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Navigating the Publishing Process

Roush, Karen PhD, RN, FNP

AJN The American Journal of Nursing: June 2017 - Volume 117 - Issue 6 - p 62–67
doi: 10.1097/01.NAJ.0000520256.42212.fc
Writing for Publication

This is the fourth and final article in a series to help nurses share their knowledge, skills, and insight through writing for publication. Nurses have something important to contribute no matter what their nursing role. This series will help nurses develop good writing habits and sharpen their writing skills. It will take nurses step by step through the publication process, highlighting what gets published and why, how to submit articles and work with editors, and common pitfalls to avoid. For the previous articles in this series, see

Karen Roush is an assistant professor at both Lehman College, Bronx, NY, and the Graduate Center, City University of New York. She is also founder of The Scholar's Voice, which works to strengthen the voice of nursing through writing mentorship for nurses. Contact author: The author has disclosed no potential conflicts of interest, financial or otherwise.

You're now ready to submit your article for publication. For new authors, navigating the publishing process can be confusing and intimidating. This article will take you through the process step by step, from the day you decide to submit your manuscript, to the day you finally see it in print. But first, a few words about authorship.

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Being an author carries responsibilities. There are ethical and legal considerations, which I'll review below, but before starting the publication process you should be clear about what it means to be an author. You are accountable for every word in your article, whether you're the first author or the fifth. The International Committee of Medical Journal Editors (ICMJE) has established criteria for authorship that all respected peer-reviewed journals support, and you'll be expected to attest that you meet these criteria when you submit an article (see ICMJE Criteria for Authorship 1). If you're one of a team of writers, make sure you can stand by everything in your paper, particularly the methodology and results sections of research reports. If you meet all the ICMJE criteria, this will not be an issue.

One final piece of advice on authorship: if your article has more than one author, you should decide the order in which the authors will be listed before the writing starts, along with each author's contribution, and come up with a plan to resolve any potential disagreements during the writing process. It's not unusual for squabbles about authorship to arise while working on a manuscript. If you establish clearly delineated parameters ahead of time, you can avoid a difficult situation down the road.

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The first step in the publishing process (once the writing is done, of course!) is deciding where to submit your manuscript. Among the many factors to consider are whether you want to submit to a peer-reviewed journal, and to one that offers open access; how to steer clear of predatory publishers; and the value of knowing publication metrics.

Peer review. Peer-reviewed journals are the most credible and respected; therefore, in most cases, that's where you'll want to publish your work. If you're in academia, only publications in peer-reviewed journals count for tenure and promotion.

Peer review is a rigorous process that begins when the journal sends potential manuscripts out to volunteer reviewers who have expertise in the subject matter or, in the case of research, in the methodology used or in statistical analysis. These reviewers advise journal editors on whether to accept a manuscript and often recommend revisions before acceptance. The purpose of peer review is to enhance the quality of manuscripts that are accepted, avoid selection bias on the part of journal editors, and ensure that the journal maintains high standards in the content it publishes. Most journals do double-blind reviews, in which neither the author nor the reviewer is identified or known to one another.

Peer-reviewed journals may be associated with a professional organization; for example, the Journal of Infusion Nursing is the official journal of the Infusion Nurses Society, and the Journal of Wound, Ostomy and Continence Nursing is the official journal of the Wound, Ostomy and Continence Nurses Society. Or they may be independent of an organization, like AJN. You can check if a journal is peer reviewed by looking on its Web site; this information is usually found under the “Journal Information” tab. You might also consider becoming a peer reviewer, which can help you become familiar with the process and, as you gain experience critically appraising manuscripts, improve your writing. Contact the editor-in-chief of a journal in your area of expertise, and tell her or him of your interest, your qualifications (include your curriculum vitae), and what types of manuscripts you would be comfortable reviewing.

Open access. Another factor to consider is whether a journal is “open access.” Open access means that the journal's content is free to readers and can be reprinted, shared, or copied without restrictions, as long as the authors are cited. Open access journals charge authors a fee to cover the cost of publication; this can range from hundreds to thousands of dollars. If you're writing a grant for a research project, you may be able to add this as a potential cost of dissemination. If your manuscript pertains to work done as part of your job, such as a quality improvement (QI) project, check to see if your organization will cover the cost of publication in an open access journal. Some open access publishers, such as the Public Library of Science, or PLOS, offer fee assistance programs. Currently, most nursing journals are not open access, though many (including AJN) offer a hybrid model in which authors have an open access option.

Predatory publishing. Trustworthy, peer-reviewed, open access journals maintain the same rigorous editorial standards as traditional peer-reviewed journals. However, the open access model has led to the proliferation of publishers, known as predatory publishers, that exist only to make money. Their publications claim to be peer reviewed but rarely are. In fact, one author tested this claim by submitting an article that was gibberish to one such journal and it was accepted and published (see Predatory publishers aggressively pursue authors through e-mail solicitation. Do not respond to calls for manuscripts or conference abstracts from any journal that is not well known to you. If you're unsure, ask a librarian or experienced authors in your field. For further guidance on avoiding predatory publications, see Think, Check, Submit (

Publication metrics. Biomedical and nursing journals track the influence of their articles in their respective fields. For many years, they used a metric known as the “impact factor,” which represents how often a journal's articles are cited in other articles in the preceding two years. The number of citations an article receives is an indication of how important that article is in building scientific knowledge. If you're in academia, you should consider the impact factors of journals to which you are considering submitting your work. For tenure and promotion, you're expected to publish not only in peer-reviewed journals, but in those with high impact factors. The impact factor can be found on a journal's Web site, usually under the “About” or “Journal Information” tab.

As publishing and the way people access information changes, an article's influence may not be fully captured by a journal's impact factor. Newer methods to measure the electronic reach and influence of journal articles have been developed, such as Altmetric, which collects online activity related to an article and converts it to a numeric value.

Which journal? When trying to determine where to send your manuscript, the most important questions to ask yourself are: who do you want to reach and where will you find them? If it's on a topic of interest to nurses in many different settings, you should consider a broad-based journal such as AJN. If it has a more narrow focus, you should consider a specialty journal, perhaps one published by an association for that specialty.

Once you have pared down the journals you're considering to only a few, go to their websites and examine the previous year's tables of contents. Do they publish the type of article you are submitting (such as QI projects or clinical review articles)? Have they published anything recently on the same topic as yours? If they have, consider a different journal and make sure to send a query ahead of time. Also, look at each journal's author guidelines to see if your manuscript meets the requirements, particularly the word count limits.

Send a query. Once you submit your manuscript to a journal, it can take months (yes, months) for it to go through the peer-review process. But though you can submit your manuscript to only one journal at a time, you can save time by querying multiple journals to see if they are interested in your topic before submission.



Use your query to make a good first impression. This letter serves as an introduction to your writing as well as to your topic, so if it is sloppily written, the editor may question your ability to produce a well-written manuscript. Unless the author guidelines indicate otherwise, send the query to the editor-in-chief and address her or him by name. Tell the editor who you are and why you are qualified to write about the topic. Describe what your manuscript is about and why it's important. Also, state why you have chosen to submit it to this particular journal. Finally, let the editor know when the manuscript will be ready for submission and provide an approximate word count. Include an abstract or an outline of the manuscript. Take a look at Sample Query.

So now your manuscript is ready and you've agreed on the order of authors, chosen a journal, sent off a query letter, and gotten a reply—yes, the editor is interested! Time to submit.

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The first thing to do when submitting your manuscript is to read the journal's author guidelines. These are found on the journal's website, usually under a tab called “For Authors” or something similar. Author guidelines include specific instructions on how to prepare manuscripts for submission, including formatting style and word count. Follow them! One of the most common mistakes authors make is not following author guidelines, which greatly diminishes the chance that their manuscript will be accepted. Most journals will not even review manuscripts that do not meet their guidelines.

Next, you need to identify a corresponding author. This is the person who will communicate with the journal throughout the submission and publication process. If you are the sole author, it's you. If there are multiple authors, any one of them can serve as the corresponding author; it's unrelated to the author order.

Before beginning the actual electronic submission process, gather all the required components (such as the abstract, tables, and figures). You will need to submit each component separately, so make sure you have separate documents of each.

Cover letter. Along with the title and a brief description of the content, the cover letter should include a statement that the manuscript has not been published or is not being submitted elsewhere. Published abstracts from conference presentations and dissertation or capstone project reports that are on a repository, such as ProQuest, are not considered publications, but if any of these apply to your manuscript, make a note of it in the cover letter. You must also disclose any potential conflicts of interest or state that there are none. Finally, if you want to reprint or adapt something that requires permission, note whether the permission has been obtained.

Abstract. Check the author guidelines for the correct way to format your abstract. Usually research reports require a structured abstract, though the headings may vary among journals. What you include in the abstract is important because when people search or scan articles, they determine what they will read or download based on the abstract. So, while you need to be concise (usually 250 to 300 words), you also need to be sure to hit the key points.

Keywords. Keywords are how readers find your article—databases use them for cross-referencing and indexing. In coming up with keywords, think about what words would you use to search for an article just like yours? Most journals ask for at least five keywords.

Body of the manuscript. This usually includes the main text and references, but some journals may ask that a cover page or the abstract be included, so check the guidelines. And make sure there are no author names anywhere on the manuscript.

Tables and figures. Most journals will have you upload tables, figures, or illustrations separately as attachments. If you are including photographs, make sure they are high resolution (at least 300 dpi).

Permissions. It is the author's responsibility to get permission to use previously published material such as tables, figures, or illustrations—even if it's your own work published previously in another journal. Do this early, so the submission or publication process isn't held up while you wait for permission or in case you need to revise the manuscript if you can't obtain it.

Forms. There are two forms all journals ask for: conflict of interest disclosure (more on this in the next section) and authorship. The authorship form asks you to declare that you (and all your coauthors) meet all four of the ICMJE criteria. Some journals go further and require a description of each author's contribution to the paper. Most journals require each author to submit her or his own form, but occasionally the corresponding author may be responsible for completing forms on behalf of all the authors.

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Conflict of interest. A conflict of interest is anything that could create bias in the writing of the manuscript. The most obvious conflicts are financial—when you or individuals or organizations you have a relationship with stand to profit from publication of the article. For example, if you are or have been a paid speaker for a pharmaceutical company that sells a drug mentioned in the article or a drug that can be used to treat a disorder you are writing about, you must disclose that information. A nonfinancial conflict of interest may occur if an author consciously or unconsciously chooses what to include or highlight in an article in order to protect or promote or devalue an institution, an academic body, or another researcher. Political or religious beliefs can also influence an author's writing if those beliefs cause the author to ignore evidence that conflicts with or contradicts those beliefs.

A potential conflict of interest is not an automatic cause for rejection of a manuscript, unless it clearly compromises credibility. The key is transparency. That's where disclosure comes in—it allows readers to take any potential conflict of interest into consideration in determining their confidence in the content of an article, particularly research findings. Along with conflicts of interest, you'll be asked to disclose any funding sources or sponsor involvement in the article and what, if any, role they played in the conception of the research or topic, data collection or analysis, and writing of the manuscript. You also need to disclose any writing assistance you had, such as an editor or medical writer, especially if paid by a third party.

Privacy and confidentiality. If someone is identified in an article—in a case study, for example—or if a reasonable possibility exists that this person could be identified, she or he must give you written permission. In my experience, most people are willing to give permission when asked, though sometimes it's hard to track them down after the fact. So, if you have an idea for an article based on a specific case or patient care experience, try to get the patient's permission ahead of time. If you can't get consent, then you must deidentify the person—remove or change any information that could reasonably lead to self-recognition or to the person being identified by others. This may include age, sex, location, physical characteristics, or any unique or rare medical conditions or manifestations. Deidentification can be difficult if those factors are critical to the article's purpose or the reader's understanding; but protecting patient confidentiality and privacy are of uppermost importance.

You must also get permission to use photographs of people, including staff members and other health care providers.

Copyright. Once your manuscript is published it becomes the property of the journal, which maintains copyright of the article, including any graphics and illustrations. Keep this in mind if you want to retain copyright of any material you've included—a graphic depiction of a new theoretical model you've developed, for example—and negotiate with the journal at the time of acceptance and before publication to retain copyright for that material. Otherwise you will need to get that journal's permission anytime you want to use the material in future publications. The exceptions are open access journals, where authors retain copyright of their articles.

Author misconduct. Integrity in research, authorship, and the publication process is critical to the development of a body of knowledge that readers can trust and that will contribute to evidence-based practices that promote safe, effective health care. Misconduct related to authorship, the reporting of data and findings, and plagiarism threatens these goals. And in addition to what was discussed earlier on authorship, make sure that everyone who contributes to the manuscript is included as an author—no ghostwriters!—and that only those who made a substantive contribution are included—no honorary authors!

Falsification or fabrication of data are the two most common types of misconduct involving the reporting of data and findings. Falsifying data is any intentional action that inaccurately presents data. Fabrication is making up data and reporting them as real. Falsification and fabrication of data are usually done to create significance where there was none or to support a desired study outcome. Researchers may discard certain completed surveys, for example, or manipulate laboratory work, or create nonexistent participants.

Plagiarism is using the work of others without appropriate attribution. It continues to be a significant problem, even more so today with the overwhelming amount of information available on the Internet and the ease of cutting and pasting text in Word programs. The most common form of plagiarism is copying something word for word from another source. Remember: whenever you take something word for word, you must place it in quotes; it is not enough to just cite the source. Another type of plagiarism is using another's ideas or arguments without citing the source or making it clear to the reader that these are not your original ideas or arguments. It is okay to use another's intellectual work—we build science on the work of those who come before us—but you must give proper attribution.



A related issue is redundant publications. These are articles that have been published more than once in journals or online: the author submitted the same material, usually in a slightly altered form, to several journals. This is not only a violation of copyright (remember, in a traditional journal the publisher retains copyright), but it is also bad science because publishing the same material several times skews the body of research for a topic by giving it more weight. Redundant publication also wastes valuable journal resources, including peer reviewers’ time, journal pages, and the cost and effort involved in the publication process. As mentioned above, abstracts presented at conferences, dissertations or capstone projects kept on databases or repositories, or study reports in clinical trial registries are not considered publications. Just remember that if your manuscript's abstract was previously presented at a conference, or is part of a dissertation or capstone project, you need to indicate so in the cover letter. For more, see Upholding Ethical and Legal Standards in Publishing.

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Once your manuscript is submitted to the journal, it will go through the peer review process. The editor usually gives it a quick read first to see if it is a good fit for the journal (the topic is of interest to readers and it is written at the appropriate level of complexity). If it is, the editor sends it out to peer reviewers who are topic or methodology experts. Peer review can take many weeks or even months. Based on the reviewers’ recommendations, an initial decision is made to reject the article, ask for a revision, or accept it; it is then sent back to the corresponding author along with any peer reviewer recommendations.



Reject. Although there are many reasons why a manuscript may be rejected—see Top Reasons Manuscripts Are Rejected (and How to Address Them)—they generally come down to two: the topic was wrong for the journal or there were serious flaws in the manuscript. If your manuscript is rejected, use the reviewer comments to revise it and submit it elsewhere. Most authors, myself included, can tell you stories of the manuscripts that were rejected, sometimes more than once, that eventually got published. Most important: don't give up on writing. Everyone gets rejected at some point.

Revise. It's a good thing! Manuscripts are rarely accepted the first go-round. If a revision is requested, it means the journal wants to publish your manuscript and most likely will if you satisfactorily address the reviewers’ recommendations. Don't be surprised if your initial reaction to reviewers’ comments is defensive—as writers, we can feel vulnerable about our “creation” and it's difficult to read criticism of something we've worked so hard on. If you try to depersonalize the comments and set them aside for a short while, by the time you come back to them you may have a more constructive perspective. That doesn't mean you'll agree with every recommendation, but that's okay. The key is to address each one—and if you choose not to make a recommended change, clearly provide your rationale for not doing so.

Accept. It's a wonderful feeling to open that e-mail and read, “Congratulations, your manuscript has been accepted for publication!” Celebrate, tell all your friends, put it on your curriculum vitae, and then get ready—your work isn't over yet. Now you start working with an editor to turn your manuscript into a published article.

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After your manuscript is accepted it will be scheduled for an issue or become available online. You will be notified of a publication date and told when you can expect to hear from the editor working to perfect your manuscript. Publications work under strict deadlines, so be sure to let the editor know if you'll be unavailable during any part of the editing process so that scheduling adjustments can be made.

During the editing process the editor will send you queries related to clarity and accuracy or simply to ask if an editing change is okay. It is important that you respond to each query and return your responses on schedule. The level of editing and fact-checking, and therefore the number of queries you'll receive, varies by journal. Some do more extensive developmental editing that will include some rewriting and reorganization to enhance comprehension and clarity. Others do only a copyedit, which addresses consistency of language and formatting style; grammatical, punctuation, and spelling errors; and accuracy. Either way, an expert editor can substantially improve the manuscript of even the most accomplished writer. Be open to the process. Appreciate the editor's skill, and if problems arise, communicate your concerns about edits respectfully. You will usually receive the final manuscript (often in the form of printed “pages”) to review and approve before publication.

Your work is now out in the world—influencing care, changing systems, or creating connections. Now it's time to start your next article!

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1. International Committee of Medical Journal Editors (ICMJE). Recommendations for the conduct, reporting, editing and publication of scholarly work in medical journals (ICMJE recommendations). Bethesda, MD: U.S National Library of Medicine; 2016 Dec.
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