1. Alexander, Susan DNP, ANP-BC, ADM-BC

Article Content

Writing is easy. All you do is stare at a blank sheet of paper until drops of blood form on your forehead. -Gene Fowler, American author and dramatist


Why don't more nurses write? It would seem that plenty of material exists on the topic of nurses and nursing care. A recent survey of Amazon using the search term "nurses" yielded 48 531 results ranging from novels to textbooks and including items such as socks with electrocardiogram tracings. At the top of the search list was a book described as "investigative journalism," offering intimate details of hazing, sex, painkiller addiction, and bullying in the everyday lives of hospital nurses. While this book was not written by a nurse, there were several books present in the search that were authored by nurses, including textbooks, fiction, nonfiction, and others. For nurses who are employed as faculty members in academic settings, there is often an expectation of publication that accompanies the position, yet the practice of writing is certainly not limited to nurse researchers and faculty. Writing and publishing can be a viable career choice for nurses, and there are strategies that may assist nurses in overcoming the hurdle of experiencing their first publication.


For Marijke Vroomen Durning, a nurse-author/editor based in Montreal, Quebec, Canada, writing was an early interest, so much so that "[horizontal ellipsis]if I was given a choice I would choose essay exams instead of multiple-choice items every time" (oral communication, M.V. Durning, January 21, 2016). Durning managed to successfully combine her years of expertise in nursing with a lifelong passion for writing into a successful career in the publishing industry. Beginning as a registered nurse in the 1980s, in her first work experience on the postpartum floor, and retiring from the palliative care field, she has literally cared for patients from birth to death and attributes her success in publishing to the rich experiences gained from her career as a nurse.


Throughout her nursing career, Durning was a freelance writer from time to time. Eventually, as her expertise began to establish her reputation in the publishing field, she was offered a position managing a team of writers, as editor for The Doctor's Guide to the Internet, an online news website for physicians. Durning went on to author chapters in several books, one of which was translated into Spanish, and to publish articles in lay health magazines and magazines for the nursing profession, such as Nursing2013. At present, she works with a roster of clients for whom she provides web- and print-based writing services, social outreach and content, and manages email correspondences on healthcare sites.


Durning credits her experiences with patients as key to informing her interest and assisting her in developing a niche in the writing industry. She believes that her success as a writer was due to her nursing background. Despite her deep interest in writing and publishing, achieving initial successes in the writing industry was not easy. Writing can be lonely work, a feeling that has been voiced by other nurse authors. According to Tina Shalof, author of A Nurse's Story, "You sit alone. You're writing, writing, writing. You don't even know if you're going to get published".1


Yet there are stories that nurses can tell, and contributions that nurses can make, apart from the usual methods of patient care, that foster persistence in nurse writers. "There is such a need for people who know about health to write about it-if they feel they can write, and they like it, take writing classes and see what it is they like to do. Do they like to write for patients? Would they prefer to write on a higher level for their peers or other healthcare professionals? Find a mentor, someone whose writing you admire and reach out to them," states Durning. Her desire to write for patients led to her interest in self-publishing a book for patients, Just the Right Dose: Your Smart Guide to Prescription Drugs and How to Take Them Safely, which was reviewed by Rob Campbell, RPh.


Durning states that her book was born of the frustration in performing endless medication reconciliations with patients and from bearing witness to the multiple errors that patients experienced in managing medications. When she initially approached publishers with her book idea, Durning was discouraged by their lack of interest, being told that the book contained nothing new for patients and that it was too small. Being convinced that the book is useful for patients, she decided to pursue the option of self-publishing. In preparation, Durning sought the advice of other authors who had similar experiences and reviewed literature about self-publishing alternatives.


Durning was committed to creating a self-published product that would be similar in quality to that achieved by working with larger publishing companies. In attempting to avoid the pitfalls associated with self-publishing, she hired an editor and proofreader to review her book, sought consultation from other nursing colleagues, and identified a pharmacist colleague who agreed to review the book as it progressed. Immediately prior to publishing, a proofreader assisted in providing a last review of the prepared copy.


She sought technical assistance in preparing her manuscript, purchasing a subscription to Jutoh, an e-publishing software application that allows an author to create e-books in ePub and Kindle formats, making them ready for distribution in any distribution site, such as Amazon's Kindle, Google Play, and Apple's iBooks. In addition to her selection of Amazon for e-publishing, Durning decided to publish traditional copies of her book, selecting IngramSpark for its ease in pricing system.


Despite the extensive planning Durning conducted prior to the self-publishing of her book, she has encountered difficulties in distribution of the book. She is "[horizontal ellipsis]not a marketer" and has "[horizontal ellipsis]not been able to get them (books) in the hands of those who would want them." Feedback from exposure she has received in radio interviews, Internet podcasts, and from the lay public has been encouraging, but she would like to get more copies in the hands of people who would benefit from reading her book. "It's in the best interests of insurers, pharmaceutical companies, and many others for clients to take meds properly," and an advantage in self-publishing is that she can change the book's cover according to the needs of clients if someone were to purchase a large quantity of copies.


As a nurse who has leveraged her experience and writing skill into a viable career, Durning has practical tips to offer those who are beginning a writing career. Most importantly, writing can be a skill polished with practice. Finding writing organizations and taking advantage of services that are offered to the public, or even joining selected organizations, may be the start of getting into the world of publishing. Examples of writing organizations for healthcare authors include the Association of Healthcare Journalists and the American Society of Journalists and Authors.


Getting support from other writers to ask questions and for validation is important, particularly in the early development of a writing career. Finding friends or colleagues to read and re-read manuscripts is essential in preparing for submission and publishing. Perfecting a work takes time and patience. A professional writer must also be ready for the editing process, which can be difficult at times. A good editor will improve the work, so it's vital to not take the editing process personally, as difficult as this may be sometimes, adds Durning.


Creative non-fiction is another area of writing in which nurses can excel, though it may cause more anxiety than the fact-based academic and scholarly writing performed by many nurses. In this type of writing, personal experiences, interpretations, and feelings are emphasized, which can create sensations of fear and vulnerability in both new and experienced writers. Nurse-author Tilda Shalof, the authors of multiple books on her experiences in nursing inclugin A Nurse's Story and The Making of a Nurse, gives herself permission to be fearless when writing, noting that the feeling of fear when she writes is a signal that "[horizontal ellipsis]there is something important and true that needs to be said. I go toward the fear, lean in and write what I find there," (written communication, T. Shalof, February 8, 2016). Shalof is meticulous in altering identifying details when she records her experiences in nursing, noting that this is crucial to protect the privacy and anonymity of patients, families, and colleagues.


Practice, discipline, and guidance are keys to attaining skill as a writer, according to Shalof. She further notes that the skill of writing takes practice, as she makes a habit of filling notebooks with pages of words that likely will never be seen by others. "I write a great deal before I feel I've produced anything worth publishing/posting. Writing is practising the scales and arpeggios and putting it out into the world is the 'performance,'". Seeking assistance from others, Shalof has attended writing workshops, recommending Barbara Turner-Vesselago ( for her skills in assisting writers to develop manuscripts.


Finally, don't let the fear of rejection discourage the urge to write. "It takes courage to be a writer and to be a nurse," notes Shalof. Rejection is an expected part of the cycle of submission and publishing, and not an indication of personal failure. Persistence is the key-review the recommendations for revision, do the rewrite, and resubmit. Writing can be rewarding and beneficial for nurse authors, particularly when acceptance letters are received!


To contact these authors, please email or visit their Web sites: Marijke Vroomem Durning, RN ( Tilda Shalof, RN ( or email her at mailto:[email protected] )




1. Kearsey K. Positive response prompts RN to publish again. Registered Nurse Journal. 2007; 19(2): 19. [Context Link]