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Nursing through the decades

Fifty years of change

Carey, Katherine W.

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doi: 10.1097/01.NURSE.0000718928.64247.b6
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BORN IN 1971, Nursing journal was the brainchild not of a nurse, but of two nonnurse editors previously employed by the pharmaceutical company Smith Kline & French (now GlaxoSmithKline). At the time, the nursing market was dominated by the American Journal of Nursing (AJN) and a somewhat smaller journal called RN. The insight of Eugene Jackson and Daniel Cheney was that neither publication spoke directly to practicing nurses. Jackson later described their vision: “It would be strictly clinical and give expert ‘how-to’ advice on bedside care. It would talk up to the nurse whose role was rapidly expanding at that time. The journal's name, Nursing'71, would be updated annually to convey the journal's mission: to keep nurses up to date with changes in nursing practice.” Nursing2020's mission statement, “to improve nursing practice by providing evidence-based, practical information with a reader-friendly approach,” remains faithful to these values.

The new journal quickly found its niche. Offered at a subscription price of $12/year, it was immediately and enthusiastically embraced by nurses. By 1975, it had far surpassed both AJN and RN in circulation. In fact, it became “the second largest paid-circulation magazine of any professional group anywhere,” according to FOLIO:, a leading publishing trade journal.

Secrets to success

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As was fitting for a journal founded by editors, Nursing stood out for its crisp, clean, concise, and conversational writing style that spoke directly to the reader. Because Jackson and Cheney had no nursing expertise themselves, they recruited expert authors and clinical editors to develop topics of interest and ensure clinical accuracy. This team approach, a close collaboration of nurse and nonnurse editors editing each article, was designed to ensure both clinical accuracy and readability. The team approach endures to this day.

Throughout his long tenure as publisher, Jackson kept an eye on the editorial standards he had set and constantly reminded the editors of their obligations to the reader. “Nurses are busy people,” he would say. “Don't waste their time. Get to the point.”

Over time, Nursing's style evolved. The journal's tone has become less conversational and more professional, but the guiding values—clinical accuracy, clarity, and above all, respect for nurses—have remained constant over the years. What follows are a few highlights of Nursing through the decades.

The early years: 1971-1991

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The first issue of Nursing appeared in November 1971. A department called Consultant's Opinion addressed the question, “What reactions to report with the new triple vaccine?” That new “triple vaccine” was the now-familiar measles-mumps-rubella (MMR) vaccine.

Among other offerings, the December issue featured an article on anger before death by Elisabeth Kubler-Ross. This pioneer in near-death studies had published her landmark book On Death and Dying just a few years earlier.

The January 1972 issue included an article jauntily entitled, “Drug Interactions by the Hundreds! How Can You Possibly Remember Them All?” The author, pharmacist Dan Hussar, recalls that at the time, the problem of drug interactions was only beginning to get the attention it deserved in pharmacy and medical circles. In fact, the term drug interactions itself was newly coined—an improvement over “physical and chemical incompatibilities” and other cumbersome terms in use at the time. Hussar continues to write the New Drugs CE articles that appear annually and has been published in the journal at least once in every year since 1972.

Recurring departments featured in the 1970s and 1980s reflected the journal's focus on hands-on nursing information: Doing It Better, Innovations in Nursing, Tips and Timesavers. One of the most widely read departments was Confidentially, in which nurses would describe an error or mistake they had made in practice and what they had learned from the experience. The incidents were real, but identifying details were changed to protect the writer's privacy (and possibly his or her job). The department survives today in modified form as Advice, P. R. N.

In a 1986 article, nurse author Judith Meissner wrote a provocative article titled, “Nurses, Are We Eating Our Young?” The question reverberated throughout the profession as nurses confronted the unflattering reality that many new nurses were driven from nursing by hostility from their own colleagues, seasoned nurses. The term “eating our young” entered the vocabulary and the issue continues to resonate.

The January 1991 issue featured one of the journal's most memorable and controversial covers. Commissioned to illustrate a CE article entitled “Easing the Grip of Angina,” it featured an artist's rendition of a hissing snake tightly wrapped around an anatomically correct heart. The letters soon began to pour in. Readers with a fear of snakes found the image highly disturbing and said they could not even look at it. “I have never been so repulsed by a journal cover,” wrote one nurse. “My immediate response was to rip it off and destroy it.” Said another reader, “If I had wanted Field & Stream, I would have subscribed to it.” At the other end of the spectrum were readers who objected to the fanciful depiction of a snake combining features of a viper and a constrictor in colors not found in nature. Following publication of some of these impassioned letters, a third wave of nurses wrote to say the image was spot on—exactly how their patients described angina.

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The middle years: 1992—2009

For the first 20 years, Nursing's editors-in-chief were talented nonnurse editors from the publishing industry. This changed in 1995 when Patricia Nornhold was tapped for the position. After her tenure, only two other accomplished RNs, Cheryl Mee and Linda Laskowski-Jones, have held this title.

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In an echo of today's pandemic, the 1990s were marked by the AIDS epidemic. In 1994, AIDS was the leading cause of death for all Americans ages 25 to 44. In response, the journal introduced a regular department called AIDS Update. Another department, Insights on Death and Dying, was authored by Joy Ufema, a nurse who established and managed her own hospice serving patients dying of AIDS.

Spurred by the risk of contracting AIDS and other bloodborne diseases from needle sticks, sharps safety became a dominant concern for nurses. In a practice change that decreased their risk, nurses stopped capping used needles before disposing of them. Equipment manufacturers responded to the issue by developing safety-engineered sharps devices familiar to nurses today.

Many of the other clinical and professional issues tackled in Nursing's pages during these years—understaffing, nurse/physician relationships, medication errors, documentation—remain relevant today while reflecting the times in which they were written. In the era before electronic health records, for example, Charting Tips was a popular department that featured portions of handwritten nursing notes to illustrate charting pitfalls.

In these years, female nurses stopped wearing nursing caps and white dress uniforms and transitioned into colorful scrubs—changes that generated controversy as many nurses lamented the loss of a “look” that allowed patients to distinguish nurses from other healthcare professionals at a glance.

Part of the impetus for these changes was growing gender diversity. In the 1970s, men comprised less than 3% of the total nursing population. Today, about 9% of nurses are men.

During this era, the journal adopted a new tag line: The Voice and Vision of Modern Nursing. Driven by changes in the nursing profession, healthcare, and society at large, the journal's language, or “house style,” gradually changed to suit the times. “Emergency rooms” became emergency departments. “Head nurses” became nurse managers. “Doctors” became physicians, then healthcare providers to acknowledge the growing presence of nonphysician providers such as NPs, nurse midwives, and physician assistants. Driven by the growing power and reach of the internet, Nursing launched its website in 2009.

The present era: 2010—2020

Taking the helm of Nursing in 2009, new Editor-in-Chief Linda Laskowski-Jones immediately stamped the journal with her own vision of contemporary nursing, adding a new tag line to the cover: Elevate, Inspire, Innovate, Energize. The journal's traditional emphasis on clinical nursing information was enhanced with a renewed emphasis on evidence-based practice. This was reflected in more detailed referencing for each article and the addition of new departments such as Inspiring Change and Nursing Research that applied improvement science and original nursing research to daily practice.

In 2015, Nursing published the results of a nationwide survey conducted to gather information on current nursing practice. Entitled “Evidence-based Practice or Sacred Cow?” the survey revealed gaps in nursing knowledge based on long-standing nursing practices that are not supported by the evidence. Noting that practice changes based on new evidence in healthcare can take up to 17 years, nurse author Julie Miller concluded that “the nursing profession must do everything in its power to adapt quickly to new and evolving evidence and not cling to comfortable traditions.”

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Highlighting the global reach of nursing, the journal introduced the Global Insights label for articles covering nursing outside of North America. Among these were several unforgettable accounts by nurses who traveled to West Africa to care for patients with Ebola virus disease during the 2014-2016 epidemic.

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In the last 10 years, no one has been untouched by the growth of technology and social media. Nursing joined the new era with a Facebook page, LinkedIn and Twitter accounts, and even podcasts.

Looking ahead

As our 50th anniversary issue goes to press, the US is gripped by the COVID-19 pandemic and wrestling with issues of diversity, gender equality, and racial justice. As they have at every crisis in the past, nurses are stepping up to meet the challenges of a rapidly changing world.

Nursing's very first motto was “All things change and we must change with them.” While this motto no longer appears on our pages, the sentiment remains as relevant as ever. We hope you enjoyed this quick look back at 50 years of nursing excellence—and we're looking forward to 50 more!

A message to nurses from Patricia Nornhold, RN, MSN

I've always been proud of the fit between the nursing profession and Nursing. The journal has enjoyed wonderful acceptance because it is written and reviewed by nurses like you, the direct caregiver—the heart of our profession. If you look at the masthead, the editorial board, and the authors, you see the nursing force that guides its pages. What you don't see is the hundreds of reviewers and consultants who peer-review the articles to ensure clinical accuracy and appropriate tone. And if you worked with the journal staff of editors, designers, and production crew as closely as I did for many years, you would know they love nurses. They work tirelessly to present useful, clinically accurate information that nurses can use in daily practice. This culture was established 50 years ago and remains in place today to serve you and our profession.

Even though I'm no longer in practice, family matters put me in daily contact with direct caregivers. In them, I see the inner strength and spirit of inquiry you and your nursing colleagues bring to your practice.

  • You accept that there's no end point to education. It can range from an immediate online search in the nurse's station to taking a CE course to returning to the classroom to advance your formal education.
  • You have solid confidence in your critical role in patient care and the effective function of the healthcare team. You are critical to decision-making.
  • You are much more willing to discuss with other nurses, healthcare colleagues, and yourself, the emotional joy and toll of your role.

What I've seen from you during the long months of the COVID-19 crisis is resilience. Information and best practices have changed for you very quickly—at times, daily. I saw you step up to news microphones to explain care procedures. I cried when I saw you cry because you became the family holding the hand of a dying patient. And I laughed when you were at the hospital door, clapping and cheering with your colleagues for a patient going home.

The nursing profession drives the journal to affirm, question, and change clinical practice. You should be proud of yourself and know that the journal tries to capture how special you are.

Patricia Nornhold was Nursing journal's clinical director before becoming its first RN editor-in-chief in 1995. Prior to her publishing career, she worked in a wide variety of practice settings, including the ED, medical/surgical and post-anesthesia units, and schools of nursing. She is proud of her service in the US Army Nurse Corps and served a tour of duty in Vietnam during the Vietnam War.

A message to nurses from Cheryl L. Mee, MSN, MBA, RN, FAAN

I became editor-in-chief of Nursing in 2000, but I originally came on board as a clinical editor in 1995. I quickly learned what made Nursing the journal that most nurses prefer. It was the teamwork of editors and nurses who combined their skills to provide important content in a well-edited, concise, clinically accurate, and easy-to-read format. I was so thrilled to take what I knew in acute care and move into an editorial role. I recall telling one of the seasoned editors that although I knew clinical nursing, I needed help learning to write better. She suggested that I read On Writing Well by William Zinsser and I still recommend that classic to nurse authors today.

I have to say one of the best parts of my years at Nursing was helping first-time nurse authors get published. Many nurses think they cannot be a nurse author because they do not know enough or have the necessary writing skills. Helping these new authors get over the barriers to writing was—and still is—a passion of mine. I started giving my Writing for Publication talk while at Nursing, and I continue giving it to this day. I have even contributed a chapter on the topic to Sigma Theta Tau International's Anatomy of Writing for Publication for Nurses.

Working on surveys and writing about such issues as staffing, healthcare errors, sexual stereotypes, and salaries was valuable not only for me, but also for the profession, and helped create dialogue with readers. I believe that engaging in a dialogue about issues is just as important as the clinical pieces.

It was truly an honor and a gift to have these experiences as a journal editor. Our team was amazing and I loved every minute!

Cheryl L. Mee was Nursing journal's editor-in-chief from 2000 to 2007. She is currently Director, Nursing Education and Assessment Consultation for Elsevier in Philadelphia, Pa.

The envelope, please

Nursing has won myriad industry awards for editorial excellence in the past 50 years—too many to mention here! Highlights from the past 20 years include FOLIO: Gold Awards for Editorial Excellence in 2001 and 2002, the American Society of Healthcare Publication Editors (ASHPE) Publication of the Year Award in 2006, a FOLIO: Silver Award for Best Full Issue in 2011, Apex Awards of Excellence for how-to writing in 2014 and for health and medical writing in 2015, a FOLIO: Eddie Award for Best Full Issue in 2016, an ASHPE Gold Award for Best Feature Article Series in 2017, ASHPE Silver Awards for Best Peer-Reviewed Journal in 2018 and 2019, the 2019 Apex Grand Award for writing, and the 2020 Apex Award of Excellence for health and medical writing. We're proud of the editorial excellence that Nursing provides to our readers year after year.

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