Journal of Nursing Education

Major Article 

Systematic Review of Educational Programs and Strategies for Developing Students’ and Nurses’ Writing Skills

Marilyn H. Oermann, PhD, RN, ANEF, FAAN; Adrianne K. Leonardelli, MLIS; Kathleen M. Turner, DNP, RN; Sharon J. Hawks, DNP, CRNA; Anne L. Derouin, DNP, CPNP; Rémi M. Hueckel, DNP, CPNP-AC


The purpose of this article is to describe the outcomes of a systematic review of educational programs and strategies for developing the writing skills of nursing students and nurses. Of 728 screened citations, 80 articles were included in the review. Writing assignments in nursing courses were the most common, followed by strategies for writing across the curriculum and specific courses to improve the writing skills of nursing students. To improve nurses’ writing skills, workshops were used most frequently. Only 28 (35%) of the articles were databased, and most articles described the writing program, strategy, or assignment but did not evaluate its effectiveness. [J Nurs Educ. 2015;54(1):28–34.]

Dr. Oermann is Thelma M. Ingles Professor of Nursing and Director of Evaluation and Educational Research, Dr. Turner is Associate Professor, Dr. Hawks is Assistant Professor, Dr. Derouin is Assistant Professor, and Dr. Hueckel is Assistant Professor, Duke University School of Nursing, and Ms. Leonardelli is Research & Education Librarian and Liaison to the School of Nursing, Duke University Medical Center Library, Durham, North Carolina.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Marilyn H. Oermann, PhD, RN, ANEF, FAAN, Thelma M. Ingles Professor of Nursing, Director of Evaluation and Educational Research, Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710; e-mail:

Received: July 17, 2014
Accepted: October 28, 2014
Posted Online: December 24, 2014


The purpose of this article is to describe the outcomes of a systematic review of educational programs and strategies for developing the writing skills of nursing students and nurses. Of 728 screened citations, 80 articles were included in the review. Writing assignments in nursing courses were the most common, followed by strategies for writing across the curriculum and specific courses to improve the writing skills of nursing students. To improve nurses’ writing skills, workshops were used most frequently. Only 28 (35%) of the articles were databased, and most articles described the writing program, strategy, or assignment but did not evaluate its effectiveness. [J Nurs Educ. 2015;54(1):28–34.]

Dr. Oermann is Thelma M. Ingles Professor of Nursing and Director of Evaluation and Educational Research, Dr. Turner is Associate Professor, Dr. Hawks is Assistant Professor, Dr. Derouin is Assistant Professor, and Dr. Hueckel is Assistant Professor, Duke University School of Nursing, and Ms. Leonardelli is Research & Education Librarian and Liaison to the School of Nursing, Duke University Medical Center Library, Durham, North Carolina.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Marilyn H. Oermann, PhD, RN, ANEF, FAAN, Thelma M. Ingles Professor of Nursing, Director of Evaluation and Educational Research, Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710; e-mail:

Received: July 17, 2014
Accepted: October 28, 2014
Posted Online: December 24, 2014

Written communication skills are critical for nursing practice, and a goal of nursing programs at all levels is to prepare students to communicate clearly and effectively in writing. The development of skills of analysis, higher-level thinking, and communication, including written and oral communication and use of emerging technologies, help to prepare graduates for working in teams and in interprofessional practice (American Association of Colleges of Nursing, 2008). At the prelicensure level, students learn to communicate patient information and to write about nursing as a profession. At the master’s and doctoral levels, the goal is to develop scholarly writing skills to disseminate the findings of research studies and evidence-based practice projects, describe innovations in clinical practice, and function as leaders in the health system.

Across all levels of nursing education, the ability to communicate in writing allows students to participate in academic discourse (Luthy, Peterson, Lassetter, & Callister, 2009). By preparing scholarly papers, students also gain an understanding of nursing as a discipline and how nurses communicate information to others, as disciplines have their own language and style of communication (Luthy et al., 2009). Through papers written in nursing courses about nursing practice, research, and nursing as a field, students develop an understanding of how to communicate ideas within the nursing literature.

On a more practical level, students need to develop the ability to write clearly to be successful in nursing courses in which papers are used as assessment strategies. With nursing students becoming more diverse in their educational background, culture, and language, written communication may be an issue for some students in the achievement of course outcomes (Latham & Ahern, 2013). Planned instructional strategies that enable students to learn to write effectively in their courses are critical for student success.

Because of the importance of developing writing skills, nursing students need experience in writing papers in their nursing programs. Learning to write requires practice, and students need feedback on their writing and an opportunity to revise papers based on that feedback. However, many student writing assignments involve short papers, concept maps, journaling, and writing-to-learn activities, rather than formal papers with drafts and feedback on writing (Luthy et al., 2009; Oermann, 2013; Oermann & Gaberson, 2014; Troxler, Vann, & Oermann, 2011). Those types of strategies, although promoting learning about the content of the assignment, may limit the development of writing skills.

Few studies have been performed on strategies used in nursing programs to improve students’ writing skills. Andre and Graves (2013) examined English and writing course requirements across baccalaureate programs in Canada. Among the 81 programs surveyed, 39 (48.1%) did not require a writing or an English literature course. Fifteen (18.5%) nursing programs required students to take an English literature course, and 32 (39.5%) programs included a writing course as a requirement. Of the writing course group, six of those courses were discipline specific, using literature from nursing and introducing students to the types of writing they will use in their courses and in nursing as a field.

Troxler et al. (2011) conducted an integrative review to identify specific approaches used in baccalaureate nursing programs to improve students’ writing skills. Two types of writing programs were used—stand-alone programs and writing activities integrated across the curriculum. Stand-alone programs, such as workshops, online writing tutorials, and writing-intensive courses, provided a focused, one-time opportunity for students to learn about good writing practices but did not allow for sustained experiences to improve the actual writing process. The second type of program involved the curriculum-wide integration of multiple writing activities to improve students’ writing (Troxler et al., 2011).

Over the years, many articles have been published that describe strategies for improving students’ writing skills. Workshops and other types of continuing education programs to engage nurses in writing for publication and to gain writing skills also have been described in the literature. For the most part, these articles reported approaches used in individual schools of nursing and health care settings. Studies that have integrated this literature in a systematic way are limited. The research question for the current review was: What types of educational programs and strategies are used in nursing to develop the writing skills of students and nurses?


The current systematic review was planned and conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Eligibility Criteria

The authors of the current review included articles published in the English language that described educational programs and strategies for developing students’ and nurses’ writing skills. The interventions examined in this review included any educational program or strategy (writing course, teaching strategy, writing assignment, or learning activity) with a primary or secondary aim to improve the writing skills of nursing students or nurses. Participants were students enrolled in a formal nursing education program at any level, including diploma, associate, baccalaureate, master’s, and doctoral programs, and nurses participating in continuing education.

Items for which no full text existed (i.e., abstracts only) were reviewed but were not included in the analysis. Also excluded were editorials, comments, and letters to the editor; articles on trends in publishing; nursing students’ and nurses’ attitudes or perceptions about writing; and writing for publication, not related to formal education or continuing education.

Search Methods for Identification of Articles

A medical librarian searched MEDLINE® (PubMed), CINAHL® Plus with Full Text, and ERIC, using a combination of controlled vocabulary terms and key words. All database searches were limited to articles published between January 2003 and April 2014. The complete MEDLINE search strategy is shown in Table 1. In addition, the librarian conducted key word searches in Web of Science® and Scopus® for relevant conference papers. The authors also reviewed reference lists of articles identified through database searches and the table of contents of nursing education journals.

MEDLINE® (PubMed) Search Strategy

Table 1:

MEDLINE® (PubMed) Search Strategy

Data Collection and Analysis

Article Selection

Two stages were included in the article selection process. In stage one, two of the authors (M.H.O., A.K.L.) independently reviewed the titles and abstracts of the citations retrieved from database searches. These reviewers used the eligibility criteria to determine whether an article should be excluded or included. In stage two, the librarian retrieved the full-text articles for all records not excluded in stage one. Each article was independently read and assessed by two authors and then presented to the review team. All articles included in the review were agreed on by the majority of the team.

Data Extraction and Synthesis

The authors independently extracted data from each article, using a collection form created by the study team. The collection form was developed to ensure accuracy and consistency in extracting the following key data: author; year; article title; nursing education/continuing education program; sample and sample size; description of the educational program or strategy; data collection method, instrument, and evaluation tool; and results. An additional item—significance/implications—was included on the collection form to allow the reviewers an opportunity to independently offer qualitative descriptions and to identify major topics and themes of the articles. From the data and discussions of the research team, the following content themes evolved: writing across the curriculum, writing courses, course assignments, faculty behaviors, workshops, and self-directed activities. In addition to thematic analysis, the articles were categorized by type (research or non-databased) and approach (primary or secondary aim to improve writing). The studies that evaluated the outcomes of writing programs and strategies were too limited and too varied to conduct a quantitative analysis.


Article Selection

The authors identified 731 citations, using the search strategy described, and an additional nine articles from other sources. From these, 118 potentially eligible articles were identified. Following review of each article, 38 were excluded, leaving a final total of 80 articles in the review (Figure).

Studies identified and included in the literature review.


Studies identified and included in the literature review.

Research Studies and Non-Databased Articles

Of the 80 articles reviewed, 53 described programs and strategies with the primary purpose of improving the writing skills of nursing students and nurses; 27 identified writing improvements as a secondary gain of a program or strategy, such as a case study written report intended for problem-based collaborative learning that also developed students’ writing abilities. Only 28 (35%) of the articles were databased, with most of the articles describing the writing program or strategy but without evaluating its effectiveness in improving the writing abilities of students or nurses.

Among the databased articles, most were descriptive studies that used surveys of student and faculty satisfaction with the writing program or strategy. For example, Cone and Van Dover (2012) offered a professional writing course at no additional cost to all incoming master’s nursing students. On course evaluations, students reported a high level of satisfaction with the course, and faculty also reported “marked improvement” in the quality of student writing (p. 273).

Various studies evaluated student perceptions of following strategies and assignments to enhance writing skills. When provided with multiple resources, students reported that sessions with writing center tutors, including tutor-guided revisions of drafts, contributed to their learning. Collaborating with librarians and in-class peer review were also beneficial. The students’ greatest challenges were grammar, using the American Psychological Association ([APA] 2010) style, and writing mechanics (McMillan & Raines, 2011). Students also reported that annotation (instructor comments written on the graded assignment) informed their next writing assignment (Ball, Franks, Jenkins, McGrath, & Leigh, 2009). Griffiths and Nicolls (2010) described a Web-based learning platform (e-Support4U), which was developed to support students’ academic writing. They used four approaches to evaluate e-Support4U: a self-assessment, data on the extent that students used the writing resources, grades on the writing assignment, and an evaluation blog. The pass rate on the assignment was 100%, and students perceived the platform to be helpful.

To learn more about students’ writing processes, Lavelle, Ball, and Maliszewski (2013) surveyed 169 nursing students, using the Inventory of Processes in College Composition. Students can use this inventory to become more aware of their beliefs about writing and to learn new strategies. Other authors evaluated their own writing programs and strategies by reviewing the grades on writing assignments and using student focus groups and self-evaluations (Bailey et al., 2007; Bickes & Schim, 2010; Carter, 2008; Gimenez, 2008; Peinhardt & Hagler, 2013; Richardson & Carrick-Sen, 2011; Salamonson, Koch, Weaver, Everett, & Jackson, 2010; Shirey, 2013; Tarrant, Dodgson, & Law, 2008).

Four of the databased articles used qualitative analysis to explore nursing students’ writing development and needs (Borglin & Fagerstrom, 2012; Carter & Rukholm, 2008; Crawford & Candlin, 2013; Gazza, Shellenbarger, & Hunker, 2013). A quasi-experimental study that analyzed students’ contributions to an online asynchronous discussion board found that students who posted a larger number of messages demonstrated evidence of using Carper’s (1978) four ways of knowing in their writing, as well as improved critical thinking and writing skills (Carter et al., 2006). Mandleco, Bohn, Callister, Lassetter, and Carlton (2012) used the CLIPS (Computerized Language Instruction & Practice Software) writing assessment tool to measure students’ writing skills before and after a 14-week scholarly writing course. They reported improved mean scores in 12 of 26 assessment categories. Using mixed methods, Martin (2012) reported that graduate students responded favorably to the use of a wiki for creating, reviewing, and editing each other’s work. The wiki assignment provided opportunities for collaboration and peer review.

Several studies explored whether participation in a writing workshop or support program improved publication rates. Across these studies, an increase was noted in manuscript production and publication rates from pre- to post-workshop participation (Rickard et al., 2009; Shatzer et al., 2010; Stone, Levett-Jones, Harris, & Sinclair, 2010). Students also reported that working with faculty provided the most support to write for publication (Dowling, Savrin, & Graham, 2013).

Educational Programs and Strategies for Developing Writing Skills

The 80 articles included in the current review revealed multiple types of writing programs and strategies used in nursing education. These included reports of how faculty integrated writing across the curriculum; writing courses; assignments in a course for improving students’ writing, which were the most common type; faculty behaviors; workshops; and self-directed activities (Table 2).

Types of Writing Programs and Strategies in Nursing Education

Table 2:

Types of Writing Programs and Strategies in Nursing Education

Writing Across the Curriculum. The current systematic review included 16 articles that were classified as writing across the curriculum. These articles described writing programs and strategies integrated across nursing courses to provide a continuous process for gaining writing skills and multiple strategies used within the courses for writing improvement. Many of these strategies were intended for students to learn how to write in the discipline and to communicate their ideas effectively to a professional nursing audience. Luthy et al. (2009) described a comprehensive writing program that included foundational writing coursework, writing assignments integrated into courses in the baccalaureate program, grading rubrics for various writing assignments, peer tutoring, and writing seminars for faculty, among other strategies.

In response to the varying writing abilities among students in their nursing programs, Gazza and Hunker (2012) developed an evidence-based scaffolding framework to facilitate the development of students’ scholarly writing abilities. Scaffolding is the linking together of multiple teaching strategies to support the development of the scholarly writer. The idea is that as independent writers develop, the scaffold, or support, is decreased and then removed. Writing assignments within courses link to or build on those in subsequent courses; collaboration among nursing faculty ensures that writing benchmarks are met, and students receive feedback from teachers and others and make revisions to their writing assignments.

Another systematic approach to promoting students’ scholarly writing was developed by Shirey (2013) for Doctor of Nursing Practice students, using SMART (Strategies, Methods, and Assessment of outcomes Related to Teaching/Learning). The SMART approach, with multiple writing strategies, was embedded in two courses in the Doctor of Nursing Practice curriculum to build writing capacity. Following implementation of the strategies, the quality of students’ papers improved, and there was an aggregate increase in writing grades of 4.81%. Other authors recommended new models of improving students’ writing skills, including intervening early in a student’s program (Hanson Diehl, 2007) and creating a learning environment that promotes both thinking and writing (Borglin, 2012).

Writing Courses. Eight articles described the use of a writing course as a method of improving students’ writing competency. Writing courses were found to be an effective strategy for improving the writing skills of beginning nursing students (Chu, Perkins, & Marks-Maran, 2012; Mandleco et al., 2012; Tesh, Hyde, & Kautz, 2014), RN-to-BSN students (Smith & Caplin, 2012; Stevens et al., 2014), graduate nursing students (Cone & Van Dover, 2012; Hays, 2005), and English as a Second Language (ESL) nursing students (Chu et al., 2012; Weaver & Jackson, 2011). A writing course can promote confidence in writing and self-expression for nursing students (Young, 2005). In a study by Chu et al. (2012), faculty members presented five sessions to help students develop academic literacy skills. Thirty-six students between their first and second year of the nursing program completed the course; two thirds of the students were nontraditional and 40% were ESL. Students developed increased confidence in their academic writing ability and their understanding of essay criteria.

Writing courses have been developed in collaboration with technical communication faculty (Stevens et al., 2014) and the English department (Mandleco et al., 2012). Online writing courses are a convenient way to share content with students and to enable students to become proficient in lower-level writing skills (e.g., grammar and sentence structure) and higher level skills (e.g., effectively integrating the literature), and they have been implemented as a mandatory requirement for program progression (Cone & Van Dover, 2012; Stevens et al., 2014).

Course Assignments. Another common theme found in the current literature review was the use of nursing course assignments to promote writing development. A total of 24 articles highlighted a range of approaches toward improving student writing through course assignments. These included blogs (Lin & Shen, 2013; Maag, 2005), journaling and reflective writings (Arhin & Cormier, 2007; Binding, Morck, & Moules, 2010; Ruland & Ahern, 2007), short written assignments in clinical courses (Oermann, 2006), and preparation of manuscripts (Bickes & Schim, 2010; McMillan & Raines, 2010; Smith, 2003), among other writing assignments. Several authors highlighted the ability to not only improve writing but also to promote critical thinking and discipline-specific writing skills through course assignments (Carter, 2008; Carter & Rukholm, 2008).

Faculty Behaviors. Another common theme in the current review was the type of strategies that educators used to provide feedback and encourage student participation in writing. Ten articles discussed topics ranging from providing written annotations and positive student feedback on written work (Ball et al., 2009; Ball, 2010; Latham & Ahern, 2013; Parboteeah & Anwar, 2009) to the creation of structured processes and guidelines to assist students with the development of their ideas and promote effective writing skills (Hardy & Ramjeet, 2005; Lavelle et al., 2013; Lee, 2003). Other articles highlighted using partnerships, including student–faculty review (Fowler & Packard, 2009) and volunteers who served as writing tutors for nursing students (Latham & Ahern, 2013).

Workshops and Self-Directed Activities. Seventeen articles described using workshops to help nursing students and nurses to develop their writing skills. This group included a precourse workshop for undergraduate students (Bailey et al., 2007) and writing workshops for graduate students (Chandler, Roberts, & DeMarco, 2005; Dewar, 2012; Heinrich, Neese, Rogers, & Facente, 2004). For practicing nurses, workshops and retreats were used most frequently to promote writing for professional publications. Five other articles in the current review shared professional writing tips or tools that could be used by either students or practicing nurses to improve their writing skills. For example, Clay (2003) offered practical, step-by-step tips for students in gathering literature, developing an essay, creating a reference list, and editing their work.


Summary of Evidence

The quality of student writing is often poor in both prelicensure and graduate nursing programs (Oermann, 2013; Roberts & Goss, 2009). The current systematic review revealed a wide range of educational programs and strategies for developing students’ writing skills. Writing assignments in nursing courses were most common, followed by programs and strategies for integrating writing across courses and the curriculum as a whole. To improve nurses’ writing skills, workshops were used frequently, with outcomes measured by number of manuscripts submitted or accepted.

Most of the articles in the current review provided descriptions of writing programs, strategies for improving students’ writing, course assignments, and writing resources. Although the variety of programs and teaching approaches is encouraging, only one third have been evaluated for effectiveness, and, in most cases, the research has examined only student and faculty satisfaction with and perceptions of a particular writing program or strategy. It is not known which of these approaches is most effective in improving students’ writing and whether any improvement found at posttest is sustained. Bickes and Schim (2010) studied a cohort of community health nursing students (54 pre- and 90 postintervention) to improve their scholarly writing, using faculty writing workshops, a standardized grading rubric, and peer review of scholarly papers. Less grade inflation and improved accuracy in grading was noted. However, it is not known whether these approaches improved students’ writing skills beyond the course assignment. Salamonson et al. (2010) conducted the only randomized controlled trial in the current review—106 first-year ESL nursing students were randomized into either the intervention group, which was a 4-day academic learning support workshop that included a writing and editing professional component, or a control group. In the workshop, students worked through a mock assignment and received feedback on how to improve their writing. Students who attended the workshop had significantly higher mean scores compared with the control group (p = 0.002) and other students who did not attend (p = 0.001). Does an intervention, such as a workshop, have any lasting effect on students’ academic writing ability?

Although many programs and strategies do not lend themselves to randomized controlled trials, nurse educators need to evaluate outcomes of their writing approaches, both at the end of a course and in the long term. In nursing education, studies are needed that compare different writing interventions to have a basis for decisions about curricula and course assignments. Intuitively, writing across the curriculum approaches would seem to be the most effective. Yet, other strategies that provide for repetitive writing activities with assessment, teacher feedback, and opportunity to revise papers may be equally valuable in improving students’ writing and would have less impact on the curriculum as a whole. It is important to acknowledge writing programs and strategies that students indicated helped them to write better and be more successful on their assignments, but more evidence is needed in nursing education. Comparing a teaching strategy that helped students to learn and, in this case, to write better, with no intervention provides little evidence to guide teaching (Cook, 2012).

Most of the literature on writing instruction in nursing education describes specific approaches used in a single course or program within one school of nursing. Except for a few authors who explored writing activities in different courses within their own programs, no reports were found in which faculty replicated teaching strategies for writing improvements to build evidence for best practices.

Recommendations for developing students’ writing abilities include guided instruction on the conventions of writing in a nursing context and the use of activities to improve writing skills that are integrated across the curriculum. A paper assignment or writing activity in one course is not sufficient to build writing skills; instead, a systematic plan is needed for the nursing program as a whole. This plan needs to include opportunities for students to write drafts of papers and receive feedback on the writing, not just on the content of the paper. Although courses and workshops on writing are effective for providing instruction about writing in nursing, they also need to be followed by writing activities in subsequent courses. Faculty can begin by assessing how many and what types of writing strategies and assignments are in their nursing program and then proceed to plan writing instruction, paper assignments, and other writing activities across courses. With this type of curriculum planning, it is feasible to evaluate whether students’ writing skills improve as they progress through the nursing program.


The major limitation of the current review was the lack of research performed of the writing programs and strategies to allow the authors to evaluate their quality and to identify which approaches are most effective in improving the writing ability of students and nurses. The research team agreed on the articles to be included in the review and on the categories selected to cluster writing programs and strategies; however, it is recognized that this a subjective process.


In the current systematic review, 80 articles were reviewed on writing programs and strategies for developing nursing students’ and nurses’ writing skills. These included reports of how faculty integrated writing across the curriculum; writing courses; assignments in a course for improving students’ writing, which was the most common type of strategy; faculty behaviors to improve and encourage writing; workshops; and self-directed activities. Multiple approaches are used, but studies on their effectiveness are limited.


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MEDLINE® (PubMed) Search Strategy

#1“Writing”[ MeSH] OR writing[tiab] OR write[tiab] OR writes[tiab] OR writer[tiab] OR writers[tiab]
#2“Education, nursing”[MeSH] OR nursing education[tiab] OR nurse education[tiab] OR nurse educator[tiab] OR nurse educators[tiab] OR nursing educator[tiab] OR nursing educators[tiab] OR “Nursing/education”[MeSH]
#3“Curriculum”[MeSH] OR curriculum[tiab] OR “Teaching”[MeSH] OR teaching[tiab] OR teach[tiab] OR teaches[tiab] OR taught[tiab]
#4“Nursing”[MeSH Subheading] OR nursing[tiab] OR “Students, Nursing”[MeSH] OR nursing student[tiab] OR nursing students[tiab] OR “Nurses”[MeSH] OR nurses[tiab] OR nurse[tiab]
#5#3 AND #4
#6#2 OR #5
#7#1 AND #6
#8#7 NOT (“Editorial”[pt] OR “Comment”[pt] OR “Letter”[pt])
#9#8 AND (English[lang] AND “2003/01/01”[PDat]: “3000/12/31”[PDat])

Types of Writing Programs and Strategies in Nursing Education

TypeNumber of Articlesa, b
Non-DatabasedResearch StudiesTotal
Course assignments to improve writing16824
Writing across the curriculum (frameworks, approaches)7916
Writing courses (for nursing students)718
Faculty behaviors (feedback, comments on papers, participation with students)6410
Self-directed (writing tips)505
Articles reviewed522880


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