Traditional university education has involved attending regularly scheduled classroom sessions and interacting with faculty and classmates in a synchronous, in-person format. Students would typically need to live in or near a university, or move to the location in order to attend graduate programs. Individuals in rural or other remote areas, as well as geographic areas lacking specific types of programs, have been disadvantaged in attending graduate nursing programs, thus reducing opportunities to educate health care providers needed in underserved areas. Graduate students in nursing are frequently women, have growing families, and typically have employment positions as registered nurses that their families rely on for financial support. Common sacrifices to participate in graduate nursing education include leaving families and loved ones behind, traveling long distances, and added personal and financial cost. A convenient graduate program that did not require weekly travel to campus was an attractive option for our faculty.
During the late 1990s it became much easier to deliver course content online in an interactive fashion, and the faculty in the School of Nursing sought funding to do exactly that. Although the new technology was intriguing and the opportunity to learn new teaching methodologies appealing, the goal driving our work was to increase access to graduate education for nurses who wanted to become nurse practitioners, nurse-midwives and public health nurse leaders, and other graduate-level specialists. Beginning with a small internal University grant, several faculty members partnered with digital technology experts to each redesign a segment of an existing face-to-face course. That opportunity to learn new strategies together in a hands-on environment was followed by funding from the Academic Health Center Vice President to redesign three core graduate nursing courses. Two large federal training grants followed and provided full funding for the redesign of all courses required for the complete transition of five graduate nursing specialties from a traditional face-to-face classroom-based program to a hybrid or blended online learning environment, thus increasing access to graduate education in the upper Midwest.
Our strategy from the beginning was to increase access and flexibility for students by reducing required time in the classroom. At the same time, we believed it was important to interact regularly with students in person to fully develop a learning community and to support professional socialization. Purchasing instructional design, video, and other services within the university, we built courses with an eye to interactivity and flexibility. A format that provided students with a common look and feel to the courses (standard course banners, format to course components, colors, etc.) was developed by our technology partners. Each course was divided into topical modules that included specific objectives, readings, other electronic resources, and guidance from faculty. That guidance was initially provided in the form of notes and study questions with some audio and PowerPoint presentations. As newer technology became available, we have introduced more audio, video and other media rich components. Face-to-face in-person sessions two to three times each semester, where students met with faculty and each other in each of their courses, were essential components in the success of our program.
This work would not have been possible without several other sources of support. Faculty members were the primary content experts and partnered with technical staff and instructional designers to redesign their courses. Administrative support was essential and key to our success. Although the project focused on a subset of graduate nursing specialties, the core courses required of all graduate nursing students were redesigned and thus affected a broader range of students who may or may not have planned to take some coursework by hybrid distance technologies. Regular interaction with and support from the associate dean for education were instrumental in our success. Biomedical library staff members were other key partners to help faculty make reading materials and resources available to students no matter where they lived. An unexpected outcome after introduction of the online option for required core courses was that the online sections became the first to fill and some face-to-face sections were canceled for lack of registrations.
The primary impact of this project was the opportunity for nurses to return to school in a more flexible and convenient environment, with clinical practicum sites in their home communities where possible. Nurse-midwives, nurse practitioners, public health and other nurse leaders, and psychiatric-mental health clinical nurse specialists are practicing in new geographic locations. These practice sites are primarily in the five state upper Midwest area, and would not have otherwise occurred without our program. Some of our graduates also practice in medically underserved areas, thus expanding the reach of quality health care.
Despite our initial success, insuring long-term sustainability following the federal funding period presented an important challenge to insure continuation of our work. From the beginning, we maintained a list of tips related to course development, interaction with students, learning activities, recommendations for process such as when to open an online course, managing course email and assignments, etc., to help faculty new to this method of teaching. Staff received training to support faculty in building course web sites and loading documents and other resources so faculty were able to concentrate on content development. Staff also participate in ongoing development related to course management systems and have been essential in supporting the faculty through two major course management system transitions. Faculty have developed new skills related to managing online courses, engaging to various degrees in the more technical aspects of creating online courses and materials.
While we worked to create internal systems to maintain and continue our online course development, attention to faculty scholarly productivity through dissemination of our work was of critical importance. Multiple papers, posters and oral presentations were generated as a result of our online learning projects. One of the most exciting was our evaluation project. In partnership with technology staff from the then Digital Media Center in the Office of Information Technology, we conducted an evaluation of 25 graduate nursing courses that had been taught online more than once, thus having had opportunity for revision. Examination of each course web site was conducted by both a technology professional and a faculty member experienced in online teaching using a common tool developed for our project. We developed this tool and an evaluation rubric following a thorough literature review and finding very little available at the time. An interview with the course faculty member was also completed to add detail that would not be apparent from the review of the course web site. The results of that project were shared in the School and published in an online international nursing educational scholarship journal (Avery, Cohen and Walker, 2009).
Significant curricular activities in the School, including a change from the awarding of a master’s to a professional doctoral degree for our nursing specialty programs, led to the development of a large number of new courses in a relatively short time period. A hallmark of our progress in promoting accessible educational formats as a School was demonstrated as the new doctoral courses were automatically developed as blended online courses. Students from across the country completed one of the first blended online master’s to doctor of nursing practice (DNP) programs in the country starting in 2007. However, as rapid course development proceeded with a much larger cadre of faculty members, some of the classic look and feel of our courses was lost during the rapid expansion. It was more difficult to remain as current in newer teaching and learning technologies. Completion of new courses for the full bachelor’s (or equivalent) to DNP program provides an opportunity for our faculty to step back, reassess our progress, and plan for the future as students use social media, mobile technology and cloud computing to enhance their learning as part of the current technology educational environment.
As the University as a whole examines the best ways to provide support to faculty to teach in technology-rich environments, the School of Nursing is re-examining and redefining our common learning environments with an eye to envisioning the best ways to engage with our students and each other to support learning. We see an opportunity to renew and advance our skills fully into the present technology learning environment following an invitation in 2012 to partner in a new pilot with the Office of Information Technology. Furthermore, use of mobile technology and cloud computing demand a re-evaluation of the best ways to support students and faculty in online teaching and learning. Faculty members continue to ask what tools and techniques can be used to best support their teaching and engage students in learning. In partnership with our colleagues in OIT and the libraries, we continually strive to challenge ourselves in the quest to increase access and improve the quality of student engagement with and within our ever-changing academic learning environment.
Results of our dissemination
References
Avery, M.D., Ringdahl, D., Juve, C., & Plumbo, P. (2003). The transition to web-based education: Enhancing access to graduate education for women's health providers. Journal of Midwifery & Women's Health, 48(6), 418-25.
Avery, M D.; Cohen, B A.; and Walker, J. D. (2008). Evaluation of an Online Graduate Nursing Curriculum: Examining Standards of Quality, International Journal of Nursing Education Scholarship: Vol. 5 : Iss. 1, Article 44. Available at: http://www.bepress.com/ijnes/vol5/iss1/art44
Anderson, K. & Avery, M. (2008). Faculty teaching time: A comparison of web-based and face-to-face graduate nursing courses. International Journal of Nursing Education Scholarship, Vol. 5 : Iss. 1, Article 2. Available at: http://www.bepress.com/ijnes/vol5/iss1/art2