By Cathryn Domrose
When Christina M. DiNapoli, DNP, FNP-BC, RN, enrolled in the DNP program at the Johns Hopkins University School of Nursing in Baltimore, she was a little skeptical, even though she knew the online nursing graduate program, ranked third in the nation by U.S. News & World Report in 2015, had a good reputation. She was concerned about the disconnect between seeing patients at the Weill Cornell Medical College Center for Sleep Medicine in New York where she works and signing onto a computer at the end of the day to take classes from instructors nearly 200 miles away, with classmates in different time zones who communicated mostly by email. “I was sort of worried I was going to be out there all alone,” said DiNapoli, who traveled to the nursing school campus in May 2014 to celebrate graduation with a close-knit group of new friends she had seen in person only a few times. “It was really the exact opposite.”
DiNapoli said she talked more often to classmates in different states than to some friends living in the same city and felt closer to her Hopkins colleagues and instructors than to some colleagues at work. She was 10 years younger than the other students, but it didn’t matter, she said. No one ever noticed or remarked upon the age difference, which might have been more obvious in a face-to-face program.
“It was great — I loved it,” she said. “I never felt alone. We’re all talking about when we can have a reunion.”
Besides offering a curriculum equal to that provided in a classroom, successful online nursing graduate programs use technology, group projects designed for online learning, and one-on-one time with instructors to create an academic environment, foster a sense of teamwork and offer professional socialization to students who almost never see each other and may have completely different schedules, said online instructors and students in three of the nation’s top-ranked programs.
“Online programs are not correspondence programs,” said Linda M. Goodfellow, PhD, RN, FAAN, clinical associate professor at Duquesne University School of Nursing in Pittsburgh, which has one of the 10 best online graduate nursing programs in the country, according to U.S. News & World Report. “We have a community of scholars. We just have to work differently at having them be part of that community.”
Enrollment in degree programs has been increasing at all levels as nurses and employers develop higher expectations of advanced education for the profession, according to healthcare researchers. Online learning is increasingly becoming the method of choice for many. About 7.1 million students took at least one online course in 2013, reflecting an annual growth rate of 6.1%, according to the Babson Survey Research Group.
To create an atmosphere of academic collegiality and community, students and instructors use a variety of tools to duplicate interactions they would normally have in person. Class discussions on case studies or situational problems are often held on message boards, with students contributing their portions whenever they sign on. They might write group papers or contribute to group projects on “wikis,” Web pages that allow collective contributions and edits. Real-time class meetings and discussions are held on Web conferencing sites. Instructors post videos of guest lectures and interviews and record student presentations for the entire class to see. They use Facetime or Skype for one-on-one meetings. Students regularly communicate among themselves and with instructors through email and by phone.
“Students have more access to me online than they do face to face,” said Christell O. Bray, PhD, RN, FNP-BC, FAANP, professor and coordinator of the family nurse practitioner program at the College of Nursing and Health Sciences, Texas A&M University, Corpus Christi. She considers herself a night person, and a student who sends her questions at 11 p.m. might get a response faster than those restricted to daytime hours. She also is better able to keep track of students’ progress and engagement, she said. “In an online course, you can’t sit in the back of the room and hide. If somebody’s not participating, I know right away.”
Online school tools transfer to real life
Matt Becka, MSN, RN, chose the online MSN leadership program at Texas A&M not just because it allowed him to keep working full time as an ED nurse and eventually take a job in another city while he went to school. Becka wanted to become comfortable with the tools and skills of online communication, from Web conferences to computer-based scheduling to proper email etiquette. Learning to work remotely “to me was a necessity,” said Becka, speaking from his office in London where he works as the senior clinical manager for Teleflex, an international medical device company. Becka communicates regularly with colleagues and clients in Europe, Africa and the Middle East. “There’s only so much business now that’s done face to face,” he said. “A significant part of your day is spent behind a computer screen.”
Becka’s experience at Texas A&M has helped him greatly in his job, he said. But he thinks experience in connecting with people online is important to many nursing jobs, whether supervising employees on different hospital campuses or using telehealth to see patients. Among other things, online education taught him to appreciate the nuances of written communication, he said. “Some people can be very direct and not realize that regardless of what you’re saying, there’s a tone associated with it.” He learned to re-read his own emails before sending them, asking, “What’s the worst way someone could take this?”
Paula Nersesian, MPH, RN, is in a traditional nursing PhD program at Johns Hopkins and also took a nurse educator certificate program online there. The diversity of students from across the country in the online program impressed her. Some taught in schools of nursing, others were educators in hospitals or clinicians working on a DNP. The wide range of experience and settings benefited peer reviews of projects and papers, she said. For instance, one of her fellow online students who worked in a hospital produced a staff development training session on contraception and sickle-cell disease that was completely different from her own project — a lecture to PhD students on a topic in genetics. “I thought it was a productive exchange, seeing how she applied her project in a (clinical) practice setting.”
But Nersesian wouldn’t want to do her PhD entirely online. Complex discussions on ethics and clinical theory that she has had in the classroom would be difficult to replicate with an asynchronous online message board, she said. “You can’t respond as quickly. There’s less back and forth. But you might accomplish that in a synchronous meeting of students online,” such as on a conferencing site.
One drawback to an online program, Nersesian said, is the time spent getting the technology to work properly — having a strong Internet connection, connecting to a VPN, remembering various passwords. A program might work on a desktop or laptop device but not a mobile one, or a connection speed might not be fast enough to run certain programs on all devices. “It’s a lot more time spent interfacing with electronic devices,” she said.
Though they are sometimes seen as ways for universities to save money, online classes require high-quality design and instruction to stay up to professional standards, nursing instructors said. Classes need to stay small to allow instructors to communicate with students, said Anne E. Belcher, PhD, RN, ANEF, FAAN, associate professor and director of the office for teaching excellence at the Johns Hopkins University School of Nursing. Good instructional designers are critical to having quality online content, she said. Whether online or face to face, “we’re very careful to have all the courses look alike, with the same syllabus and content.”
“Capping the number of students is a huge thing” in a good DNP program, DiNapoli said. She would be concerned about an online program with 100 students in a class. The one-on-one relationship with an instructor would be difficult, she said. “Universities need to take into consideration all of the resources they have” when offering online programs.
Instructional designers at Johns Hopkins constantly look for new technology that allows students and instructors to better interact, such as VoiceThread, which allows participants to record their voices for presentations or discussions, Belcher said. Her program, at students’ request, is also looking at Jing, a screen-casting technology that allows instructors to comment verbally on online student papers. “They hear the feeling in our voices,” she said. “I can say what I’m concerned about or pleased about more easily than I can in writing.”
Some programs require more in-person time than others. Johns Hopkins’ DNP program requires students to spend a week on campus three times a year for the first year and once during the second, Belcher said, though other graduate nursing programs are completely online. At Duquesne, PhD students travel to the campus for a weeklong orientation, and most return again to defend their dissertations, which are recorded and streamed onto the Internet so fellow students can watch and ask questions in real time, Goodfellow said.
Though they don’t believe online learning will ever completely replace the traditional classroom, online instructors say it is another important way to provide higher education to those who want it, and will increase along with the demand for education. “It is a different way of learning than when I started out,” Bray said. “I don’t think either one of them is better. I think it’s what fits the needs of each student.”
Cathryn Domrose is a staff writer.
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