Monday, 11 July 2016

The h-index: meritocracy or spurious reductionism?

Niall McCrae, King’s College London

A recent JAN editorial has put a few ‘noses out of joint’. Editor-in-chief Roger Watson, far from the metropolitan elites in the cool climes of Hull, has emulated the irreverent poet Philip Larkin, whose verbal bombs from that smoky port were as loud as those of the Luftwaffe’s blitz in the Second World War.

Surveying the publication activity of the nursing professoriate, Watson et al. (2016) found several cases of chairs of nursing departments whose output was no better than that of a novice research worker. According to the Scopus database, some had h-index scores of 1; this could amount to a single publication, cited once. Watson et al.’s exposé has drawn an angry response, but as the Lancaster bomb crews once said: the greater the flak, the closer you are to the target.

An eloquent riposte by Gary Rolfe (2016) in the Journal of Clinical Nursing showed Watson et al.’s findings to be flawed, partly due to reliance on a database of dubious comprehensiveness. Scopus misses some nursing journals, authors’ details are frequently incorrect, and a more fundamental problem in the blunt collation of data is in the loss to female scholars whose names changed on marriage.

Accepting some of the criticisms, Watson would prefer Web of Science for a future survey, and the ORCiD number should be used to prevent disadvantage to women. Perhaps someone could take this on, but the results will not be any more impressive across the board. My h-index in Scopus lingers at a modest 8; in Web of Science it is a paltry 6. These numbers are frustratingly low for a writer with two books, numerous book chapters and over 50 published papers. By contrast, Google Scholar would give me a reassuring score of 12, being more inclusive in journal coverage and in types of citation.

No metric will satisfy all, but the h-index is an objective measurement not merely of the number of publications but the author’s impact. A paper in The Lancet will contribute much more to the score than one published in the East Yorkshire Archives of Health & Postmodern Poetry (impact factor unavailable).

A nursing professoriate emerged later in the UK than in the USA, and it seems that confidence in the academic prowess of the discipline is not as well developed here as in other countries. Deans of nursing faculties or chairs of nursing departments have a vital role in contributing to the science and knowledge of healthcare, and publication is the vehicle for changing and improving practice. Rolfe suggested that professors be rated by a mystical p-index, for which no criteria were offered. The h-index may seem crude, but at least it is objective, whereas a nebulous notion of ‘influence’ would be highly subjective – and could perpetuate an 'old boys club'.

Indeed, Rolfe’s argument, while persuasive on many points, has a degree of the reactionary tone of the establishment. Professors of nursing are not suited to an ivory towers mentality, and they should be able to face criticism from the likes of Watson et al., who will keep us on our toes. Let’s not shoot the messenger.


Rolfe G (2016) Professorial Leadership and the h-index: the rights and wrongs of academic nursing Journal of Clinical Nursing DOI: 10.1111/jocn.13428

Watson R, McDonagh R, Thompson DR (2016) h-indices: an update on the performance of professors in nursing in the UK Journal of Advanced Nursing DOI: 10.1111/jan.12924

Tuesday, 5 July 2016

Graduate nurses save more lives

Roger Watson, Editor-in-Chief

The value of graduates in nursing is already well known from previous studies, for example, the RN4CAST study (Sasso et al. 2015).  However, these studies measured the extent to which graduate nurses were present in hospitals and the extent to which patients survive.  There was no direct link between the nurses providing care for specific patients.  Now a study from Qatar by Gkantaras et al. (2016) titled: 'The effect of Nurse GraduaTeness on patient mortality: a cross-sectional survey (the NuGaT study)' has made that link and it supports the view that the higher the proportion of graduates who care for a patient, the more likely the patient is to survive their stay in hospital.

The NuGaT study used patient electronic records where the nurses who cared for patients identifed themselves by a uniqure personal code each time nursing care was provided.  From this code it was possible to identify the nurses and find out whether or not they were a graduates.

You can listen to this as a podcast


Gkantaras I, Hafhoud ZR, Foreman B, Thompson DR, Cannaby AM, Deshpanda DH, Watson R, Topping A, Gray R (2016) The effect of Nurse GraduaTeness on patient mortality: a cross-sectional survey (the NuGaT study) Journal of Advanced Nursing doi: 10.111/jan.13059

Sasso L, Bagnasco A, Zanini M, Catania G, Aleo G, Santullo A, Spandorano F, Icardi G, Watson R, Sermeus W (2015) RN4CAST@IT: why is it important for Italy to take part in the RN4CATS project? Journal of Advanced Nursing doi: 10.1111/jan.12709

Wednesday, 29 June 2016

Nursing in the year AD 2000*

Roger Watson, Editor-in-Chief

When I was very young - and even in 1975 when the lecture by Peggy Nuttall on which the paper is based was delivered - the year AD 2000 was one when we would have solved most of the problems of humanity; cars would fly and we would be able to communicate by speaking to our wristwatch. The 'crisis' in the UK National Health Service (NHS) referred to by Nuttall would no longer be an issue as economic and social progress would be such that we could look back over 25 years and laugh at our ignorance.  Well, how wrong was that assessment?  In fact, of the three things mentoined above only one has been achieved: we can speak to people via our wristwatches!  But the NHS remains in crisis and cars seem to be as dependent on tarmacadam roads as they were then.  I learned a great deal from Look and Learn magazine but I think it raised my hopes too much.

I urge you to read this excellent and prescient piece and tick off the issues which Nuttall identifies will be relevant in AD 2000: chronic ill-health; immigration; primary healthcare; retention of nurses in the workforce; the effect of night-shift working on nurses.  All of these are issues now and, while she did not refer to non-communicable diseases or global health, you feel that she could see how these would be issues in the next century.  She also points to the internal strife in nursing, that was evident then and it is evident now.

I think that this JAN classic paper from the first volume indicates the quality of some of our nursing leaders at this time, to whom we probably owe the survival of and the progress made by our profession.  It also demonstrates the vision of Founding Editor Dr James P Smith who ensured that JAN was reflecting the very best thinking about the situation of and the future of nursing; in this case 25 years on.

You can listen to this as a podcast


Nuttal P (1976) Nursing in the year AD 2000 Journal of Advanced Nursing 1, 101-110

* Peggy Nuttall was Vice Chairman, Royal College of Nursing, London and this was an address, the First Battersea Memorial Lecture, on 7 November 1975 to the Association of Integrated and Degree Courses in Nursing

Tuesday, 28 June 2016

Are nursing students imposters?

Roger Watson, Editor-in-Chief

I recall, having been deemed fit to manage the ward, having the keys to the ward slid along the floor to me by the charge nurse as she was going off the ward to dinner and her saying 'you're in charge'; I was a final year student nurse and it was my first time and - yes - I felt like an imposter.  Surely someone else should be doing this and not me.

This article from New Zealand, Australia and the UK by Christensen et al. (2016) titled: 'Do nursing students experience Imposter Phenomenon? An international comparison of final year undergraduate nursing students' readiness for registration' and published in JAN looks at the Imposter Phenomenon in nursing students.  The aim of the study was 'to examine the extent at which imposter phenomenon is evident in four final year nursing student cohorts in Australia, New Zealand and the UK.'  Over 200 final year nursing students were invovled and completed two questionnaires: one about preparedness to work as a nurse; and one about fear of not being able to perform properly.  The results suggest that 38.5% of the sample could be classifed as 'imposters'.  While the reasons for imposter feelings were not clear the authors conclude: 'nursing students report internalized feelings which suggest their performance and competence once qualified may be compromised' and 'it is recommended that educational programmes designed for this student cohort should be mindful of this internal conflict.'

You can listen to this as a podcast


CHRISTENSEN M., AUBEELUCK A., FERGUSSON D., CRAFT J., KNIGHT J., WIRIHANA L. & STUPPLE E. (2016) Do nursing students experience Imposter Phenomenon? An international comparison of final year undergraduate nursing students' readiness for registration. Journal of Advanced Nursing doi:10.1111/jan.13034

Sunday, 26 June 2016

Contemplations on the Tasks of Motherhood: 1976 - 2016

Rita H. Pickler, Editor

In the first volume of the Journal of Advanced Nursing, author, researcher, theorist, and educator Reva Rubin wrote:
Pregnancy is more than a period of gestation, growth and development of the fetus…Pregnancy is also a period of identity reformulation, a period of reordering interpersonal relationships and interpersonal space, and a period of personality maturation (Rubin 1976).
Still true.

Rubin, whose work often seems overshadowed by that of her student, mentee, and fellow theorist, Ramona Mercer (i.e. Mercer & Ferketich 1990), introduced the concept of Maternal Role Attainment in the late 1960’s. She described the maternal role as a complex cognitive and social process that is learned, reciprocal, and interactive. Rubin developed her theory through a series of case studies over her many years as nurse and teacher. She observed how mothers used their senses to become familiar with their infants. She was an early proponent of “rooming-in” and other strategies to keep mother and baby together after birth. As a nursing student in the 1970’s, I remember reading, discussing, and applying Rubin’s work to my clinical practice.

But times change and theories, and ideas, go out of style and use. And in fact, much has changed about what we know happens physically, psychologically, and socially to women during pregnancy. We know much more than we did about how a woman’s well-being affects the fetus and her child. We know that what happens during pregnancy, and even before pregnancy, can have long-lasting effects on both mother and child.

Poor pregnancy outcomes throughout the world continue to exact a toll in terms of prematurity, congenital illness, and lifelong risk for poor health. So, we might be wise to rethink Rubin’s “tasks” as important to the repertoire a pregnant woman needs in order to traverse the gap to motherhood. As a nurse long interested in promoting healthy birth outcomes, this re-reading of Rubin’s paper from 30 years ago has given me fresh ideas about ways to facilitate the work of maternal role attainment. For although the language and yes, some of the ideas need refreshing, most certainly the general notion that promoting maternal health and well-being will lead to improved health and well-being for the world’s children will never be out of style.


Mercer, R.T, & Ferketch. (1990) Predictors of parental attachment during early parenthood.
Journal of Advanced Nursing, 15, 268–280, DOI: 10.1111/j.1365-2648.1990.tb01813.x

Rubin, R., (1976) Maternal tasks in pregnancy. Journal of Advanced Nursing, 1, 367-376.

Wednesday, 22 June 2016

It's not only patients who suffer in emergency care

Roger Watson, Editor-in-Chief

When I first read the title of this article when it arrived in manuscript form I assumed it referred to patients but then realised it referred to nurses and the effect that working in emergency care can have on them.  And it makes sense.  I always consider emergency nurses as a relatively robust bunch.  I have to confess - as a nurse who formerly and exclusively worked with older people - that emergency care never appealed to me and my very brief encounters with it as a student and in the army left me a quivering wreck...and nothing even happened.  Imagine if it had.

This article from Scotland by Morrison and Joy (2016) titled: 'Secondary traumatic stress in the emergency department' and published in JAN aimed to 'To investigate the prevalence of secondary traumatic stress among emergency nurses in the West of Scotland and explore their experiences of this.'  It used quantitaive and qualitative methods and studies 80 nurses in 4 hospitals.

The results are alarming in that 75% of nurses reported recently at least one secondary traumatic stress (STS) symptom and 39% could be classified as suffering from STS.  The work shows some similarrity and some differences from previous work on the same phenomenon in the USA.  Acknowledging some limitations of their work, the authors conclude: 'Further research is required to corroborate these results and findings and develop the evidence base further, with particular regard to the effects of STS among Emergency nurses of differing levels of experience and the impact of this on the provision of quality patient care.'

You can listen to this as a podcast


MORRISON L.E. & JOY J.P. (2016) Secondary traumatic stress in the emergency department Journal of Advanced Nursing doi: 1 10.1111/jan.13030