An overview of 5‐year patterns and trends in the Journal of Nursing Management

The Journal of Nursing Management (2019) is an international forum which aims to inform and advance the discipline of nursing management and leadership. The Journal encourages scholarly debate and critical analysis to provide evidence that may underpin and illuminate the practice of management, innovation and leadership in nursing and health care. It publishes current issues and developments in practice in the form of research papers, in-depth commentaries and analyses. The Journal welcomes papers from researchers, academics, practitioners, managers and policymakers from a range of countries and backgrounds that examine relevant issues and contribute to the body of knowledge in international nursing management and leadership worldwide. An exploration of the recent output of scholars within the Journal of Nursing Management is insightful and provides a little more information on research activity in the field and the extent to which the overarching aims of the Journal are being achieved. The aim of this editorial is to provide a brief overview of general patterns and trends in publications in the Journal of Nursing Management with a focus on the past five years (2015–2019) and to suggest ways in which this information could be utilized to inform the future strategic direction of the journal and future publications. A search within the Scopus database (2019) revealed that there have been 2,266 publications in the Journal since its foundation in 1993. The majority of these papers are research articles (78.7%, n = 1,785). There are smaller numbers of literature reviews (7.9% n = 179) and editorials (7.5%, n = 170). The remainder of the papers consists of letters, commentaries and conference papers. The top ten countries publishing most frequently in the Journal (in descending order) were the USA, the UK, Australia, Canada, Sweden, Finland, Ireland, Norway, Italy and Taiwan. Half of these are English-speaking countries. The most frequently published institutions were from mostly English-speaking countries: Western University, Canada; University of Toronto, Canada; Swansea University, Wales, UK; Kings College London, UK; Trinity College Dublin, Ireland; University of Technology Sydney, Australia; University of Alberta, Canada; Maine Medical Centre, Maine, USA; Itä-Suomen yliopisto (University of Eastern Finland), Finland and University of South-Eastern Norway. A 5-year analysis (Scopus, 2019) within the journal revealed that 562 papers have been published during this time, and the top-ranking published universities and establishments remain relatively consistent with University of Technology Sydney, Australia; Itä-Suomen yliopisto (University of Eastern Finland), Finland; Trinity College Dublin, Ireland; Western University, Canada and University of Toronto, Canada comprising the top five. The most frequently published countries of origin remain those that are English speaking: (a) USA; (b) Australia; (c) UK; (d) Canada; and (e) Finland. An increasing number of papers (83%, n = 466) were research articles, with smaller numbers of literature reviews emerging (2%, n = 11). In terms of topics [according to Weberg's, Mangold, Porter-O'Grady, & Malloch, 2018 outline of the leadership role in nursing], two of the main foci of these papers in the Journal of Nursing Management were navigating care networks/creating the context for professional practice and staffing, scheduling and patient care assignments (Table 1). There was also some attention paid to the capacity of the person to lead. There was a smaller percentage (<10%) of papers published in other areas pertinent to the nurse leader (Table 1). Interestingly, a previous editorial in the Journal of Nursing Management (Jasper & Crossan, 2012:643) revealed similar omissions, as it revealed ‘persistent themes’ in relation to general literature on nurse managers, as the role of the nurse manager/leader and its components; evaluation of the role and identification of the developmental needs of nurse managers. As such areas that are depleted of publications (delegation and supervision, negotiation, accountability and ownership) and those with few papers—principles of ethical decision-making, managing your career and resources for healthcare excellence are likely areas that could be developed in the context of nursing management for the future. It is likely that the emphasis on practical aspects of health care and management (navigating care networks/creating the context for professional practice and staffing, scheduling and patient care assignments) reflects a concern with day-to-day operations rather than taking a more helicopter or strategic outlook. It is true that many of the other facets of the leadership role (Table 1, 4–15) inform and influence day-to-day practice; however, most of these elements of the role also require long-term planning and as such are concerned with strategic development of nursing, nursing management and health care. In keeping with current awareness within health care on care left undone, missed care and rationalizing care (Palese et al., 2019), it is possible that some of these activities would likely not be missed (if not executed correctly) in the day-to-day environment and therefore less likely to be prioritized from either a practical or research perspective and this could perhaps explain why they have received less attention. However, this finding is not new; indeed, this focus and concern with day-to-day operations at the expense of more global concerns and strategy was identified some time ago by Carney and Crossan (2009:655), global scholars in health services management. They suggested that ‘it is by no means clear that nurse managers view strategy development as part of their management role’ (Carney & Crossan, 2009:655). They further state ‘developing and managing strategy is a critical success factor for healthcare managers’ (Carney & Crossan, 2009:655). Interestingly in 2009, Carney examined the use and influence of strategy within nursing and midwifery by exploring databases using the key term ‘strategy’ in the title. The authors revealed that only 10% of papers made reference to this. A similar approach, applied to the Journal of Nursing Management [using strategy or strategic in the title], revealed that only 2.69% of all papers (n = 61) contained such content. When this analysis was applied to the aforementioned papers published in the Journal of Nursing Management in last five years (n = 562), only 1.24% (n = 7) of papers made reference to these concepts. So it appears, in keeping with the aforementioned findings (Table 1), that there is little emphasis on strategy and conversely a concern with more urgent matters of immediate consequence to clinicians. More recently in 2016, the World Health Organization outlined a vision for strengthening strategy for nursing and midwifery. They outlined four important themes in global strategic development firstly ensuring an ‘educated, competent and motivated’ workforce within effective and responsive health systems at all levels and in different setting. Secondly ‘optimizing policy development’ and ‘effective leadership’, management and governance. They also highlighted the importance of ‘working together to maximize the capacities and potentials of nurses and midwives through intra- and interprofessional collaborative partnerships, education and continuing professional development and finally ‘mobilizing political will to invest in building effective evidence based nursing and midwifery workforce development’ (WHO, 2016:1). Within this context, the WHO identified workforce planning and upskilling the nursing and midwifery workforce as essential for the development of the professions but more importantly to support a quality healthcare system (WHO, 2016). From the emerging areas of leadership and management that scholars and researchers have focused on in the Journal in last five years (Table 1), it is clear that while there has been a clear investment in workforce and environmental issues, concepts that the WHO prioritized, few of the WHO's (2016) strategic issues have been addressed. Career development and building future leaders, for example, have been highlighted by the WHO (2016) as important, so too has interprofessional working, and yet these topics have received little attention. Of note, the theme of interprofessional working was highlighted recently in the Journal by Hu and Broome (2019:3) who explored interprofessional working in clinical in the People's Republic of China and proposed a theory of the ‘development of the interprofessional collaborative team’. The authors outline how this team progresses and unifies through phases of exploration, integration and finally adjustment. Clarifying each other's roles is an important consideration within this process, and ultimately, the unified team is beneficial for healthcare practice and patient outcomes. While a useful starting point, more research is needed, especially in culturally specific contexts such as China to outline and develop ways of managing and measuring interprofessional working ways of working and its impact on patient outcomes. In terms of the gaps in research and dissemination related to policy, Palese et al. (2019), a group including nurse clinicians/managers, recently demonstrated a novel focus on policy in the Journal by outlining the process and outcomes of a consensus approach to developing policies and actions in response to missed care in Italy. Such policy work is vital in contemporary nursing. While there are many examples of descriptions of missed care, there is little empirical exploration of policy or activities to address the problem. This work and the improvement and development of policy research and publications mean intensifying and focusing research endeavours beyond description to strategic action. One further area that receives very limited attention in recent years is principles of ethical decision-making (Table 1). Although not highlighted per se within recent WHO (2015, 2016) strategy, it is increasingly being recognized that nurses in practice face many ethical issues (Silén & Svantesso, 2019). This situation is likely to intensify given changing patterns of illness. It is well understood internationally that in most societies healthcare needs are changing in an unprecedented fashion. Advances in medicine, including detection, treatment, prevention together with improved socio-economic circumstances, increased access to health care and improved understandings of the contribution of lifestyle mean not only that people are living longer, but older people are presenting with a novel co-morbidity with consequential impacts on personal health, personal needs and the vision for societal support of the ageing population (Kagan, 2015, 2016). There are also concurrent ethical issues as society struggles with treatment decisions, end of life care, and emerging policy and legislation related to euthanasia internationally (Pesut et al., 2019). In this Journal, Silén and Svantesso (2019:1) recently drew attention not only to the presence of ethical issues in health care, but the effect that these have on nurses’ well being. In response to this, they developed a ‘clinical ethics support service’ that had a positive and beneficial outcome for staff. While a small qualitative study, the findings did reveal that providing time and space for reflection on ethical issues could potentially be beneficial to clinical staff, and staff expressed the need to continue with such support. Another consideration is in relation to how these patterns and trends fit with international trends in healthcare research. While exploring ‘health writing trends’ to identify what the ‘future holds’, Guillemard (2018) recently highlighted patient-centred communication; rapid technological advancements; digital health; big data; real-world data; personalized and precision medicine; ongoing challenges regarding access to research and patient experience as priority and important themes in healthcare research. Certainly, these are overarching elements that may inform nursing management research for the future and are worth careful consideration in terms of future direction and strategies of nursing management research. It is important too that researchers ought to continue to focus on their strengths in relation to workforce and staffing issues; patient care assignments; developing the role of the leader but also seek to research in areas such as policy, legislation, licensing and professional nurse roles, becoming a professional nurse and principles of ethical decision-making; delegation and supervision; negotiation; accountability and ownership; leadership and practice partnerships; managing your career and resources for healthcare excellence to address current gaps. Particular gaps that emerge are the impact of leadership, interdisciplinary models of care, policy and safety, ethics. Future research in these areas ought to take consideration of the use of big data sets and digital technology in the context of patient-centred care and increasingly ageing population. In keeping with the aims and scope of the Journal of Nursing Management (2019), the Journal primarily publishes research papers, undoubtedly contributing to its overall goal of providing an evidence base for the field. The Journal also achieves its goal of internationality, although notably dominated by English-speaking nations. This is not surprising given that English is considered the ‘language of health science’ (da Silva et al., 2009) and English as a second language is a recognized barrier in dissemination for international nursing scholars (He & Hu, 2012). The Journal also aims to inform practitioners and researchers in nursing management and leadership; explore and debate current issues in nursing management and leadership; assess the evidence for current practice; develop best practice in nursing management and leadership; examine the impact of policy developments; and address issues in governance. The extent to which the Journal is fully achieving these aims, especially in relation to policy and governance, is uncertain, given this analysis. The Journal recognizes that ‘complex and rapidly changing nature of global health care is constantly generating new challenges and questions’, and in this regard, researchers and clinicians ought to be encouraged and supported to explore novel research questions that arise beyond the day-to-day immediacies and priorities. Taking a more long-term view of the nursing and midwifery profession and exploring facets of management and leadership roles in a more comprehensive way will lead to the Journal strengthening the achievement of its overall aims. As Carney and Crossan (2009:655) suggest ‘much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making’; however, there is a need for greater coordination of action to ensure that nursing is actively ‘supported in influencing and shaping health and health care policy’. Nurses and midwives ‘need to grasp the importance of balancing the needs of the patient and health service stakeholders’ and begin to ‘deliver on their strategic objectives across clinical, education, leadership, research and community areas’ (Carney & Crossan, 2009:658). Ultimately, ‘[nurse and midwifery] managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted’ (Carney & Crossan, 2009:658). Developing a vision for research and development within nursing and midwifery management and leadership is therefore a priority. This vision needs to encompass research priorities that directly influence staffing and workforce issues, clinical environments and the leadership role, but also to begin to explore those areas that receive less examination such as ethical issues, ethical leadership and ethical decision-making; resources; career development; the impact of leadership styles; change and innovation; practice partnerships; skills of conflict management; delegation; accountability and ownership and policy. Any such development needs to be undertaken in relation to national and global research priorities and healthcare trends. It would also be useful to harness contemporary approaches within health research such as use of large data sets, digital technology and patient-focused research that would ultimately contribute to the development of scholarship in this field in a more meaningful way.

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