DOI: 10.1111/jonm.

12866

EDITORIAL

An overview of 5-year patterns and trends in the Journal

of Nursing Management
stent with University of Technology Sydney, Australia; Itä-Suomen
opisto (University of Eastern Finland), Finland; Trinity College Dublin,
The Journal of Nursing Management (2019) is an international forum eland; Western University, Canada and University of
which aims to inform and advance the discipline of nursing manage- Toronto, Canada comprising the top five. The most frequently pub- lished
ment and leadership. The Journal encourages scholarly debate and countries of origin remain those that are English speaking: (a) USA; (b)
critical analysis to provide evidence that may underpin and illumi- Australia; (c) UK; (d) Canada; and (e) Finland. An increasing number of
papers (83%, ​n ​= 466) were research articles, with smaller
nate the practice of management, innovation and leadership in nurs- ing
and health care. It publishes current issues and developments in practice numbers of literature reviews emerging (2%, ​n ​= 11).
in the form of research papers, in-depth commentaries and analyses. In terms of topics [according to Weberg's, Mangold,
The Journal welcomes papers from researchers, academ- ics, Porter-O'Grady, & Malloch, 2018 outline of the leadership role in
practitioners, managers and policymakers from a range of coun- tries nursing], two of the main foci of these papers in the ​Journal of Nursing
and backgrounds that examine relevant issues and contribute Management ​were navigating care networks/creating the context for
to the body of knowledge in international nursing management and professional practice and staffing, scheduling and pa-
leadership worldwide. An exploration of the recent output of schol- ars tient care assignments (Table 1). There was also some attention paid to
within the ​Journal of Nursing Management ​is insightful and pro- vides a the capacity of the person to lead. There was a smaller percent- age
little more information on research activity in the field and the extent to (<10%) of papers published in other areas pertinent to the nurse leader
which the overarching aims of the Journal are being achieved. The aim of (Table 1). Interestingly, a previous editorial in the Journal of Nursing
this editorial is to provide a brief overview of Management (Jasper & Crossan, 2012:643) revealed similar omissions,
general patterns and trends in publications in the Journal of Nursing as it revealed ‘persistent themes’ in relation to general lit-
Management with a focus on the past five years (2015–2019) and to erature on nurse managers, as the role of the nurse manager/leader and
suggest ways in which this information could be utilized to inform the its components; evaluation of the role and identification of the
future strategic direction of the journal and future publications. developmental needs of nurse managers.
A search within the Scopus database (2019) revealed that As such areas that are depleted of publications (delegation and
there have been 2,266 publications in the Journal since its foundation in supervision, negotiation, accountability and ownership) and those with

1993. The majority of these papers are research articles (78.7%, ​n ​= few papers—principles of ethical decision-making, managing
1,785). There are smaller numbers of literature reviews (7.9% ​n = ​ 179) your career and resources for healthcare excellence are likely areas that
​ 170). The remainder of the pa- pers consists of could be developed in the context of nursing management for the future.
and editorials (7.5%, ​n =
letters, commentaries and conference papers. The top ten countries It is likely that the emphasis on practical aspects of health care and
publishing most frequently in the Journal (in de- scending order) were the management (navigating care networks/creating the con- text for
USA, the UK, Australia, Canada, Sweden, professional practice and staffing, scheduling and patient care
Finland, Ireland, Norway, Italy and Taiwan. Half of these are English- assignments) reflects a concern with day-to-day operations
speaking countries. The most frequently published institutions were from rather than taking a more helicopter or strategic outlook. It is true that
mostly English-speaking countries: Western University, Canada; many of the other facets of the leadership role (Table 1, 4–15) inform and
University of Toronto, Canada; Swansea University, Wales, UK; Kings influence day-to-day practice; however, most of these elements of the
College London, UK; Trinity College Dublin, Ireland; University of role also require long-term planning and as such are concerned with
Technology Sydney, Australia; University of Alberta, strategic development of nursing, nursing man- agement and health
Canada; Maine Medical Centre, Maine, USA; Itä-Suomen yliopisto care. In keeping with current awareness within
(University of Eastern Finland), Finland and University of South- Eastern health care on care left undone, missed care and rationalizing care
Norway. (Palese et al., 2019), it is possible that some of these activities would
A 5-year analysis (Scopus, 2019) within the journal revealed likely not be missed (if not executed correctly) in the day-to-day en-
that 562 papers have been published during this time, and the top-rank- vironment and therefore less likely to be prioritized from either a practical
ing published universities and establishments remain relatively con- or research perspective and this could perhaps explain why they have
 received less attention. cern with day-to-day operations at the expense of more global concerns
and strategy was identified some time ago by Carney
However, this finding is not new; indeed, this focus and con-

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458 ​ ​
| EDITORIAL
Nursing leadership topics
and Crossan (2009:655), global scholars in health services man-
agement. 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 ‘strat- egy’ 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
​ 61) contained such content. When this analysis was applied to the aforementioned
that only 2.69% of all papers (​n =
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 aforemen- tioned 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 out- lined a vision for strengthening strategy for nursing and mid- wifery. They
outlined four important themes in global strategic development firstly ensuring an ‘educated, competent and moti- vated’ workforce
within effective and responsive health systems at all levels and in different setting. Secondly ‘optimizing policy
development’ and ‘effective leadership’, management and gover- nance. They also highlighted the importance of ‘working together
to maximize the capacities and potentials of nurses and midwives through intra- and interprofessional collaborative partnerships,
Number of papers (%)
TAB LE 1 An outline of patterns and trends in papers published the Journal of Nursing Management 2015–2019 ​1a​ ​Navigating the
Care Networks and Creating the
165 (29.35%)
[according to Weberg et al.'s, 2018 outline ​Context for Professional Practice
of topics related to the leadership role in
2 Staffing, Scheduling and Patient Care Assignments 99 (17.61%)
nursing]
3 The Person of the Leader the Capacity to Lead 64 (11.538%)
4 Policy, Legislation, Licensing and Professional Nurse
Roles
51 (9.07%)
5 Change and Innovation 44 (7.82%)
6 Applying the practices of leadership 41 (7.29%)
7 Conflict Skills For the clinical Leader 36 (6.4%)
8 Becoming a professional nurse 29 (5.16%)
9 Leadership and Practice Partnerships 20 (3.55%)
10 Managing your Career 7 (1.24%)
11 Resources for Healthcare Excellence 3 (0.53%)
12 Principles of Ethical Decision Making 3 (0.53%)
13 Delegation and Supervision 0 (0.0%)
14 Negotiation 0 (0.0%)
15 Accountability & Ownership 0 (0.0%)
All papers (2015–2019) 562 (100%)
a​
Numbers only prioritize distribution within this analysis.
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 impor- tantly 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 ad- justment. 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 con- texts such as China to outline and develop ways of managing
and measuring interprofessional working ways of working and its impact on patient outcomes.

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| EDITORIAL
459 ​
In terms of the gaps in research and dissemination related to policy, Palese et al. (2019), a group including nurse clinicians/man-
agers, 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 empir- ical 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 in- ternationally that in most societies healthcare needs are
changing
in an unprecedented fashion. Advances in medicine, including de- tection, treatment, prevention together with improved socio-eco-
nomic 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, per-
sonal needs and the vision for societal support of the ageing popu- lation (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) re- cently 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 communi-
cation; rapid technological advancements; digital health; big data;
real-world data; personalized and precision medicine; ongoing chal- lenges regarding access to research and patient experience as
pri- ority and important themes in healthcare research. Certainly, these are overarching elements that may inform nursing
management re- search 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
profes- sional 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 ad- dress 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-cen- tred 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
international-
ity, 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 schol- ars (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 develop- ments; 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 rec-
ognizes 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
over- all 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 ac-
tively ‘supported in influencing and shaping health and health care policy’. Nurses and midwives ‘need to grasp the importance of
bal- ancing the needs of the patient and health service stakeholders’ and begin to ‘deliver on their strategic objectives across
clinical, educa- tion, 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
de- livery 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-mak- ing; resources; career development; the impact of
leadership styles; change and innovation; practice partnerships; skills of conflict

460 ​ ​
| EDITORIAL
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