Engaging Clinical Nurses

Engaging Clinical Nurses in Manuscript Preparation and Publication

Patricia A. Johnston and Kelly J. Brassil

nurse author & Editor, 2014, 24(4), 4

Nurses engage in innovative clinical activities on a daily basis that may not be disseminated due to limitations of time, resources, and confidence to write for publication.  As a result, a disproportionate number of articles address quality improvement, evidence-based practice, and nurse-driven research when compared with the number of such activities in which nurses engage in a diversity of clinical settings.  As more healthcare organizations, systems, and institutions strive to attract qualified, high-caliber nurses in a competitive marketplace, develop nurse clinicians and scholars to contribute to clinical practice and knowledge, and attain or maintain specialty accreditation or designation such as the Magnet Recognition Program®, creating engaging and sustainable programs to support publications by clinical nurses is critical.  Exemplary programs should include several characteristics: cultivating a culture of inquiry, providing the necessary resources, identifying collaborative mentors, and engaging clinical staff.

WHY WRITE?

Empowering nurses to understand the impetus for writing is the first step to encouraging thoughtful engagement in the writing process.  Oermann and Hays (2010) identify five main reasons nurses should engage in writing for publication, specifically:

  1. to share ideas and expertise with other nurses;
  2. to disseminate evidence and the findings of nursing research studies;
  3. for promotion, tenure and other personal decisions;
  4. for development of own knowledge and skills; and
  5. for personal satisfaction (p. 3).

In addition to personal and professional motivators, Keen (2007) identifies several external pressures for nurses to write for publication, among which are the need to generate a nursing-driven body of knowledge and pressure from governmental organizations to increase productivity.  This is reflected by both the Institute of Medicine (2010) in its publication, The Future of Nursing: Leading Change, Advancing Health, and by the American Nurses Credentialing Center’s (2014) Magnet Recognition Program® both of which emphasize the need for dissemination of best practices.  In order to support sharing knowledge and preparing the nursing profession for the future, obstacles to publishing need to be mitigated.

Barriers to publication may be personal, namely, questioning what and how to write, as well as whether the individual feels confident enough to write (Driscoll & Driscoll, 2002). Additional barriers include limited time (Fraser, 2014), limited resources, no previous experience with publishing (Wollin & Fairweather, 2008), as well as the perception that publishing is someone else’s responsibility (Happell, 2008).  Innovative, sustainable approaches are necessary to overcome these barriers and to empower and engage clinical nurses across practice settings in the thoughtful dissemination of their work through manuscript development for professional publication.  While many articles provide insight for novice nurse writers on how to approach clinical publication, in this article four key components are identified by which nurse leaders may promote dissemination of knowledge by clinical nurses, namely: cultivating a culture of inquiry, providing the necessary resources, identifying collaborative mentors, and engaging clinical staff.

COMPONENTS OF A SUCCESSFUL PROGRAM

Cultivating a Culture of Inquiry

The foundation step of evidence-based practice articulated by Melnyk and Fineout-Overholt (2011) is to cultivate a spirit of inquiry.  The same can be said for professional writing and publication, a natural progression in an environment that cultivates appreciative inquiry.  Such a culture includes a sense of excitement around developing, evaluating, and disseminating best practices, role modeling by key leaders, infrastructure that provides the support and tools necessary to disseminate best practices, and mentors who can guide the novice nurse writer through the process of manuscript development and publication (Melnyk & Fineout-Overholt, 2011).  Cultivating a culture of inquiry requires multidisciplinary administrative engagement to ensure staff are educated about and encouraged to participate in disseminating evidence-based practices, quality improvement initiatives and research.

Providing the Necessary Resources

Resources, whether time or materials, are consistently cited as a major barrier to nurses’ abilities to disseminate best practices through publication.  Time is the most valuable resource as it is primarily and appropriately focused on patient care in a diversity of clinical settings.  Designating time for scholarly writing and mentorship can seem overwhelming when balancing  professional development with patient care delivery.  However, creative methods for delineating time for mentorship and writing, such as lunch and learn sessions, are pivotal to successfully committing to and completing scholarly writing for publication (Davidhizar et al., 1999).

In addition to time, ensuring that nurses have access to resources, such as databases, research librarians, mentors, editorial staff, and nurse leaders skilled in publishing, and that they know how to access these resources, is essential to supporting the development of new nurse scholars.  Though many institutions may not have all of the resources listed above, even the presence of more than one may have a tremendous impact on the success of nurses in disseminating their work.

Identifying Collaborative Mentors

Collaborative mentors are also fundamental to the writing process (McErlane & Niemi, 2013).  Nurses who are new to scholarly writing may feel overwhelmed or intimidated by the process.  Therefore, partnering with a mentor who is experienced in manuscript writing and publishing can provide structure and guidance that transform the writing experience from one that is stressful and anxiety provoking to one that is formative and productive.  Mentors may come from any number of educational or clinical backgrounds, however their ability to work collaboratively with staff who are new to the writing process is essential in cultivating productive mentoring relationships.  The goal is not that the mentor writes the article, but that he or she provides structured support and revisions with the nurse or nurses taking the lead in writing the clinical content.  One opportunity may exist in the increasing number of individuals completing Doctorate of Nursing Practice degrees.  These individuals may prove invaluable in partnering with other nurses, often in the clinical setting in which the doctorally prepared nurse practices, and may be mutually beneficial to both individuals.  While the novice nurse writer gains valuable writing mentorship, the doctorally prepared nurse may gain opportunities to co-author manuscripts depending on his/her level of involvement in the writing process.  The goal of a successful writing mentoring program would be to guide novice nurse writers through the process such that they too could become mentors to subsequent nurse writing teams.

Engaging Clinical Staff

Regardless of the amount of resources invested in the process, such a program cannot be successful unless clinical staff feel engaged and empowered to participate.  Even institutions with abundant resources may experience a dearth of publications if nurses are not engaged in the process.  Certainly designating resources, including time, materials and mentors, is an excellent step to demonstrate to nurses that there is an investment in their success, but many nurses may ask, given the time commitment involved in seeing a manuscript through from inception through editing, submission and revisions, “What’s in it for me?”  While some nurses may be motivated by the opportunity to participate in the writing process itself, it may also be necessary to incentivize participation in other ways to further engage nurses in the process.  This could include tying in manuscript development and submission with professional development or career advancement goals, which in turn may result in salary benefits.  While the idealist may envision a community of nurses engaged for the sake of science, patient care, and organizational outcomes (e.g. Magnet designation), all of which are important components of a highly functioning culture of inquiry, practically individuals are motivated by a diversity of incentives.

CASE STUDY

At a National Cancer Institute-designated comprehensive cancer center a multifaceted approach to supporting nurses in the development, implementation, assessment, and dissemination of research and evidence-based practice was implemented.  A major priority of this initiative was to increase the number of nurse-led publications on quality improvement, evidence-based practice, and research.  Equally important was fostering a culture of inquiry among nurses across the institution in a diversity of roles and practice settings, and ensuring the appropriate time, materials, and mentoring to support nurses interested in writing manuscripts.  This was in part achieved through the hiring of an individual responsible for developing programmatic elements in support of nurse engagement in evidence-based practice, quality improvement and research, and the dissemination of this work.  This individual assists in several aspects of the manuscript development and publication process: mentoring nurses or nurse-led teams in discussing the potential topic of interest for publication; engaging a research librarian to assist in a review of the literature on the topic of interest to see what, if anything, has been published; working with the authors to identify what new contribution they may make to the literature; identifying the appropriate journal for submission and supporting the authors in querying the journal editor if appropriate; providing mentorship on the development of the manuscript; reading and providing revisions on manuscript drafts; and supporting nurses through the submission and publication preparation process.  Nurses from diverse academic backgrounds and professional roles are encouraged to serve as authors or lead a team of nurse or interprofessional authors in developing manuscripts for publication.  Nurses are particularly encouraged to evaluate evidence-based practices in their work environment in addition to quality improvement and research initiatives and publish their findings.

Initial challenges existed in encouraging nurses to recognize opportunities for publications and in conveying they had the ability, resources, and most importantly the clinical knowledge, to make significant contributions to the literature. As teams of nurses were successful in submitting manuscripts that were accepted for publication, additional staff expressed interest in pursuing similar opportunities.  Over the initial six month period 12 articles were submitted, which included original research publications, quality improvement initiatives, evidence-based practice, case studies, and reviews of the literature.  Of these submissions seven were accepted for publication, two were returned, and an additional three are pending response.  Since that time 15 nurse-led teams have formed and are in various stages of manuscript submission.  This initiative attests to the power that cultivating a culture of inquiry, providing resources of time, materials, and mentors, and engaging clinical nurses can have on nurses’ engagement in manuscript development and publication.

CONCLUSION

The evolving nature of healthcare and requirements of accreditation and specialty designation increasingly emphasize the need for nurses to drive clinical care and their own professional practice forward through dissemination of thoughtful evidence-based, quality improvement, and research initiatives.  Encouraging clinical nurses to develop and publish manuscripts in the context of competing personal and professional demands requires a commitment to developing a culture of inquiry in the professional practice setting, as well as the resources of time, material, and mentors, to successfully engage nurses to pursue publication.  In a context of often shrinking resources innovative approaches to support clinical nurses in developing manuscripts is imperative to ensure that best practices are not siloed within single organizations due to  lack of engagement, resources, or confidence to publish.  Nursing and interprofessional communities are strengthened in their ability to advance professional practice and clinical care through exposure to innovative, evidence-based practices shared through publication.

References

  1. American Nurses Credentialing Center, (2014). 2014 Magnet Application Manual. Silver Spring, MD: Author.
  2. Davidhizar, R. E., Bechtel, G. A., & Lillis P. P. (1999). The role of nursing administrators in empowering scholarly productivity among clinicians. Seminars for Nurse Managers, 7(4), 179-182.
  3. Driscoll, J., & Driscoll, A. (2002). Writing an article for publication: an open invitation.  International Journal of Orthopaedic and Trauma Nursing, 6, 144-152.
  4. Fraser, D. (2014). Spreading the word – your word that is: writing clinical articles for publication.  Neonatal Network, 33(2), 63-64.
  5. Happell, B. (2008). Writing for publication: a practical guide. Nursing Standard, 22(28), 35-40.
  6. Institute of Medicine. (2010). The future of nursing: leading change, advancing health.  Washington, DC: National Academies Press.
  7. Keen, A. (2007). Writing for publication: pressures, barriers and support strategies.Nurse Education Today, 27(5), 382-388.
  8. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare, (2nd ed). Philadelphia, PA: Wolters Kluwer Health Lippincott Williams & Wilkins.
  9. McErlane, K., & Niemi, J. (2013). Partner up for success: writing for publication.Kentucky Nurse, 61(2), 9.
  10. Oermann, M., & Hays, J. (2010). Writing for publication in nursing, (2nd ed). New York, NY: Springer Publishing.
  11. Wollin, J. A., & Fairweather, C. T. (2008). Finding your voice: key elements to consider when writing for publication. British Journal of Nursing, 16(22), 1418-1421.

About the Authors

Copyright 2014: The authors. May not be reproduced without permission.
Journal Complication Copyright 2015: John Wiley and Sons Ltd

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