Writing a Letter to the Editor: Tips for Success

Writing a Letter to the Editor: Tips for Success

Jacqueline K. Owens

Nurse Author & Editor, 2020, 30(3), 4

Every nurse has an opportunity to dialogue about important issues by submitting a letter to the editor. Not every nurse will become a well-published author, but all who read a journal article are eligible to contribute to nursing literature. Readers have a responsibility to improve the literature by ensuring the accuracy of content and holding authors and editors accountable. The requirements are simple: you must thoroughly read the article; carefully think about its content and your response; and are familiar with, or are willing to learn about, other literature on the topic.5 Publication of letters is highly competitive due to the number that editors receive. However, there is little guidance for potential authors available in the nursing literature. In this article, I will discuss steps to create a scholarly letter.

Why Write a Letter?

There are several good reasons to consider writing a letter to the editor. If you are a novice author, this can be an appropriate way to begin your writing trajectory. Many skills that contribute to a coherent, substantive article are also important in letter writing. But, the overall task is less overwhelming in scope and is typically accomplished in a shorter timeline.

A published article is the start of discussion about a topic, it is not the last word. Responses by letter writers continue the scholarly dialogue as an opportunity to engage with peers in the discipline. A letter can offer a rebuttal based on the writer’s perspective and experience, or a chance to correct errors or suggest a clarification that was missing in the original publication. Whatever the aim, new information is offered. For example, a letter from a practicing clinician can add clinical insight to an area of scholarship.

The International Committee of Medical Journal Editors (ICMJE) notes correspondence as important to tenets of science and recommends that peer-reviewed journals publish letters to the editor, noting that journals should, “…provide readers with a mechanism for submitting comments, questions, or criticisms about published articles…through a correspondence section or online forum.”4, para 1 Letters are indexed in databases such as the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, typically alongside the original content as recommended by the ICMJE. This post-publication dialogue continues the peer review process and is one way to maintain and strengthen the evidence.1

Finally, writing a letter to the editor can be an effective pedagogical strategy to help nursing students improve critical appraisal and scholarly writing skills. However, an entire class individually submitting letters to a journal editor rarely results in useful, publishable content. This process frustrates editors, who want to encourage novice writers, but are faced with more submissions than they can possibly use. Journal clubs have been one successful strategy. Green and Johnson2 utilized a journal club and letter writing assignment with health sciences students. Their study of approximately 450 student letters over seven years resulted in 12 letters submitted to the editor, with 10 publications. In another strategy, journal club members discussed an article and worked together to write an appropriate scholarly response.6 The keys to this strategy are: 1) a primary goal to teach the critical appraisal and writing skills necessary to author a letter, 2) the inclusion of pre-submission peer review to determine potential revisions, and 3) a peer-based process to select the best letter(s) for actual submission. For success, a large group should focus first on the process, rather than the outcome.

Tips for Writing Letters

Most journals have guidelines for letters related to length, the style or format required, and if applicable, a time limit for responses. Examine some published letters to determine the style of the journal. Be sure that a previous letter has not already discussed your concerns. It is also a good idea to search the literature and the Internet to confirm that your content is original and has not been addressed elsewhere, such as in an eLetter forum or a blog.

As you start to write, begin with the purpose of your letter. Focus on one or two critical points. Resist the urge to include minor arguments; it is better to effectively comment on the most important thoughts than to ramble.1 State each point separately. Keep your content simple and focused, writing in a way that is easy to understand. Be brief and to the point; it is not necessary to reiterate large portions of the original article. Use your space instead to provide new information about the topic. Ensure that your statements are accurate and objective, using scholarly references if appropriate. Avoid anecdotal content unless absolutely necessary. If so, be clear that it stems from your experience and use general terms to avoid a potential breach of confidentiality.

Letters that offer constructive criticism are more interesting to readers and may have a greater chance of acceptance over those that simply reinforce points from an article.1 The tone of your letter is an important consideration. Be civil and professional. When offering constructive criticism or a disagreement, write in a courteous and neutral tone. Avoid personal comments about the author(s). Language that is condescending or rude detracts from and discredits your message at best; at worst it can open the journal to potential litigation. Scholarly dialogue is not facilitated by alienating potential readers with obvious agendas or incendiary language.

When your letter is finished, let it rest before a second read; ask a colleague to be a reader; double check for correct formatting and grammar; and make revisions.1 Submit your work with a brief cover letter to the editor unless the guidelines direct otherwise. This introduces your letter to the editor for consideration and assures that editorial processes are respected, such as declaration of conflicts of interest and copyright transfer.4

Which Letters are Not Useful?

Most letters are responses to published content and are submitted to the same journal as the original article. Some editors also accept letters about matters of interest, such as emerging topics in the discipline or clinical pearls appropriate to the journal audience. Much less common are letters that discuss preliminary findings from research, case studies, or clinical topics such as adverse drug reactions. If this is the purpose of your submission, be sure to check whether the journal features these types of letters. Even preliminary research findings must have evidence of methodological rigor; a letter to the editor is not a backup venue to publish weak evidence that would not or has not been successful in the peer review process.

I occasionally receive passionate letters describing perceived wrongs in the workplace from the perspective of an employee or discussing a policy that has failed one or more patients. It is not prudent to publish what amounts to a rant. These letters lack objectivity as I cannot know the viewpoint of others involved. Such a letter could also invite litigation as often the writer describes the alleged wrong in such detail that the situation is potentially identifiable. A simple Google search of the writer’s name can often easily identify affiliations. Certainly, systems level inequities exist and I have empathy for the writer, but this is not a useful letter that is publishable in a scholarly journal. If tempted to write such a missive, consider writing for the cathartic value, but not as a letter to the editor. After time has passed it may be possible to write in a neutral, measured approach appropriate for professional publication.

The Screening Process for Letters

Letters to the editor are screened, but usually do not undergo peer review. An exception to this may be for journals that accept case reports, such as unusual clinical presentations or drug reactions, or preliminary research briefs. Typically, the editor evaluates your letter for timeliness; grammar and correct journal formatting; purpose and clarity of content; substantive content and contribution to the literature; and support for your assertions.

If your letter responds to a specific article, the editor will contact the author(s) to offer the chance to reply. Authors may or may not choose to respond. The ICMJE4 guidelines assert that the authors of an article have a duty to address substantial criticisms discussed in a letter or online forum in kind. A responsible editor will encourage a variety of opinions and promote debate, but is free to reject letters deemed irrelevant, uninteresting, or inappropriate.

Letters may be edited for journal style, length, or grammar. You will receive a proof of your letter and should review that carefully. Be sensitive to deadlines to respond with your approval. Page space is a consideration for print journals so unless editing of your letter changes its meaning substantively, limit your requests to correcting errors.

Other Considerations

Another consideration is electronic space for letters to the editor featured by many print journals, not to be confused with fully online journals with a dedicated space for letters. The advantages of this first option, often called eLetters, are that a letter can often be published quickly, and there is room to include a greater number of responses. However, there are disadvantages. Letters posted to response forums associated with journals typically appear only online and may not be edited, or indexed in databases.1,4 If the letter is not indexed, it is not searchable in the database and may not be searchable on the official journal website, thus limiting access to those familiar with the journal and its forum.

One controversy related to journal correspondence is the appropriate contact person. In general, if you have questions, you should contact the journal editor, and not the article author(s). However, letter authors have sometimes faced lengthy delays and barriers, leading to an opinion by some that it can be useful and appropriate to directly contact article authors in the interest of moving forward with scholarly dialogue.3 It should be recognized that this is a concern, but the traditionally accepted process is to first communicate with the editor, who is considered an impartial party in the discussion and assures that appropriate procedures for publication are followed.5

Conclusion

In conclusion, remember that every journal reader is a post-publication peer reviewer and potential contributor to the science. If you seek to begin your effort as a scholarly writer, or if you have substantive knowledge to add clarification or correct a possible error in a published article, take the opportunity to craft a letter! Work to state your purpose and ideas clearly in a brief, thoughtful response written in a neutral tone. Add support from the literature when you can. Make sure that your response is timely. It may be your letter that is selected to continue the dialogue about an important topic in nursing and healthcare!

References

  1. Dotson, B. (2013). New practitioner’s forum: Writing a letter to the editor. American Journal of Health-Systems Pharmacy, 70(2), 95. doi: https://doi.org/10.1093/ajhp/70.2.95
  2. Green, B.N., & Johnson, C. D. (2007). Use of a modified journal club and letters to editors to teach critical appraisal skills. Journal of Allied Health, 36(1), 47-51.
  3. Hsieh, C-H., Tseng, C-C., Shen, J-Y., & Chuang, P-Y. (2018, November 02). Tortuous and torturous: Why publishing a critical letter to the editor is so difficult. Retraction Watch. Retrieved from: https://retractionwatch.com/2020/06/22/tortuous-and-torturous-why-publishing-a-critical-letter-to-the-editor-is-so-difficult/
  4. ICMJE: International Committee of Medical Journal Editors. (2020). Correspondence. Retrieved from: http://www.icmje.org/recommendations/browse/publishing-and-editorial-issues/correspondence.html
  5. Johnson, C. & Green, B. (2006). How to write a letter to the editor: An author’s guide. Journal of Chiropractic Medicine, 4(5), 144 – 147. doi: 10.1016/S0899-3467(07)60147-5
  6. Kallen, A.J., Wilson, C.T., Russell, M.A., Larson, R.J., Davies, L., Sirovich, B.E., Schwartz, L. M., Woloshin, S., & Welch, H. G. (2006). Group writing of letters to the editor as the goal of journal club. JAMA: Journal of the American Medical Association, 296(9), 1049-1054. doi:10.1001/jama.296.9.1053

About the Author

Jaqueline K. Owens, PhD, RN, CNE is an associate professor of nursing at Ashland University Schar College of Nursing and Health Sciences in Ashland, OH. She is Editor-in-Chief of OJIN: The Online Journal of Issues in Nursing. Prior to this position, she served as Associate Editor from 2007-2011 and became the journal’s first Editorial Assistant in 2003. Jackie has presented many writing workshops for nurses at regional research days throughout Ohio. Particular areas of interest are online scholarly publishing, predatory publishing practices, and novice author publication. She is also a member of the Authors-in-Residence for Nurse Author & Editor.

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