In addition to being expert clinicians, advanced practice RNs (APRNs) frequently assume nursing faculty and leadership positions (American Association of Colleges of Nursing, 2006). In these roles, APRNs must contribute to nursing science by disseminating clinical projects through publication (Melnyk, 2013). The contributions made to science by nurse clinicians are significant and unique because they are developed from both scientific evidence and clinical practice (Roush, 2017). Publishing their findings in scholarly journals benefits the scientific community and supports career advancement for these nurses.
Unfortunately, expert nurse clinicians publish less frequently compared to research nurses and nursing professors (Oman, Mancuso, Ceballos, Makic, & Fink, 2016). Consequently, they often feel unqualified to contribute to scientific literature (Bowling, 2013). Reasons frequently given for low publication rates include poor writing skills and low writing self-efficacy (Derouin et al., 2015; Tyndall & Caswell, 2017). Self-efficacy is an individual's belief in his or her capability to complete a desired activity (Bandura, 1986). Increasing self-efficacy has been shown to improve writing skills (Miller, Russell, Cheng, & Skarbek, 2015); therefore, it is important to invest in and support scientific writing among nurses.
Several strategies have been found to increase writing skills and self-efficacy among nurses. A structured writing course or workshop is one of the most effective formats to increase publication rates among nurses (Derouin et al., 2015; McGrail, Rickard, & Jones, 2006). For example, eight nurses participating in a 1-week intensive writing class and a monthly writing group increased publication rates by 73% over a 2-year period (Rickard et al., 2009). Courses that have proven most effective are those taught by writing experts. For example, a series of four writing workshops, led by an experienced editor or publisher, increased publication knowledge, confidence, and motivation among nursing university staff and affiliates (Wilson, Sharrad, Rasmussen, & Kernick, 2013). However, it is often difficult for clinicians to attend a series of workshops on specific dates due to their variable and busy work schedules. Online writing programs, which offer scheduling flexibility and instruction similar to in-person workshops, are a potential solution. In a study of 52 nursing students who were taking an online 16-week writing course, Miller et al. (2015) reported significant improvements in writing self-efficacy and writing competency among the students who successfully completed the course.
Unfortunately, writing courses alone are associated with challenges, such as information retention. Although information retention varies among learners, on average individuals forget approximately 55% of what they learn within 8 years of course completion (Thalheimer, 2010). A promising tool to increase information retention and recall may be a checklist that summarizes writing course content. In health care, checklists are common and have proven effective in assuring the quality and safety of processes and products (Gawande, 2009). For example, a strong correlation has been demonstrated between postoperative complications and the World Health Organization's (WHO) Surgical Safety Checklist (Bergs et al., 2014). In addition to improving health care delivery, checklists are emerging as an effective means to improve scientific writing. Experts contend that writing tools, such as checklists, can improve the transparency of research methods in manuscripts (Marušić, 2015). For example, in one randomized controlled trial, a checklist improved the completeness of manuscripts among graduate medical school and public health students (Barnes et al., 2015). An additional benefit of a writing checklist is that it facilitates self-evaluation, which has been shown to increase writing self-efficacy among nursing students (Schunk, 2003).
This article presents a writing program designed to enhance scientific writing skills among APRNs enrolled in a graduate program. The writing program was designed by nurse faculty and includes online modules and a half-day workshop taught by an expert nurse author and editor. In addition, a writing checklist that was created to build and enrich scientific writing skills among APRNs was implemented and evaluated during the writing program.
Setting and Participants
Participants included APRNs who were enrolled in a Doctor of Nursing Practice (DNP) program at a large university in the southeastern United States. This writing program was created, implemented, and evaluated by DNP faculty with the intention of improving APRNs' writing skills through the curriculum. According to the university's policy, the project was exempted from requiring internal review board approval because it was not considered human subjects research. All APRN students were required to complete the program; however, providing feedback on the program was optional.
Online Modules and Writing Workshop. The writing program consists of four online modules and a 4-hour on-campus writing workshop delivered in one semester. The online modules were facilitated by a DNP faculty member. The program began with students having access to all of the online modules. Students were asked to review each module that followed with a writing assignment or an optional quiz graded as pass/fail. Module content was selected through consultation with authors who served as peer reviewers or were editors for scholarly journals. Module topics included:
- Scholarly writing and style.
- Mechanics of scholarly writing.
- Grammar, vocabulary, and formatting.
- Organization of a scholarly paper.
At approximately week 7 in the course, students attended a writing workshop. The workshop was led by an expert author and editor who was a member of the DNP faculty. The workshop began with a lecture followed by writing exercises in which students were asked to apply what they had learned from the online modules. Next, DNP faculty members trained students on the use of the checklist. Students were asked to use the checklist to evaluate two paragraphs of a peer's writing sample. This evaluation was followed by a peer discussion in which students discussed areas they each could focus on to improve writing. Faculty members were available to answer student questions.
Checklist. A checklist (Table 1) was created by two of the authors (R.H., M.H.). The checklist draws from the online modules and workshop content to help writers identify weaknesses and discern when a manuscript has been edited sufficiently and is ready for submission. The checklist is divided into five sections: overall content of the writing, paragraph structure, sentence structure, words, and throughout the paragraphs, which refers to consistency between paragraphs. The checklist is designed in a concise manner that instructs writers to review each item, then check yes or no if that item was sufficiently addressed. If an item needs improvement, indicated by a check in a gray box, then writers can revert to the module content that addresses those specific writing skills and edit the manuscript. The checklist can be used either independently or for peer review. If used for peer review, the checklist contains instructions on how to edit a document. These peer review edits can provide authors with guidance on how to improve their writing.
Self-Efficacy. Writing self-efficacy was measured as a proximal outcome to writing skills that may have been acquired through the program. It was selected as the outcome of interest because it facilitates writing skills (Miller, Russell, Cheng, & Skarbek, 2015). Self-efficacy was measured by a modified version of the Postsecondary Writerly Self-Efficacy Scale (Table 2) that has excellent reliability (Cronbach's α = .931 and split-half reliability = .864) (Schmidt & Alexander, 2012) and has been used previously with nursing students (Miller et al., 2015). The measure includes 13 items about writing self-efficacy that are scored with a level of agreement ranging from 0% to 100%, with higher scores indicating more agreement.
Writing Self-Efficacy Scores
Checklist Evaluation. Students also were asked three open-ended questions about the checklist. Specifically, students were asked what they found most and least useful about the writing checklist, and whether they had any additional thoughts or comments about the checklist. Finally, information was collected about when they received their previous degree and whether they had ever published an article in a peer-reviewed journal.
Total score, mean, and standard deviation were calculated for each item on the Postsecondary Writerly Self-Efficacy Scale using Excel® version 15.33. Responses to the open-ended questions were coded individually by the first and second authors to identify common themes. Coding discrepancies were discussed and resolved.
This program was implemented with APRNs who were enrolled in a DNP program. Individual demographics were not obtained. However, demographic data for the DNP cohort are presented in Table 3. The self-efficacy scale and checklist evaluation were optional to complete, and 70% of the cohort (76 of the 109 students) completed the forms. These 76 students graduated from their last nursing program an average of 5 years ago (baccalaureate nursing degree or Master of Science in Nursing degree). Of the 76 students who completed the program and evaluation, 9 (24%) had published previously in a scholarly journal.
Writing self-efficacy scores for each item of the scale are detailed in Table 2. The overall self-efficacy average score was 79% (SD = 8) which corresponds to “agree” on the measure.
Three main themes emerged about the most useful parts of the checklist. First, students reported the most useful thing about the checklist was its user-friendly format (n = 29). One individual commented that the checklist was “clean and precise in stating the expectations for good scientific writing.” Second, students reported the checklist identified areas of writing that needed improvement (n = 9). One student wrote that the checklist “helped find my weakness,” and another student stated that the checklist “clearly identified the components that need to be corrected.” Third, students noted that the checklist guided the process of self-editing (n = 9). One student wrote that the checklist “breaks down the details of what to look for,” and another student noted that the checklist was an “organized way to edit and review.”
When asked what was least useful about the checklist, most of the students who provided a response stated “nothing” or “everything was great” (n = 10). However, two of the 76 students who completed the evaluation identified a specific section as least useful (the sentence and throughout the paragraph sections). Four students thought the checklist was too long, and two students felt they needed more time to learn how to use it.
Finally, students provided additional feedback. Eight students had positive remarks about the checklist and indicated they plan to use the checklist in the future. One student stated, “It's very helpful for understanding how to improve my writing.” Four students made suggestions to improve the checklist, and three students recommended more training and time with the checklist. Only two students expressed uncertainty about the usefulness of the checklist.
In general, the writing self-efficacy scores indicated that overall students have a positive belief about their ability to write scholarly papers. This multicomponent writing program contained scientific writing skills that APRNs need to improve nursing care and science. The checklist expands on existing writing education strategies for nurses and can be applied to a draft document at any time throughout a nurse's scholarly career. Due to clinical obligations, nurses may have lengthy amounts of time between scholarly writing. The checklist is something nurses can use at any time to refresh their memories on how to construct a scholarly paper.
Several limitations should be considered with this writing program. First, this information was tested among nurses currently enrolled in a DNP program who are likely writing more than the general APRN population. Second, writing self-efficacy was not assessed prior to the program; thus, a recall bias may have existed as nurses reflected on their preprogram writing self-efficacy to complete postprogram measures. Finally, self-efficacy scores were not obtained for 33 students who declined to participate in the evaluation process. The scores and opinions of these students may have altered the final results.
A writing program that includes a series of online lessons, a half-day workshop, and a writing checklist can provide nurses with the information and tools to participate in scholarly writing. This program can be implemented in schools and clinical sites as an instructional or refresher course for writing. Moreover, graduates of the course can refer to the checklist to evaluate their writing skills throughout their careers. Clinicians can use the checklist with colleagues to help guide and mentor the writing process. In addition, the program could be implemented as a continuing education program to support staff development.
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|Directions: Apply the questions below to your writing sample. Answer each question by checking the yes or no box. Look at the items for any checked gray boxes. These items, with checked gray boxes, are areas to focus on to improve your writing|
|Can you identify a sentence stating the main problem or question to be addressed? If yes, underline it.|
|Can you identify words the writer used to “take a stance” or persuade the reader there is an important question this manuscript will address? If yes, circle them.|
|Are you persuaded through these opening paragraphs that this manuscript will contribute something significant or new?|
|Does the evidence cited support the problem or question presented?|
|Is the cited literature current?|
|Does each paragraph have one clear main point?|
|Are there logical bridges from one sentence to the next? If no, draw a circle between sentences lacking logical bridges.|
|Are sequencing terms used appropriately? If no, circle incorrectly used terms.|
|Are the foci of the first and last sentences of the paragraph consistent?|
|Is the main character the subject of each sentence?|
|Do subjects and verbs agree in each sentence? If no, circle subject/verbs that do not agree and draw a line to connect them.|
|Are there any long sentences that can be divided into two sentences? If yes, draw a line to divide them.|
|Are there any dangling participles? If yes, underline them.|
|Are there any unnecessary commas? If yes, cross them out.|
|Are there words that do not add meaning to a sentence? If yes, cross them out.|
|Are there words that can be replaced with more simple words? If yes, circle them.|
|Throughout the Paragraphs|
|Is active voice used?|
|Is first person used sparingly?|
|Can any content be omitted from the opening paragraphs?|
|Do sentences containing citations flow with the writing style and voice of the author? If no, there may be reason to suspect plagiarism (intentional or unintentional).|
Writing Self-Efficacy Scores
|1||I can articulate my strengths and challenges as a writer.||77||19|
|2||I can find and incorporate appropriate evidence to support important points in my paper.||74||20|
|3||I can be recognized by others as a strong writer.||70||18|
|4||When I read a rough draft, I can identify gaps when they are present in the paper.||79||18|
|5||I can maintain a sense of who my audience is as I am writing a paper.||69||19|
|6||When I read drafts written by classmates, I can provide them with valuable feedback.||87||13|
|7||Once I have completed a draft, I can eliminate both small and large sections that are no longer necessary.||76||19|
|8||I can write a paper without experiencing overwhelming feelings of fear or distress.||64||20|
|9||The writing checklist helped me edit my colleague's writing.||87||13|
|10||The writing checklist helped me understand how to improve my writing.||87||12|
|11||The writing checklist was easy to use.||89||11|
|12||The amount of time it took me to complete the writing checklist is acceptable to me.||86||15|
|13||I will use the writing checklist in the future.||87||12|
|Variable||Participants (N = 109)|
| Other/not reported||1||1|
|Average age, years (range)||33 (23 to 60)|
| American Indian or Alaska Native||1||0.92|
| Black or African American||12||11.01|
| Hispanic or Latino||1||0.92|
| Two or more races||3||2.75|
| Not indicated or unknown||3||2.75|
|Average years of RN experience (range)||8.5 (0 to 38)|
|Program information, n|
| Post-BSN DNP||29||27|
| Post-MSN DNP||55||50|
| DNP = nurse anesthesia||25||23|