Libraries: informing nurses anytime, anywhere

When the world’s latest health findings are just a few clicks away, do we still need medical libraries and librarians?

“I think they are probably more important than ever,” argues Peter Murgatroyd, library manager for Counties Manukau District Health Board (DHB), “because the evidence and knowledge to inform your work is greater than ever, through online technology and online resources, and what most people find is they are overwhelmed by potential information sources.”

Murgatroyd says a key role of his team of six librarians is to identify the high-value, highly relevant evidence-based resources (usually subscriber-only) that can best inform practice.

“Dr Google has a role to play – particularly for consumers – but for a nurse, doctor or allied health professional, they need to rely on evidence they know is validated and is not going to cause harm.”

Viv Kerr, library manager for Hawke’s Bay District Health Board, agrees, saying libraries and librarians’ comprehensive knowledge of the majority of electronic resources makes them a one-stop shop for nurses. “This is more efficient for them as they have a centralised point of contact.”

Sue Hayward, director of nursing for Waikato District Health Board, sees DHB libraries as a great asset to nursing, with Waikato’s own library services closely involved with the project to provide an online nursing procedure resource that is now delivered to 10 DHBs across the country.

“The support we get from our librarians is phenomenal. And I think in every DHB where nursing leadership links with the libraries and the librarians we become much richer for it.”

In 2015 the stereotype of medical libraries as institutions with dusty text books and shelf after shelf of hard-bound journals is long gone, with more and more DHB libraries now supplying material via subscriber databases, e-journals and e-books. A trek across the hospital to access that e-material is also no longer necessary, with intranet access available at ward desktop computers or, as more and more hospitals get wifi, via cell phones, tablets or laptops. Even when hospital staff head home, many can still login to their DHB library’s electronic resources.

Ask a librarian – they know where to look

“You might have a nurse get lucky and snatch a five-minute break to take a look at something,” says Kerr. “But realistically, hospital libraries have had to get smart and make available resources via the intranet.”

In the case of Hawke’s Bay, the pressure to invest more in electronic resources than in print was also prompted by DHB staff stretching from Wairoa to the north to Waipukurau in the south (and until recently the Chatham Islands).

Kerr says a nurse on the ward can now access the library’s complete electronic resources – from catalogue to electronic databases – from their desktop computer.

“If they want to get a book out (electronic or print), they don’t actually have to come to the library – we will send it to them. So everything they require is at their fingertips really,” she says.

“And if they can’t find an article or we don’t hold it, we will interloan it for them – we make it as easy as we can. It’s about supplying the information, not hanging onto it.

“DHB libraries have a good wealth of knowledge and staff are always happy to support any type of inquiry or study.”

Kerr says nurses commonly ask her for help with literature searches, particularly to find evidence for policy development, updating procedures or DHB innovation projects, as well as postgraduate study. She says nurses also seek out articles to read for professional development or as part of a journal club.

Kerr is also education and development manager and says the combined library and education centre offers a multitude of different services for nurses and other staff, including links to online training modules, helping people use Microsoft Word, or learning about endnotes and referencing.

“We are talking about busy people so they do often need a lot of support and help to get to where they need to be.”

Murgatroyd also says his librarian team has specialist expertise with databases so can offer DHB staff a literature search service for the latest evidence to support clinical research, new initiatives and DHB projects etc. and can also offer all health professional staff a one-on-one tutorial on what resources are available and how to best use them.

He adds that Counties-Manukau, where he has been library manager since late 2013, has also moved away from the traditional hospital library model that was largely focused on just servicing doctors’ and nurses’ patient care roles.

He says with his DHB being one of the largest – with more than 5,000 staff and an annual budget of around $1.5 billion – the focus of the library is on the business of health as a whole and not just to inform patient diagnosis and treatment.

“We need to inform not just clinicians but managers, project leaders and staff involved in improvement initiatives,” he says. “So we need to understand the health system well enough to identify potential sources of data, reports and literature for staff but also keep an eye on social media and blogs to understand the current thinking around particular fields of practice. We curate both types of resources.”

By curation, he means identifying and pulling together relevant information from a range of different sources into an “easily accessible package that provides good coverage of a subject area”.

For instance, Counties Manukau has a very large Pacific population so many staff have a special interest in Pacific health and are looking at how they can address the very challenging needs of the Pacific community. Murgatroyd says the information is often out there but it’s scattered and people often don’t know how to start, so the library has pulled together a cluster of  links to some of the best resources in a variety of areas, including Pacific health, Māori health and, recently added, Asian health. These clearinghouse sites are sited on Healthpoint so are freely available to all interested people.

Some still unaware of what libraries offer online

Murgatroyd says some nurses are avid users of these curated resources on Healthpoint  and other resources the library offers  electronically.

“But there are many nurses who don’t make use of the library and who aren’t aware of the shift in resources, including nurses who may have been working for a long time and remember the library primarily as a physical place you went to find a physical journal or book.

“So some maybe aren’t aware that so much more (library resources) are now accessible from their ward desktop computer or their laptop … and increasingly in the future through apps and mobile access.”

He says he still comes across nurses, doctors and allied health professionals who have no idea what is available from the library service until they are actually sat down and shown.

Kerr says with many nurses having been away from study for a number of years before they take up postgraduate study, she offers support and advice in study areas like referencing, footnotes and assignment management.

When it comes to postgraduate study, Murgatroyd says he is keen for the library to support postgraduate students to be self-reliant and build their capability to use the libraries of the university or polytechnic where they are enrolled. “That’s a shift we’ve made here and I’m not sure what other DHBs do, but we feel that it’s far more sensible to encourage our staff to be aware of the resources that are available through their tertiary provider and for us to complement that and not duplicate it.”

Many of the health libraries are also linked together via Te Puna (the National Library) Health Library Group, which shares resources via interloan, and there is also a health special interest group in the national librarian organisation LIANZA.

Still a physical space for study and reflection

While more and more resource material is whizzing around electronically, ‘virtual library’ style, the ’real‘ library space continues to appeal to many.

Both Counties Manukau and Hawke’s Bay DHB libraries are connected to their DHB’s learning centres. In Counties-Manukau’s case, the library is adjacent to the Ko Awatea innovation and learning centre and in Hawke’s Bay the library and the education centre share a single physical space, with the purpose-built centre opening in 2005.

Kerr says nurses at Hawke’s Bay mostly use the library electronically for research but some will retreat to the physical space when they need to study or work on a project or assignment – including after hours. (When Kerr first joined the DHB in 2004 only DHB doctors were allowed after-hours access to the library but she soon saw this changed.)

Now nurses often set themselves up in a corner for a few days, with the library pretty flexible about allowing them to leave their study material huddled in one spot.

“We know that people like to build themselves a nest for a few days,” laughs Kerr.

She says some nurses are regular library visitors; many would never or rarely ever use the library, and some arrive in a hurry two days – or even on the day – before an assignment is due. But in Hawke’s Bay’s case most DHB nurses have been through the door because they enter the space on their way to training or lectures in the learning centre lecture theatre or meeting rooms.

“So they might inquire about their training course then wander off around the library browsing, sit down to read a newspaper or book, or jump on a library computer to look up their training history record.”

Murgatroyd says likewise some nurses are very heavy users and appreciative of the service offered, including providing a resource space they can come to after-hours or at weekends to work on their projects or professional development.

DHB libraries: sharing with the community

Some charge, and others like Hawke’s Bay and Waikato make much of their material and services (depending on subscription licenses) free to nurses in the community health sector from aged care to hospices.

Murgatroyd says when he joined Counties Manukau DHB he was asked to take a new strategic approach to the library’s work.

“My team’s role is to take a bigger view and not let our vision stop at the doors of the hospital but think of our wider partnership with PHOs and primary care,” says Murgatroyd. “Also to look at how we can improve access to resources and information for our community.”

He says his challenge has been to extend access to its resources within its existing budget. Ideally he would have liked to provide access to all the many nurses working in schools across South Auckland and nurses in other community roles. But he began by negotiating with publishers for increased electronic access to its major databases and journals for health professionals working for local primary health organisations (PHOs) – some companies have given extended access initially for free and others are charging a 10 per cent premium.

The new service went live in September 2014 with the key flagship offer to nurses being access to the full text nursing and allied health literature database CINAHL.  Murgatroyd says take-up from the PHOs is a “slow burn”, with each PHO asked to nominate a key contact who can arrange usernames and passwords for electronic access for interested nurses, doctors and other health professionals.

Meanwhile its physical library is open to any health professionals – from hospices to rest homes and schools to general practice – to access during office working hours. “We have a ‘walk-in, sit-down and make yourself at home and we will help you find what you need to find’ policy,” says Murgatroyd. He says the library’s philosophy is to have as equitable access to library resources as possible for clinicians, whether they are serving patients in a small rural practice or at Middlemore Hospital.

Kerr says the DHB library service has been open to non-DHB health professionals for at least eight years as part of the DHB’s ‘transform and sustain’ focus on the Hawke’s Bay health system as a whole. This means the library also incorporates health professionals from the wider community in any consultation or planning. She says the reality is that not many non-DHB staff physically visit the library but they do access the resources available electronically (some are not available to non-DHB staff due to on-site only licences) and if they are visiting the hospital for Grand Rounds or training they will come and visit afterwards.

Check it out for yourself

Take a visit to your local DHB library in person to check out what is on offer, is Kerr’s final advice to nurses.

“There is just a raft of resources that will help them … even if they’re not sure what they want. Just go in and talk to somebody. They don’t need to be fully knowledgeable about libraries because librarians are always happy to help and to show you what you need to know and help you get what you need to get.

“Definitely feel free to come and visit – I would encourage it actually.” Kerr says she speaks each year on orientation day for new nurses and one of the first things she always says is “don’t leave it to the last minute – come and see us first because we can inevitably help you. It gets more difficult the longer you leave it.

“It doesn’t matter what it is, I would suggest you ask a librarian because nine times out of 10 they will be able to point you in the right direction,” laughs Kerr. “You would be surprised the knowledge that librarians have of any organisation.” :