In the practice environment, nurses are guided by evidence-based practice, policy, and procedures specific to their institutions. Comparably, nurses in academia refer to recent and relevant academic literature based upon institutional licenses. In preparation for the Nursing Theory Annual Conference, a gap was revealed among members of the Nursology Theory Collective dependent upon their work environment as it related to access to nursing knowledge. As described by a member of the Nursology Theory Collective who has worked in the practice environment, “I attempted to access a nursing research article from fifty years ago and found that I would have to pay $49, when the same article was freely available to my academic colleagues through their organizational access.” This member’s experience was not in isolation, and ended up being more of a norm than a rarity. At the publishers permission the article was able to be shared by academics to those without appropriate access in practice, but this is not a permanent solution and nor should it be a norm.
The question then arose: should access to nursing knowledge be a privilege or a right? Dependent upon our organizational affiliation (or lack thereof) nurses are blocked from relevant and essential nursing knowledge. Practicing nurses then have to consider purchasing academic literature, whether per article or journal subscription, at prices that may be unaffordable for their salary. Nurses in academics face similar issues when they are limited by what specific journal licenses their organizations may have. Ultimately, this may lead to nurses reaching out to colleagues located in other institutions in order to gain access to literature that is needed for their work.
The lack of equity in access to nursing and other disciplinary knowledge further perpetuates issues in nursing, such as the theory-practice gap also, referred to as the academic-practice gap. How can nurses in practice be expected to consider recent and relevant knowledge if they do not have access to it? Some nurses may never realize what they are, and are not able, to access. For example, when nurses’ are on-boarded or oriented into their healthcare institutions, if they are not educated on their resources (such as journal subscriptions or medical libraries – also, why aren’t there nursing or nursology libraries?), how can they be expected to use it for practice, education, or research? Similarly, how can nurses in academia educate or complete research on relevant nursing issues if they are blocked by paywalls (or should we say, selective paywalls – something to consider)? Reaching out to colleagues can result in loss of time/productivity, and coincidentally can place a colleague in an awkward situation. Moreover, this lack of equity in access to knowledge perpetuates a delay in translational research. Remember the old saying that it takes 17 years for research to become practical knowledge? In this day in age where knowledge is produced at such exponential rates, this shouldn’t be the norm.
Solutions for Change: Making Nursing Knowledge a Right
Instead of perseverating on the identified gap at hand, perhaps it’s time to discuss potential solutions and make nursing knowledge a right and not a privilege. Our hope is with this blog you can begin to educate yourself on what is equitable access to nursing knowledge, including potential solutions for change. With this, perhaps you can take some of these solutions back to your institution and colleagues, and keep some in mind for your future work. The following list contains potential identified solutions to creating equity in access to nursing knowledge.
1. Blogs on Nursing and Nursology
Blogging, as well as reading nursing blogs, is a great way to engage with the global nursing community without borders. Through these interactions, you have the capability to learn more about the work of others (whether in-process or complete) be exposed to new ways of thinking, have discussions around important topics, receive feedback on your work, and be referred to relevant and available resources. For example, on Nursology.net you can find blogs on resources for teaching, sociopolitical issues, student perspectives, and exemplars for theories, philosophies, and more. Other notable nursing blogs (such as at the American Journal of Nursing or Advances in Nursing Science) offer an opportunity for nurses to read about and discuss scholarly issues without a fee. Interestingly though, many academic journals do not have an adjacent blog. Perhaps it’s time for editors to consider integrating a blog for their journal, and maybe it is time for you to consider writing a blog about something you are passionate about?
2. Journal Clubs
While journal clubs get a bad reputation for disorganization and/or low participation, they are an effective way to develop community for equitable knowledge access. Whether internal to your institution, or external with colleagues (what about a journal club for practicing nurses AND nurses in academia?!), a journal club can be a great way to help disseminate relevant nursing knowledge to colleagues who otherwise wouldn’t be exposed. Additionally, journal clubs help stimulate discussion on potentially overlooked issues and knowledge gaps, driving our discipline into the future.
3. Nurses On Boards
Often when we think about boards, we picture a dry and unproductive boardroom meeting that could have been summed up in an email (also referred to as CHBAE). This is not to say that this doesn’t occur… but, nurses are hugely underrepresented on boards across the U.S. (and probably the world). The Nurses on Boards Coalition “represents national nursing and other organizations working to build healthier communities in America by increasing nurses’ presence on corporate, health-related, and other boards, panels, and commissions.” How does this relate to knowledge equity in nursing you ask? Well, if nurses are underrepresented on boards, ultimately, what is approved as valid knowledge within an institution (think about hospitals here) will lack a nursing voice. Conversely, if nurses have a voice on boards, they can bring their unique disciplinary perspective to the institution and help drive what IS considered as valid knowledge. Think back to the medical library versus nursing library comment above, or maybe you have another example in mind? That being said, think how your voice could impact your institution on a board, and how that voice could help shape the future of knowledge equity in nursing.
4. Development of Anthology’s on Nursing Knowledge
In 1986, the book titled “Perspectives on Nursing Theory” was published by Dr. Leslie Nicoll which “is an anthology of classic and contemporary peer-reviewed articles that address various theoretical and philosophical perspectives on knowledge development in research and practice” (Reed & Shearer, 2012, p. vii). Since the original publication, there have been six editions of this book, most recently by Dr. Pamela Reed and Dr. Nelma Shearer. This book is an exemplar of what nurses in academia can do to promote access to knowledge for those in the practice environment. Dependent upon the area of expertise (whether theory or perhaps another topic) similar books can be developed that are a collection of the classic and contemporary peer-reviewed articles that address the area of interest. Moreover, as new editions are developed (hopefully faster than 17 years), practicing nurses have an ability to access essential knowledge which helps bridge the theory-practice gap, and simultaneously, translate research into practice. In addition, in light of environmental concerns related to book production, authors, editors, and publishers should consider decreased prices on electronic book versions to decrease their carbon footprint, and also to increase access to nursing knowledge.
5. Open Access Nursing Repositories and Journals
Open access journals and repositories make original research freely available via the internet. While there are concerns around the quality of articles contained within open access repositories and journals, there are acceptable options provided by notable nursing organizations. For example, Sigma Theta Tau International hosts the Virginia Henderson Global Nursing e-Repository (otherwise referred to as the Henderson Repository). The Henderson Repository “is the only repository solely dedicated to sharing works created by nurses around the world. It is an open digital academic and clinical focused service that freely collects, preserves, and disseminates full-text nursing research, educational, and evidence-based practice materials in a variety of formats and item types.” You can even find posters that have been presented at conferences, such as the Nursology Theory Collective’s poster at the King Conference in 2019. Lastly, there is also an underlying community collection that contains theses and dissertations that have been completed and defended, making it easier to access unpublished works (which is also important!). That being said, have you shared your important work with a nursing repository?
6-?. You decide!
While this list is not exhaustive, this is just the beginning. If you have any further solutions to suggest on how to promote equity in access to nursing knowledge, please comment below. Remember, there are no wrong answers! We believe in the incorporation of nursing theory into practice, and practice into nursing theory, and we suggest that to support our discipline we need to close the gap in access to knowledge. Nurses in academia and practice need each other. We are interdependent and better together. We hope that in the process of closing this gap, we can foster collaboration across settings between nurses, ultimately bettering the health and well-being for all.
Nursing knowledge should be a right and not a privilege, and we all need to work together to enable it to be that way.
Note: The Nursology Theory Collective would like to thank Mike Taylor for bringing up this important issue to discuss with the Nursology community.
Reed, P. G., & Shearer, N. B. C. (2012). Perspectives on nursing theory (6th ed.). Lippincott Williams & Wilkins.