South Wales have access to journals and clinical guides at any point in their careers: https://www.ciap.health.nsw.gov.au/
A colleague from the Netherlands weighed in to say her experience was similar to mine, in that once students leave college or university, journals are typically no longer available. Nurses who wish to evaluate the scientific value of protocols have no easy way of looking for studies that provide evidence for or against them.
Professionals working for the National Health Service have ongoing access to Open Athens / Knowledge Network, which provides access to many scientific journals: https://www.openathens.net/nhs_users.php
A nursing colleague from Germany noted that nurses there are usually trained at vocational schools where access to scientific journals even for teaching staff, let alone students, may be very challenging due to budget constraints. Another nurse echoed the concern that there are both time constraints and lack of education on how to generate data and work with results in relation to EBP.
Pacific Island Nations
An epidemiologist and professor of public health medicine in rural and isolated islands in the Pacific who runs a medical officer program to train physicians and improve the skills of existing public health and medical workforces reached out too. The low budgets for any program at all limit opportunities for journal access, which in turn hampers the ability of the educational staff to stay up to date on knowledge to pass on to the professionals they work with.
#NoJournalsNoEBP – What’s Next?
Our conversations on #NoJournalsNoEBP are far from over. We want to continue collecting stories about how lack of access to scientific journals impacts health care and public health professionals in the United States and abroad. We want to continue curating resources to help alleviate the strain and share them widely so that our colleagues who lack academic affiliations can find ways to get the literature they need to do evidence-based practice in their fields.
If you are reading this blog and do not use Twitter, feel free to share your stories or resources to firstname.lastname@example.org and I will amplify your voice across our platforms.
Let’s keep this conversation going.
Bio: Melanie Rogers, MPH, BSN, RN is a public health nurse in the state of Colorado. Throughout her years in practice, she has been active in professional organizations for public health nursing and encourages all nurses to get involved with the organizations of their specialties. Melanie can be found on Twitter at
@MRogersRN or working with nursing students when they are on public health rotations.