1. Rohan, Annie J. PhD, RN, NNP-BC, CPNP-PC, FAANP

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An unusual headline recently crossed my newsfeed: "World Health Organization Becomes First of United Nations Agencies to Join Coalition to Implement Plan SHOCK." As a long-time intensive care provider, I envisioned Plan SHOCK or Plan S to be a new clinical tool with international applicability for treating the sickest of patients. Perhaps it was a sepsis calculator? I discovered that Plan Shock was hardly a clinical treatment regimen. Today, the World Health Organization (WHO) announces it is the first United Nations agency to join a coalition of research funders and charitable foundations (cOAlition S) to make Plan S, full and immediate open access to research publications, a reality (World Health Organization, 2019).


WHO is joining the Bill and Melinda Gates Foundation, Wellcome Trust, and numerous other influential research funders, agencies, and ambassadors to endorse Plan S. The plan is based on 10 principles (cOAlition S, n.d.), the key of which states that research supported by public or private grants be published in high-quality open-access repositories or journals, without delay, by 2021. Other principles call for publication fees to be standardized, capped, and covered by funders or universities, and not individual researchers.


Consider the last time that you sought to answer a clinical question by accessing PubMed, or CINAHL, or the Google Scholar database. After entering keywords and reviewing several titles and abstracts, the potentially best source of evidence is identified. You click on the link for the full-text article...and a payment screen appears. "Add this article to your cart: $35," or "Subscribe to this journal: $199." You look for the next best source of evidence...repeating the process until you find a full-text article. Perhaps that article is a little older than your original choice, or the sample population is slightly different, but it is the best that you can find. The problem of limited access to evidence sources, one that Plan S seeks to resolve, is so common in our professional lives that many of us have succumbed to acceptance. Many practicing nurses do not have free access to a medical library (Rogers, 2019). Imagine the impact of the many small improvements in practice and education that would be made if only we could easily access the best information.


Pushback on Plan S involves complex and significant challenges to a transition. Most parties commend cOAlition S for its bold vision. There must be significant safeguards for integrity of scientific literature in full open-access venues. Opponents voice concern that Plan S may not support high-quality peer review and puts university-owned and other important and international journals at risk for sustainability. There must be careful planning for complexities in certain disciplines where scientists have entrenched professional reward systems that depend upon publishing in highly selective journals that currently have paywalls. MCN is a hybrid journal that has a combination of open-access and subscription articles. Authors can choose to pay a fee for the article to be immediately available online and authors retain copyright of the article. Fees are usually paid by the authors' funding agency or institution.


Translation of Plan S principles into action will require extensive restructuring in the publication community, in libraries, and in research and academic institutions. The 2021 deadline for Plan S is approaching. Challenges and opportunities that present in transition are many; your professional voice will be important in advocating for your patients, for your institution, and for the integrity of our discipline's scholarship. Please take some time to follow Plan Shock and join the discussion.




cOAlition S. (n.d.). Part I: The Plan S principles. Retrieved from


Rogers M. (2019). No journals, no evidence-based practice: Research inaccessibility affects many nurses. MCN. The American Journal of Maternal Child Nursing, 44(6), 309. doi:10.1097/NMC.0000000000000573 [Context Link]


World Health Organization. (2019, August 29). WHO joins coalition for free digital access to health research. Retrieved from[Context Link]