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1 Education INSIGHT ON... Special Section

2 Insight on... Education The decision to go back to college to complete a degree or get an advanced degree is never made lightly. Many nurses wonder how or even if a degree will benefit them, and which degree will enable them to meet their aspirations. Others are considering returning to school but face multiple obstacles. In this article, we explore online Is an online nursing education program right for you? learning as a nursing education option. We explain the types of online programs and learning formats available and discuss the factors to consider before applying to and selecting a program. Online options for obtaining nursing degrees are burgeoning. By Sheila Burke, MSN, RN, and Bobbie Whitworth, PhD, RNC Online education seriously? The question of whether online classes or degrees are as good as classroom-based ones has been the topic of several well-designed research studies. A meta-analysis that examined 86 experimental and quasi-experimental studies concluded that in nearly two-thirds of the studies, students who took distance education courses outperformed their classroom counterparts. So online programs weren t just as good as traditional educational programs; they were better. In traditional educational settings, the typical nursing course format involves a professor lecturing at the front of the room. Although technological tools may be used in the classroom, students invariably become passive recipients of information, writing feverishly to try to capture every word the professor utters. One author notes that the traditional academic model has not harnessed and integrated the extraordinary technological resources we are creating, which have the capacity to transform teaching and learning. In some colleges and universities that offer nursing courses online, lectures have been eliminated or replaced with interactive seminars. Some online nursing programs, for example, provide interactive seminars to students in all nursing courses. Seminars have multiple uses, including providing a platform for faculty to present information not yet available in a textbook, addressing topics that students have expressed an interest in, or answering questions on course content. Use of online seminars helps learners make connections among readings, online discussion, and written assignments. The instructor promotes these connections by clarifying concepts or helping learners think more deeply about a particular issue. Through this process, learners don t simply memorize material for the sake of later regurgitating it on an exam. Instead, they must demonstrate mastery of the material, which faculty evaluates based on student posts on interactive discussion boards and written papers. In short, distance education provides a deeper cognitive exercise. Are online courses the right choice for you? The most important prerequisite for success with online nursing education is for the learner to be motivated internally. The nursing profession seeks people who generally are internally motivated, as observed in a typical shift where we don t need a supervisor standing over us telling us it s time to take vitals or you need to administer 8 P.M. medications now. Nurses have to know on their own what needs to be done and organize their own time effectively to do it. Another important consideration is your work/ home schedule. Say you work swing shifts or must often work mandatory overtime, making traditional class attendance difficult; online learning may be a good choice for you. The same goes if you have multiple family responsibilities and can allocate school time between 9 and 11 P.M. 42 American Nurse Today Volume 5, Number 5

3 ONLINE PROGRAMS Bachelor of Science in Nursing (BSN) Completion Program Master of Science in Nursing (MSN) Post-Master s Certificates in Nursing Earn a higher degree. To make a greater difference. In today s ever-changing health care environment an advanced degree can go a long way in moving your career forward. Walden University s School of Nursing helps RNs from all educational backgrounds gain the enhanced skills and training they need to succeed and thrive. Walden is an accredited institution with 40 years of experience in distance education. In April 2009, U.S. News & World Report again identified Walden as having the No. 2 largest online, graduate nursing program by enrollment. Get the nursing degree you need to make the difference you want for your future and the future of health care WaldenU.edu/nursing Walden University is accredited by The Higher Learning Commission and a member of the North Central Association, Walden University s Master of Science in Nursing (MSN) is accredited by the Commission on Collegiate Nursing Education (CCNE), a national accrediting agency recognized by the U.S. Department of Education and the Council for Higher Education Accreditation.

4 Insight on... Education If you re considering online courses, first assess your computer skills. If you aren t sure how to turn on a computer, you re likely to have difficulty starting an online program. Basic computer literacy, including , word processing programs such as Microsoft Word, and the ability to navigate the Internet are prerequisites to online learning. Choosing the right online program Before applying to or enrolling in an online program, do your homework. Start by preparing a list of questions relevant to your decision. Here are some important things to consider: Regional accreditation. The United States has six regional accrediting bodies that assess colleges and universities to ensure academic quality. Some schools may indicate they are licensed by a particular state as a private school, yet don t have regional accreditation. But regional accreditation is essential; generally, it s the deciding factor in whether your degree will be accepted by employers or other colleges or universities. Length of time to degree completion. Knowing how long it will take to get your degree helps you predict when you ll finish. We d all like to complete a baccalaureate or master s degree in no time at all, but you should never sacrifice learning for speed. Find out how many courses are required and the length of each course. Some programs have terms that last only a few weeks, while others are similar to a typical college semester. Prior learning or transfer credit. Some colleges and universities establish arbitrary expiration dates on college credits, prohibiting transfer of course credits obtained more than 5 or 10 years ago. Before you commit to enrolling, the school should commit in writing which courses from your transcripts they ll accept toward degree completion and those you must take at their school. Must-have support services When exploring online nursing education programs, don t settle for a program unless it provides at least the following services: Orientation. The school should offer orientation to help you learn how to navigate the program and your classroom. You shouldn t be expected to figure it out completely on your own. Counselors for admissions and advice. Once admitted, you should be assigned an advisor to help you navigate the school infrastructure and serve as a go-to person for questions. Registration. A well-run program should have a point person you can contact with questions or to discuss issues. Also, find out whether the student or the school is responsible for initiating the preterm registration process. Financial aid and student accounts. Whether you re relying on employer-sponsored tuition reimbursement, student loans, grants, or assistantships, financing your education is a huge commitment. The school s financial aid department should be able to help you understand and plan for educational expenses. Technical support. Technical support staff should be available at critical times. If you need to submit a paper, say, by midnight, support staff who leave at 5 P.M. Friday afternoon won t be around to help you. Faculty and tutoring availability. Occasionally, every student needs help understanding a concept or solving a problem. Find out the school s policies on faculty members availability to students for evening or weekend appointments, if needed. Disability services. Technology must be accessible for students with disabilities to fully participate in online education. Congress now requires schools to eliminate information technology barriers to persons with disabilities. If you have a disability, make sure the school offers the resources you ll need to succeed in your program. Library services. Ask about library holdings specific to nursing and other healthcare journals. Find out if the program offers a library orientation and whether you can speak directly with a librarian if you need research assistance. Taking multiple courses simultaneously. Academic work in an online program can be intense, so try to determine in advance if the course load is manageable. Some programs are lock-step, meaning you must finish one course before you can take the second, and each course builds on the previous one. You may be allowed to take just one course at a time; conversely, some programs let you take more than one course simultaneously. Both approaches affect your total time to degree com- 44 American Nurse Today Volume 5, Number 5

5 pletion. We suggest starting with just one course. While everyone wants to finish quickly, you don t want to find out by the end of the second week that you ve bitten off more than you can chew. Nor do you want to wake up one morning realizing you have 15 chapters to read from three different books in three different courses by the end of the week, and not nearly enough time to do it. Begin with one course to see how it meshes with your time management, work, and family life. Technology requirements. Most schools generally require that students have MS Windows compatible computers, Internet access, and Microsoft Word and PowerPoint software. Find out about additional hardware or software requirements, such as a Web cam, microphone, or scanner. Practicum/internship. The best nursing programs include practicum requirements in courses, giving students opportunities to socialize into a new nursing role and serving as a laboratory to apply new knowledge to realworld situations. Practicum experiences can lead to job opportunities for many students. Does the online program offer support services? Support services are an important component of an online learning environment during and even after you complete your program. Colleges and universities can offer a wide range of support services. At the very least, insist on basic services, such as orientation and counselors. (See Must-have support services.) Opening doors online When considering online university and program options, be sure to self-assess your learning style and professional education aspirations. Then gather information about several schools curricula, degree requirements, and support services to help choose the degree and university that best matches your own needs. Online learning has opened doors for many students who otherwise couldn t have attended college because of life s multiple competing demands. With expansion and improvements in online education, Web-based education programs are enabling nurses to become more competitive in the healthcare workplace and prepare for new or expanded roles. Visit for a complete list of selected references. Sheila Burke is dean of the School of Nursing at Kaplan Higher Education. Bobbie Whitworth is chair of the Bachelor of Science in Nursing Program at Kaplan University. Insight on... Education ANA Members Benefit at Drexel Online Take advantage of a 25% tuition reduction! Advance your nursing education with Drexel University Online. Ranked among the best by U.S.News & World Report, Drexel offers you fully accredited nursing programs in a format that works with your busy schedule. Plus, through the ANA-Drexel Online partnership, you re entitled to receive specially reduced tuition rates. Academic Excellence, Online Convenience RN-BSN RN-BSN-MSN MSN in Nursing Education and Faculty Role MSN Nurse Practitioner Programs BS in Health Services Administration And more! Apply online at no cost: Enter ANA as your partner code when you apply to receive your tuition reduction. Contact Your Partnership Liaison Kathy Pischke (215)

6 Insight on... Education W H AT W O R K S Nursing student support groups ease stress Weekly support groups helped lower dropout rates at a community-level nursing program in California. By Diane Alvy, LMFT, RN Nursing school can cause a tremendous amount of stress, which may lead some students to drop out. Dropout rates for community colleges can range from 18% to 20%. Like other people under significant stress, nursing students commonly experience powerlessness, isolation, and loss of one s sense of individuality and personal responsibility. In 2007, the American Nurses Association California (ANA/C) passed a resolution favoring implementation of support groups within nursing programs to lower stress, broaden student-body diversity, and reduce dropout rates. In the Los Angeles area, after one communitylevel nursing program implemented weekly support groups, the school dropout rate fell from 20% to 5%. Most students attending this college are from minority groups, promoting the goal of broadening diversity of the nursing workforce. Nursing students include many Hispanic-, Filipino-, Korean-, and African-Americans. Students in the support groups, who ranged from age 21 to 52, met weekly in groups of 10 for 90 minutes. They signed consent forms and were reassured that group discussions would be confidential and wouldn t interfere with their school standing. Both the time allotment and number of students per session worked efficiently by giving each student enough time to candidly discuss his or her experiences and feelings without fear of a breach in 46 American Nurse Today Volume 5, Number 5

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8 Insight on... Education confidentiality. Students created closer bonds with each other as they shared similar concerns, triumphs, and frustrations. The program also enhanced both student-teacher and faculty-faculty relationships. Group facilitators were licensed marriage and family therapists or, in some cases, interns. All facilitators completed a course in counseling student healthcare professionals. They received weekly supervision together to ensure they d all follow the same format. The facilitator s job was to keep the group on track by providing a set format for each week. Before the groups began, agreements were signed stipulating when and where the groups would begin, along with contact information, which information could be shared between school administrators and students, and confidentiality agreements. The program s success has helped to ensure even greater success among a larger graduating class of minority students. The support groups benefited faculty as well as students. Clinical instructors found students who d attended these groups were less stressed and more confident in initiating duties. Professional development was emphasized and students quickly became more students created closer bonds with each other as they shared similar concerns. familiar with their new roles. Also, the groups helped free up more time for teachers to evaluate students skills. More research is needed to make support groups a part of nursing schools curricula. Related costs are minimal. The Los Angeles community college used grant money to fund the project director s salary, group facilitators, small gifts for students, and snacks. Students who participated reported they perceived the group as a refuge a comforting, worthwhile forum in which to debrief each week. The support groups are ongoing. They begin when the student s clinical rotations start a time when psychological issues are most ripe and continue up to graduation. Diane Alvy is founder and director of Stop Nursing Shortages, Inc., in Los Angeles, California. The ANA/C General Assembly unanimously passed the resolution she authored favoring support groups in nursing schools. For more information on how to incorporate support groups within nursing programs, visit For a copy of the 2007 resolution ( Strategy to Address Stress, Attrition Rates and the Facilitation of a Broader Student Diversity Base as it Relates to Nursing Schools: Incorporate Support Groups in all California Pre-licensure Nursing Programs ) favoring support groups, go to click on Members and then Resolutions. Move your nursing career to the next level we make it easy with online nursing programs. Nurse Educator Online Track Features Provides a solid foundation of educational and theoretical knowledge for the classroom and clinical, as well as curriculum development. MSN students gain practical experience teaching undergraduate students in an academic setting. Nurse Executive Online Track Features Provides a solid foundation in the areas of finance, human resources, management/leadership, strategic planning, and legal and ethical issues. MSN students gain practical experience working with a nurse administrator in a clinical setting. Both MSN tracks are two-year, online programs and feature the availability of part-time study. Additionally, each program has a Capstone Project, which allows individuals to identify areas of special interest for an in-depth development of an evidence-based project. The place where you belong. 720 N. 87th St. Omaha, NE (402) Nebraska Methodist College, an affiliate of Methodist Health System. Nebraska Methodist College admits students of any race, color and national or ethnic origin. Nebraska Methodist College is fully accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools, the accrediting agency for which the College is situated. Questions may be directed to: or (312) American Nurse Today Volume 5, Number 5

9 Understanding the DNP degree The author explains how the doctor of nursing practice degree could help resolve important issues facing today s nurses. By Matthew J. Patzek, BSN, RN CEN, CNOR For years, doctorally prepared nurses have focused on issues that help define nursing as a profession. In contrast, nurses involved in direct patient care have dealt consistently with inadequate staffing, high nurse-patient ratios, mandatory overtime, safety issues, and lack of respect. Does this dichotomy reflect a lack of cohesive vision and leadership in nursing? Do nursing leaders and professional organizations truly understand the day-to-day issues that direct-care nurses face? Many nurses believe these groups are out of touch with the needs of most nurses and that nurses with doctor of nursing practice (DNP) degrees can help bridge the gap. Nursing leaders have always valued advanced education. For the past 20 years, nurses seeking advanced practice certification have been required to obtain master s degrees. But recently, the nursing profession has been forced to reexamine whether a master s degree is the best educational preparation for advanced practice nurses (APNs) in light of the following issues: rapid expansion of knowledge required by APNs to function in interdisciplinary teams increasing complexity of the healthcare system concerns about the delivery of safe, cost-effective health care demands for nurses to function at higher levels and help design systems that provide safe, costeffective care shortage of faculty required to prepare future nurses and leaders specialist preparation programs that call for more credit hours than most graduate degrees require. With those concerns in mind, the American Association of Colleges of Nursing (AACN) in 2004 issued a position statement on the DNP, which called for changing APNs preparation level from master s to doctoral degrees by This initiative was supported by many specialty nursing organizations and the Institute of Medicine, which has studied such topics as the state of the nation s healthcare delivery system, patient safety, health professional education, and leadership for nursing practice. A brief history of the DNP degree In 1979, Case Western Reserve University in Cleveland opened the first clinical doctoral program in nursing, which offered a nursing doctorate (ND) degree. Designed as an entry-level program similar to the doctor of medicine degree, it didn t require specialization. Rather, it provided an entry-level nursing education for students with a bachelor s or master s degree in another field. Today it s called a DNP program and has been redesigned to allow nurses with BSNs or MSNs to continue their education. Previously, nurses with advanced degrees seeking to expand their clinical-specialty knowledge had few options. The researched-oriented PhD and doctor of nursing science (DNSc) programs didn t suit their practical or clinical needs. In 1999, the University of Tennessee Health Science Center opened the first DNP program offering a clinically focused terminal degree. It was quickly followed by similar programs at the University of Kentucky and Columbia University. According to AACN, DNP programs are now available in 35 states. Twenty-eight new programs were opened in 2009, bringing the total number of programs to 120. Data collected through AACN s annual survey and a supplemental survey in February 2010 found an additional 161 DNP programs in the planning stages. Nearly 72% of schools with APN programs now either offer or plan to offer DNP programs. (For more information on the DNP initiative and a list of programs that offer DNPs, visit Putting nurses on equal footing Many nurses and healthcare professionals believe the DNP gives nurses equality with their healthcare counterparts, such as physicians, dentists, optometrists, and physical therapists. Yet the DNP remains controversial. (See Pros and cons of the DNP degree.) Those who favor the DNP believe the issues raised Insight on... Education May 2010 American Nurse Today 49

10 Insight on... Education by its opponents can be resolved. For instance, the concern that some DNP educational programs might be more rigorous than others could be addressed by AACN s Essentials of Doctoral Education for Advanced Practice Nursing, which established curriculum guidelines that set competency standards for all graduates. Also, although some universities may have difficulty granting DNP degrees under their current charters, perhaps they could partner with DNP-granting universities to overcome this problem. As for the concern about promotion and tenure for faculty members without PhDs, these issues are institution-specific and officials at some schools are reevaluating them. A growing demand What s more, a demand for the DNP clearly exists. According to one study, 25% of BSN graduates will move towards APN degrees; 52% of them plan to become nurse practitioners and 23% seek to become certified registered nurse anesthetists. For them, the DNP is the preferred terminal degree. Only 5% of respondents said they will seek PhDs. One needs-based survey found 51% of respondents were interested in furthering their education; of those, only 2% expressed interest in a researched-focused PhD degree. Pros and cons of the DNP degree Advocates for the doctor of nursing practice (DNP) degree claim it will: allow nurses to engage in problem solving and critical thinking to meet today s increasingly complex healthcare delivery needs permit nurses to focus on improving their clinical practice aid in developing new nursing leaders in a knowledgeable society promote scholarship through clinical practice in healthcare delivery models and evidence-based practice help address the faculty shortage lead to academic tenure enhance interdisciplinary practice promote a more positive view of advanced nursing practice produce graduates who are better prepared in the business and organizational aspects of their practice and better able to effect more positive professional changes make nursing consistent with other health professions transitioning to higher educational requirements. Medicine (MD), dentistry (DDS), pharmacy (PharmD), psychology (PsyD), physical therapy (DPT), and audiology (AudD) all offer practice doctorates. Those opposed to the DNP believe that master s preparation is sufficient to maintain excellence in clinical practice, and that requirements for the degree might vary, with some educational programs being more rigorous. They also argue that the DNP: might evolve into a research degree that mimics the PhD imposes undue hardship on nurses pursuing it, because completing the program takes 5 or more years for those with bachelor s degrees in nursing and 1 to 3 years for those with master s degrees won t reduce resistance to the independence of advanced practice nurses might necessitate changes to current standards, legislation, regulations, and certification requirements might increase conflict and divisiveness in nursing might not allow academic promotion and tenure could marginalize nursing in both the academic and clinical practice environments could divert time and energy from such issues as the nursing shortage and quality of care poses significant challenges for some educational institutions interested in offering it. Can the DNP ease the faculty shortage? A 2006 study suggested that offering DNPs to nurses interested in clinically focused degrees could ease the nursing faculty shortage. In the study, 71% of respondents chose a DNP program after evaluating PhD, DNSc, and DNP programs. Of those, 55% cited nursing education as their career goal and 39% cited clinical practice. The Institute of Medicine s report Health Professions Education: A Bridge to Quality stated, All health professionals should be educated to deliver patient-centered care and be members of an interdisciplinary team, emphasizing evidenced-based practice, quality improvement approaches and informatics. Following the lead of these organizations, these professionals now have a purpose and direction to advance the nursing profession and move toward their goals. Nursing has made major advances over the past 20 years and will continue to grow through education, awareness, and knowledge. It must advance DNP specialty preparation to an equal footing with other healthcare professionals in terms of ability to address today s complex healthcare delivery concerns. DNP programs prepare nurses to achieve the highest standards, enhance clinical expertise, and analyze care models that are cost-effective and based on the strongest evidence. The DNP may be the answer to preparing clinically competent leaders who understand the issues faced by practicing nurses and can find solutions to effect positive changes. Selected references Visit for a complete list of selected references. Matthew J. Patzek is a staff nurse in the emergency and operating rooms at Main Line Health, Paoli Hospital in Paoli, Pennsylvania. 50 American Nurse Today Volume 5, Number 5

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