Nursing education via distance learning is not a new phenomenon and continues to gain in popularity. In fact, distance in formal education dates back to the middle of the 1800s with the transfer of letters between an instructor and a student (Potempa, 2001). More recently a survey in 1998, conducted by the American Association of Colleges of Nursing, revealed that 51% of nursing schools claimed to incorporate some component of distance education in their program of study (American Association of Colleges of Nursing, 1999). While face-to-face nursing education remains the primary method for the transfer of information and skills, it cannot be denied that distance education in nursing remains a viable addition and, in some cases, an alternative to traditional instruction. The convenient access and widespread use of the Internet have cemented the value and availability of distance education for nurses both nationally and internationally.

The current and predicted nursing shortage lends support for the need to promote the advancement of nursing education, particularly with distance learning. One would expect the workforce to grow proportionately with the addition of educational venues. Specifically, nurse educators continue to be in especially high demand. The faculty shortage impedes the matriculation of qualified candidates into schools of nursing, thus contributing to the overall shortage. Therefore, the growing numbers of distance master's and doctoral programs facilitate the development of nursing faculty, as well as advanced practice nurses (Billings, 2007).

Distance Nursing Education Defined

Distance education is defined as "institutionally based formal education where the learning group is separated and where telecommunications technologies are used to unite the learning group" (Simonson, Smaldino, Albright, & Zvacek, 2006, p. 169). Kolowich (2010) reports that the number of fully online RN-to-BSN programs in the United States have grown from 96 in 2007 to 129 in 2009, a fraction when considering the 621 programs that currently exist nationwide. Distance programs come in a variety of formats: synchronously, requiring students to interact at the same time and asynchronously, when students choose their interaction times based upon facilitator-assigned course requirements.

Programs may be strictly online or of a hybrid nature requiring face-to-face on-campus interaction each term or a one-time visit to campus per program. Technologies used to connect students with faculty may include print, audio, video, or computer. Other terms cited by Gruendemann (2007) to describe distance learning include "Web-based teaching, e-pedagogy, e-tutoring, distributive learning, technology-mediated instruction, and online teaching and learning" (p. 575). Distance learning takes place in undergraduate programs, RN-to-BSN programs, refresher courses, graduate programs, and healthcare facilities where RNs are learning new clinical specialties such as perioperative nursing (Gruendemann, 2007). In 2005, surveys indicated that the majority of distance enrollees were participants in the RN-to-BSN program (Lewis & Farrell, 2005).

Distance Learning Advantages

A distinct advantage with distance nursing education, particularly the online format, is flexibility, especially for busy professionals attempting to juggle work and family responsibilities. Online courses also offer geographic flexibility particularly beneficial for those students in remote areas of the country, saving travel time while increasing accessibility to a wide variety of course offerings. Linking geographic regions via the Internet creates a cohesiveness and collaboration among students and faculty members promoting a global exchange of ideas and information not possible in traditional learning environments.

By virtue of the fact that successful distance learners must be responsible and self-directed may prompt participants to acquire greater personal and professional accountability. Online education creates opportunities to improve technology skills and students often report a newfound comfort with computer use. Experts agree that the increased availability of distance nursing education may have the ability to ease the nursing shortage. Enabling more RNs to pursue advanced degrees can help to relieve the critical lack of nursing faculty, thus maximizing enrollments in undergraduate nursing programs (Talbert, 2009).

Distance Learning Disadvantages

Distance learning is not without its shortcomings and presents challenges for learner and instructor alike. Naturally, the lack of face-to-face contact strains the student-faculty relationship. Instructor responsiveness delays contribute to student anxiety and difficulty understanding course materials. Depending on the individual, this format may ultimately lead to student frustration, creating feelings of isolation and insecurity. Distance students experience less collegiality as opposed to their traditional classroom counterparts. Gruendemann (2007) reports the "lack of personalized instruction" results in a "style of learning that is difficult for some students, with drop-out rates that are higher than for traditional learning" (p. 578).

Instructors must acclimate themselves to a paradigm shift from instructor to facilitator. New modalities of teaching and learning can be time-consuming. For example, posting written messages is more labor intensive than classroom dialogue, requiring consistent student participation and facilitator oversight. Dependence on technology can place added stress on student and facilitator, requiring all participants to be comfortable and knowledgeable with navigating the platform. Facilitators, in particular, must be computer savvy. Finally, there are high costs associated with program development that may be passed on through tuition costs depending on the institution (Gruendemann, 2007).

Distance Education Delivery

Distance learning programs via a virtual classroom use a variety of computer program platforms to facilitate the electronic connection to the class. There are several online computer platforms that are used throughout the US educational system and selection is strictly an institutional preference. Some of the most commonly employed platforms include Blackboard, Angel (acquired by Blackboard in May, 2009), Moodle, Sakai, and Adobe Acrobat Connect Professional Meeting. These platforms allow the online student to interact with the course instructor and sometimes class members in multiple ways. Basic methods include online real-time (synchronous) discussion with the instructor or class members that use a discussion format via audio/video Web cam; course restrictive e-mails to only students in the class or the instructor; discussion boards in which responses or questions are posted in written format through a self-paced (asynchronous) area, then accessed by students and faculty at a time of individual choosing; homework areas where assignments are electronically submitted; and quiz/examination administration (Smith, 2009).

The Blackboard(TM) platform is used by more than 70% of American colleges and universities (Bradford, Porciello, Balkon, & Backus, 2007). Recommendations for usage include the following hardware requirements: at least 2.0 gigahertz, a minimum of 512 megabytes, with 1 gigabyte being optimal, a hard drive of at least 120 gigabytes for videotape and any compressed file presentations, and a graphics card with at least 64 megabytes of graphic memory to keep streamed or downloaded video playing without interruption (Servonsky, Daniels, & Davis, 2005). Since Blackboard(TM) is entirely Web-based, to ensure success and minimize transmission delays that cause frustration, the student should employ high-speed Internet connections such as cable, DSL, or satellite, especially for graduate-level courses in which documents and content are too large for dial-up service. Minimum software requirements include Microsoft Internet Explorer 6.0(R) or higher with Java Script(R) as well as Windows XP Professional(R)/Home(R) or Windows 2000(R) (Servonsky et al., 2005).

The Blackboard(TM) platform is not without drawbacks. For distance program facilitators, course preparation is more time-consuming than traditional face-to-face instruction. The platform also lacks an instant messaging feature creating delay in real-time communication. In addition, posting a written response is slower and more labor-intensive for the student than a verbal exchange of ideas in the conventional setting. Typed responses require more focus, because student replies are interconnected or threaded, one upon the other. Written postings often become a complex series of statements and it can become difficult to ascertain who is responding to whom. In contrast, spoken language uses auditory reception and is processed more quickly by the participants. Blackboard(TM) enables the facilitator to monitor online participation by reporting the quantity and quality of student engagement, thereby placing specific demands on time spent in the virtual classroom. As a result, virtual class time in all probability may be equal to or greater than the time students spend in face-to-face instruction.

The Successful Distance Nursing Student

Proficiency in computer use will result in a more satisfying, less stressful distance learning experience. Prospective students can avail themselves of online survey tools to help to determine their ability to handle the distance format. Survey sites can be accessed from the Indiana College Network, the National Coalition for Telecommunications, Education and Learning, Thomson Peterson's Distance Learning, and the University of Michigan-Flint Online (Damazo, Shovein, Huston, & Fox, 2002). Computer and Internet capabilities must be sufficient to support the institutional platform. Students would do well to check the program's computer requirement before matriculating in to any distance program. Nursing students have reported an increase in computer skills as a result of participation in a distance program (Ryan, Carlton, & Ali, 1999).

The ability to express oneself via written communication is also essential, because this is the primary method of interaction. While not as spontaneous as verbal classroom exchange, written postings prompt students to research topics and develop critically, thought-filled responses. Distance programs are rigorous undertakings. Students need to be motivated and self-directed. Johnston, Killion, and Oomen (2005) purport that "online courses are equal or more challenging than traditional face to face courses because the primary responsibility for facilitating learning shifts to the student" (p. 4). The lack of face-to-face instructor oversight can lead to procrastination; therefore, the distance learner must have superior time management skills and self-discipline. As well, lack of real-time instructor-student interaction may be particularly challenging for those nurses who have had a long absence from academia.

Conclusion

Distance nursing programs continue to flourish and are a popular alternative to traditional learning. Accessibility to the Web, program choices, and convenience contribute to the expansion and acceptance of this approach to nursing education. Experts agree that distance programs may help to ease not only the critical nursing shortage but the lack of nursing educators as well (Billings, 2007). Distance education assists in making nursing programs more accessible, enabling fewer educators to reach a wider, geographically dispersed audience of professionals, especially those seeking to build upon entry-level preparation with advanced degrees. An increase in master- and doctoral-prepared educators should increase qualified candidate enrollment into schools of nursing, thus easing the predicted shortage by the impending retirement of the baby boomer workforce.

Nurses particularly comfortable with technology are especially suited for distance nursing programs. However, the sense of isolation that is often experienced with this type of learning ought to be considered. To prevent such feelings, learners must be diligent in communicating regularly with facilitators and colleagues. Student program choice should consider accreditation standards, the ability to transfer credits, costs, and whether an on-campus component is required. Damazo et al. (2002) contend that "most high-quality programs require students to visit the campus so that they can be acquainted with the faculty and the program philosophy" (p. 97).

Johnston et al. (2005) reported that "recent research found online delivery to be just as effective as traditional face to face courses" (p. 2). However, results have yet to be published as to the effectiveness of online nursing programs in the provision of basic licensure requirements. At the very least, nursing clinical requirements should continue to incorporate a component of face-to-face instruction in combination with online course work. Certain nursing skills require the demonstration of competence that at this point in time can be evaluated only by instructor supervision. Yet, the popularity and success of the online RN-to-BSN program of study would seem to validate the appeal distance learning has for many nurses. The reach of the World Wide Web and advances in technology continue to proliferate at astounding rates. As the evolution of nursing education continues to unfold, one need only to imagine the possibilities and the promise distance programs hold for the future of professional nursing.

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