Civility in Nursing Peer Review

Civility in Nursing Peer Review: Giving and Receiving Feedback

Jennifer Chicca and Teresa Shellenbarger

Nurse author & Editor, 2018, 28(4), 5

A novice author prepared and submitted a manuscript to a professional nursing journal. This author is nervous and excited as she awaits the reply of the peer reviewers and the journal editor. The author receives feedback from the peer reviewers.  Figure 1 provides an excerpt of some of the comments received.  Figure 1. An example of peer review feedback

The journal editor informs the author that for this paper to be accepted, she must revise the work and address the reviewer’s suggestions.  The manuscript status is labeled, “Accepted pending major revision.” The author feels overwhelmed, inadequate, frustrated, and considers whether she can make the revisions requested.  She is concerned if she can address these issues or if she should even resubmit the paper to another journal.


Nursing peer review involves experts, usually unpaid volunteers, reviewing written work submitted by authors and providing feedback (Harding, 2010; John Wiley & Sons, Inc. [Wiley], 2018; Wierzbinski-Cross, 2017). Peer reviewers generally use guidelines and/or checklists provided by the publisher to review these submissions and provide their feedback to the editor.  Frequently reviewers are asked to evaluate items such as adherence to journal guidelines, accuracy, credibility, relevance, fit within the scope of a journal, and contribution to the discipline (Harding, 2010; Wierzbinski-Cross, 2017). Ultimately, this peer review process should provide authors with feedback to improve their work and give editors the necessary information they need to make publication decisions.

Unfortunately, the nursing peer review process does not always meet its intended purpose. Why? One of the reasons may be attributed to peer to peer incivility. Incivility, or “one or more rude, discourteous, or disrespectful actions that may or may not have negative intent behind them”, is common within nursing (American Nurses Association [ANA], 2018, para. 2).  The peer review process is no exception (Amerson, 2018). Research suggests nurses do not often recognize their own incivility against their peers (Amerson, 2018). Figure 1 provides an example of a peer review which has multiple instances of disrespectful and demeaning language.  This review even had numerous occurrences where the reviewer used all capital letters, which is usually perceived as yelling. Nurse authors, many of whom are often inexperienced writers, can feel angry, hurt, and resentful of the peer review and publication process when they experience incivility (Amerson, 2018; Harding, 2010). Their work may be acceptable, or with revisions may make meaningful contributions to nursing; however, incivility in peer review may discourage authors from revising current works or submitting future works.

What is the solution? Civility in the nursing peer review process must occur with each member involved: peer reviewers, authors, and editors. Considerations for each member are detailed in the next sections.

Considerations for Peer Reviewers

To ensure peer reviewers help meet the intended purpose of the peer review process, feedback needs to be carefully delivered. Before even agreeing to review a manuscript, peer reviewers should ensure that the work is within their area of expertise, that they have adequate time to thoughtfully review the submission, and they do not have any competing personal, financial, or intellectual interests (Amerson, 2018). Additionally, peer reviewers should try to move beyond just being civil. Their feedback can provide objective but useful suggestions that enhance clarity and promote author growth while ensuring quality publications for the journal.

The following steps can guide manuscript review by peer reviewers:

  1. Review the journal’s scope, purpose, readership, and review criteria. Use specific journal review guidelines and/or checklists when available.
  2. Remember the authors may be inexperienced but still spent significant time and effort on their manuscript and are often nervous to receive the review.
  3. Set the tone in all communications: encourage, be caring, aim to be constructive and collaborative, and be objective, neutral, and factual.
  4. Acknowledge the manuscript’s main points and provide positive feedback first.
  5. Offer general suggestions regarding flow, organization, substance, and application of the manuscript.
  6. Follow general suggestions with specific feedback and recommendations for improvement.
  7. Close the review by encouraging the author, no matter the recommendation, and thank the author for taking the time to submit their work.
  8. Continue to engage in personal/professional development to improve peer review skills. For example, read the letter that the editor provides to the author.  If available, read what other reviewers wrote about the submission (Amerson, 2018; Harding, 2010; Laskowski-Jones, 2018a; Wierzbinski-Cross, 2017; Wiley, 2018).

Considerations for Authors

Authors first need to give themselves credit for having the courage to submit their work. What’s next? Take a deep breath and keep an open mind. Approach the peer review process with the mindset that feedback is an opportunity to grow and learn. When first receiving the feedback, read through it once. Allow a day or two before revisiting the review particularly if the review is negative. Let the feedback soak in and ask questions such as what can be learned from this? How can the feedback improve current and/or future works? After you have processed the feedback, begin your revisions. Then, after using the feedback to improve the manuscript, it is time to reply to the peer reviewers. Consider the following steps:

  1. Craft a response table with peer reviewer comments in the left column and author responses in the right column.
  2. Remember that peer review is unpaid, voluntary work so thank the peer reviewers for their time and effort. If you notice something peer reviewers did well (for example, attention to detail or provided specific examples for improvement), let them know.
  3. Set the tone in all communications: be respectful and humble, state facts, and do not get defensive. If peer reviewers were uncivil, do not engage in this behavior or point this out in your responses; this will not be a constructive endeavor.
  4. Fill out each cell in the table carefully, letting the peer reviewers know what actions were taken to address their comments. If no action was taken, politely and factually state why no action was taken. It may also be appropriate to ask for further clarification.
  5. Do not give up. The vast majority of manuscripts need to be revised at least once before a publication decision is made. Be patient with the process.
  6. If the decision is to revise and resubmit, then that is what you should do. Do not let an uncivil review get under your skin and you withdraw the manuscript from consideration out of spite. That only hurts you.
  7. After completing the review and revision (if appropriate), engage in personal/professional development. Reflect on what could be done better for future works and incorporate those suggestions into the next submission (Laskowski-Jones, 2018b).

Considerations for Editors

Editors depend upon the volunteer pool of reviewers to offer guidance for decision-making about manuscript quality, thus serving as an intermediary in the publication process.  The advice of reviewers is critical but ultimately the decision of acceptance rests with the editor.  Therefore, editors need to ensure that the reviews provide constructive and helpful guidance that will direct the authors. The Committee on Publication Ethics (COPE) suggests that editors send reviewer comments to authors in their entirety, unless they are offensive. Given this recommendation by COPE, editors should take steps to ensure that the reviews are civil, supportive, and clear. The following steps can guide editors:

  1. Select reviewers who provide the needed content expertise for manuscript consideration.
  2. Provide orientation and guidance for peer reviewers, setting clear expectations for their work.
  3. Consider providing sample or model reviews that can be used as a guide for reviewers.
  4. Communicate to reviewers about performance expectations and the quality of their reviews.
  5. Carefully read reviewers’ comments and monitor the reviews provided.
  6. Do not use reviewers who regularly provide uncivil or poor-quality reviews.

Other Resources for Peer Reviewers, Authors, and Editors

There are numerous resources available to assist all involved in the publication process. The following resources provide additional guidance for peer reviewers, authors, and editors about writing, reviewing, and publishing.

  • Committee on Publication Ethics [COPE]. (2011). Code of conduct and best practice guidelines for journal editors. Retrieved from
  • Freda, M. C., & Nicoll, L. H. (2015). The editor’s handbook. (2nd ed.).  Philadelphia, PA: Wolters Kluwer. 
  • International Academy of Nursing Editors. (n.d.). About editing and reviewing. Retrieved from
  • John Wiley and Sons, Inc. (2018). Author Services.  Retrieved from
  • Oermann, M. H., & Hays, J. C. (2019). Writing for publication in nursing (4th ed.). New York, NY: Springer.
  • Saver, C. L. (2017). Anatomy of writing for publication for nurses (3rd ed.). Indianapolis, IN: Sigma Theta Tau International.

And of course, many of the articles published here in Nurse Author & Editor!


How might Figure 1 be transformed into a more civil peer review? Figure 2 provides an example revision of the earlier peer review. Figure 2. Example peer review feedback, revisited.

Although the above example focuses on a peer reviewer’s feedback, peer reviewers, authors, and editors are all responsible for conducting themselves civilly in peer review and publication processes. The culture of incivility in nursing peer review is not conducive to sustaining and developing nursing science. It is important all nurses are encouraged and supported in the important journey of sharing ideas through publication.


  1. American Nurses Association [ANA]. (2018). Violence, incivility, & bullying. Retrieved from
  2. Amerson, R. (2018). Does the peer-review process facilitate incivility among nurse scholars? Nursing Forum, 1-2. doi:10.1111/nug.12277
  3. Harding, A. D. (2010). How to phrase feedback in peer reviews for nurse authors? Advanced Emergency Nursing Journal, 32(4), 333-337.
  4. John Wiley & Sons, Inc. [Wiley]. (2018). Author services: With you every step of the way. Retrieved from
  5. Laskowski-Jones, L. (2018a). Giving constructive feedback-constructively. Nursing 2018, 48(6), 6. doi:10.1097/01.NURSE.0000532753.56742.e0 
  6. Laskowski-Jones, L. (2018b). Receiving constructive feedback constructively. Nursing 2018, 48(7), 6. doi:10.1097/01.NURSE.0000534098.79486.a4 
  7. Wierzbinski-Cross, H. (2017). Peer review. Journal for Nurses in Professional Development, 33(2), 102-104. doi:10.1097/NND.0000000000000327

About the Authors

Jennifer Chicca MS, RN is a Graduate Assistant and PhD Candidate at Indiana University of Pennsylvania, Indiana, PA. She is an experienced nurse and has worked in nursing professional development and with undergraduate and graduate students in a variety of roles and settings. Contact Jennifer by email:

Teresa Shellenbarger PhD, RN, CNE, ANEF is a Distinguished University Professor and the Doctoral Program Coordinator in the Department of Nursing and Allied Health Professions at Indiana University of Pennsylvania, Indiana, PA. She is an experienced nurse educator and author. She currently serves as an Author-In-Residence for Nurse Author & Editor and regularly contributes articles about writing. Contact Teresa by email:

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Copyright 2018: The Authors. May not be reproduced without permission.
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