Case Reports, Electronic Publishing, Evidence-Based Practice, Nurse Practitioner, Writing for Publication



  1. Waldrop, Julee


Abstract: Professional communication and the dissemination of expertise are expected of nurses prepared at the doctoral level. However, little emphasis is placed on opportunities for professional writing in most clinically focused doctoral programs for nurse practitioners. This innovative extracurricular writing project provided a professional writing experience for novice writers, helping them gain the confidence needed to achieve dissemination beyond the educational setting in the form of a self-published e-book. This project could be used for many other types of writing in nursing.


Article Content

Professional communication and the dissemination of expertise are expected outcomes of nurses prepared at the doctoral level. Communicating expertise is considered essential to the advancement of the profession as a practice-based discipline. As stewards of the discipline, doctorally prepared nurses should be challenged to take on the responsibility of giving back not only to the profession but also to the greater system of health care by knowledge dissemination (Shirey, 2013).


Baccalaureate to doctor of nursing practice (DNP) curricula focus on preparing expert clinicians with the knowledge and skills to provide direct patient care using current, evidence-based guidelines and to implement evidence-based practice change. Little focus is placed on professional writing and providing opportunities to gain the confidence needed to achieve dissemination beyond the educational setting (Hunker, Gazza, & Shellenbarger 2014; Ryan, Walker, Scala, & Smith, 2014). Opportunities to write and revise as components of professional responsibility are limited in most practice-based curricula (Hunker et al., 2014; Oermann et al., 2015), and many nurses express fear at the possibility of sharing what they know (Heinrich, 2009). Indeed, few practicing nurses, at any level, consider writing for publication.


Long (2103) argues that, in order for nurses to write, they must believe they can do so. Belief in one's ability to succeed is one of the primary components of self-efficacy, and it contributes independently to actual writing outcomes. New evidence supports the approach of providing feedback on written work to students in a low-stakes environment, despite the increased work required to do so by faculty (Melzer, 2014).


This innovative extracurricular writing project provided a professional writing experience for novice, unpublished DNP students with a guaranteed positive outcome of publication in the form of an e-book. Knowing that their contribution would definitely be "in print" (although only electronically) helped motivate the 10 students who volunteered to participate. With the support of a faculty/editor with more than 15 years of extensive publication experience, students worked through multiple revisions of their cases to be included as chapters in a self-published e-book titled Pediatric Case Studies to Develop Diagnostic Reasoning.



This writing project for BSN-DNP nurse practitioner students was built on a required case study assignment that focused on using evidence to make clinical decisions in the care of a pediatric patient. The students who volunteered to participate in the project were given a uniform template for revising the case study with additional information on developing differential diagnoses, as well as the identification of web-based resources for clinicians and the patient/family.


The template brought consistency to each chapter (Joint Pain, Abdominal Pain, Upper Respiratory Complaints, Abnormal Movements, Vertigo, White Patches in Mouth, Headache & Double Vision, Rash, Cough, Sore Throat). Each chapter began with presentation of the patient encounter, including all relevant parts of the history and physical exam.


Four questions formed the subheadings for each chapter:


1. What are the top differential diagnoses? Each differential diagnosis was presented with signs and symptoms and then compared to the patient's actual presentation. A determination was made as to whether or not the differential was supported or refuted.


2. Was further testing needed? Rationale was required to justify tests and procedures, and results were presented.


3. Based on the information provided so far, what is the most likely diagnosis?


4. What is the evidence-based approach to managing this patient?



Reorganizing the case content into a more prescribed format, which included items such as patient resources that were not part of the original course assignment, took more time than the students anticipated. Changing the wording and style from that used in a course assignment to the more formal style expected for publication and responding to editorial comments was challenging for most of the contributors. The faculty editor set deadlines for revised submissions similar to the process used in peer-reviewed publications. On average, each contribution was revised four times. The faculty editor prepared an introductory chapter on the diagnostic reasoning process used in each chapter along with suggestions on how the book could be used by teachers and students.


Once a written work is generated, the author automatically holds the copyright (US Copyright Office, n.d.). In this case the contributors signed a copyright release and conflict of interest disclosure to the editor for the specific purpose of publishing this e-book. The students agreed that any profits would be donated, on an annual basis, to the school's DNP program into an account that was started to provide students with funding for completion of their DNP projects. For a project such as this, decision regarding profits should be agreed upon up front and documented in writing, possibly even with legal consultation.



One of the most popular formats for e-reading is Kindle(R), which has a direct publishing platform on ( The basic version is free and has a guidebook with easy-to-follow, step-by-step directions for either PC or Mac. Instructions on cover design using Adobe Photoshop(R) or other similar programs are also provided. What the e-book will actually look like on the Kindle e-reader can be monitored by using the Kindle Previewer App ( If needed, Create Space(R) ( is an Amazon company that provides fee-based publishing services such as copyediting or cover design.


Once fully formatted, the files are directly submitted to the KDP website. At this time, the price of the e-book is also set. Although KDP does take a percentage of the revenues, there is no penalty if there are no sales. Once processed, the book appears on, available as a Kindle edition e-book for purchase.


An excellent feature for publications with clinical content is that the e-book can be edited at anytime. Those who have already purchased the book will receive a notification that a revision is available and they may download the new version for no additional cost.



Some nursing education programs offer "how-to" or scientific writing courses that aim to help students write better papers for coursework or prepare manuscripts for publication. Although these courses do provide an external incentive, in the form of a grade, to motivate students to complete their work, they may not always provide the encouragement and support needed by novice writers.


This was a voluntary extracurricular project that often went to the bottom of the students' to-do list. An unforeseen aspect that increased the total editing time for the faculty member was the need to check the accuracy of the students' references and ensure the content was up to date and based on evidence. Time is one of the frequently mentioned barriers to working with students on their writing (Melzer, 2014).


This exercise in writing and revising based on feedback should lead to improved self-efficacy and confidence in writing as reported by Long (2013) and Melzer (2014). Once the e-book was finished and available on, the newly published authors were extremely proud of what they had accomplished. Because this e-book can be used by students and educators, the contributors felt that they might be part of making a difference in future nurse practitioner education and patient care. They all reported adding the publication to their resumes, which helped them stand apart from other new graduates.


This project was a positive first step in gaining the confidence to write for an audience. Perhaps these new nurse practitioners will consider writing for a peer-reviewed publication next. This project could be used for many other types of writing in nursing. Clinical topics abound, and nurses and nursing students at all levels of educational preparation have stories, reflections, and lessons learned that, if disseminated, can inform, inspire, and motivate others.




Heinrich K. T. (2009). Why more nurses should write for publication (but don't). American Nurse Today, 4(8), 11-12. [Context Link]


Hunker D. F., Gazza E. A., & Shellenbarger T. (2014). Evidence-based knowledge, skills, and attitudes for scholarly writing development across all levels of nursing education. Journal of Professional Nursing, 30(4), 341-346. doi:10.1016/j.profnurs.2013.11.003 [Context Link]


Long T. (2013). Self-efficacy and writing beliefs in nursing. Nurse Author Editor, 23(4), 1-5. [Context Link]


Melzer D. (2014). Writing across the curriculum: A national study of college writing. Boulder, CO: University of Colorado Press, Utah State University Press. [Context Link]


Oermann M. H., Leonardelli A. K., Turner K. M., Hawks S. J., Derouin A. L., & Hueckel R. M. (2015). Systematic review of educational programs and strategies for developing students' and nurses' writing skills. Journal of Nursing Education, 54(1), 28-34. doi:10.3928/01484834-20141224-01 [Context Link]


Ryan M. M., Walker M., Scala M., & Smith V. (2014). (un)Disciplining the nurse writer: Doctoral nursing students' perspective on writing capacity. Nursing Inquiry, 21(4), 294-300. doi:10.111/nin.12045 [Context Link]


Shirey M. R. (2013). Building scholarly writing capacity in the doctor of nursing practice program. Journal of Professional Nursing, 29(3), 137-147. doi:10.1016/j.profnurs.2012.04.019 [Context Link]


US Copyright Office. (n.d.). Copyright in general. Retrieved from[Context Link]