This paper examines the growing U.S. nursing shortage and how distance learning and online education are being deployed to expand access to nursing programs. It reviews enrollment barriers at traditional nursing schools, surveys existing online RN and BSN programs at institutions such as Indiana University, the University of Phoenix, and Rio Salado College, and analyzes the particular challenge of providing hands-on clinical training in an online environment. The paper also considers simulation laboratories as a technology-based middle ground and concludes with a review of literature on the future trajectory of online nursing education, emphasizing the need for systematic, theory-driven course design to meet a growing and diverse healthcare workforce.
The nursing shortage in the United States is expected to worsen as baby boomers age and their healthcare needs grow. Compounding the problem, nursing colleges and universities across the country are struggling to expand enrollment levels to meet rising demand for nursing care. Technology-driven solutions, including online learning, are being studied and increasingly utilized to address these needs. However, a number of difficulties persist with such technology-based approaches — most notably the hands-on clinical coursework that is an essential component of any nursing curriculum. In the future, some of these challenges may be better resolved as the need for nurses continues to grow.
In 2006, officials with the Health Resources and Services Administration projected that the nation's nursing shortage would grow to more than one million nurses by the year 2020 (Fact Sheet). Such shortages are not consistent from one state to another, or even across regions within states.
Michigan's Center for Nursing conducted a study of its schools to determine the status of nursing programs statewide. In some cases, qualified applicants were not enrolled even though there were unfilled admission slots. Programs may have difficulty filling slots if they lack faculty, facilities, or clinical placement sites. Openings may also go unfilled if there are too few qualified applicants, if admitted applicants do not enroll for financial or personal reasons, or if they are accepted to other programs. Yet, while some programs report insufficient qualified applicants, most say they have more qualified applicants than approved admission slots. Overall, among the 40 institutions studied, 4,298 qualified applicants were not enrolled.
The American Association of Colleges of Nursing (AACN) recognizes that technological advances are creating new opportunities to improve both the quality of and access to nursing education. In Washington State (Department of Health), for example, several programs use Blackboard and other technologies as communication aids. Seven nursing programs identified portions of specific courses available online, one program made all course syllabi and materials available online, five programs used interactive television, two reported web-based or web-enhanced courses, and one was video-streaming selected courses. The AACN notes that the model of students and faculty being tied to a single institution for their entire academic life is no longer the norm. The potential for students to take core coursework at multiple institutions for credit through online learning is now feasible, and faculty may work for a traditional university while also teaching in "virtual universities."
Utilizing distance learning to obtain a degree as a registered nurse is becoming increasingly common. At Indiana University, for instance, all required courses in the nursing major for the RN-to-BS program are offered via the Internet. Clinical courses are arranged in the student's own community, and general education requirements can be fulfilled through a combination of distance learning coursework, the Indiana College Network, and a local college or university. On-campus visits are not required.
In 2005, Karen Brown conducted a qualitative research study of the RN-from-LPN education program at Central Michigan University, which was the first online RN completion degree of its kind. Overall, graduates were satisfied with the program but noted specific areas for improvement, including student preparation, faculty-student communication, and testing. Four themes emerged from the data: (a) students entered the program with some unrealistic expectations about its rigor and flexibility; (b) the student cohort provided learner bonding and support that positively affected learning; (c) students faced several barriers to success; and (d) the program provided access and career advancement to those who might not have been able to attend a traditional program. Online programs thus offer a means of increasing the number of registered nurses by expanding access, provided that barriers are minimized. According to Bird, another example is Rio Salado College in Tempe, which offers online coursework supplemented by a 900-hour clinical component at one of a dozen partner medical centers. Upon successful completion, students receive an Associate in Applied Science degree and are prepared to enter a field facing widespread shortages of trained personnel.
Where distance learning works well across varied degree programs, its deployment depends on institutional preference and culture. The University of Phoenix, for instance, offers online programs only for full-time RN-to-Bachelor of Science in Nursing (BSN) students, with one immersion course at a time lasting five to six weeks. The University of Nebraska Medical Center College of Nursing's distance learning program delivers a doctoral track for master's-prepared faculty at sites in South Dakota, Nevada, and Kansas. Master's students at the University of South Dakota take graduate courses for the psychiatric nursing specialty remotely through Nebraska's program and earn their core courses and degree from USD (AACN Bulletin). Because of the requirement for clinical coursework, obtaining an entry-level LPN degree entirely online is considerably more difficult. At Northwestern Michigan College, for example, clinical classes are based on regional placements and must be taken in Traverse City. The school acknowledges: "While in the future we hope we can come up with cooperative solutions between states and between nursing programs, we are not there yet."
"Difficulties arranging hands-on clinical placements online"
"Simulation equipment as shared clinical training alternative"
"Literature review on online nursing education trends"
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