Using Educational Technology and Distance Education to Impact the Shortage of Baccalaureate Prepared Nurses

By

Stoerm Anderson MSN, RN, Katherine Dougherty, MS, MSN, EdD, RN, Ava Miller MEd, MN, EdD, RN, Anne Rath Rentfro, MSN, RN, CS, and Sally Roach MSN, RN, HNC

Abstract

In 1999, The University of Texas at Brownsville and Texas Southmost College Bachelor of Science in Nursing Degree Completion Program embarked on a Distance Education Initiative that was designed to meet the needs of a growing population of Registered Nurses seeking a Bachelor of Science Degree in Nursing. The program, known as being conceived based on Lower Rio Grande Valley students' needs and offer a flexible, student driven alternative to the more traditional BSN programs in the Upper Rio Grande Valley. Continued student assessment and feedback was built into the programmatic plan for self-evaluation and determined that there was a need to evolve the original program into a distance education format to meet the scheduling needs of working nurses. This new distance education format needed to be thoroughly accessible to the target population. In order to accomplish this, technology was integrated into the course delivery schema by means of video conferencing and online instruction. This program now delivers all courses as distance education courses. This report illustrates how one program is meeting the needs of its students by providing high quality nursing education in a progressive and accessible distance education format.

The concept of developing a Bachelor of Science in Nursing (BSN) Degree Completion Program at The University of Texas at Brownsville and Texas Southmost College (UTB/TSC) was introduced in 1991. In 1993, a needs assessment was conducted to determine if an RN to BSN program was needed via a survey completed by working registered nurses and graduates of associate degree programs. The results of this survey clearly identified the need for a Bachelor of Science in Nursing Degree Completion Program that would seamlessly articulate with the already established Associate Degree Nursing Program. A proposal to develop the program was approved by The Texas Higher Education Coordinating Board along with the Texas Board of Nurse Examiners and the UTB/TSC BSN Degree Completion Program was implemented in September 1995.

The need for a distance education component was identified shortly after the program was implemented. The typical student in the BSN Degree Completion Program was found to be a married Hispanic female between 25 and 34 years of age. Of the 60 students, who have been enrolled, 80% are female and 20% are male. The males range in age from 25 to 80. Nearly all, 99%, of the students work full-time as registered nurses and many of the students have at least one dependent. The vast majority, 90%, of the students have been out of their basic nursing school from one to five years prior to entering the program. Ninety-nine percent of the students responding to the 1993 needs assessment expressed a desire to return to school while continuing to work as Registered Nurses and indicated a need for flexible class scheduling and site selection for class offerings. Some students, thirteen percent, were unable to continue enrollment in the program due to scheduling conflicts with work. During the conception of our distance education programming, the employers in the Lower Rio Grande Valley began to increase the number of managerial positions requiring a BSN degree.

The increasing demand for baccalaureate prepared nurses in the region and the need for flexibility in programs wishing to provide for that demand prompted the UTB/TSC BSN Degree Completion Program to launch a Distance Education Initiative (DEI). The goals of the DEI were to: 1) improve access to the BSN program; 2) increase enrollment in the BSN program from eight entering students to at least twelve entering student in the first year 3) improve retention in the BSN program from seventy-five percent to eighty-five percent by the year 2002; 4) maintain student satisfaction with the BSN program as measured by university generated surveys that can be customized for each program. The University added the following item to the student survey: “To what extent did this course contribute to your overall satisfaction with the BSN Program”; and 5) increase the number of baccalaureate prepared registered nurses in South Texas due to the current nursing shortage and the lack of baccalaureate prepared nurses to assume the positions requiring this preparation. Additionally, it was important that the DEI not change the students’ impact upon the community as professional nurses and as students moving into and/or retaining leadership positions in area institutions and health care facilities. Our students make an impact on the community since the program has a strong community focus. They complete community interface projects and during their leadership capstone course, they must develop a community project that will live beyond them and make a positive change in the community. Refer to table 1 which describes the leadership capstone and examples of community projects.

A Gradual Transition to Distance Education

The DEI was implemented by slowly transitioning the program from traditional, classroom-based education to the use of two-way video conferencing (V-TEL) and online (web-based) educational environments. The transition was begun in the fall of 1999. One course was taught using V-TEL and another was offered online. By the spring semester of 2002, all courses were taught using V-TEL or conducted online. Of the nine nursing courses, all of them have some combination of Web and V-Tel; five are taught using V-TEL four are online.

During that first semester, Spring 2002, the DE courses were offered to students who were already enrolled in the program and had participated in traditional classroom-based BSN courses. This enabled the faculty to discuss the DEI with the students face-to-face prior to and, in some cases, during its initial implementation. Only two courses were initially offered in DE format, so students and faculty continued to meet in a traditional classroom setting for the remainder of the courses. This allowed faculty and students to have input into the programming during its development and implementation. This input formed the basis for refinements during implementation and evaluation of the courses. The second semester, the same two DE courses were offered to new, incoming students. These new students also participated in the same classroom-based courses. Thus, the BSN faculty were able to make the adjustments and refinements with the new students that they were able to make during the courses’ initial implementation. One or two courses were changed from classroom-based to DE format each semester until all nine courses in the program had been changed. The transition to the new format was completed in the fall of 2001. Three of the four faculty members have continued to want face-to-face via V-tel and maintained that formatting within their courses. Our goal is to be 100% online provided that money is available and technology-based problems do not interfere with our progress.

Implementing Two-Way Video Conferencing

The courses offered by V-TEL initially allowed students a choice of two sites: one at the main campus and another at a local hospital, 35 miles distant. Each site was required to have the equipment to support the two-way video conferencing system. At the main campus, a technician was available before and during the class to alleviate technical problems if they arose. The students did not have to commit to a specific site, but were able to switch between sites based on their personal preference or their need on class day. For example, a home health nurse might elect to attend class at the main campus one night and choose the distant site when the workday ended in close proximity to that site.

The room at each site was arranged with the table positioned to give the appearance that students were sitting at a conference table. The cameras were programmed to move toward the student who was talking. Using V-TEL courses, the faculty sought to simulate a traditional classroom environment through the use of technology. Since some of the students had difficulty coming to a classroom, the classroom was brought to them. Educational delivery or our teaching methods did not change, though there was more technical help available than would have been the case in a traditional classroom-based setting. The technology needs significantly increased as the V-tel and Web technologies were integrated. Assistance was made available on campus to make sure students and faculty had the support they needed for the new delivery formats.

The distance education coordinator was at the distant site on the first class day to orient the students to the V-TEL system. The coordinator was at the distant site for approximately 15 minutes at the beginning of each class in order to give handouts and collect papers. This facilitated the students and faculty transition to this new distance environment. The coordinator would bring degree plans, programmatic information and also collect assignments and other materials from the students such as transcripts.

The availability of the coordinator caused a smooth transition and made someone available remotely to answer questions as well as to insure that the V-TEL equipment was functioning properly prior to the beginning of class.

Implementing Online Courses

Faculty developed their own online courses. The university provided faculty support with the technical aspects of developing and managing an online course. A basic template was designed for the courses so that there would be a similar format for each course. Online courses were entirely asynchronous and typically consisted of 10-12 units or modules that are completed during a 16-week semester. Objectives, assignments, and clinical instructions were given within each unit. Students met face-to-face on the first day of class for orientation to the course and instruction on how to navigate the web site.

Courses were developed specifically to be taught online and were designed to contain small assignments that scaled up to more in-depth projects. One of the four faculty has a background in curriculum and instruction that was useful in the development of the online courses. Attendance was tracked based on weekly communication with the instructor by email and with the class as a whole by bulletin board and/or listserv.

Course web pages contained information regarding class assignments and due dates as well as resources and links to bulletin boards and other important addresses such as programmatic links, university, specialty sites, and student success links. Class assignments were structured so that the student independently completed them and received feedback from their instructors within one week after having submitted them by email. Faculty advocated cooperation and the students were encouraged to share and collaborate amongst themselves on the course bulletin boards and listserves. Students have threaded discussions both formally and informally. Faculty participate and monitor formal discussions, for example, case study discussions.

The instructor or a UTB/TSC computer technician dealt with technical problems by email or phone. As each of the 4 full time associate professors developed a repertoire of technical support solutions, these were shared amongst the other faculty. Eventually solutions were implemented in courses before presenting as problems.
The online courses were designed so that students did not need to have experience working with computers to be successful. Some students were in no need of further instruction to manage their progress through the program while others had never used a computer before and were at times, technologically challenged. The benefits to the online coursework were not only the asynchronous students do not have to be somewhere at any specific time, but that everyone will leave the program with computer skills and a BSN.

The computer skills necessary throughout the program were embedded in class assignments in the) health promotion course taught during the first semester.. By the end of the first semester, students who came into the program with little or no computer expertise had developed the skills they would need to take an online course. During this first semester, students also learned to: 1) navigate, search and interact with the Internet, 2) use listserves, bulletin boards and email for communication and file transfer; and 3) access and use the library from an offsite computer.

Students who did not own or have access to a computer were able to use the computer center at the university. The computer center had flexible hours in order to meet the students’ needs. Due to the asynchronous format, the students had the ability to access the course materials through the computer center at times that were convenient to them instead of having set class times during the week. There are public libraries in the region that have computers available for those students who did not wish to purchase a computer or travel to the university computer center. Only 20 percent of the students did not have computers. Technical assistance was available to those students needing additional instruction by phone, fax, online and in-person office hours and email.

The Clinical Component

The clinical component of the UTB/TSC BSN degree completion program has always been focused on building on the nurses’ existing skill base and increasing their involvement with the community. The clinical components of the 4 clinical courses involve independent projects and/or the use of preceptors. The approach to the clinical aspect was the same as in the traditional classroom format. The DEI has not affected the way in which clinical practicums are conducted but has changed the method of faculty-student, student-student and faculty-preceptor communication.

The nature of the clinical interactions and community-based settings require the students to actively interact and participate in the health of the community. The resulting projects that arise from this interaction significantly impact the health of the people residing in the community. Refer to table 1 to review the clinical project for the leadership capstone course and specific examples. The major impact has been in the area of service to the community. The students and faculty also interact on professional levels with other nurses in the community. Our faculty and students are visible throughout the community. Students have had a powerful impact on the institutions with which they interface and have prompted policy changes. All of the leadership projects are structured at the institutional or community level and eighty percent have resulted in a change in institutional policies.

Conclusions

Although faculty initially expressed an interest in developing and implementing the DEI, their level of involvement and enthusiasm grew as the initiative was implemented. Each of the 4 faculty members became sincerely committed to the DE concept over time and reported being very satisfied with teaching in a DE format. The comfort level of leaving the known delivery mechanism within the traditional classroom to for the unknown delivery via V-Tel and the Web created an uneasy feeling and raised some skepticism. The feedback from 90% of the graduates, have made it clear that DEI made a difference in their ability to completing their degrees. Many wrote personal testimonies to the fact that this was the only way they could have reached their goal of a baccalaureate education. Some of the comments made by students include: “I have found the web-based most helpful because it has really helped me to expand my computer and Internet knowledge. I will be interested to take any on-line course in the future” and “The BSN program is designed to be very flexible and student friendly. It provides lateral movement for the student to pace themselves and coordinate their work/job responsibilities with BSN program commitments.” One of the most satisfying parts of teaching in a DE format has been the extent to which student interactions with the faculty have become more meaningful based on the integration of technology. The ability to email and communicate with the faculty member more frequently than in the traditional classroom format, caused an increase in dialoguing. The faculty feel they get to know the students better because there is much more personal correspondence that typifies an online class. They got to know their students as individuals more readily than in a traditional classroom-based educational environment. The quiet student is no longer necessarily quiet when communicating by email. This method of communication allows the student to think, rethink, write, and re-write a message before sending it off, often, students who would not speak out in class flourish in an online environment. They have the time to think through what they want to say and when positively reinforced, gain confidence in this communication technique. The faculty felt that there were more meaningful exchanges occurred in the relatively un-intimidating discourse of email correspondence. The weekly attendance email generally transformed into a running dialog between the faculty and student. Faculty reported that this led to an increase in knowledge about their students’ learning needs. Student interactions in written format have shown an improvement in their ability to write, the quality of the work submitted, and an increase in critical thinking skills. The students commented on their ability to learn in the comfort of their own homes.

The goals of the DEI were met since student enrollment in the BSN program increased by 85% when a 50 % improvement was targeted. Graduates indicated, in 46 program-end surveys that: 1) the DEI was instrumental in their success in the program, 2) had the classes not been offered in a distance education format it would have been impossible for them to earn a BSN degree, and 3) the computer skills they acquired during the program were beneficial in their jobs. Program satisfaction for the students, as reported in these surveys, had been very high throughout the history of the program, but became enthusiastically high after the implementation of the DEI. The same university distributed graduate survey was used with the addition of an additional DE Survey that contained one question that measured the extent to which the DE Program contributed to their ability to enroll in a BSN Program and two open ended questions that asked the student which aspects of the DE Program then found most helpful and which aspects they found most difficult. All students indicated that the DE Program contributed to their ability to enroll in a BSN Program.

The BSN program surveys their graduate’s 8-10 employers at six months and twelve months after graduation to ascertain employer satisfaction with the program’s graduates. Employer satisfaction, as reported in these surveys, had been very high throughout the history of the program, and remained very high, between 90-100% very positive, after the implementation of the DEI. One of the advantages the employers perceived was a lack of scheduling issues given the asynchronous format.

The UTB/TSC RN to BSN Nursing Distance Education Completion Program Initiative was implemented in 1999 and has been deemed a success from the faculty, students and employers. The BSN program, through creatively devised and conducted projects such as the DEI, continues to meet the need for baccalaureate nursing graduates in the Lower Rio Grande Valley of Texas.

Bibliography

Cragg, C.E., Plotnikoff, R.C., Hugo, K. & Casey A. (2001). Perspective transformation in RN-to-BSN distance education. Journal of Nursing Education, 40(7), 317-322.
Kennerly, S. (2001). Fostering interaction through multimedia. Nurse Educator, 26(2), 90-94.
Malloy, S., DeNatale, M. L. (2001). Online critical thinking. Nurse Educator, 26(4), 191-197.
Martin, P., Klotz, L. (2001). Implementing a nursing program via live interactive video. Nurse Educator, 26(4), 187-190.
Zalon, M. L. (2001). A prime-time primer for distance education. Nurse Educator, 25(1), 28-33.


Authors’ Bios


Stoerm Anderson MSN, RN

Stoerm Anderson is currently investigating internet usage trends in Central Chinese university students as part of a project funded by the Ministry of Education of China. Stoerm has been a nurse for eleven years and has nine years teaching experience with the School of Health Sciences at the University of Texas at Brownsville. Stoerm also has experience in hospital education and multicultural educational in international education.

Katherine Dougherty, MS, MSN, EdD, RN

Katherine Dougherty is Chair of the Department of Nursing and Director of the Bachelor of Science in Nursing Program at The University of Texas at Brownsville and Texas Southmost College. Dr. Dougherty and the BSN faculty requested and received permission for a distance education initiative from the Texas Board of Nurse Examiners in 1998 to offer courses to Valley Baptist Medical Center. Permission was granted in 2002 to add Knapp Medical Center as a second distance site. The University of Texas System approved the Distance BSN Program n May 2002 when all courses were delivered by distance education technology, either by video-conferencing or web-based instruction. Dr. Dougherty is a member of The Texas Nurses Association Committee on Education.

Ava Miller MEd, MN, EdD, RN,

Ava Miller, Associate Professor at the University of Texas at Brownsville, has over 27 years nursing experience and 17 years teaching at The University of Texas at Brownsville. Her areas of expertise are in research, leadership, and student retention. Dr Miller’s research includes the development of an instrument to measure students’ perceptions of caring behaviors exhibited by instructors. Dr Miller has developed four online nursing courses for the Bachelor of Science Program at The University of Texas at Brownsville.

Anne Rath Rentfro, MSN, RN, CS

Anne Rentfro is currently Associate Professor for the Department of Nursing at the University of Texas at Brownsville where she teaches in the Bachelor of Science in Nursing Program which is a distance education initiative. She received the Chancellor’s Award for Teaching Excellence in 1995 from the University of Texas. She is currently certified as a clinical specialist in medical surgical nursing by the American Nurse’s Credentialing Center and has practiced in the past as a certified diabetes educator.

Ms Rentfro’s nursing practice has included leadership positions as well as joint clinical and faculty appointments. She acted as project director for a Robert Wood Johnson and Pew Charitable Trust’s “Strengthening Hospital Nursing” grant. She has co-authored the Student Study Guide to Accompany Wong’s Nursing Care of Infants and Children along with many of the student and instructor manuals and electronic resources for the Wong pediatric series of publications.


Sally Roach MSN, RN, HNC

Sally Roach, Associate Professor at the University of Texas at Brownsville (UTB), has taught nursing for over 16 years. During that time she has written extensively, having three textbooks and accompanying ancillaries (i.e. instructor manuals and student workbooks), to her credit. At UTB she teaches two online courses, Professional Nursing in the Community and Family Centered Nursing. Additionally, Ms. Roach is a Certified Holistic Nurse and teaches courses in Holistic Nursing at the university. Previously, she was employed as staff nurse, charge nurse and nursing supervisor.

Table 1: NURS 4612: Leadership in Professional Nursing: The Leadership Change Project

The change project is undertaken as a semester long project that culminates in a presentation and written paper. The nature of the project is ultimately chosen by the student in collaboration with the preceptor and faculty. The primary criteria for the project are that it be of interest to the student and have a lasting effect. The project must "live" on beyond the time the student is engaged in its implementation. For instance, some student choose to develop, needed, teaching programs, or patient information booklets, or traveling inservice programs. These projects remain in use long after the student has graduated.

Examples of Student Change Projects

Development of a Orientation Manual for New School Nurses


Development of a First Aid Teaching Booklet for Peer Teaching in Middle Schools

Development of a Video Based Course for Basic EKG Interpretation

Development of a Community Teaching Program for Car Seat Safety

Development of a Fetal Kick Count Teaching Tool for Mothers

Development and Implementation of the Electronic Record in the Critical Care Unit

Development of a Continuous Quality Improvement and Quality Assessment Indicator Program Operating Manual

Development of a Cardiopulmonary Rehabilitation Patient Teaching Guide

Development of a Nursing Website: “RGV Nursing Today: Incorporating Local Heritage and Culture in Nursing”

Development of a Quality Assurance pocket Tool and Retooling for a Border Hospital

Development of an Orientation Manual for Emergency Department Nurses