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I have been writing professionally in nursing for more than 25 years. I have lived through the transition from manual typewriter to the personal computer, from dot matrix printer to laser. With each transition, there was a grace period in which the older technology was still acceptable. I remember when students typed their papers and faculty allowed three corrections per page. Now as an Editor, I won't accept a paper that hasn't been prepared using a word processor. As for the errors....


One transition that I ponder on a daily basis is requiring authors to use a bibliography database manager (BDM) to prepare their in-text citations and reference list. I have been harping on this subject for quite a while now, 1-3 but based on my personal experience in this editorial office, the number of authors who have embraced this technology is miniscule compared to the number who have not. I realize there is a learning curve for any new software, but in my estimation, it is a valuable investment of time.


There are three major BDMs on the market right now: EndNote6, Reference Manager 10, and ProCite5. I am most familiar with EndNote but have a working knowledge of the other two. They all perform the same basic functions: (1) maintain a library of reference citations; (2) allow searching of remote databases from within the program; and (3) with a word processor, format in-text citations and the reference list according to a selected style. Each program has its own particular interface. They have various bells and whistles which I find are more useful for experienced users. The bottom line is that they all basically do the same thing (manage a reference library) and in my experience, these programs do it very well.


Why use a BDM? Certainly it will make your work easier but there is another important reason:accuracy. Foreman and Kirchhoff 4 documented error rates of 38.4% (clinical) and 21.3% (nonclinical) in professional nursing journals. I work very hard to make sure the citations in CIN are accurate but, unfortunately, I do not have the time or staff to verify every reference in every article we publish. It is the responsibility of the author to make sure that references contained in a manuscript are accurate and correct.


The good news is that we have tools that can directly address these issues-tools that were not available when Foreman and Kirchhoff 4 did their study. Using these tools, I think it is possible to have error rates that are close to zero. Electronic databases such as MEDLINE and CINAHL are the gold standard by which citation databases are measured. Importing references directly from one of these databases into a BDM can help to eliminate re-keying errors. Using a BDM to write and format your paper can help to ensure that all references in the text are on the reference list and that the reference list is formatted correctly. Who among us hasn't puzzled over the proper way to reference an article published in a supplement or a paper from a conference proceeding? And, despite the popularity of the Publication Manual of the American Psychological Association,5 it is not the only style manual in the world. There are hundreds, if not thousands, of different styles, each with their own little quirk of where the date is placed, what is italicized, and how pages are listed. A BDM can help to ensure that references are formatted correctly for the style you have selected.


A caveat here: remember the computer adage of GIGO, garbage in/garbage out. A BDM only formats the reference consistent with a selected style; it does not correct inaccurate data or insert missing information. This is why importing references directly from a citation database is so useful-more information will be included than you are likely to key in and it will be accurate. See Figure 1 for an illustration of a citation imported from MEDLINE into ProCite5. Notice the amount of information contained, including the abstract. Some styles require the use of issue numbers; others don't. Some list all author names, others use et al after 1, 3, or 5 authors. Because this reference citation is complete, the BDM will be able to correctly format the reference. Look at these examples and notice the subtle changes:

Figure 1 - Click to enlarge in new window Illustration of a reference imported from MEDLINE in ProCite5.

APA, 5th edition:


Chochinov, H. M., Tataryn, D., Clinch, J. J., & Dudgeon, D. (1999). Will to live in the terminally ill. Lancet, 354 (9181), 816-819.


AMA (the style of CIN and CINPlus):


1. Chochinov HM, Tataryn D, Clinch JJ, Dudgeon D. Will to live in the terminally ill. Lancet. 1999;354(9181):816-819.




Chochinov, H. M., et al. "Will to Live in the Terminally Ill."Lancet 354.9181 (1999): 816-9.



For many, I suspect that the process of entering references into a BDM seems to be a daunting task and may be a barrier to using these programs. This is another reason why importing references into the BDM library is so advantageous-they can be imported in a fraction of the time it would take to type them in by hand. I recently created a library of articles published in CIN and CINPlus from 1984 to the present (698 citations). The process took 15 minutes. A colleague created a library from her dissertation proposal reference list (273 citations in all). She estimated 1 minute per reference. In all, it was the better part of a day's work but she felt it was worth it. In the process, she discovered that the typed reference list had an error rate of almost 50%! You can imagine that she is very relieved, knowing that the references in the final dissertation and all ensuing manuscripts will have a much higher level of accuracy than in her proposal.


It is not difficult to create a reference library by importing references. You do need to have a working knowledge of the BDM you are using and you also need to make a few key decisions. Let's work through the process step by step.



As noted above, all BDMs have the ability to search remote libraries from within the program. You need to be using a computer with a connection to the Internet for this to work. You also need to have access to the database you wish to search. PubMed at the National Library of Medicine is free, as are many others, but the programs also include connection files for libraries that require a user ID and password. An advantage of searching within the program is that references can be searched and imported in one step. A disadvantage is that the search interfaces are very basic.


Alternatively, you can search a database outside of the BDM and then save and import references. This is an extra step. On the other hand, most databases have sophisticated search screens that allow you to combine keywords in a variety of ways and limit searches using any number of parameters. These types of searches are not easily done within a BDM.



My preference is to always start with MEDLINE, using the PubMed interface from the National Library of Medine ( Why? It's free, it's accurate, it's updated weekly and the database is huge-12 million articles and counting. My next choice is CINAHL ( To access CINAHL directly you must pay a subscription fee but you may have access available to you through school or work. Check with your library service to find out.


These two databases provide citations to references in journals. To access references to books you need to use an electronic "card catalog." LOCATORplus (, also at the National Library of Medicine, works well. Government agencies are also excellent repositories of documents and reports. You can search for back issues of Morbidity and Mortality Weekly Report at the CDC (, clinical practice guidelines at the Agency for Healthcare Research and Quality (, and so on.



Do you have a stack of photocopied articles that you have collected over the years that you want to enter into the database? Or are you starting from scratch, conducting a literature review and creating a library? Or, maybe you want to do what I did earlier, that is, create a library of citations for a specific journal or specific author. Each of these will require a slightly different search strategy. Let's use the first example for a detailed review of the process and then I'll briefly explain how I would approach the other two.


The Magical "Single Citation Matcher"

PubMed has a wonderful feature called the single citation matcher ( It is found on the left side of the screen under "PubMed Services." Single citation matcher allows you to search the MEDLINE database for individual articles, quickly and easily. Figure 2 is a picture of the single citation matcher screen. You do not need to type in all the reference information; just type in the minimal amount needed to match to the unique reference. Using the Chochinov citation from before, I typed in Lancet, 1999, 9181, and 816 (see Figure 2). This was enough to successfully match to the citation (see Figure 3).

Figure 2 - Click to enlarge in new window Single Citation Matcher in PubMed.
Figure 3 - Click to enlarge in new window Retrieved reference.

Another great feature in PubMed is the clipboard. When you find references you want to save, you can add them to the clipboard by pressing the "ClipAdd" button (see Figure 3). Up to 500 references can be added to the clipboard.


Despite its name, the single citation matcher can also retrieve multiple references. Perhaps you have 6 articles in your stack from CIN in 2000. Entering the name of the journal and the year will retrieve all of the articles for that year. You can then just check the ones you want (using the radio box next to the reference number) and paste the references to the clipboard. If you just type in the journal name, the single citation matcher will retrieve all the articles for that journal that are in the database. This was the strategy I used to create my CIN library. Similarly, if you have multiple articles by the same author, you can search and retrieve on the author's name.


The single citation matcher is great for generating a list of references from an existing reference list. If you are starting from scratch, then you should use the traditional search interface in PubMed. I find the preview feature very helpful in the initial stages to target and narrow a search. As you find articles that are relevant, check them and paste them to the clipboard. No matter how the articles get onto the clipboard, the process for getting them off, and into your BDM, is the same.


The Clipboard

Once you have your articles on the clipboard, the next step is to save them to be imported into your BDM. Click on "clipboard" to view the clipboard contents (Figure 4). The box that says "Display" will generate a drop-down menu of different display/save options. Choose MEDLINE from the list and then click "Save." You will be presented with a file download screen; choose the option to save the file to disk; give it a name and location you'll remember; and press OK.

Figure 4 - Click to enlarge in new window Clipboard in MEDLINE with one reference to be saved.

Importing the Citations

The last step is to import the list of citations into the BDM. In EndNote6, the import feature is on the "File" menu. In Reference Manager, choose "Import text files" from the "References" menu. ProCite5 gives the same option ("Import text files") but it is found on the "Tools" menu. For each program, choose "PubMed" as the import filter. Click OK and the task proceeds automatically. Figures 5 and 6 illustrate successful import screens in EndNote6 and Reference Manager. If you have retrieved citations in another database, such as CINAHL, make sure you select the correct import filter.

Figure 5 - Click to enlarge in new window Screenshot in EndNote 6 illustrating the import screen.
Figure 5 - Click to enlarge in new window Screenshot in EndNote 6 illustrating the import screen.


Whether you are a seasoned researcher or a novice, a widely-published author or a student, if you are doing any sort of writing that requires documented references, you need to be using a BDM. Take the time to learn how to use features available in the program to make your work easier, faster, and more accurate. Creating a BDM library using electronic databases such as PubMed or CINAHL is not complicated, once you understand the basic steps. The result will be a valuable reference library that will enhance your scholarship.


EndNote6, Reference Manager 10, and ProCite5 are all available from:


ISI Research Soft


2141 Palomar Airport Road, Suite 350


Carlsbad, CA 92009


Phone: 760-438-5526


Sales: 800-722-1227


Fax: 760-438-5573







Prices vary; all are available with student discounts. EndNote6 and ProCite5 come in versions for Windows and MacIntosh; Reference Manager is only available in a Windows version. A handy comparison table of the 3 programs can be found at




1. Nicoll LH. Managing bibliographic information. J Nurs Adm. 1993; 23( 9):13-14, 19. [Context Link]


2. Nicoll LH. EndNote version 4 (software review). Comput Nurs. 2001; 19( 1):6-10. [Context Link]


3. Nicoll LH, Ouellette TH, Bird DC, Harper J, Kelley J. Bibliography Database Managers: A Comparative Review. Comput Nurs. 1996; 14( 1):45-56. [Context Link]


4. Foreman MD, Kirchhoff KT. Accuracy of references in nursing journals. Res Nurs Health. 1987; 10( 3):177-183. [Context Link]


5. American Psychological Association. Publication Manual of the American Psychological Association. 5th ed. Washington, DC: Author; 2001. [Context Link]