Nursing students and nurses who work in academia enjoy institutional access to peer-reviewed research journals while they retain an academic affiliation. Nurses in practice often are not so lucky. Whatever our work setting, the expectation is that we use evidence-based practice (EBP) when caring for our patients and communities. There is a challenge to maintaining a body of up-to-date knowledge for EBP when so many of us have lost our access to research publications once out of school, and thus may be operating on out-of-date information. We risk harm to the populations we serve when we are unable to read and evaluate for ourselves the evidence behind EBP recommendations for our nursing specialties.

Of the 3.9 million nurses in the United States, the majority do not retain an academic affiliation. Upon graduation, our access to an academic library and its accessible online research journals disappears. Nurses who work in settings tied to academic medical institutions might have medical library access. However, medical libraries in hospitals are cost centers, not revenue-generating centers, and over the last decade have begun to disappear as noted in Harrow et al. (2019). In 2007, there were 2,055 medical libraries, with a decrease to 1,384 in 2017. Medical libraries do not exist at all for many nurses, such as those at smaller facilities, primary care, and public health. Nurses might have access to a journal by a professional organization membership, but this leaves out much of the workforce and much of the evidence. Nurses in practice are a key part of nursing education as they precept students for their clinical rotations. Lack of access to journals for nurses in practice creates a further downstream problem in nursing education, when practicing nurses may be demonstrating out-of-date knowledge, technique, or skills to the students they precept. Lack of journal access hampers EBP for nurses in practice and those entering the workforce; thus, patients and communities we serve are at risk.

Schools of nursing prepare nurses to become lifelong learners, but should they abandon their alumni once they have left their programs? Universities and colleges should consider allowing their graduates to have continued access to the academic library services, even if it is at a nominal fee. Licensing agreement typically prohibits electronic library access to those without current institutional affiliation; however, these contracts can be renegotiated in the future to include nurses who have graduated from the school. Nurses in practice who precept student nurses are generally not receiving additional compensation for these educational services. Provision of electronic library access to practicing nurses who precept nursing students should be the minimum level of support for these on-the-spot educators. This would require some investment-libraries maintain prices for subscriptions based on number of users, and adding more subscribers may be challenging. Licensing agreements can be reviewed and revised.

There are systems-level solutions to this problem. One excellent example is Health Evidence Resource for Washington State (HEALWA), a partnership between University of Washington and Washington Department of Health. For a $21 fee collected at license renewal, all nurses in Washington have online access to over 5,000 research journals. If such a system existed in every state, then no nurse would be left behind. When nurses have access to the latest evidence via peer-reviewed journals, patients and communities we serve benefit. Safe, high-quality nursing care requires ready access to current evidence via health institution libraries.

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