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Virtual learning: Nurse leaders offer strategies for choosing online programs


Technology has touched nearly every aspect of Americans’ lives. It’s changed how people communicate, work, and learn. And while some nurses view the explosion of online nursing programs as a benefit to students, others have some concerns about the efficacy and, in some rare cases, the legitimacy of these programs.
Registered nurse (RN) leaders all agree, however, that people need to fully investigate any beginning or advanced nursing program that’s offered online—before they sign on the dotted line.
One aspect that students should examine is the structure of the program, because online courses and programs vary. Some can be asynchronous, which means that the student and the instructor are “in class” at different times. Some are “interactive,” which means that students and teachers are interacting in “live time,” such as through Web-based seminars, for at least a portion of a course. Other courses require scheduled face-to-face meetings in addition to online work.
According to the American Association of Colleges of Nursing (AACN) report, 2006-2007 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, the breakdown of nursing degree programs that offer more than 50% of their courses online is as follows: entry-level baccalaureate programs, 1%; master’s nursing programs, 24.1%; research-focused doctoral programs, 16.5%; and doctor of nursing practice programs, 25%.
Research on medical programs with online components showed that those that combine online and in-person course work had the best student outcomes, and some nurses believe the same holds true for nursing programs.
“If a school’s online program—be it a BSN, MS, or PhD—meets our essential competencies and standards, there should be no significant differences in student outcomes,” says Jeanette Lancaster, PhD, RN, FAAN, president of AACN and the dean of the University of Virginia, Charlottesville, School of Nursing.
In terms of clinical rotations, students may work with faculty from the nursing program or work with pre-arranged preceptors at facilities near their homes—depending on the structure of the online program.

Fulfilling a need
In 1997, when nurse educators at the University of Colorado at Denver and Health Sciences Center (UCDHSC) started their fully online graduate program, they expected to attract students from remote areas of their state.
“We really were targeting rural nurses, because we felt they shouldn’t have to move, drive 5 hours to our school, or take classes so sporadically that it takes them 10 years to get a master’s degree,” says Diane Skiba, PhD, FAAN, FACMI, professor and project director of the I-Collaboratory: Partnerships in Learning at UCDHSC School of Nursing. “But we found that most of the nurses who applied for our online program came from across the street at University Hospital, where they either worked the night shift or had other significant demands on their time.
“We realized we discovered an unmet need,” says Skiba, who wrote a chapter on online learning for the seventh edition of the Mosby-published Current Issues in Nursing. (The chapter provides questions students should ask about Web-based courses and online programs.) Since the online graduate program launched, the school added a totally online RN-to-BS program and an undergraduate program, which blends traditional, in-class courses with online offerings.
The need for flexibility is indeed a key factor that’s fuel­ing the growth of online, or distance, learning programs.
“These programs offer a real possibility to someone who’s always wanted to become a nurse, but feels
she or he can’t attend traditional classes because of ongoing family or work responsibilities,” says Beverly Malone, PhD, RN, FAAN, chief executive officer of the National League for Nursing (NLN) and former ANA president.
This access and convenience make distance a “non-issue,” she adds. “However, the responsibility we have in nursing is to ensure that we manage these programs so they meet quality standards.”

Buyer beware
Some “companies” have used the tremendous growth of legitimate online programs and the ongoing RN shortage to line their pockets by offering fraudulent degrees. Some target people who want to become nurses, while others focus on practicing RNs who want to advance their careers—without effort.
State boards across the country have reported ongoing problems with some publishing companies that imply that if a student pays them, for example, $5,000 for study materials, she or he will be able to become an RN, says Nancy Spector, PhD, RN, director of education for the National Council of State Boards of Nursing.
“Some of these companies even associate themselves with other programs, leading people to believe they are earning their degree from an accredited nursing school,” she says. “Prospective students need to be smart consumers.”
Laurie Badzek JD, RN, LLM, director of ANA’s Center for Ethics and Human Rights, also is concerned about RNs knowingly or unknowingly pursuing advanced degrees that are fraudulent.
“At ANA, I’ve received e-mail messages from nurses who are concerned about colleagues who are ‘purchasing’ degrees, generally so they can advance into managerial positions,” says Badzek, also a professor at West Virginia University School of Nursing. “They get these ‘degrees’ without doing anything more than filling out some information and paying a fee.”
Badzek maintains that it’s only a minority of nurses who pursue bogus degrees, but says “it’s clearly unethical and most likely illegal.”
Aside from the cost or credit for “life” experiences, nurses should be suspicious when an online program requires a prospective student to register or provide detailed personal information before gaining substantive information on the program itself.

Strategies for online success
The vast majority of programs are legitimate, and their numbers are likely to grow. That said, nurse leaders and educators suggest that prospective students look for and consider the following characteristics when evaluating programs.

Proper accreditation
The two major accrediting bodies are the AACN-affiliated Commission on Collegiate Nursing Education and the NLN Accrediting Commission. Students also should determine whether the entire college or university has been approved by the regional accrediting agency, such as the Northwest Commission on Colleges and Universities. Accreditation shows that the program is meeting quality standards.
Also, entry-level programs must meet board of nursing standards for students to be able to sit for the NCLEX, and there are accrediting bodies for nurse-midwifery and other advanced practice nursing programs. A school’s NCLEX pass rate can be a helpful indicator.

Clinical experience
Clinical rotations should be supervised by qualified professionals. Many distance programs allow students to work with preceptors who are located in nearby facilities.
However, when looking at these preceptor-supervised clinicals, students need to check with their state nursing board to ensure it allows for this type of experience, according to Spector. Some states must approve all preceptored clinical experiences that take place within their geographic borders, even if the online program is already approved by another state.

Prospective students should take the personal approach by seeking current students and faculty to discuss aspects of the program. They also should research the reputation of the institution and faculty.

Learning style compatibility
Students need to determine if their learning style is compatible with an online approach. Students need to have discipline to keep up with the class workload, and those who require instant interaction may be better served in a traditional classroom setting.
“How well students function—whether in an online or traditional program—depends on what the learner brings to the table and puts into the course work,” says Julie Aucoin, PhD, RN-BC, CNE, the leader of a National Nursing Staff Development Organization task force that developed a position statement called Principles of Academic Nursing Education Programs Delivered at a Distance.
The statement captures the challenges that institutions face in offering online programs and provides students with recommendations on choosing a distance learning program. Several nursing organizations have endorsed the statement, which is available online at
Skiba also offers a series of questions in her book chapter to help students determine if they are ready for online learning. Another resource is

Adequate personal interaction
Some nurse leaders are particularly concerned about limited face-to-face, hands-on interaction for students in entry-level nursing programs. They urge these students to look for programs that offer a blend of online and in-person course work that allows for ample opportunities to interact with faculty, preceptors, other nursing staff, and other students.

Available support services
Prospective students also should investigate whether the institution offers online participants a full range of support services. For example, nursing students typically have reading requirements, so distance learners need to ensure they have access to the university’s online library, Skiba points out.
Concludes Skiba, “The No. 1 recommendation I give people is that they should do their homework, be as selective about these programs as they would when considering a traditional program, and use common sense.”

Susan Trossman, RN, is the senior reporter in ANA’s Communications Department.

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