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Guidance Provided to Authors on Citing and Formatting References in Nursing Journals

Nicoll, Leslie H. PhD, MBA, RN, FAAN; Oermann, Marilyn H. PhD, RN, ANEF, FAAN; Chinn, Peggy L. PhD, RN, FAAN; Conklin, Jamie L. MSLIS; Amarasekara, Sathya MS; McCarty, Midori MA

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Journal for Nurses in Professional Development: 3/4 2018 - Volume 34 - Issue 2 - p 54-59
doi: 10.1097/NND.0000000000000430
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An early step in developing a research study or planning a project or new initiative is to review the literature. The literature review provides the background for the study or project and reveals gaps in knowledge and practice. When a manuscript for publication is prepared on the project, the references document the literature reviewed by the author and are essential information for editors, peer reviewers, and, ultimately, readers. To facilitate communication about the references, which provide the foundation for the article, information about the citation and reference format to use for a manuscript should be described clearly in the Instructions for Authors for the journal selected for manuscript submission.

There are varying styles for citing literature in a manuscript and for preparing the references on the list at the end. Citations document the source of a statement or an idea expressed in the text that is not the author’s own work. Through the citations, the author indicates the content that was taken from another source (Masic, 2014). In general, in-text citations follow three formats: (a) name-year (or author-date), which is a parenthetical citation including the author(s)’ last name(s) and publication year (in this style, the reference list is ordered alphabetically); (b) citation-sequence, with the numbers presented sequentially in the text, either superscripted, in brackets, or in parentheses, and the reference list formatted in numerical order; and (c) citation-name, wherein the number in a citation (superscript, brackets, parentheses) refers to an item on the reference list. The reference list is ordered alphabetically, and as a result, the citation numbers in the text will not be sequential.

Different formats in journals are used for citations depending on the selected style manual. For example, the Publication Manual of the American Psychological Association (APA) uses a name-year format (APA, 2009). The style manual of the American Medical Association (AMA) uses a citation-sequence format (AMA, 2007). Both of these style guides provide detailed information for the author on how references should be prepared and formatted on the reference list.

Other reference styles that are common in the health and social sciences include the National Library of Medicine (NLM) style, which is used for references in MEDLINE/PubMed (U.S. NLM, 2014). The NLM format is the style recommended by the International Committee of Medical Journal Editors (ICMJE) in its Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals (ICMJE, 2017). The source for NLM style is Citing Medicine (Patrias, 2015). This document provides guidance on how to style citations on the reference list, but not how to cite them in the text, which can be a source of confusion for an author, particularly if the information is not included in the Information for Authors of a journal that uses NLM style.

Another common style is Vancouver, which is a citation-sequence style. The name came from a meeting of the ICMJE held in Vancouver, British Columbia, in 1978, in which the editor attendees sought to standardize the format for citations in medical journals. Although they were partially successful—for example, most medical journals use a citation-sequence format for citations—there are still inconsistencies (Kratochvil, 2017). Comparing AMA and Vancouver styles for similarities reveals many commonalities. Both are citation-sequence styles that conform to the Uniform Requirements for Manuscripts of the ICMJE. But more narrowly, formatting differs in minor details between the two, such as what is italicized and whether the citation numbers are bracketed or superscripted (Clauss, Muller, & Codron, 2013).

Harvard style uses a name-year format for references, similar to APA (Chernin, 1988). However, in terms of styling citations on the reference list, there is no “Harvard” style guide that one can purchase or borrow from the library (Fulton, 2012). Various universities, journals, and even countries (e.g., Australia) have created their own guidelines for how to prepare the reference list. Although there may be overall similarities among these various Harvard formats, such that the citation usually begins with the author(s)’ names followed by the year of publication, there can be wide variation in the citation details, which can be confounding to authors.

Other common styles include The Chicago Manual of Style (The University of Chicago Press Editorial Staff, 2017), which has two documentation systems, (a) notes and bibliography or (b) name-year, and the MLA Handbook (Modern Language Association, 2016), used typically in the humanities. In journalism, the Associated Press Stylebook, which is updated annually (Associated Press, 2017), and the New York Times Manual of Style and Usage (Siegal & Connolly, 2015) are commonly used. These latter style guides focus on language and usage, not reference citations, because as Philip Corbett notes in the Preface to the New York Times Manual, “We are journalists—not scholars or poets…our goal is clear, precise, literate prose that effectively conveys important information to busy readers” (Corbett, 2015, p. 5).

Need for Reference Accuracy

Regardless of style, references need to be complete and accurate. This is essential to retrieve the cited document and to give the original author credit for the work (Nicoll, 2017; Oermann & Hays, 2015). In most cases, published documents are obtained using bibliographic databases such as PubMed, CINAHL, or Google Scholar. The citation information needs to be accurate to locate the abstract or full-text article (Masic, 2013; Speck & St. Pierre Schneider, 2013). Although bibliographic management software such as Zotero or EndNote helps authors prepare their citations and references based on a specific style, it is up to the author to ensure that the reference is complete and accurate (Chinn, 2016; Oermann et al., 2018). Even with bibliographic management software, errors in references still occur (Homol, 2014; Kratochvil, 2017).

Instructions for Authors About References in Manuscript

Several studies analyzing journals’ Instructions for Authors have found that guidance on how to format references is one of the most complete portions of these instructions. In a study of 25 medical laboratory technology journals, all 25 journals explained the referencing style (Horvat, Mlinaric, Omazic, & Supak-Smolcic, 2016). An analysis of the author guidelines of 197 Croatian open access journals indicated that 72 journals described authors’ responsibilities, which included the accuracy of references (Stojanovski, 2015). In another study of the Instructions for Authors in biomedical and physical science journals, Nambiar, Tilak, and Cerejo (2014) found that formatting instructions, which included reference styles, received the highest score in terms of clarity and completeness in both journal types.

In a recent study, it was reported that half (n = 105, 50.2%) of the 245 nursing journals in the Directory of Nursing Journals, housed at the International Academy of Nursing Editors (INANE) website, used APA style (6th edition) as the reference format, followed by the AMA style (10th edition; n = 55, 26.3%; Oermann et al., 2018). Harvard style, similar to APA with a name-year format for citations in text, was used in 37 (17.7%) journals. However, that study did not examine the instructions provided to authors on preparing citations and references for the manuscript. Many nurse authors are not familiar with reference styles other than the one they used as a student (Oermann et al., 2018). Therefore, the author guidelines need to describe how to prepare citations and references for submission of a manuscript to the journal; authors seek out and need this information. Errors in references not only affect giving proper credit to authors cited in the manuscript and retrieving documents, they can also influence the peer reviewers’ decision whether to recommend acceptance or rejection.


The purpose of the current study was to analyze information provided in the Instructions for Authors on preparing citations and references in nursing journals. The aim was to assess if sufficient guidance was provided to authors on the reference style to use and the method for formatting citations and references in the manuscript.



This was a descriptive study of the Instructions for Authors of nursing journals in the Directory of Nursing Journals (n = 245) at the INANE website. After accessing each of the Instructions for Authors from the website, reference styles used by nursing journals were identified, and the Instructions were examined further to determine if they provided additional information and examples to guide preparation of citations and references.


In an earlier study (Oermann et al., 2018), a data capture form was developed for recording information about the author guidelines of nursing journals. The form collected information on the reference style used by the journal, if examples were provided of how to prepare citations in the text and references on the list at the end, and if the Instructions for Authors had other guidelines or information on referencing in the manuscript.

Data Analysis

The data were entered into a Research Electronic Data Capture (REDCap) database. Data were analyzed using descriptive statistics, frequencies, and percentages with SAS/STAT software version 9.3 (SAS Institute Inc., Cary, NC, 2010).


Most nursing journals use the name-year format for citations (n = 142, 67.9%), such as the APA or Harvard style. One third of the Instructions for Authors (n = 82, 33.5%) included examples of how to prepare citations in the text using this format. There were 55 journals that used the AMA reference style (citation-sequence with superscripted numbers in the text). Other reference styles specified by nursing journals included the ICMJE or NLM (n = 13, 5.3%); Vancouver (n = 9, 3.7%); and The Chicago Manual of Style (n = 3, 1.2%). None of the nursing journals specified Modern Language Association as the style guide. Twenty-seven nursing journals (11.0%) did not indicate a reference style to use for preparing manuscripts for submission to the journal. The instructions for these journals provided no guidance for authors on how to prepare the citations or references.

Location of the journal’s publisher seems to influence the reference style adopted by the journal. Journals published in the United States used APA (n = 84) and AMA (n = 50) styles exclusively; none listed Harvard or Vancouver. International journals implemented the Harvard style most frequently (n = 37), followed by APA (n = 20), Vancouver (n = 8), and AMA (n = 5).

Thirty-nine (70.9%) of the nursing journals that used AMA style included examples of how to prepare the citations in text, for example, superscripted numbers, numbers in brackets, or numbers in parentheses. AMA style specifies superscripted numbers, so those that ask for another format are requesting a deviation from the standard.

The NLM style and its variants, Vancouver and ICMJE, do not include guidance on how to cite references in the text. This study found that there were 19 journals that used one of these styles, and of these, 17 (89.5%) provided examples of text citations, specifically superscripted number (n = 10, 58.8%); number in brackets (n = 4, 23.5%); name, year in parentheses (n = 2, 11.8%); or number in parentheses (n = 1, 5.9%). Having this information available is a plus, particularly for nurse authors who are not familiar with these styles. In total, 93 (38.0%) nursing journals described how to present citations in the text with examples.

The Instructions for Authors of nursing journals were quite complete when it came to examples and descriptions of the format to use for various types of citations on the reference list (see Table 1). More than half of the journals had examples of how to format articles (n = 158, 64.5%), books (n = 148, 60.4%), and chapters in an edited book (n = 118, 48.2%). Considering the uncertainty among authors in referencing websites and other electronic sources (Homol, 2014; Oermann, Nordstrom, Ineson, & Wilmes, 2008), less than half of the journals provided examples of how to prepare references on websites (n = 100, 40.8%) and online journals (n = 26, 10.6%), which is an area of concern. There were 27 examples of how to cite a data set (11.0%).

Examples of References Provided in Instructions for Authors


An important question is: Who has ultimate responsibility for the accuracy of citations in the text and on the reference list? As a manuscript moves through the potential publication process, it will be reviewed by many people: the author(s), the editor(s), and the peer reviewers; after acceptance, copy editors and managing editors become part of the chain. All of these people will look at the citations and reference list—some in a cursory fashion and others with greater scrutiny. Errors and inaccurate references in the published literature are an ongoing and persistent problem. Foreman and Kirchhoff (1987) evaluated 17 clinical and nonclinical nursing journals and found error rates of 38.4% and 28.3%, respectively, in the reference citations. Three decades later, high rates of reference errors continue to be documented in the health sciences literature, including page number errors (44.8%) and misspelling of the author(s)’ names (20.2%; Karabulut, 2017). Authors may believe that part of the manuscript production process after acceptance includes a step (by copy editors or someone else) to make sure all references are accurate and correct, whereas editors and publication staff may believe that this primary obligation rests with the author(s). Clearly, this is a multifaceted problem, and expecting one group or entity to shoulder full responsibility is not going to provide a solution, as decades of research and experience have shown.

Bibliography database managers (BDMs), such as Endnote or Paperpile, have long been touted as a way to ensure accuracy in citations and references. They are successful up to a point, but they still rely on user input. If incorrect information is keyed in or imported into the BDM, then the resulting citation will also be inaccurate. Major errors, such as misspelled author names or wrong year, can prevent a citation from being retrieved (Oermann et al., 2008). Minor errors may have less impact regarding retrieval but still reflect poorly on the authors, the journal, and the overall credibility of the article (Lok, Chan, & Martinson, 2001).

Further complicating the problem with using a BDM is the fact that not all styles that are used to generate references are completely accurate (Kratochvil, 2017). Many BDMs rely on styles from the Citation Style Language (CSL) open source project ( This is a crowdsourced project with over 8,000 styles; although that number sounds impressive, clearly, when relying on volunteers, errors are bound to occur. Many CSL files are specific to a journal, not a style manual; even so, personal experience has shown that journal specific outputs may still have errors.

Another important issue for authors to be aware of when using a BDM is sentence case versus title case in article titles, journal names, and book titles. Using APA as an example, that style specifies that article and book titles be written in sentence case while journal names be written in title case. Citations that are imported from a database, such as PubMed, will likely have article titles in title case, as the NLM indexers no longer change the capitalization of titles that they import (J. Conklin, personal communication, September 25, 2017). Changing capitalization in a BDM has always been an issue, because there is no easy way for a program to recognize proper nouns and capitalize them accordingly (Gruber, 2015). Thus, it falls to the nurse author to manually adjust capitalization in article, book, and journal titles.

Although this may sound daunting, the encouraging finding from this study is that most nursing journals that were assessed primarily use two formats: APA and AMA (n = 160, 76.6%). Thus, an author with a working knowledge of these two formats should be well positioned to have a strong start on formatting citations and references correctly in a manuscript (Oermann et al., 2018). Using a BDM can enhance the process of preparing citations and references, but it is important to make sure that (a) the style is set up to properly output the citation, (b) the inputted information for each citation in the BDM is accurate, and (c) article and book titles are edited to sentence case. Both APA and AMA present article titles in sentence case; AMA uses title case for book titles, but the CSL for AMA style will correctly change book titles to title case.

Lok et al. (2001) found that having more than one author and limiting the number of references were both effective strategies to increase the accuracy of references and citations. Certainly having “more eyes” to review manuscript drafts and reference lists makes common sense, but it might be wise to assign one person final responsibility for ensuring the accuracy of the finished manuscript and reference list. The number of references in an article is always an issue. It is important to be comprehensive, but at the same time, over-referencing is also a problem (Nicoll, 2012). From the prior study, it was found that only 44 of 238 journals (18.5%) put a limit on the number of references (Oermann et al., 2018). For those that did have a limit, the number ranged from 3 to 150 with a median of 40.

Another solution to the problem of reference accuracy is not to put the full burden on the author. In 2011, the international publisher, Elsevier, began a trial of “Your Paper Your Way” (YPYW; Davies, 2012), wherein authors can format their paper in any way they wish. A specific style manual for reference citations is not recommended, but whatever format the author opts to use, citations and references must be consistent and accurate. Following a successful trial, YPYW was made available to all Elsevier journals in 2013 (Fennell & Gill, 2013). From the Elsevier journals included in the Directory of Nursing Journals (n = 35), 8 (22.9%) have implemented YPYW, whereas 27 (77.1%) have not. Assuming further adoption, authors are again reminded of their responsibility for reference accuracy, which makes all of the foregoing discussion still relevant.

Nursing professional development practitioners have a role in preparing staff nurses and other healthcare providers to disseminate their work in the literature. Writing for publication is critical to share the findings of studies done in the agency, quality improvement projects, and new ideas and practices. Preparing manuscripts for publication requires referencing important and up-to-date literature in the paper, understanding the role of references and need for accuracy, knowing when to include a citation to avoid plagiarism and give the original authors credit for their work, and knowing how to format citations and references based on the journal guidelines. As nursing professional development practitioners guide staff in writing for publication, the importance of accuracy in references and how to format citations and references need to be included in this preparation.


Accuracy of citations and the reference list in any published article is of tremendous importance and reflects on the credibility of the author, journal, the author’s research or project, and perhaps even their organization. Despite decades of trying to achieve standardization in citation of references in the health science literature, journals still adopt a wide variety of styles, and even within styles, there are inconsistencies, as this study found. Authors may defer selecting a journal for article submission if it uses a reference style that is unfamiliar; as this is a matter of mechanics, not science, this is an unfortunate decision. The encouraging news is that APA and AMA styles are predominant in the nursing literature, which should help to ameliorate some of this anxiety for authors.

The review of Instructions for Authors in this study provides evidence that journal editors are aware of the issue that nurse authors face regarding reference accuracy. In addition to having 85.3% of the journals reviewed providing the name of a specific style guide, more than half gave examples of types of reference citations, including articles, books, and chapters in books. Guidelines might be strengthened with more examples of websites, online journals, and data sets. Authors can always refer to the reference list in an article or two in a current issue of the journal to see additional examples.

Electronic resources, such as databases for searching (PubMed, CINAHL), automatic importing features to eliminate rekeying, and BDMs to manage a reference database and create citations and reference lists in finished manuscripts, can be timesavers and also improve reference accuracy. Still, all users of these resources are reminded nothing is truly automatic and magical; every citation that is imported should be reviewed for accuracy and completeness. Necessary corrections, such as changing the case of article titles, should be made in the BDM and not in the final reference list.

Last, initiatives such as YPYW may be another way to reduce author anxiety about reference formatting and styling. Even so, the caveat remains that reference accuracy, no matter what style is used, is of paramount importance, and the primary responsibility for this remains with the author.


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