1. Mason, Diana J. PhD, RN, FAAN

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Dear Sophia: When I last wrote to you, it was on the occasion of AJN's centennial. Today, the occasion is historic, but not celebratory.

Figure. Diana J. Mas... - Click to enlarge in new windowFigure. Diana J. Mason, PhD, RN, FAAN

This month marks the end of AJN's 107-year relationship with the ANA. After this issue, ANA members will no longer receive AJN unless they continue their subscription on their own, and AJN, the oldest and largest-circulating nursing journal in the world, will no longer be the official journal of the ANA.


I was profoundly disappointed in March to receive word that the ANA had chosen to work with another publisher to produce a new publication for its members. For two years, AJN and its publisher, Lippincott Williams and Wilkins (LWW), had presented various proposals that would have permitted ANA members to continue to receive AJN as a benefit. In August 2005 the ANA issued to a variety of publishers a request for proposals for a "journal agreement" that would cost the ANA nothing-or even generate revenue. Recognizing that the ANA was struggling financially, LWW's final offer in January 2006 was to provide AJN to individual ANA members at a substantial discount, as well as provide a financial benefit to the ANA. Unfortunately, this last offer was rejected.


I am astonished that a professional organization of the ANA's stature would choose not to ally itself with the highest-quality publication available. And that's what AJN is. I'm proud to say this to you, Sophia, and to all readers, including ANA members. AJN has received numerous awards for its articles and for its dissemination of original research findings. It is the nursing journal most often cited in the mainstream media and highly regarded by journalists. Since 2002 subscriptions to AJN by non-ANA members have increased by 34%-an almost unheard-of feat in journal publishing these days. We've achieved this position by tackling controversial issues and publishing many positions, including some unpopular ones, on a variety of issues.

Figure. Sophia Palme... - Click to enlarge in new windowFigure. Sophia Palmer

And the ANA is partly responsible for this success. In 1996 LWW purchased AJN from the ANA, with the understanding that the ANA would use the proceeds from the purchase to provide members with subscriptions for 10 years, at the lowest price available to anyone. That arrangement assisted in the journal's transformation in recent years from one that was losing subscribers, advertisers, and its solid reputation into the leading nursing journal in the world.


You wrote of editorial excellence in your first editorial in AJN, in October 1900: "It will be the aim of the editors to present month by month the most useful facts, the most progressive thought, and the latest news that the profession has to offer in the most attractive form that can be secured." When I accepted the position of editor-in-chief of AJN at the end of 1998, I did so with the intention of restoring the journal to what I believed the profession deserved. I wanted to be faithful to your wish that the journal represent a variety of perspectives, not only the association's positions.


But excellence in journalism isn't cheap or easy-it wasn't in your day and it certainly isn't today. The AJN editorial team works hard to adhere to the standards set by the International Committee of Medical Journal Editors and other bodies in biomedical and mainstream publishing. This entails rigorous peer review and evaluation of manuscripts, disclosure of authors' finacial ties to industry, elimination of the influence of advertising on articles, the checking of facts and references, and painstaking editing to ensure readability and relevance.


For years I have believed strongly that ANA members would want a journal with these qualities, and I still do. It never occurred to me that the ANA might not want the same-for its members or for the profession.


I wonder, Sophia, whether my insistence on editorial independence became a problem for the ANA. I heard from the association's leadership on several occasions, when we published a news report, poem, or editorial that they believed to be in opposition to the ANA's aims and positions or that mentioned a competing organization. We always printed their letters, even when they were highly critical of something we published. Also, for years at AJN, ANA staff have reviewed page proofs of articles that included mention of the ANA, and they sometimes requested that I cut from, add to, or otherwise change what was written. We had always evaluated these requests with our readers in mind.


The ANA claims that leaving its alliance with AJN was a business decision. While it might have been a "financial" decision, it was not a business decision. That would have required the ANA's leaders to consider how the journal fits into the association's mission, as well as how it could have been used as a strategic tool for promoting the ANA's membership and the profession as a whole. That didn't happen.


Sophia, I worry about the future of the ANA. The ANA's Code of Ethics for Nurses with Interpretive Statements states, "The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice[horizontal ellipsis]." What "values" is the ANA communicating with its decision?


The answer may be represented in numbers. Materials circulated at the 2006 House of Delegates meeting in June noted that membership in ANA was down to 150,000. This is a decline of about 25% in the past decade and represents only 5% of the 2.9 million nurses in this country. As an almost 30-year member of the ANA, I find these developments deeply troubling. What will happen if the ANA becomes so weakened that it folds or is unable to speak on behalf of the nation's nurses?


And I must admit that I don't have high expectations for the ANA's new publication. Will it have editorial independence? The ANA's promotional materials for the new publication note that the ANA (along with the editor and editorial board) will review all manuscripts, which will leave the door open for censorship. Since advertising revenue will be the publication's financial cornerstone and largely determine its success or failure, will the publication put procedures in place to ensure impartial coverage of topics and guard against advertising having an influence on the selection of editorial content? Attempts by advertisers to influence what is held up as "science" is a contentious issue in biomedical publishing today, including nursing.


You may be wondering what the ANA's decision means for the future of AJN.


This journal's founders were members of the ANA (originally called the Association of Alumnae of Trained Nurses of the United States) who put up their own money to launch AJN in 1900. Perhaps now it is fitting that individual nurses must once again support this journal on their own.


I have a silver pin that was purchased by Mary Roberts, editor of AJN from 1921 to 1949, and designated the "AJN editor's pin" to be handed down from editor to editor. Such was the realization of the legacy that AJN represents to the profession and to ANA members. While there will be challenges during this time of transition, the staff and the publisher of AJN are committed to building upon this important heritage. We've made AJN available for free online ( to subscribers and will soon be making available to libraries a searchable electronic version of the entire archive of AJN, beginning with the October 1900 issue. This rich collection documents the history of American nursing, the American Red Cross, military nursing, developments in clinical practice, advances in the profession, and the views of nurses worldwide-as AJN will continue to do.


The ANA is abandoning not just an excellent nursing journal but also this legacy. Nonetheless, Sophia, AJN is and will remain the profession's journal.