Peer review remains the cornerstone of academic publishing and underpins the credibility, integrity and advancement of scientific knowledge. Within nursing and the wider health sciences, peer review performs a vital gatekeeping function by ensuring that research and scholarship are robust, ethically conducted and meaningful for practice. Despite its centrality, peer review is under clear and obvious strain. Editors across journals are increasingly reporting considerable difficulties in securing timely reviews of adequate quality. In this editorial we consider the contemporary challenges of finding peer reviewers, reflect on the collective responsibility of the academic community, explore the possibility of paying peer reviewers and consider emerging debates about the use of artificial intelligence (AI). What is abundantly clear is that peer review for journals cannot continue in its current form if it is to maintain its primary purpose. The current crisis in peer review has been widely recognised across health disciplines with editors routinely reporting low acceptance rates for review invitations, with some needing to invite dozens of potential reviewers to secure just two reviewers for a manuscript. The reasons for this are multifactorial and widely discussed in the academic publishing world where there is consensus that academic publishing is a system under pressure (Adam 2025). The dominant factors creating this pressure are the constantly growing time constraints faced by academics who are being challenged to undertake more teaching, more research and take greater responsibility for administration, leaving limited capacity for unpaid scholarly activities such as peer review. At the same time, the volume of article submissions has grown exponentially. At the Journal of Clinical Nursing we have seen a 30% increase in new manuscripts so far in 2026, following a 43% increase in 2025. Like many disciplines in health and biomedicine, manuscripts are now being submitted for consideration by nursing journals on a scale that far exceeds the capacity of current peer review systems. This expansion reflects broader structural drivers, including intensification of ‘publish or perish’ cultures, the increasing globalisation of research and expectations of national research assessment exercises. Ironically, the same drivers that have increased demand for publication have not equivalently incentivised participation in the peer review process. The consequences are significant. Delays in completing peer reviews affect authors' careers, can impact on funding timelines and risks slowing the dissemination of new knowledge that could inform professional decision-making. In nursing and applied health sciences, delayed or suboptimal peer review will inevitably have an impact on the timely translation of evidence into clinical practice, with potential downstream effects on patient safety and quality of care. Existing challenges include a smaller pool of willing reviewers leading to reviewer fatigue, narrowing perspectives and reinforcing bias. Some reviewers do not take sufficient time to complete a thorough review, resulting in superficial or inconsistent feedback, or feedback that is unduly harsh or unprofessional, damaging authors' confidence. Delays in identifying willing peer reviewers also have cascading effects on both the quality and efficiency of the publication processes (Horta and Jung 2024). At its core, peer review is a reciprocal endeavour positioned as a professional obligation grounded in collective responsibility for the scholarly record (Committee on Publication Ethics 2017). Academics submit their work to journals with the expectation that it will be reviewed by knowledgeable peers. Historically, there has been an implicit expectation, if not an obligation, for those who benefit from peer review to also contribute to it. This reciprocity appears increasingly fragile. There is a growing tension between viewing academia as a ‘community of scholars’ and as a transactional system. When considering the ‘community of scholars’ model, peer review is a shared responsibility and part of the collective enterprise of advancing knowledge in a discipline. In a transactional model, activities are weighed against measurable outputs, such as publications, grants and other metrics. Unfortunately, peer review is often invisible in performance frameworks and inevitably becomes deprioritised by individual academics and organisations. This shift raises important ethical questions. If academics rely on peer review to validate their own work, can they justifiably opt out of contributing to the same system? It could be argued that peer review should be considered a professional duty, akin to teaching, research and other academic engagement activities. Failure to formally recognise peer review within academic workload models risks perpetuating a system that depends on invisible labour while simultaneously undermining its sustainability. The intrinsic benefits of engaging in peer review should not be overlooked. Peer review provides early access to emerging research, can build professional networks, enhances critical appraisal skills and informs a reviewer's own writing. We would contend that undertaking peer review is a form of continuing professional development that is as relevant to early career scholars as it is to established professors. Reframing peer review as a scholarly privilege, rather than an unnecessary burden, could help to reinvigorate engagement in this important process (Choi and Montayre 2025). Furthermore, ensuring that peer review work is recognised and formalised within academic workload models would raise the prominence and importance of this academic activity. One proposed solution to reviewer scarcity might be financial remuneration. The logic is straightforward. If peer review requires expertise and time, then it should be recognised and rewarded accordingly (Emanuele and Minoretti 2025). Payment could incentivise participation, improve accountability and acknowledge the value of reviewers' contributions. However, the introduction of payment raises complex questions. Would it fundamentally alter the ethos of peer review? Could it create inequities, privileging those with time to review for income while marginalising others? There are also practical considerations. Who would bear the cost? Journals already operate within constrained financial models so additional expenses might ultimately be passed on to authors or institutions. There is also a risk that payment could compromise the perceived impartiality of peer review. If reviewers are compensated, might they feel pressure, either consciously or unconsciously, to provide favourable reviews? Alternatively, could payment incentivise speed over quality? Paying peer reviewers might contribute to solving some of the current challenges but might also lead to new complications. Alongside these debates, the rapid development of AI is transforming academic publishing. AI tools are already being used to assist editors in identifying potential peer reviewers based on expertise and publication history; so might the next step be for AI to undertake the peer review process itself. How this review process is described would, of course, need to change as the input of peers is removed from the process. The potential advantages are clear. AI can process large volumes of text rapidly, identify methodological inconsistencies and provide structured feedback. In a system overwhelmed by scale, AI could offer greater efficiency, scalability and even quality. Some would even argue that human peer review is no longer sufficient to ensure research integrity, given the sheer volume of submissions (Bauchner and Rivara 2026). There is growing evidence that AI-assisted reviews can approximate human performance in certain domains, particularly in identifying technical errors or summarising content. Moreover, AI could reduce reviewer workload by generating preliminary assessments that human reviewers can refine. Indeed, proposals have been made for AI-generated ‘baseline reviews’ that serve as a starting point for human evaluation (Macario 2026). However, the use of AI in peer review is not without risks. Concerns include issues of bias, confidentiality and the potential for misuse. AI systems could replicate existing biases and might favour certain institutions, methodologies or writing styles. AI might also struggle to assess novelty or the potential of a research paper to make an original contribution to knowledge, areas where human expertise and experience remain critical. Transparency is also a significant concern with readers and authors having a legitimate interest in knowing whether a review involved the use of AI, making clear disclosure policies essential (Aczel et al. 2025). AI is developing at an astonishing rate and it is inevitable that current concerns will be overcome in the near future. The current crisis in peer review and developments in the use of AI leads to a fundamental question. Does peer review require a human reviewer? The answer, at present, is almost certainly ‘yes’, but with important caveats. Peer review is not merely a technical exercise but is a process of scholarly judgement. It involves evaluating the significance of the research, including its contribution to existing knowledge and possible implications for practice. In nursing, this includes assessing relevance to patient care, ethical considerations and the integration of evidence into practice contexts. These are important human judgements, informed by experience, values and professional insight. Yet it would be naïve to assume that peer review can remain unchanged. The scale and complexity of contemporary publishing demand new approaches. A hybrid model, combining AI efficiency with human judgement, may represent the most pragmatic solution. In such a model, AI could support routine aspects of review, while human reviewers focus on higher-order evaluation. Importantly, the introduction of AI should not absolve academics of their responsibility to engage in peer review. Rather, it should enable more effective participation, reducing burden while preserving the integrity of the process. It is also worth noting that open peer review, where reviewer identities and reports are published alongside articles, represents a further structural reform that could improve accountability and transparency and warrants consideration alongside possible technological solutions. Addressing the peer review crisis requires more than technological solutions. It demands cultural and structural change. Institutions, publishers and individual academics all have important roles to play. First, academic institutions should recognise and reward peer review as a core scholarly activity. This could include incorporating peer reviewing into promotion criteria, workload models and professional development frameworks. Visibility and recognition are essential to sustaining engagement. Second, publishers should continue to innovate in how they support those who commit to undertake peer reviews, both in the tools made available to them and the training provided. Third, the academic community needs to reaffirm its collective responsibility. Peer review is not an external service provided by others but a shared endeavour that depends on mutual participation. Without this commitment, the current system risks becoming unsustainable. Finally, the integration of AI should be approached thoughtfully and transparently. Clear guidelines, ethical frameworks and ongoing evaluation will be essential to ensure that AI enhances and supports the quality of the peer review process. Peer review stands at a crossroads. The challenges of reviewer scarcity, increasing submission volumes and evolving technologies are reshaping the landscape of academic publishing. While solutions such as payment and AI offer potential, they also raise important questions about the nature and purpose of peer review. At its heart, peer review is a collective enterprise and a manifestation of the academic community's commitment to rigour, integrity and shared knowledge. Peer review, in some form, will remain an important part of the publication process so the question is whether academics are willing to sustain it. As we look to the future of peer review, we need to ask if academics do not continue to engage in the process, then who, or what, will take their place? The authors have nothing to report. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no data sets were generated or analysed during the preparation of this Editorial.
Gelling et al. (Fri,) studied this question.