Learn how to prevent common problems.
- Authors can take practical steps to reduce the risk of manuscript rejection during the publication process.
- Common reasons for rejection at different stages—before peer review, after peer review, and following revision submissions—can be addressed with targeted strategies.
- Authors can view rejection as a learning opportunity, using reviewer feedback to strengthen their work and improve their chances of success when submitting to another journal.
WHEN NURSES SHARE their expertise, they benefit colleagues and patients; however, many remain reluctant because they fear rejection. Nobody likes rejection, whether from a friend, the organization you hoped to work for, or the journal where you submitted your manuscript. Fortunately, you can minimize the likelihood of rejection by following a few simple strategies.
These strategies—grounded in the literature (for example, Teixeira da Silva and Nazarovets and Kembro and colleagues), my 30-plus years of publishing experience, and an ongoing dialogue with editors and writers—address rejection across the manuscript process: before peer review (PR), after PR, and following PR revision. Before discussing these strategies, it’s important to understand a few ground rules related to rejection.
Ground rules
Consider these three ground rules when thinking about rejection.
Don’t get discouraged. Even prominent researchers and clinicians experience rejection. As reported in The New York Times, Katalin Karikó and Drew Weissman received the 2023 Nobel Prize in Physiology or Medicine for their work leading to the development of mRNA vaccines for COVID-19. However, two well-respected journals, Nature and Science, rejected their manuscript before it was published in Immunity.
Many prolific nurse researchers and clinicians encounter manuscript rejection. Several years ago, I heard Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, a former dean of The Ohio State University’s College of Nursing who has published widely and is editor of Worldviews On Evidence-Based Nursing, speak at a Sigma Theta Tau International convention about her own experiences with rejection. When she and her writing partners receive a rejection notice, they review the PR comments, revise the article as needed, and submit it to another journal. This matter-of-fact approach highlights how rejection doesn’t have to end your publication journey.
It’s the manuscript, not you. Editors and peer reviewers focus on the merits of the manuscript, not your ability as a nurse, author, or researcher. Try not to take rejection personally, but rather see it as a learning opportunity. The feedback you may receive after a rejection can help make you a better writer.
Not everything is under your control. Editors aren’t perfect. They might decide too quickly not to send an article for PR or conclude that the PR comments are too negative to offer the authors a chance to revise and resubmit. In either situation, the reality may be that the manuscript could have been salvaged.
Now that the ground rules are clear, let’s consider some common problems that may lead to a rejected manuscript and ideas for how to avoid them. Addressing these early on will not only help you avoid rejection but also will save time if you’re asked to revise and resubmit.
Pre-peer review
After initial submission, editors evaluate a manuscript to determine whether it should be sent for PR. Peer reviewers are typically volunteers with busy schedules, which limits the pool from which editors can draw. As a result, editors want to respect reviewers’ time by not sending manuscripts that are clearly unsuitable for publication. Rejections before PR (desk rejections) are common. For example, according to Pickler, they comprised 58% of rejections for Nursing Research in 2020. Several problems can trigger a desk rejection.
Problem: The manuscript doesn’t fit the journal’s editorial mission. For example, an article on how to choose an appropriate wound dressing wouldn’t be a good match for the Journal of Nursing Scholarship, which focuses primarily on research. Similarly, a manuscript based on a concept analysis wouldn’t fit the clinical focus of American Nurse Journal.
Solution: Find a suitable journal match for your topic. First consider journals you read on a regular basis. If you don’t find a good fit, access the Directory of Nursing Journals (nursingeditors.com/journals-directory/). These journals have been vetted by the International Academy of Nursing Editors, so the directory is highly unlikely to contain predatory journals, which you should avoid. (Read more about predatory journals at bit.ly/4sOCfLS and bit.ly/48JaAog.) Each entry provides an overview of the journal, including a description, publisher, and the editor’s email, along with a link to the journal’s website.
To explore possible publication options, review the journal’s mission statement, which you can find in the journal and on the journal’s website under the link for author guidelines or instructions. Mission statements tend to be broad, so read the current issue and several past issues to understand the journal’s purpose, target readers, and types of articles. If you’re unsure, ask your colleagues for their insights.
Problem: A similar article is slated for publication, or your topic is too similar to a recently published article.
Solution: Review the table of contents for the past 18 months or so to ensure your topic hasn’t been covered. If it has, does your manuscript provide a different perspective? For example, critical care nursing journals frequently publish articles about sepsis, but because of its severity, editors appreciate new angles.
Unless the author guidelines state that queries aren’t accepted, send one before writing your manuscript to gauge interest. In the query, usually sent via email to the editor, explain why the topic is important to the journal’s readers and provide a concise overview or abstract if the author guidelines request one. Briefly state your qualifications related to the topic, such as serving on the quality improvement team that completed the project or your years of experience caring for patients with a particular condition. If your topic is similar to a recent article, describe how your manuscript will provide a different insight.
State the purpose of the query in the subject line of the email; for instance: “Proposed article on new guidelines for sleep apnea for American Nurse Journal.” Don’t include attachments, which could result in your email landing in the editor’s spam folder.
Proof your query before sending. In her article “We get letters,” Pickler notes that editors look for the basics, such as grammatically correct writing and a salutation and signature.
Problem: The author hasn’t followed the author guidelines. Nearly all editors will tell you that this is one of the primary frustrations of their job.
Solution: The obvious solution is to follow the author guidelines. In addition to information about the journal’s mission, these guidelines detail the types of articles accepted, manuscript format, word count or page length, reference style, and PR process. Pay particular attention to article type. If the guidelines don’t list case studies (and you don’t see any published in past issues), the journal editors are unlikely to accept your case study, no matter how good it is.
Pay attention to details. Using the wrong citation style (such as American Medical Association instead of American Psychological Association) or ignoring the word count stipulated in the guidelines may result in manuscript rejection.
Problem: The editors uncover an ethical issue such as plagiarism, inappropriate use of artificial intelligence (AI) or failure to disclose its use, or lack of permission for graphics.
Solution: To avoid inadvertent plagiarism, clearly track sources so you can properly cite them in the manuscript. Programs such as Mendeley and Zotero can help with this; they also automate switching reference styles. Correct citation includes both reference format and citation within the manuscript. A study by Wakeling and colleagues found a citation quotation error rate of 16.6% in published articles across natural and life sciences journals. Problems included inappropriate generalization, exaggeration of findings, oversimplification or omission of key details, misunderstanding or misrepresenting the cited paper, and citing an article not relevant to the text.
If you have access to a plagiarism-detection/AI program, perform a self-check before submitting. These programs aren’t perfect (for example, they may falsely detect AI-generated content), but they’re helpful. In fact, most journals now use them to screen submitted manuscripts. If the similarity score between your manuscript and previously published work is too high, editors may reject your manuscript.
Review the author guidelines for acceptable use of AI. Most journals follow recommendations from the International Committee of Medical Journal Editors, which state that journals should require authors to disclose AI use. In addition to basic spelling and grammar checking, you can use AI for data collection and analysis as well as writing assistance—but not for creating full manuscripts or large portions such as the discussion section of a research report. Your disclosure should include how you used AI and how you fact-checked the information.
Some journals have specific disclosure formats, such as this one from the Journal of Obstetric, Gynecologic, & Neonatal Nursing: “During the preparation of this work the author(s) used [NAME TOOL/SERVICE] to/for [REASON]. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.”
The rules surrounding the use of AI in publishing continue to evolve, making it critical to review each journal’s policy carefully.
For all articles, obtain permission to reuse graphics published elsewhere. If a reuse fee is required, you may be able to indicate that permission will be obtained upon acceptance of the article for publication, but check the author guidelines.
For studies, clearly state whether you obtained Institutional Review Board approval or why it wasn’t needed. In addition, note the registration of clinical trials to avoid an automatic rejection. The National Institutes of Health (NIH) defines a clinical trial as “a research study in which one or more human subjects are prospectively assigned to one or more interventions (which may include placebo or other control) to evaluate the effects of those interventions on health-related biomedical or behavioral outcomes.” Government-funded studies and most funding agencies require registration. (Quality improvement studies or observational trials where intervention isn’t at the discretion of the investigator aren’t considered clinical trials.) Register your clinical trial before enrollment starts. To see if your study meets the definition of a clinical trial, use the NIH decision tool (grants.nih.gov/policy-and-compliance/policy-topics/clinical-trials/ct-decision).
Honestly complete conflict-of-interest forms. For example, perhaps you’re writing about the treatment of anemia in dialysis patients and you’re a speaker for a company that manufactures a medication used in that treatment. Not disclosing a potential conflict up front will usually lead to a rejection, whereas disclosing conflicts simply informs readers of the facts and doesn’t necessarily mean the journal will reject your manuscript.
The conflict-of-interest form typically asks about funding sources, such as grants for studies, although some journals have a separate form for funding disclosures. If the journal doesn’t have a specified form, include this information at the end of your manuscript.
After peer review
A journal may reject your manuscript based on comments from peer reviewers.
Problem: The manuscript doesn’t contribute to the literature. The reviewers may feel the manuscript contains no new insights or strategies that will prove useful to the journal’s readers.
Solution: Conduct an effective literature review before beginning your study or project and prior to writing the clinical article. Doing so allows you to determine if gaps exist that your work can fill. Use multiple databases so you don’t overlook key information. Platforms such as Elicit, OpenEvidence, and Semantic Scholar can help in comparing and summarizing studies, and you can use tools such as Adobe Acrobat to summarize individual articles. Ultimately, you’ll need to review the information yourself to ensure accuracy, but these tools provide a good place to start.
Your manuscript must pass the “so what” test: Readers will want to understand the value of the information to them. In the introduction, state the unmet need, and in the discussion, describe how the work provides new insights or strategies. Nakayama notes that context helps readers assess content relevance. Strategies for improving context include comparing findings with established benchmarks and discussing how your work fits with current practice.
Your contributions don’t have to be groundbreaking. For example, your research may involve an understudied patient population or your project may present a solution for a common clinical issue. Be sure to provide sufficient detail so that others can implement your solution in their own settings. Remember that although you may think the value of your manuscript is obvious, you need to connect the dots for the reviewers and, ultimately, the readers.
Problem: The research is flawed.
Solution: Unfortunately, this issue frequently can’t be corrected retroactively; although, sometimes data re-analysis is possible or you can clarify areas of concern. For example, you may need to provide more information to justify your methodology. However, the best prevention is to plan carefully. Share your research plan with experts to obtain feedback and manage data collection and analysis. For instance, before the study, consult with statisticians about appropriate statistical tests.
In addition, most nursing journals require studies and quality improvement projects to have a theoretical or conceptual framework or model. It’s difficult to retrofit a framework after completing the work, so consider this up front. Ultimately, aim to show strong conceptualization, methodology, and data analysis.
Another methodology issue involves using an instrument created by the study author without first establishing its validity and reliability. When possible, use instruments with established validity and reliability.
Problem: The manuscript is poorly written or organized or a specific section is weak or has issues.
Solution: Before submitting your manuscript, review each section carefully. Ask colleagues to read and provide input. Some colleagues may feel reluctant to criticize your work, so give them permission up front to conduct a rigorous analysis so you can improve the manuscript. Also include someone from your target readership to review it, as needed. For example, if you’re a critical care nurse writing an article on suctioning for a home care nurse journal, ask a home care nurse to review your manuscript. If you’re writing about a complex topic for an audience of novice clinicians, ask a novice nurse to review the article before submission.
Detailed information on writing is beyond the scope of this article, but a few tips may prove helpful. I approach writing and editing by wearing “three hats,” representing the roles of reader, editor, and peer reviewer. I try to address the needs of all three groups. For instance, the peer reviewer may have questions about my explanation of a complex physiological procedure that the average reader may not think of asking. (See Writing tips.)
Writing tips
These strategies can help your manuscript stand out to editors, peer reviewers, and readers.
- Use publication guidelines, when available, specific to the type of article you’re writing. Check the author guidelines for any assistance in this area. For example, many journals require authors to follow the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 when reporting quality improvement projects. You can access guidelines at equator-network.org.
- Read past issues of the journal to review article structure.
- Base clinical articles on the evidence and clearly state the link to practice.
- Avoid overuse of jargon, unnecessarily complex words, grammatical errors, and wordiness (longer isn’t necessarily better).
- Use active voice to improve readability, when appropriate.
- Include reliability and validity of tests used with study participants and ensure accurate reporting of statistical tests.
- Try to anticipate potential reader questions.
- Avoid confirmation bias, which is the tendency to search for, interpret, and remember information in a way that supports your existing beliefs while ignoring or dismissing opposing evidence.
- Create a complete package. Consider everything that will strengthen your manuscript, including graphics, sidebars, titles, and keywords. Ensure everything flows together. For instance, don’t introduce a new concept in your conclusion.
After revisions
Even if an article isn’t rejected after PR, journal editors frequently ask authors to revise a manuscript based on the reviewers’ comments and resubmit it before the editor decides whether to accept it for publication.
Problem: The author hasn’t addressed the PR comments.
Solution: The solution is easy: Address all comments, even if you don’t plan to make a requested change. If you disagree with a comment, respond with a respectful, well-reasoned rebuttal that clearly supports your position. A table can help ensure you don’t miss any comments. (See Sample manuscript revision table.)
Sample manuscript revision table
Using this type of table helps ensure you address each peer review comment. You don’t have to make every requested change, but you do need to explain why you’re not making a change. You can add page numbers to highlight change location.
In some cases, peer reviewers may offer conflicting suggestions. If you truly can’t determine the best direction, consider reaching out to the editor. However, conflicting advice also may indicate an unclear section that requires revision.
If rejection occurs
At some point in your writing career, despite your best efforts, you’ll likely receive a rejection letter (usually sent via email). This letter can spark various emotions, ranging from anger to disappointment to feeling like a failure. Remind yourself of the ground rules and turn the rejection into a learning experience. (See Coping with rejection.)
Coping with rejection
Even after you’ve followed the advice in this article, your manuscript may be rejected. Using the photovoice method (which included photography, interviews, and a focus group) with authors who had experienced manuscript rejection, Argan and colleagues identified three strategies for responding:
Avoidant. These strategies included denial (for instance, believing the reviewers were biased rather than accepting a problem existed with the manuscript); venting frustration to colleagues; and self-distraction (such as working on other projects or going for a walk).
Neutral. Some authors used humor to mitigate their response to rejection.
Approach. In this case, authors may have first engaged in self-distraction, but they ultimately accepted the rejection and reviewed the feedback to determine the reasons behind it. They sought support from family, members of their social circle, and other authors who had experienced rejection. They also planned their next steps, such as submitting to another journal, and engaged in positive reframing by focusing on what they learned from the experience.
Approach strategies offer the most positive options for coping with rejection. They also will help you stay on your writing path and improve your writing skills.
If the editor provides PR comments, use them to improve your manuscript or understand whether you missed the mark in choosing the target journal. If PR comments aren’t included, most journals will provide them upon request. You also might want to share the manuscript and reviews with a trusted colleague to obtain feedback.
It’s usually best not to email or call the editor to explain why your manuscript shouldn’t have been rejected. It’s highly unlikely to work, and you don’t want to jeopardize future submissions to the same journal. However, if you feel the PR comments were inappropriate, email the editor and calmly express your concerns, being sure to present your thoughts objectively.
If you believe you can revise the manuscript for resubmission elsewhere, carefully select a journal, review its guidelines, and work on your revisions. Use the feedback you’ve received to revise the manuscript and tailor it to the new journal. Don’t simply send the original manuscript.
In some cases, you may decide you don’t want to invest time in revising. That’s perfectly fine; you likely gained valuable insights from the feedback you received, which will enhance your future writing efforts.
Above all, keep writing so colleagues and patients can benefit from your knowledge. Fortunately, as with any skill, practice will improve your ability. In addition, the tips provided here will help reduce the likelihood of future manuscript rejections.
Cynthia Saver is a medical writer in Columbia, Maryland, and editor of Anatomy of Writing for Publication for Nurses, 5th edition. She frequently speaks on writing topics.
American Nurse Journal. 2026; 21(7). Doi: 10.51256/ANJ072620
References
Argan M, Dinç H, Argan MT, Özer A. What does rejection look like? A photovoice study on emotions and coping regarding manuscript rejection. Curr Psychol. 2023;16:1-19. doi:10.1007/s12144-023-04253-5
International Committee of Medical Journal Editors. Use of artificial intelligence in publishing. icmje.org/recommendations/browse/artificial-intelligence
Jounral of Obstetric, Gynecologic, & Neonatal Nursing. Style guide for authors. legacyfileshare.elsevier.com/promis_misc/JOGNN%20Style%20Guide%20for%20Authors.pdf
Kembro JH, Kunisch S, Durach CF. Why review papers get rejected: Common pitfalls and how to avoid them. Int J Phys Distrib Logist Manag. 2025;55(11):163-92. doi:0.1108/IJPDLM-03-2025-0125
Mueller B, Kolata G. Nobel prize awarded to Covid vaccine pioneers. The New York Times. October 3, 2023. https://www.nytimes.com/2023/10/02/health/nobel-prize-medicine.html
Nakayama DK. Turning a rejection into an accepted manuscript: How to rework a rejected manuscript. Am Surg. 2026;92(4):1059-61. doi:10.1177/00031348261416454
National Institutes of Health. NIH’s definition of a clinical trial. April 13, 2026. grants.nih.gov/policy-and-compliance/policy-topics/clinical-trials/definition
Pickler RH. Getting reviewed. Nurs Res. 2021;70(4):237-8. doi:10.1097/NNR.0000000000000515
Pickler RH. We get letters. The Writer’s Camp Journal. 2026;2(1):9. doi:10.5281/zenodo.18270341
Saver C. How to select and query a publication. In: Saver C. Anatomy of Writing for Publication for Nurses. 5th ed. Indianapolis, IN: Sigma Theta Tau International; 2024; 38-56.
Teixeira da Silva JA, Nazarovets M. Rejected papers in academic publishing: Turning negatives into positives to maximize paper acceptance. Learned Publishing. 2024;38(1):e1649. doi:10/.1002/leap.1649
Wakeling S, Paramita ML, Pinfield S. How do authors perceive the way their work is cited? Findings from a large-scale survey on quotation accuracy. JASIST. 2025;76(10):1396-1410. doi: 10,1002/asi.70000
Key words: manuscript rejection, writing, publishing
