nursing manuscript, nursing publication, writing



  1. Browne, Nancy T. MS, PPCNP-BC, CBN


Abstract: As professional nurses, opportunities to spread our knowledge are endless. Despite this, the opportunity to do so in writing is often pushed to the bottom of the list. The goal of this paper is to simplify the writing experience and expose it for what it is: a straightforward task when approached by knowledgeable professionals in an organized manner. Preparation to write, the writing phase, and the editing and rewriting phase will be discussed, followed by sections on ethical considerations, barriers, and resources.


Article Content

"Would you write an article for publication?" This question is guaranteed to cause stress! Barriers to writing may loom as insurmountable. By examining the publishing and writing process, one is able to break down the effort into achievable tasks. The purpose of this manuscript is to take a stepwise approach to writing and publication; completing one step at a time will lead to a polished and published manuscript.




The best place to start is with your own good idea. "Write what you know" brings a confidence and interest level that can make writing joyful. First time writers often feel a lack of expertise; however, all nurses have valuable knowledge to share based on their education and experience. The first step is to find a topic that is important to you. Undoubtedly, you will need to do further research on this topic; you do not need to initially be an expert. But it is extremely helpful to care about the topic, as this will come through in your writing more than any facts you share.


One suggestion in choosing a topic is to ask "for what knowledge do my colleagues seek me?" Whether you are early in your career or experienced or whether clinical, educational, or research based, every nurse gravitates to skills or knowledge that comes "easily." It is tempting to profess that "everyone can do this/knows this," but that is not the case. Take some time to think about what interests you, what comes easily, what you turn to first in a professional journal; these provide clues for your topic.


Past professional speaking or poster presentations are another source of inspiration. Research, organization, and preparation for these activities are already complete; this knowledge is ready to be organized into outline form as the basis of a manuscript. Ideally, all posters or professional presentations should be considered for published manuscripts in some venue.


Type of Manuscript

Now that you have a topic about which you are excited to write, decide what type or form of manuscript to publish. Certain ideas lend themselves to certain forms. For example, if you are performing scientific research, the manuscript will probably be a formal research article. If you have an interesting and unique patient care experience, then a case report would be appropriate. Perhaps your clinical role is described as unique by other colleagues; your story would be well suited for a clinical article. Other types of manuscript forms include book chapters, nursing narratives (exemplars), continuing education courses, professional issues essays (ethics, legal), policy columns, editorials, letters to the editor, reviews of books and media, and public interest writing for lay journals (Alexander, 2011). Not all writing needs to be lengthy; if time is short, consider a form that is very focused such as a nursing narrative. Opportunities to write are varied, and at least one is within every nurse's timeline and expertise.



As you choose your topic and writing form, you are focusing your project. The next area to consider is who your audience will be. Presenting research results leads you to consider nursing research journals. Your essay on discrimination of obese children in schools could lead to a journal subscribed to by educators. An article on a new gastrostomy technique in the Journal of Pediatric Surgical Nursing will reach a focused group of nurses who have significant influence on implementing this technique.


Selecting a Journal

Having determined your ideal audience, explore the media for a journal or publishing opportunity that best meets your goal. There are over 200 nursing and allied health journals in the United States, with hundreds more internationally. Several online sites list biomedical journals (Table 1; Oermann & Hays, 2011; Saver, 2011a). Rather than becoming overwhelmed with all the choices, assume that journals that publish material meaningful to you probably are interested in publishing your topic. Ask colleagues to make suggestions of their "go to" journals.

Table 1 - Click to enlarge in new windowTABLE 1 Directories of Nursing and Allied Health Journals

Three important questions in journal selection are as follows: is the journal peer reviewed, is it indexed, and what is its impact factor? Readers can expect that information in peer-reviewed manuscripts is validated by experts in the material; reviewers evaluate content for relevancy, methods, clarity of ideas, and current and relevant references. Indexing refers to a journal being included in online databases such as PubMed (National Library of Medicine) and the Cumulative Index to Nursing and Allied Health Literature. Not all journals are indexed in every database. Ideally, the journal that publishes your manuscript is indexed; ease of finding your article by colleagues searching on your topic increases the manuscript's readership and message. The journal's impact factor is a score based on the number of times any article in the journal is cited in other journals during the past 2 years.


Before approaching your chosen journal, research what that journal has published in the past 6 months. Pay close attention to manuscript content and format, feedback in letters to the editor, and the journal's general tone. Author guidelines may request a query letter with your manuscript idea clearly stated. Queries are as formal or informal as the situation requires. Keep your query short, simple, and to the point. Include in your query letter evidence that you have researched past issues of the journal and how your idea fits into its overall educational goals (Saver, 2011a).


Author guidelines are important to consider when making your choice. Guidelines are found on the journal's Web site and available to potential authors. Guidelines advise the author on length of manuscript, publication style, organization, review format (peer or not), and publication process. Journal editors follow these guidelines closely, as they are designed to organize and streamline the process from writer's query (if used) or initial submission to publication. If the writer is unclear or unfamiliar with any of the guidelines, the journal's editor is available for clarification and support.


Oermann and Hays (2011) suggest ranking your five top choices for journal submission with a strong emphasis on journals that are peer-reviewed and indexed; if rejected by the first choice, then move on quickly to the second. Oermann and Hays encourage a higher ranking for journals that offer the greatest possibility of publication over those with a high index factor or high profile. As long as your manuscript is able to be accessed by a literature search (indexed) and has the validation of peer review, then the sooner it is published, the sooner your message can add to the body of literature (Oermann & Hays, 2011). Journals with fewer manuscript submissions and shorter time to publication offer opportunity to the less experienced author.



Authorship can be simple (single author) or very complex (multiple authors). In addition to the obvious pitfalls that working as a team may bring, credit for contribution to the entire manuscript has legal, ethical, and often professional promotion implications. The International Committee of Medical Journal Editors guidelines for authorship are an excellent source of information (International Committee of Medical Journal Editors, 2008). Authorship is a complex topic; an in-depth discussion is provided by Oermann and Hays (2011). Covered specifically are the areas of author order, what constitutes participation, author responsibilities, lead authorship, and abuses of authorship. Collaboration with one or more colleagues can be extremely rewarding and enriching to the final manuscript. If all authors know the professional authorship guidelines, expectations, and responsibilities initially, the process can be mutually enjoyable.


Literature Review

No matter how knowledgeable one is, it is important to review the current professional literature for confirmation and new information. Several online databases are available (Nicoll, 2011). The literature review process consists of searching a database using key words related to your topic. One method is to initially search your topic globally, subsequently narrowing your focus. This is done by excluding articles that do not pertain to your topic and assessing those that remain. Add more key words and identify recurring articles. Read the reference lists of your most pertinent articles to find references your search may have missed. Review articles are a good source of key references.


There are two types of reference sources: primary and secondary. Primary sources are the original document, report, or manuscript describing a certain event or data; this is the preferred reference source. A secondary source quotes or summarizes the primary source; secondary sources are valid to use when it is not reasonable to obtain the primary source (e.g., original letter from Florence Nightingale).


Author guidelines often suggest references be published within the past 5 years. Certainly, there are valid and important references older than this time frame; they are referred to as classic or landmark articles. If used, these references should include information that became the foundation for future work in the topic area. An in-depth review of a large series of patients with a rare disease would be an example of a classic manuscript.


After reference selection, acquire the entire reference manuscript, collate with other references by subtopic, and begin your reading. After the publication process is complete, file your references with your manuscript (in either digital or paper format). These papers, along with other correspondence with the publisher, are your record of research for your manuscript.



The outline is the skeleton of your manuscript, your writing road map. After reading your references and thinking about the topic, it is very tempting to begin to write. Often, this lends itself to a rambling article. While every writer has their own writing pattern, for the beginning writer (and many experienced ones), having an organizational structure makes the experience more productive. Take your time when creating the outline; often, it is helpful to revisit and rewrite for a few days to be sure of your path. The final outline becomes the headings and subheadings of your manuscript. A carefully considered outline used to form the headings of your manuscript allows you to proceed with the writing phase in an orderly manner.



To format the manuscript, refer to the author guidelines for the specific publication style chosen by the journal. Nursing/medical journals often use the Publication Manual of the American Psychological Association (American Psychological Association [APA], 2010) or the AMA Manual of Style (Iverson et al., 2007). Publishers' styles are not negotiable; possessing a copy of the appropriate style manual is well worth the investment for both first time and experienced writers. Accuracy and organization of reference citations are critical for manuscript consideration and acceptance.



When you agree to write for a journal, you have entered into a contract. Editors plan issues around a group of articles that are arranged for months ahead of publication. Once you agree to write for an edition, you are "filling a slot." Be sure you are very realistic estimating your writing schedule. One strategy is to estimate how much time you can devote a day (or week) to this process. Include from acceptance of your manuscript idea through revisions and final submission. Then estimate how much of that time can be devoted to each stage of the process. This will give you an estimate of a time frame to give to your editor. Be sure to add extra time for unexpected developments in your life. If your timeline is interrupted, communicate with your editor as soon as possible. Your editor will appreciate frequent updates of your progress, so that decisions on the publisher's end can be made effectively.



This is the phase of the process that can be the most intimidating: the blank computer screen! However, if you've made an outline and placed it into your manuscript's Word document, the screen is not blank; it merely needs to be filled in with your words. Writing a paragraph and section at a time makes the project seem more manageable.



The title is extremely important, as it conveys the meaning of your hard work. It is the only information that the potential reader has to decide if they will spend their limited time reading your article. One philosophy of title construction is to have a working title, which is revised when the paper is complete; you will only truly know the emphasis of your manuscript when your thoughts and writing are complete. Ideal title construction is concise and uses the manuscript's key words, preferably in the beginning of the title.



If your journal requires an abstract, this is the second most important section. If your title has attracted the reader's attention, they will move on to the abstract. Often, the abstract is written last, when the writer is saturated with the process. The abstract outline should be developed early and revised as you write to reflect the manuscript's highlights. Abstracts are defined as structured or unstructured. Structured abstracts are typically used for research manuscripts with specific sections (purpose, design, methods, findings, and conclusion); word count is generally 250 or less. Unstructured abstracts are used for less formal manuscripts and use a paragraph form of, typically, 50-75 words. Author guidelines will define the structure and word count.



At this point, your paper contains the manuscript outline with headings formatted according to the journal's style. The opening paragraph is often the most difficult. One suggestion is to merely state the topic of your manuscript and what subtopics the reader can expect to see discussed. Spend less time on formulating sentences and grammar; these can and will be addressed during the rewriting stage. This is the time to start the flow of words, one sentence at a time.


Fill in outline. After completing the introduction, start with the first paragraph in the next section. Attempt to focus on just this section; move the rest of the sections to the background. Talk to the reader either informally (this article) or more formally (research article). Think of each section as its own manuscript and write what you want to share with the reader.


Flow. Of course, each section is not its own manuscript. The flow of the article should progress in a logical manner. The end of one section ideally moves smoothly to the next. The reader should be able to skim over the headings of the manuscript and follow where the writer is going. Sometimes, this may mean rearranging your outline. If you've spent productive time on your outline, think carefully before reordering headings. Sometimes it is better to keep the original structure and see how the paper reads when complete. At that point, rearrangement, if needed, can be done.


Manage citations. APA style (this manuscript) is organized by author/year citation in the body of the manuscript; corresponding references are arranged alphabetically in the reference section immediately following the manuscript. AMA style uses a number system where references are sequentially numbered in the manuscript (suprascript) and listed in corresponding numerical order in the reference section. Develop a plan for knowing which reference goes where. AMA style can be problematic if you later add a reference to the manuscript; subsequent references will need to be renumbered.



A reference list is evaluated by quality, timeliness, and depth. References allow the reader (who was drawn to your topic) to read more about different aspects of the topic.


References are the writer's documentation of supportive literature for the essence of their writing. At its most basic form, your writing is a synthesis of concepts from other experts (references) and your own expertise to form the message of your manuscript. For example, two excellent books (Oermann & Hays, 2011; Saver, 2011a) are used as references for this manuscript; they provide more in-depth information than could be provided in a single article. At the same time, this author adds her own observations and lessons learned to several sections; these are not mentioned in the citations referenced.


It bears repeating that formatting your references according to the style chosen by your publisher is a basic element of manuscript writing. A common misconception is that there are copyeditors who "clean up" references and other formatting issues after manuscript submission. Copyeditors will identify (usually in track changes) errors, but not correct them. If the identified error is missing information, the author must go back to the literature or their files for this data. This process is time-consuming and essential for the manuscript to be accepted. Having a style manual within reach is the best way to make this process as easy as possible.


Table and Figures

Tables are generally lists or collections of information more easily assimilated in a breakout panel than written in the body of the text. Author guidelines outline if tables follow the manuscript's reference section or are submitted as a separate document.


Figures are diagrams, illustrations, or pictures submitted to accompany the text. Figures are usually JPEG, TIFF, or BMP files. They are submitted separately in their own folder, never imbedded in the manuscript (Pavlovich-Danis, 2011). Quality of the picture or illustration is very important to the publisher; author guidelines will be very specific. Permission to republish tables and figures is needed unless copyright is held by the author.



Finally, you type the last paragraph of your outline! Your manuscript, references, tables, and figures are complete. You are ready for feedback from your peers. While we all hope that we have written the perfect manuscript with no rewrites or corrections necessary, the truth is that at least three revisions are generally necessary before publication.


At this point, the writer needs the opinion of a trusted expert on the written topic. A good choice is a colleague who knows the topic and is willing to give you honest feedback. It is great to get back a manuscript and be told "perfect!"; however, it is unlikely to be true and not helpful as the writer prepares to submit the manuscript to the publisher. Most writers have one or two colleagues they know will (respectfully) give them honest feedback. It is worth the time to search out such colleagues. Another important reviewer is a colleague who is not familiar with your topic. Perhaps a less experienced coworker who will point out phrases or concepts the writer incorrectly felt were universal. This is also a wonderful way to introduce and mentor a younger colleague into the writing process.


Finally, after putting the manuscript away for several days, the writer should return to the manuscript and reread it with fresh eyes. Read for clarity, concepts, flow, and content. Incorporate the feedback from your colleagues. Then, reread for errors in spelling, grammar, sentence structure, and style. Pay particular attention to the references. Be sure that all references on your reference list are cited in the manuscript and that all citations in your manuscript are listed in the reference list. Check references and citations against the original article for correct spelling of authors' names, year of publication, article title, journal name, volume number, and page numbers. No one else in the process will check as thoroughly as you, if at all.


If there are major omissions or errors or the journal style is not followed, the manuscript will be returned for correction or possibly simply rejected. One editor likened a great manuscript with incomplete, sloppy references as going to a job interview in your best suit and unpolished, old shoes. Properly formatted references save your editor time and say a great deal about a writer's attention to detail, following guidelines, and overall quality of work. If you are unsure of your accuracy, it is very worthwhile to seek a colleague who is an expert to assist you as you learn the process.



After thought, organization, writing, and rewriting your manuscript, you are ready to submit to your journal. Check the guidelines again on how the publisher requests submission. Be sure your electronic files are labeled with your name and date. File your work in an electronic and/or paper file clearly labeled with submission date. Document any conflicts of interest. The transfer of copyright of the manuscript to the publisher is submitted along with permissions. Expect that your manuscript will be returned and resubmitted at least once, so knowing which version you are working on is important. Communicate with your editor that the manuscript is sent and that you are available to discuss any questions.



Editor Review

The editor's job is to produce the best possible edition of the journal. Editors want you to succeed and will work with you to achieve success. It is in everyone's best interest to publish your manuscript in a timely manner. Effective communication with the editor throughout the early phases of the manuscript process will make surprises at this stage unlikely. Once the editor accepts your article, the timetable to publication is set. Many departments and editorial assistants depend on each other and the author to maintain the production timetable.


When your editor receives your manuscript, it is reviewed for completeness and adherence to author guidelines. If the editor feels the manuscript needs to be revised from a formatting or writing style, it may be returned to the author with specific requests and resubmission requested. If the manuscript does not meet the author guidelines in several areas, the manuscript may be returned and not accepted for resubmission. While these situations do occur, they can be avoided by careful preparation as outlined above. More likely, your manuscript will be read by your editor and sent out for peer review.


Peer Review

Many nursing journals use a peer review process. The journal editor responsible for your manuscript will send it out to nurses familiar with your topic for content review. Some journal editors will ask for suggested peers who the author feels are experts on the topic; occasionally, editors will ask if there are reviewers they should avoid in this professional instance. Usually, the reviewer and author are blind to each other, although there are instances where their identities are known. As author, you will know what system your editor uses early in the writing process by reading the author guidelines.


The goal of peer review is to ask an expert colleague to review the manuscript for content and accuracy of statements. The reviewer will address the reference list to comment on completeness and appropriateness and if references reflect the latest literature on the topic. The reviewer makes comments and suggestions by using track changes and/or creating a summary list of items to address. Peer reviewers are asked to comment on general readability, length, and format as it pertains to their overall ability to read and assimilate the information easily. Reviewers are not asked to correct grammar or spelling, references, or other formatting issues; they are asked to comment on these areas only if they detract from the manuscript.


Return of Manuscript to Author

Upon receiving the peer-reviewed manuscript, your editor will send a copy to you with a turnaround time of 1-2 days; expect this and try to arrange your schedule to accommodate the rewrite time. You will be asked to review the track changes and/or summary list, accept what you feel appropriate, and provide rationale to the editor for any decision not to accept reviewer feedback. Using a summary sheet addressing reviewer feedback point by point provides the editor with organized, data-driven explanations for your decisions. While there are occasions where reviewers' comments sound harsh or perhaps pompous, most reviewers take pride in genuinely assisting writers to prevent misinformation or misunderstood statements from being published. Often, reviewers (who review as a professional courtesy on a tight timeline) will make very helpful statements, offer a more appropriate reference, and provide guidance that strengthens the manuscript.


Attempt to see the "red ink" as a way to improve your message before publication. This may be difficult when you have already invested so much. If needed, turn to your editor or a well-published, trusted colleague who will be more objective in assisting with the "what and how" of incorporating peer reviewers' comments. Most likely, as a published writer, you will be asked to perform a peer review in the future; remember how helpful (and hurtful) comments were phrased.


After all comments have been addressed (including those from the copyeditor on noncontent issues), it is time to read and check one more time. Then, submit it for the final time, take a deep breath, congratulate yourself on achieving a goal, and "let it go."



Copyright, Permissions, Confidentiality, and Plagiarism

Copyright, permissions, confidentiality, and plagiarism are four concepts that are interwoven with writing for publication. While the basic definitions apply to any level of writing (professional, fiction, nonfiction, online, etc.), the depth of application of legal and ethical rules depends on many factors. Writers are encouraged to read more in-depth explanations to familiarize themselves with how these concepts apply to their particular manuscripts (Brent, 2011).



What deters so many nursing professionals from writing for publication? Two common reasons, time and inexperience, are addressed in this section.



Time, or lack thereof, is the most common reason colleagues give for not writing an article for publication (Saver, 2011b). This is a legitimate concern for nursing organizations and our profession. Nursing professionals nearly always multitask and rarely are supported professionally with dedicated time to write. After an exhausting day (both emotionally and physically), it is difficult to defend asking a colleague to start a manuscript. And yet, sharing our information with colleagues is how our profession grows and patient care improves. Dedicated time to write professionally should be encouraged by nursing leadership; if this is not forthcoming, here are some strategies that may allow professional nurses the opportunity to publish.


First, if you commit to writing professionally, elevate writing to the level of some other ongoing event in your week that is important to you. Perhaps it is church, dinner with friends, or a class. Now find one more 30-minute time block to set aside each day (or an hour twice a week, etc.). Put it on your calendar with all your other meetings and appointments. Then organize the task (as outlined in this manuscript). If taken in small amounts of time, you will be able to work your way methodically through the process. Find a place where you are able to write. Each of us will choose different methodologies to put this plan in place; the key is to decide writing is a priority and organize it into manageable small tasks.



The second common reason to resist writing is inexperience with the process, which leads to lack of confidence (Saver, 2011b). Finding a mentor to help you through the business and creative sides of writing is invaluable. As a coach, your mentor will give you encouragement and feedback along the way. It is unrealistic (and unnecessary) to attempt this process without assistance. You will find your mentor among colleagues you professionally respect. All great colleagues are not great mentors. It takes skill, dedication, and patience to nurture a less experienced colleague. Personalities should match well. New writers are encouraged to take the time to find a mentor with whom they can begin a professional collaboration. Mentorship is one of the most important and rewarding professional relationships in nursing.



Nurses are primarily educated as nurses, not writers. While some programs emphasize writing for publication (as opposed to writing for a course), most nurses benefit from ongoing education related to writing and publishing. Writing workshops, professional conference writing sessions, and online writing courses are a few ways that nurses can advance their writing education.


The literature review for this manuscript resulted in two excellent resources for nurses interested in publication. Anatomy of Writing for Publication for Nurses (Saver, 2011a) and Writing for Publication in Nursing (Oermann & Hays, 2011) are tutorials on publication for nurses. Both the novice writer and well-published nurse researcher will find information and resources that are both in-depth and easy to understand.


Since manuscript style is so vitally important, the other prerequisite to writing is the appropriate style manual, usually APA (2010) or AMA (Iverson et al., 2007). Having these resources on your desk will save hours of time!



Writing for publication brings many rewards, both professional and personal. Professional, well-written publications add to the nursing body of knowledge and enhance the writer's professional resume. Knowledgeable writing often is expected in certain professional career tracts; respect from colleagues and professional growth enhance self-confidence and self-esteem. Professional advancement can be associated with publication and research.


Synthesizing and sharing knowledge related to health care improves the care of our patients. Colleagues appreciate the time an author takes to review a subject's literature, critically analyze the information, collate salient points, and succinctly outline and write the findings, complete with the author's professional observations.



Writing for publication can be a leap of professional faith; however, it also can be tremendously rewarding. Preparing and writing a manuscript brings the opportunity to increase the writer's knowledge, share this knowledge with colleagues, and improve an aspect of care for patients. Adding to the literature, no matter what form the writing takes, will increase knowledge and improve care. As pediatric surgical nurses, we care for infants and children who often do not have a voice. Professional writing is a powerful tool. Lending a voice to our patients is powerful motivation.



The author would like to thank Pam Pieper for reviewing this manuscript.




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