Nurse Education in Practice (2005) 5, 91–96

NurseEducation

www.elsevierhealth.com/journals/nepr

in Practice

Writing for publication: a new skill for nurses?

Julie Taylor*, Phil Lyon, Jane Harris

School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK

Accepted 30 March 2004

Summary In this article, we outline a voluntary staff development course –Writing for Publication – and its operation in the context of changing policy,practice and professional demands. One year from course completion we are in aposition to discuss its success. We argue that, in a small but significant way, aparadigm shift in nursing is reflected in requests for the course, and for places on it.Clearly, there are new professional needs to be met.

�c 2004 Elsevier Ltd. All rights reserved.

KEYWORDSWriting for publication;Nursing skills;Education;Curriculum

Introduction

As tutors on a voluntary staff development course– Writing for Publication – we were surprised bythe high level of demand for places, and provokedinto consideration of the basis for this interest.Participants came from a variety of health caresettings and, while individual motivations wereimportant, so too were changing expectationswithin the profession.

Nursing now requires an evaluation of practiceand puts a high value on evidence and account-ability. Good practice needs purposeful dissemi-nation rather than ad hoc transmission. Policy andpractice requirements feed into the way thatnursing activity is organised and evaluated, withprofessionals increasingly needing to formallycommunicate the lessons learned. This is no longerrestricted to senior posts.

* Corresponding author. Tel.: +44-1382-348532; fax: +44-1382-348533.

E-mail address: j.z.taylor@dundee.ac.uk.

1471-5953/$ - see front matter �c 2004 Elsevier Ltd. All rights reserdoi:10.1016/j.nepr.2004.03.007

If they are to survive, all professions changetheir characteristics, knowledge and skills re-quirements to accommodate emergent practicedemands. Nursing is, and should be, no excep-tion. Arguably, nursing now has a new set ofchallenges in the form of requirements for pub-lished reports of practice development and of ac-ademic research. Before considering newparameters, however, there has long been amandate for writing about the professionaltask. Nightingale was but first in what became adistinguished tradition of educators writing aboutnursing in books and journals. However, this hadnot been expected of practising nurses in the waythat many now perceive as a role requirement. Asan odd footnote to history, one of the questions onthe application form drawn up for Nightingale’sSchool of Nursing was . . . ‘can you read and writewell?’ (Jamieson and Sewall, 1949, p. 381). Whilethe question served a different purpose in the mid-19th century, there is new relevance in the needfor many nurses to effectively communicatepractice experience and research to professionalaudiences.

ved.

92 J. Taylor et al.

Background and context

Historically, nursing focused on the basic care re-lationship when that was a scarce commodity andtrained recruits accordingly, if with varying de-grees of commitment. Then as now, to practicenursing required knowledge of techniques to re-duce pain and the possibility of infection. Thesenursing skills transformed patient care and en-hanced the prospects of recovery. The identifica-tion of appropriate skills, and the initial difficultiesof establishing them in a disparate and disvaluedoccupation are well-documented (see, for exampleBarton, 1925; Seymer, 1956; Abel-Smith, 1960;Nolan, 1998). Nightingale’s own discussion of basicnursing skills (Skretkowicz, 1992) is a classicstatement of what are now basic procedures butwhich, at the time of their publication (1860),served to lift the vagaries of unqualified practice toa well-argued rationale for purposive action.Moreover, detachment from the socio-politicalcontext of the day gives her writing an atemporalquality and a continued relevance.

The passage of time does not diminish the rel-evance of these basic skills but introduces addi-tions. Increased complexity of nurses’ roles is, inpart, a function of more complex health technol-ogy. For example, dietary regimes for many con-ditions might be distantly related to Nightingale’sobservation on appropriateness of specific foods inpatient care but are now infinitely more complex.Drug therapy and electronic monitoring equipmentall add to the knowledge base and call for newskills to augment the basic framework of care.Nursing never was simply a profession dealing di-rectly with its clients, it was practised in organi-sations that sought employee compliance to ruleswhich were not solely those of the practitioners.Such organisations – primarily hospitals and thelocal or national administration of which they areconstituents – bring with them requirements forhierarchical responsibility to be manifest in writtenrecords, memoranda and the like.

Unlike many occupations, the increasing com-plexity of hospitals as organisations and the tech-nology deployed for even quite commonplaceconditions, has not degraded traditional skills.Nursing roles now have more rather than fewerdemands, and Braverman’s observation of declinein the . . . ‘combination of knowledge of materialsand processes with the practiced manual dexteri-ties’ (Braverman, 1974, p. 442) . . .that character-ised craft mastery is not something that mostnurses would recognise. They may, however, dis-agree with the changed emphasis on traditional job

elements or training strategies (Pfeil, 2001), butthat is different.

The way in which nurses approach practice haschanged radically in the last decade and the au-thors propose that the demand for, and success ofthe Writing for Publication course is one reflectionof this. The causes of change are multifaceted,though interrelated, but can be broadly describedas educational, political and professional.

During the 1980s, a major review of nurse edu-cation was undertaken that – in part – paved theway for what we are now experiencing with coursessuch as Writing for Publication. That review cul-minated in the relocation of traditional nursetraining from within National Health Service es-tablishments to diploma level programmes withinuniversities (UKCC, 1986). A corresponding shift inculture ensued which began to break down theboundaries between practising nurses, and the one-time minority of nurses engaged in teaching andresearch within higher education. Practising nursesnow see writing an account of their experiences forpublication as an option for them, and not merelythe province of academics.

Government commitment to quality and clinicaleffectiveness within the NHS has been particularlyevident since 1997 (Department of Health, 1997;Scottish Office, 1997). Subsequent documents havereinforced this, and local policies have encouragedpractitioners to adopt a more critical approach topractice, and to develop such practice in line withevidence. Ways in which nurses have responded tothis challenge have included undertaking furtheracademic study and becoming involved in audit andpractice based research. Crucially, such scholarlyactivity was not previously perceived as part of thepractising nurse’s role.

In the Scope of Professional Practice (UKCC,1992), the profession endorsed the development ofnurses’ roles and in 1994 introduced a frameworkto regulate post registration practice and educa-tion (UKCC, 1994). Scotland’s strategy for nursingand midwifery (Scottish Executive Health Depart-ment, 2001) clearly outlined the contribution nur-ses had to play in improving the health of thepeople of Scotland and urged nurses to lead ini-tiatives to meet patients’ needs, evaluate practiceand share good practice. An ideal forum for thiswas Writing for Publication.

The course

The request for Writing for Publication coursecame from a confederation of Trust and Health

93Writing for publication: a new skill for nurses?

Board Chief Nurses in partnership with universitysenior staff. Precedent had been established in theform of external provision that had been recentlywithdrawn. The confederation perceived this as agap in service provision and it was framed in termsof needs expressed by practising nurses. Conse-quently a decision was made to put togetherContinuing Professional Development (CPD) provi-sion to be taught in four separate half-day work-shop sessions supported by participant groupingsand tutorials.

Our first Writing for Publication course was adirect response to the confederation request and21 participants were accepted with numbers beinglimited by the practicalities of the workshop for-mat. Four participants never registered leaving aclass size of 17. Those we could not accommodatewere offered places for a subsequent course. Al-though the course was open to university andclinical staff alike, the majority (n ¼ 12; 71%) ofparticipants were from clinical areas. Practitionersall felt that they had undertaken a project worthdisseminating more widely, but needed somepractical help in translating what they had doneinto publishable text. Article content was seldom aproblem but getting the structure right was adaunting prospect. The nurse lecturers who at-tended as participants were, on the whole, newermembers of academic staff often with a recentlycompleted postgraduate degree. They too neededpractical help to convert their material into anarticle.

Whatever their current posts, participantswere invariably juggling conflicting time de-mands. This had the effect of making articledrafting a much slower process than they wouldhave wished – despite discussions on the impor-tance of taking control over their time if theywished to see projects in print. The inevitability of‘slippage’ on individual writing timetables madefor creative tension for ourselves and participantsalike.

The curriculum

The curriculum was designed by the authors whobetween them have published in a wide range ofmedia. Drawing largely on Luey (Luey, 2002) interms of the content, we were nevertheless posedsome interesting problems. While we hoped thatparticipants would enjoy the course in its ownright, the only true measure of success would be toget most, if not all, of them into print within arelatively short timescale. Decisions to accept andpublish the output of course participants would be

made by editors in circumstances that were largelyunknowable to us, let alone within our control. Inpedagogic terms, assessment of course effective-ness was not only external, but subject to decisionsmade on the basis of issues as diverse as perceivedrelevance, article backlogs and edition themes, asmuch as the academic integrity of the submittedwork.

Notwithstanding the difficulties of getting out-put published, it was recognised that the coursehad to focus on three issues:

• confidence,• writing,• publishing.

For planning purposes, becoming a participantwas indicative of a lack of confidence in tacklingthe intrinsically difficult task of writing and pub-lishing, some technical difficulty with formal writ-ing for publication, or simply not knowing how toget material published.

All combinations had to be addressed and,while any of these issues might be the startingpoint, we considered confidence building the pri-ority and operationalised this in the teaching styleas well as the conscious efforts to demystify bothwriting and publishing. Interestingly, all partici-pants had practice experience, innovations orresearch they wanted to publish but – for whateverreason – had not managed to accomplish on theirown. All two-hour sessions were taught by theauthors as a team and broke frequently into sub-groupings for discussions on specific issues.Groupings and pairings – arranged on an ad hocbasis – were important for reducing the inherentisolation of episodic classroom sessions. Partici-pants had to rapidly feel comfortable with thesetting and each other if the very limited contacttime was to be fully exploited.

Course evaluation – however qualitatively de-scribed – could only be measured in quantitativeterms by the number of submissions (successful orotherwise) to journals, and in the long term byparticipants appearing in press. Starkly, howevermuch participants may have enjoyed themselves,course success would be measured principally onpublication. Given the realities of timelag betweenfirst draft to publication, we knew that quantita-tive evaluation could only take place one yearpost-course: hence May 2003. While the coursecontinues to develop, the format is still basedlargely on our experience of the first course. Wehave run further courses since then, and data col-lection is ongoing.

94 J. Taylor et al.

Session 1 (October 2001)

Introductions and assignment to groups and pair-ings were preludes to substantive presentations on:

• strategies for successful writing,• personal goals and target journals,• referencing techniques.

Each involved some aspect of group, paired orindividual working and culminated with goal settingfor completion before the next session. Tutorialsupport was available as required in the interveningperiod. An important teaching tactic was to makecontact between sessions as a reminder to write –and not simply think about writing. Althoughtermed our ‘nagging letters’, participants gener-ally found them of value.

Session 2 (December 2001)

Participants had been given the task of identifyingan appropriate journal for the type of writing theyhad in mind, checking author requirements, shap-ing their material and preparing an abstract in theappropriate style. Everyone had produced an ab-stract and individual efforts – circulated to allgroup members prior to the session – were dis-sected and discussed.

Additionally, participants were pointed towardsthe next stage – producing a draft article – bytaught sessions focusing on:

• structuring a paper,• different articles for different audiences,• writing styles.

Again tutorial support was available as requiredto augment peer support and a ‘nagging letter’ wasposted as the next session approached.

Session 3 (February 2002)

All participants produced draft articles – indeedtwo had already submitted these for publicationand had them accepted. Some were relativelyshort pieces designed for practitioner readership,others ran to several thousand words reportingprojects with which the authors had been in-volved. Late arrival of some articles meant thatcollation was also late and distribution could onlybe made on the morning of Session 3. This was farfrom ideal but all were now able to appreciate thetyranny of deadlines. Some discussion of outputwas possible but this had to be augmented by post-

session follow up from peers and the teachingteam. Moving the agenda forward, there werepresentations on:

• lessons learned about personal writing require-ments,

• the role of reviewers,• rules of submission.

For the next session, participants were to re-draft on the basis of lecturer/peer suggestions andhave the article as near ready for submission as waspossible. It was made clear that authors could goahead and submit once they felt sufficiently con-fident with the quality of their writing if theywished.

Session 4 (April 2002)

Polished drafts were circulated prior to the finalsession for comment – simulating the role of re-viewers. Equally, the teaching focused on positiveresponses to negative comments that might bemade about articles by reviewers:

• targets for submission,• how to reshape articles,• maintaining motivation.

At this point also, participants were asked toevaluate the course and to address the question ofperceived effects on their writing and the produc-tion of an article for publication. Such data werefed into subsequentWriting for Publication coursesoffered but, ultimately, the real test was alwaysthe proportion who would have a publication undertheir belts within the next twelve months. Allow-ance had to be made for a more protracted draftingand submission process in the timetable for ourevaluation of the course. For practical purposes,we decided to allow one year beyond the end of thecourse to monitor the outcomes. We offeredcontinuing support to participants after the courseto ensure that any over-run on their writingschedules did not jeopardise publication. At theend of the course, some articles had still been inearly draft form and it would have been dispiritingnot to at least achieve submission draft. Evenwithout delays in the writing process, and withspeedy acceptance, publishing schedules are vari-able. For some journals, even one year might beoptimistic but was thought a reasonable compro-mise for this purpose. Whilst unlikely to be com-plete, at the very minimum Fig. 1 describes theoutcomes one year on from course completion.

Participant characteristics and outcomes one year on

Number Percentage

Participants registered 21 n/a

Participants who paid fee 17 100

Participants started session one 17 100

Participants completed 17 100

Participants from practice 12 71

Participants from higher education 5 29

(of which) new lecturers 3 18

Produced abstracts 17 100

Produced first draft 16 94

Completed final draft 16 94

Articles submitted 14 82

Articles submitted and rejected outright 0 0

Published 11 65

Figure 1 Participant characteristics and outcomes one year on.

95Writing for publication: a new skill for nurses?

Of our original 17 participants, Fig. 1 shows that11 were already in print: a success rate of 65%. Infact, a reasonably impressive 94% of participantsproduced a final draft and indeed may now havesubmitted without our knowledge. Of those sub-mitted to journals, only three were either workingon feedback from the reviewers, or were stillawaiting the review process. No submitted articlewas rejected outright.

Between a rock and a hard place

Our success in participant publication is, on theface of it, something to celebrate in its own rightbut there were ancillary benefits. Success not onlygenerated further demand for repeat courses,participants often experienced the course as a shopwindow for higher education. Some have sinceregistered with us on post-registration and post-graduate programmes. Our partner Trusts weresatisfied that we responded directly to their re-quests and were able to address a specific trainingneed. Throughout the UK, here are hundreds ofpractice initiatives that are exciting and innova-tive. Colleagues want to tell that story. Sometimesthey just need help capturing it on paper. More-over, people want to hear such practice stories.

Whilst on a personal level this is certainly ex-citing, professionally it can leave us, the coursetutors, in a double-bind situation. Publicationsemanating from the course appear in a range of

journals including Nursing Standard, ProfessionalNurse, Journal of Advanced Nursing, Social WorkEducation, Journal of Hospital Chaplaincy andCommunity Practitioner. In terms of our own aca-demic output though, not only are few of thesejournals credited with a high impact factor for UKResearch Assessment Exercise purposes but, even ifthey were, our names do not appear on the arti-cles. It was suggested to us that we might make it astipulation of the course that we had joint au-thorship with the participants. Given the amount ofeffort expended on some drafts this has at timeshad some resonance, but these were participantstories from practice and we did not feel morallyable to share their success. Some may disagreewith such a stance. However, it has meant that ourown published output has not increased coinci-dentally as a result of the course.

While teaching and learning is a key scholarlyactivity as well, Writing for Publication did notappear on any of our timetables, nor was it wellfunded. As it was not central to our service provi-sion nor to our teaching strategy, it meant that thecourse was not recognised within our individualteaching portfolios and was something we have hadto increasingly ‘squeeze in’. Moreover, while thedirect contact was limited, commenting carefullyand constructively on numerous drafts was a time-consuming activity. The residual activity long afterofficial course completion was equally weighty, buttended to be invisible. Whilst perhaps episodic,there was continued demand that could only bemet outside of our regular scholarly activity. Thus,

96 J. Taylor et al.

Writing for Publication could not be viewed as akey teaching activity for any of us.

For us, this course and its successors broughttheir own reward. However, there was little gainfor the higher education institution and therein liesa challenge. We would propose a radical shift ofemphasis that recognises the changed circum-stances of practising nurses who now actively seekto share their practice beyond the traditional wardsettings. We would argue that facilitating suchneeds should be accorded permanent and centralstatus in higher education – and that researchactivity could reflect the vicarious nature of theproducts of this facilitation.

Conclusion

One of the benefits of Writing for Publication in-cludes the advancement of nursing knowledge(Duff, 2001). That individual nurses are motivatedenough to share good practice, disseminate theirown research findings, or highlight areas for de-bate, is a salutary lesson for those in academia.The push for evidence and individual accountabilityrepresents a visible shift in the field of nursing andmidwifery that has been largely overlooked. Nurseshave not been taught writing directly as a skill intheir training (Whitehead, 2002) but while nurseshave always written, a new range of factors hasbrought the skill of writing for publication into themainstream. Wills and Kaiser (2002), for example,argue that the mentoring role should also includethat of writing skills and other scholarly activities.Publication is increasingly valued in the clinical jobmarket and noted as evidence of disseminationwithin the clinical governance cycle. Clinicalpractitioners are increasingly likely to be recipientsof special grants and awards, where disseminationis written into the contract.

Perhaps contentiously, we would argue that theprofession itself is now more academically driven.So many more individuals are involved in or influ-enced by research than they were even ten yearsago. It should not be surprising that writing for

publication is an emergent skill that is becominghighly sought by those in practice. It is our viewthat we are monitoring a shift in the profession andthat demand for courses such as Writing for Pub-lication is a proxy indicator of this. As academics,this is a change in the profession deserving a posi-tive response.

References

Abel-Smith, B., 1960. A History of the Nursing Profession.Heinemann, London.

Barton, E., 1925. The History and Progress of Poor-Law Nursing.Law & Local Government Publications, London.

Braverman, H., 1974. Labor and Monopoly Capital: The Degra-dation of Work in the Twentieth Century. Monthly ReviewPress, New York NY.

Department of Health, 1997. The New NHS: Modern, Depend-able. The Stationery Office, London.

Duff, D., 2001. Writing for publication. AXON 22 (4), 36–39.Jamieson E., Sewall, M., 1949. Trends in Nursing History: Their

Relationship to World Events. Saunders, Philadelphia PA.Luey, B., 2002. Handbook for Academic Authors. Cambridge

University Press, Cambridge.Nolan, M., 1998. Towards the next Research Assessment Exer-

cise (Planning the nursing approach to the year 2000Research Assessment Exercise). British Journal of Nursing 7(1), 6.

Pfeil, M., 2001. Reintroducing skills teaching to nurse education:an action research project. Nurse Education Today 21,616–623.

Scottish Executive Health Department, 2001. Caring for Scotland– The Strategy for Nursing and Midwifery in Scotland. TheStationery Office, Edinburgh.

Scottish Office, 1997. Designed to Care: Renewing the NHS inScotland. The Stationery Office, Edinburgh.

Seymer, L., 1956. A General History of Nursing. Faber & Faber,London.

Skretkowicz, V., 1992. Florence Nightingale’s Notes on Nursing.Scutari, London.

UKCC, 1986. Project 2000: A New Preparation for Practice.UKCC, London.

UKCC, 1992. The Scope of Professional Practice. UKCC, London.UKCC, 1994. The Council’s Standards for Education and Practice

following Registration. UKCC, London.Whitehead, D., 2002. The academic writing experiences of a

group of student nurses: a phenomenological study. Journalof Advanced Nursing 38 (5), 498–506.

Wills C., Kaiser, L., 2002. Navigating the course of scholarlyproductivity: the protegee’s role in mentoring. NursingOutlook 50 (2), 61–66.