While there are actually many (617) Associate Degree and some (59) Hospital School Diploma programs enabling their graduates to take the NCLEX exam leading to licensure as a Registered Nurse, the clear trend over the last 30 years has been for the bachelor’s degree, granted by one of the nation’s 259 four-year college or university schools or departments of Nursing to be regarded as the most desirable entry level credential for professional nurses today.
There are therefore now literally thousands of Nursing faculty at bachelor-degree granting institutions who have faculty status with the possibility of tenure and promotion.
With that status has come increasing pressure for them to publish on a regular basis, much as is required of faculty in other academic department or schools on campus. The problem is that there have traditionally been few rubrics on what constitutes a reasonable expectation in terms of the number of articles and the reputational ranking of the journals within which they might appear.
The Old General Rules
To a great degree, Nursing had long gotten a pass on some of the stricter norms for scholarly productivity and consideration of the relative prestige of journal venues that one would expect of the Chemistry department in the College of Arts & Sciences, the College of Engineering, or even the School of Medicine, the field closest to it in shared concerns. This is an unspoken exemption that at some universities the School of Nursing shares with Schools of Education, Social Work, Home Economics (now better known as Human Environmental Sciences), or even Library & Information Science.
These are all, for better or worse, and mostly for worse in terms of prestige and campus funding, “women’s” service professions traditionally featuring faculty with heavy classroom teaching loads and after-class oversight scheduling and coordination duties in sometimes far-flung hospitals and clinics. The terminal degree awarded to their students would typically be a bachelor’s or a master’s degree at best. Course content was simply assumed by higher academic authorities on campus to be based largely on knowledge derived from other more scholarly or higher order professional fields (i.e. on medicine in the case of Nursing) and that such papers as appeared in the appropriate journals might best be based merely on years of experience, consensus of practitioners, and fairly simple and typically small-scale empirical work.
Criteria for what counted as scholarly communication for tenure and promotion purposes was often rather generous (conference talks, poster sessions, book reviews, local or state Nursing newsletter notices) and when articles in journals were considered, it was often enough just to say that they were “Peer-reviewed, “ and let it go at that.
The tenure process generally involved getting the chair of the Nursing Department or School to sign off on the affirmative vote of the already tenured instructors concerning a tenure candidate, and submit this to the Dean, Provost, President or Board of Trustees. The document would somewhere vouch that the candidate’s publication record in terms of quantity and quality met with the traditions of the Nursing profession as best decided internally by the Nursing faculty themselves.
Occasionally a nominally independent verification of this claim for research sufficiency would be sought from a small selection of external reviewers. However, these were almost always from regional peer Nursing schools selected by members of the local Nursing faculty, whose reviewers would frankly be expected to affirm what the local faculty had to say. Consequently, barring any other independent source of information or advice, the top academic official on campus had little choice or grounds to do anything but sign off on the local faculty vote.
But no more.
The New Order
With time, and as college deans, university provosts, and presidents or chancellors have changed over recent decades, they have been made more and more aware of powerful new online tools that allow them at least some independent bases of comparison of faculty outputs, including those of the departments and colleges of Nursing on their campus with other campuses.
Principal among these are the ability to retrieve online the list of publications in Nursing journals from other institutions (even if could not read the papers with understanding, these senior academic administrators could certainly count them) and they could even make some reasonably valid use of Thomson-Reuters Journal Citation Reports Impact Factors to see which schools had the highest percentage of articles in journals with the best rankings.
Even if those particular rankings are acknowledged to be imperfect, they are almost always used in the absence of anything else. There is nothing else yet that is so widely publicized and applied so near universally. (There are for example, over 105 articles in the literature of my profession, Library & Information Science that involve them in some meaningful way.)
In addition, senior academic officials who evaluate dossiers in scientific and clinical fields have not only developed a pretty good feel over time for which are prominent and reputable publishers, but they can refresh their memories of “who publishes what” with a few mouse clicks without ever leaving their desktops.
Deans, Provosts, Presidents and Chancellors are scarcely alone in adopting and adapting these online finding tools to build up a certain independent level of expertise. They have been joined by people who publish reputational rankings, like the staff of the US News & World Report , and a great many external funding agencies and foundations who wanted to be sure to back winners with their bucks.
To a great degree this new sophistication in discernment of research output comes at a time when the very newest Nursing faculty members are being judged by the senior members of departments or schools of Nursing who published little or not at all when they came up, many years ago, and even now they are uncertain as to how to respond reasonably for verification of the competitive standing of journals, given that many of them still may not be publishing within them frequently.
In short, it can be a confusing time for top academic administrators, senior faculty members of Nursing Schools, and Nurses coming up for tenure or promotion.
The Two Great Questions
This confluence of old habits and new information technology has led to the two great questions of the day.
From the Provost or other senior academic officer we get the key credibility question:
“How can I believe your simply saying that a Nursing journal is peer-reviewed, even with the concurrence of your colleagues at nearby universities that this is so, conveys enough information to help me make an informed judgment on your judgment, instead of just rubber stamping it, when I see other programs across the country doing a lot more?”
From the candidate for tenure or promotion we get the key fairness question:
“How can you expect me to publish as many papers and in the same places as a professor at a top ten school when I have more contact hours, more students, more committees, less internal seed money, no nearby collaborators with research experience, no major teaching hospital or medical school affiliation, no graduate programs here, etc.”
The answers to both questions may provide one very good solution:
The pattern of the national leaders can affirm the basic quality of regional peer output even if the first still numerically overwhelms the second.
A compromise position is actually possible, at least in terms of the journal quality control dilemma, if not in the quotas of articles published. This can be done by comparing the patterns of some of the national leaders against that of regional peers, and looking primarily at the number of schools in either group that publish in the same journals with some frequency. (It’s important that just cherry picking one school out of either group does not allow for good standards setting, because even some nationally prominent schools are eccentric in their emphasis on some journal-----an emphasis that is not shared when other equally prominent schools are added to the mix.)
I first chose ten university-based Nursing schools out of the top twenty from the last US News & World Report ratings (2007), which it must be explained all had graduate as well as baccalaureate programs, and were based in the same city (and often on the same campus) as their medical school and their major cooperating teaching hospitals, with which they often also offered Advanced Practitioner certification programs.
These programs tended to have larger facilities and faculties than most “ordinary” collegiate Nursing schools, and included endowed chairs in some cases, and major journal editors in all cases.
These prominent programs were at universities that generally had national reputations as research leaders in virtually all the fields in which they offered degrees. In short, it was no surprise that these schools were so highly regarded.
I then chose a regional peer group that would be appropriate for much of the Midwest and South, but which pointedly did not include any members of the national top ten group.
These nursing programs were all accredited and generally based at the flagship or other large campuses of their state university system, but not located within any medical school complex (which typically was located in the largest city or cities in the state away from the Nursing campus).
While some of these regional peer schools offered graduate degrees in Nursing and Advanced Practice certification programs, others did not.
While some of the programs were parts of identifiably independent Colleges of Nursing nominally co-equal to the College of Education or Arts & Sciences in terms of campus organization and hierarchies, other programs were subsumed into colleges of education or human services or some other cluster of fields.
What best characterized this field was the heterogeneity of the status, size, facilities, staffing, and enrollment of these schools, a situation which is actually much closer to the reality of the mosaic of collegiate nursing programs today.
Using the Web of Science (WoS) database, I approximated the 2001-2010 output of Nursing faculty (generally as primary authors) in what were clearly Nursing journals (as opposed to their coauthored output in journals of medicine, public health, primary or high school health teaching, etc.). I entered “Nursing” in a Topic search box, then the appropriate abbreviation for the school (obtainable from their clickable online list of approved abbreviations) in an “Address” search box, and the desired period from the “Timespan” boxes. When the results came up, I once again clicked on the “Refine Subject Areas” box for “Nursing” journals only to keep sharp the focus on Nursing journals alone. I then clicked on the “Refine Source Titles” box to provide “more options/values…” which gave me a most-to-least frequency rank-ordered list of specifically Nursing journals to analyze.
While noting the total journal output for each Nursing program, I decided to focus on comparisons of the more general journals of nursing and nursing education, taking particular note of the top 10 of these for each school, rather than on parsing out specialty journals such as those devoted more narrowly to cancer, mental health, or obstetrics nursing, etc.
This was done for two reasons:
First, while both groups of schools had both general Nursing journals and some Nursing specialty journals, the types of specialties represented varied greatly, with some specialties absent altogether from regional peer programs making comparisons with national top ten schools problematic. (On the whole top national top ten Nursing schools featured a higher proportion of its output, up to half, in Nursing specialty journals while regional peers, often lacking access to all the Medical & Nursing specialty services in large teaching hospitals and medical schools, rarely are able to contribute as high as one third of their output to similar specialty journals.
Second, Impact Factor data is really fair only when all the journals have a similar subject scope (It’s fair to compare one general Nursing journal with another general Nursing journal, but unfair to call, for example, the American Journal of Critical Care a better Nursing journal than the American Journal of Nursing because the two journals have significantly different scopes and audiences.)
So How Did the National Top Ten Do Relative to the Regional Peer Group?
Unsurprisingly, the top ten national leaders published many more articles than the regional peer group: 1415 vs. 614 in the same time frame. What was somewhat unexpected was that while the top ten general Nursing journals from each group were somewhat different in rank order, they shared six of the same core titles.
The Six Shared Journals
In alphabetical order we had: the American Journal of Nursing, the Journal of Advanced Nursing, the Journal of Nursing Education, the Journal of Professional Nursing, Nursing Outlook, and Nursing Research.
What else do the shared six share?
They are in fact, all refereed.
They are all published by well-known firms and societies.
Wiley has the Journal of Advanced Nursing.
Slack ------well known in Nursing if not in many other fields-------has the Journal of Nursing Education.
Elsevier is represented by Nursing Outlook which it publishes on behalf of the American Academy of Nursing, as well as the Journal of Professional Nursing, issued in cooperation with the American Association of Colleges of Nursing.
Wolters Kluwer Health, still much better known as Lippincott, Williams & Wilkins, issues Nursing Research in conjunction with the Eastern Nursing Research Society and the Western Institute of Nursing.
Lippincott, Williams & Wilkins also publishes the American Journal of Nursing, voted by over three quarters of the members of the Biomedical and Life Sciences Division of the Special Libraries Association ------the sponsors of this blog--------- as the single most influential journal of Nursing of the twentieth century.
How do these six differ among themselves?
Most notably they appear to be all over the map in terms of relative Impact Factors, but this requires some caution before leaping to conclusions.
While two titles, the Journal of Advanced Nursing and Nursing Research, are clearly among the most cited general nursing research venues, three others are mid-range, Nursing Outlook, the Journal of Nursing Education, and the American Journal of Nursing.
One holds markedly lower rank, the Journal of Professional Nursing, according to the latest JCR rankings to which I have access (2008, the 2009s are out but not yet available to me). However, even this last title is much better in Impact Factors that might be imagined because the difference in calculations is only a matter of a few tenths of a point between it and the three mid-range journals just mentioned.
The fact of the matter is that while Impact Factors among Nursing journals give you a good idea of which five to ten journals are at the very top or at the very bottom of the approximately 60-70 titles being compared each year , they disclose that almost 40 other Nursing journals are bunched rather closely together, with statistically weak justification for ranking them in any hard and fast order, other than being in the mainstream, if not the headwaters or the backwaters of Nursing publications.
What they these Impact Factors nonetheless do is to provide proof that the articles in these journals are cited by other Nursing researchers around the world, at least to some degree, and are not just local venues of convenience for lesser papers.
What about the journals that are prominent among the top ten national schools but not in the top ten among the regional peers?
There are four journals more prominent among the top ten national programs that do not frequently appear in the top ten lists of the regional peers. (Some authors from the regional peer groups appear in them, but not frequently enough to make the journal one of their top ten titles.) Which are these, and what can be said about them?
First, all of them are peer-reviewed.
The International Journal of Nursing Studies is published by Elsevier. It is at the very top of general Nursing journals in Impact Factors. It is British-based and has a great many editors from the UK, Canada, Australia and New Zealand in addition to four of whom are senior faculty at US top 10 Nursing programs.
The Journal of Clinical Nursing is published by Wiley. Like the International Journal mentioned above, a journal with which it directly competes, it is UK based but has an even broader representation of editors from the former British Commonwealth the European Union, as well as a few from notable programs in the US. It is not quite at the top, but in the top quarter in terms of Impact Factors.
The Journal of Nursing Scholarship is published by Wiley on behalf of Sigma Theta Tau, the US national Nursing honors society. It ranks in the middle of the field in Impact Factors.
The Western Journal of Nursing Research is published by Sage Press, a notable firm in the Social Sciences and Education, on behalf of the Midwestern Nursing Research Society. It ranks in the middle of the field in Impact Factors.
In sum, all four are very sound journals at the top or mid-range of Nursing in prestige and Impact factors. Two are clearly more cosmopolitan in authorship and readership than most titles favored by our regional peer group faculty.
What about the journals that are prominent among the regional peer schools but not in the top ten among the national top ten schools?
There are four journals more prominent among the regional peer programs that do not frequently appear in the top ten lists of the national top ten schools. (Some authors from the top ten schools appear in them, but not frequently enough to make the journal one of their top ten titles.) Which are these, and what can be said about them?
Two of these journals are theme-issue based, meaning that the journal editor or a guest editor assembles a panel of expert authors on a single topic on which each article focuses. Publishers are fans of this journal format, because it frequently generates extra sales of individual issues as a kind of topical best practices collection, or state of the art review. It is clear that some editing of submitted manuscripts must be involved but it seems that the crucial point in quality control, may not be traditional double blind peer review, but rather getting the issue theme and its author team approved fairly early on in the process.
It is not surprising that the two journals involved, Nursing Clinics of North America and Advances in Nursing Science are direct competitors. Nursing Clinics comes from Elsevier, while Advances is a Lippincott, Williams and Wilkins title. Nursing Clinics fares rather poorly in Impact Factors while the Advances are in the top quarter by that measure.
The two other titles where regional peers appear quite often are Nursing Education Perspectives from the National League of Nursing, and Nurse Educator from Lippincott, Williams & Wilkins. Both are peer-reviewed in the more traditional sense, but both titles fares poorly in Impact Factors.
Does the presence of these regional peer four titles tell us much vis-à-vis the four titles of the top ten schools?
I think it is safe to say that overall, the higher level of research may be found in the top ten school four than the regional peer four, but that the regional peer four titles make more sense for Nursing professors who still view their jobs primarily as teachers. Two of their titles are clearly focused on methods and trends in teaching Nursing, while the remaining two provide in effect, high-level course packs quite literally authored by teams of invited experts for upper division and graduate courses.
What is the consensus opinion of medical librarians on this?
The closest thing that my profession has to say on this, apart from voting the American Journal of Nursing the most influential of the 20th century, comes from a continuation of the old Brandon-Hill List, published and republished in a number of places, but most pertinently for our purposes in Nursing Outlook 2002; 50:100-113. It names the following journals discussed in this blog as essential to any Nursing collection: Advances in Nursing Science, American Journal of Nursing, Journal of Nursing Education, Journal of Nursing Scholarship, Journal of Professional Nursing, Nursing Clinics of North America, Nursing Education Perspectives, Nursing Outlook, and Nursing Research. It considers the following to be genuinely reputable, sound journals that would be good additions to any Nursing collections, after the essentials were already in place: Journal of Advanced Nursing, Nurse Educator, and the Western Journal of Nursing Research.
I suspect that the marginally lower rating given to the Journal of Advanced Nursing, might provide us with an explanation of why the International Journal of Nursing Studies and the Journal of Clinical Nursing were not included: the list is slanted to stocking the small US hospital library and favored journals that had a higher proportion of American research or researchers, and was not necessarily a reflection on their quality as venues for scholarly work on the whole.
Indeed, the biggest surprise for those who are too ardent in using Impact Factors without considering other factors, is that one title identified by two expert librarians as essential, the Nursing Clinics of North America, is ranked so poorly, while the people who most closely monitor journal use in terms of what circulates or is read-online, the remaining community of medical librarians, are very likely to second Brandon-Hill’s high regard for it.
Advice to provosts and nursing faculty seeking tenure & promotion, neither of whom are not at a top ten university school of nursing .
Regional Peer School Provosts, if your candidates manages to publish about half as many papers as their peers in a top ten school, they are probably doing quite well with the resources you are able to provide them. You are going to have to give them more to get more out of them. Impact factors are one tool for you to use, but not the only tool in making your evaluation. Do not expect all of their papers, now and even in the future, to appear in journals ranking in the top quarter in Impact Factors. But by the same token be very leery of an assortment of papers in which few if any come from that Impact Factor level, particularly if there are no top ten school authors in the journals in which your own faculty publish for prolonged stretches of time. (If no top ten schools publish in a journal over the course of a year, be suspicious and ask for explanations.) Look for the usual statements of peer-review and rely on the reputation and longevity of the publishers behind the journal. They did not get to be “venerable robber barons” by selling their principal buyers (medical librarians, as it turns out) unadulterated tripe. They have built their demand by being in their own way very demanding of their editors and authors.
Nursing Faculty Members At Regional Peer Schools: Choose more wisely than ever the journals within which you send your manuscripts. Getting at least some of your papers into some of the shared six titles in this paper, is probably a very good idea, both because it is routinely done by the very talented, very driven, very hard-working scholars in top ten schools ------and because it has demonstrably been done by your regional peers at least some of the time. Do not, however, be ashamed of being primarily a Nurse educator. You may well not have as much ready access to specialty research teams at a medical school or its teaching hospital and few if any of your colleagues are likely to be major Nursing journal editors, but you do have at least as much access (and probably much more contact time) as well as a great responsibility to the kids in front of you and the patients that will one day be in their charge. Studies involving understanding their pre-Nursing backgrounds and abilities, improving their understanding of Nursing concepts and procedures, and the monitoring of their follow-on careers and needs for continuing education, remain important to both your career and to the profession at large. Nonetheless, when the opportunity presents itself, to do work that leads to publication in Nursing specialty journals, jump on it. It will be a good way to distinguish yourself and promote diversity of expertise in your own Nursing school or department.
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