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Online course in two-year nursing education.


The purpose of this study was to examine the feasibility of offering an online nursing course at a community college in Iowa. Using a qualitative design, data were gathered from administrators and nursing instructors using interviews and a survey to understand the perceptions about offering a pharmacology course online and the impact of the format on student learning. The results of this study will inform faculty in community colleges about the advantages and disadvantages of developing online courses and will add to the nursing education literature.


Online education has captured the interest of educators. Because of increased technology opportunities, educators have the capability to deliver programs of study outside the traditional classroom (Mills & Hrubetz, 2001). Specifically, nursing education has become interested in this type of course delivery. The internet has the capacity of delivering nursing courses online to cover class content and provide increased access for students. Many students live in rural areas and do not have access to education. Others have families and jobs that restrict their collegiate opportunities. One important implication for online classes in nursing is the type of courses nurse educators can offer due to the nature of the practice of nursing. Pharmacology may be one possibility for nurses to offer online because of class content with minimal clinical component.

Further research regarding the feasibility of online nursing classes in a vocational setting is necessary. To date, there is a dearth of literature on this topic. Since most of the research literature tends to focus on online education with regards to arts and sciences, this inquiry provides new ways to examine the feasibility of an online pharmacology course in a vocational nursing program.

The availability of the Internet in the college setting has prompted colleges to take advantage of the new technology, and to spend millions of dollars to update their computer systems. The World Wide Web has had tremendous influence on recent student learning. The need to integrate information technology into nursing education is well documented (Kenney, 2002). According to the American Association of Colleges of Nursing (AACN, 2000), technological advances provide the opportunity to increase opportunities and improve the quality of and access to nursing education. However, technology remains a neglected topic in many nursing programs and, as a result, many nursing students are missing the opportunity to take advantage of this new educational technology. The nursing faculty has been reluctant to offer an online course because of the nature of nursing education. Nursing education is known as a "hands on" profession, and many classes require "psychomotor skills" to be taught in the classroom. However, pharmacology is primarily lectured based, and may be a good option for an online nursing course.

Literature Review

Online Learning

Educators have been challenged by the need to use a variety of teaching approaches. Educators are recognizing the necessity of offering online instruction to meet the demands of the students (Cuellar, 2002). Short (2000) maintains that courses delivered online are breaking down geographic restrictions and opening doors with academic opportunities for learning at home. It was estimated that in 2002, 2.2 million college students enrolled in online courses, an increase from 710,000 in 1998 (Cuellar, 2002). Cuellar further reports this number is predicted to rise 30% annually. At present, 84% of public 4-year college settings are offering online courses. Currently in Iowa seven community colleges belong to the Iowa Community College Online Consortium (ICCOC). The Consortium of colleges partner together to offer associate degrees completely online. These colleges offer approximately 200 online classes annually. In addition to the online consortium, three other community colleges in Iowa offer online classes.

Billings, Connors and Skiba, (2001) state that the "future education and training will be independent of time and place. Learners will have access to a wide range of media, as well as sources of education" (p. 41). Distance education emphasizes the "virtual classroom." In this virtual classroom, distance education stresses the importance of design of the instruction, support of the learner, interaction between the student and faculty, and evaluation of learning outcomes (Boyle & Wambach, 2001). Kenny (2002) further reports, "Over the last decade it has been argued that Web-enhanced classes provide consistency of educational delivery, reduces instruction time, enhances effectiveness and mastery of learning, improves retention and increases student motivation, satisfaction and enjoyment in learning" (p. 128).

Benefits and Challenges of Online Nursing Classes

The nursing profession must find ways to deliver adequate nursing educational theory to those choosing to advance their nursing education. These opportunities need to be meaningful and well accepted by students, faculty, and others within the medical community. Careful use of technology may enhance the field's ability to educate nurses for practice, prepare future nurse educators, and advance nursing science in an era when the number of professional nurses, qualified nurse faculty, and nurse researchers is well below the national need (AACN, 2000). Certainly the Web has tremendous potential for online learning. Lessons, courses or entire programs can be delivered wherever the learner is--at home, workplace, community or university settings (Billings & Bachmeier, 1994). The American Association of Colleges of Nursing (AACN) organized a task force in 2000, entitled, Distance Technology and Nursing Education, which published a paper reviewing the benefits, challenges, and recommendations for schools when deciding to implement distant education courses (Predko, 2001). Benefits of online education included improving quality and access to nursing education. Online education would also increase collaboration among nursing faculties in teaching, research and practice. Students would have choices regarding furthering their education.

Several challenges were identified from the task force. Of concern is the need for appropriate faculty support and proper development when preparing to teach online. Additionally, providing adequate student support with online education may be a challenge. For example, providing adequate technology assistance could be difficult for a college. Other concerns addressed were quality, cost and efficiency of distance education. Other important facets to be considered with distance learning include changes and challenges facing the role of faculty, strains on existing colleges' organizational structure, and finances (Predko, 2001). During the past few years, colleges have committed billions of dollars to the use of advanced technology for online learning. However, supporters and critics are requiring the educational community to take a step back and carefully assess outcomes of online education.

Advantages and Disadvantages with Online Learning

Billings (2000) stated Web technology is being used to enhance learning communities and support learner-centered strategies for students. However, Billings suggests that further studies are needed to identify positive outcomes for the student and teacher. A good understanding of the complexity of both teaching and learning in online instruction is essential for students and instructors before taking or teaching an online course. There are both benefits and concerns about the use of online instruction (Ross & Schulz, 1999). Although learners may benefit from online instruction, the instructor may find developing a course a daunting task (Ross & Schulz, 1999). The authors articulated five advantages and five disadvantages for students and instructors with online instruction. The five advantages include: 1) has the potential to meet students' individual learning; 2) once developed, online resources can save the professor time; 3) can enhance the meaning of richness of the college curriculum; 4) electronic material can help improve teaching excellent; and 5) can improve student motivation and willingness to learn. The five disadvantages include: 1) student or the professor may not have adequate knowledge of computer technology; 2) material can be time consuming to develop; 3) technology may not work when the professor needs it the most; 4) a steep learning curve is to be expected when developing multimedia material; and 5) bandwidth-intensive media may be unattainable for students with slow access to the Internet. The advantages and disadvantages statements demonstrate that online teaching can be a positive experience from an instructor's standpoint; however, developing the course can be very time consuming. When all goes well with technology, learning can be smooth and enhanced. But, when there is a technology failure, it can be extremely frustrating to the instructor and the learner. It is very important to have an alternative plan when using online learning.

When used appropriately, the Web can enhance student learning. Instructors can develop innovative methods to enhance various learning styles. For example, the use of videos online could enhance a lecture. However, an instructor must realize that becoming an effective online teacher requires effort. Ross and Schulz (1999) maintain that "Technology innovations involving the Internet require a great deal of time, energy, creativity, and often monetary resources for development" (p. 124). However, the authors believe the potential benefits outweigh the effort required for online teaching. Specifically, they stressed that it is important to point out that the first year of development is often very time consuming, more so than subsequent years. Once instructors develop these ideas and useful tools, the educator will begin to create positive, interactive, and powerful teaching tools that may be used by many classes in the following academic years. It is advisable to start small and slowly build a web class (Ross & Schulz, 1999). It is recommended that schools plan strategically for distance education; rather than rushing into programs that lack administrative commitment, sufficient resources, and thoughtful policies (AACN, 2000).

Nursing Faculty's Attitude toward Online Nursing

It is apparent that faculty find success with online teaching, however, the nursing faculty did agree that course planning and implementation interaction took additional time (Cuellar, 2002). In fact, Cuellar reported that it might take up to two or three times longer to develop an online course rather than the traditional class. It is important to develop time-sensitive planning strategies and design approaches that facilitate ease in course development and delivery. Christianson, Tiene and Luft (2002) support the viability of online instruction in nursing education; although, educators must be prepared for anxiety as well as excitement. Most instructors feel that the online approach is successful, and they enjoy this type of teaching. One faculty member reported, "My attitude has completely changed. At first I was skeptical, but now I'm excited by it. My students have deeper insight, work harder, and above all else, learn more" (Christianson, Tiene & Luft, 2002, p. 227). Others ask questions, "What will it look like if nursing undertakes education the next generation of nurses through online learning?" (Langford & Hardin, 1999) "Can nursing move beyond traditional learning environments and embrace the values congruent with adult learners in the sphere of online learning?" (Langford & Hardin, 1999) Although literature and some faculty support online courses, only a small number of nursing schools have offered online courses for more than 10 years, appropriateness of online format for nursing education has been one of the major barriers (Reinert & Fryback, 1997).

Purpose of the Study

The purpose of this study was to examine the feasibility of offering an online nursing course in the License Practical Nurse (LPN) curriculum at a rural community college in Iowa (referred to as Midwestern Iowa Community College [MICC]). The objectives of the study were the following: 1) to gather information from the college's administrative leadership team to probe their attitudes and perspectives about offering a pharmacology course online in the nursing department; 2) to collect information from other Iowa community colleges' nursing faculty who offer online pharmacology and the extent to which this delivery method impacts student learning; and 3) to probe the extent to which the college's nursing administration supported the feasibility of offering a pharmacology course online in the nursing department.

As demonstrated in the literature, nursing education may find new ways to offer classes. Teachers are being asked to adapt their courses for online delivery, while students are being promised more flexible learning formats (Vrasidas & McIsaac, 1999). Offering diversity or flexibility in learning is important in rural areas. Because of new technology, students can have access to a variety of ways to learn, which will lead to improvement in student learning and success (Halstead & Coudret, 2000). The research questions guiding this study include the following:

* Is an online course feasible as part of the nursing program?

* What are the benefits and/or barriers in offering an online course in the nursing program?

* What are the benefits and/or barriers for an online instructor?

* Is a pharmacology course a good option for an online nursing course?

A better understanding of online nursing education is necessary and will be useful in the nursing department, and for the community college administration to implement programs that benefit students. A study that provides more in-depth information pertaining to the feasibility of offering online classes in the college's nursing program will provide valuable information for community colleges, nursing faculty and the college. Information from this study could provide data on the type of class that is conducive to the online format in a nursing program. This study will also build on current literature regarding the benefits to faculty and identify the challenges with teaching online.

Data Sources and Methods

The participants included: 1) selected members of the college administrative leadership (i.e., Vice President of Instruction, and Director of Arts and Sciences), 2) past and present nursing administrators from the college (i.e., Chairs of Nursing Division, and 3) pharmacology instructors currently teaching pharmacology courses for the Iowa Community College Online Consortium (ICCOC) to nursing students in an Iowa community college setting. The interviews were audio-taped with permission from the participants and transcribed. The purpose of the interviews was to gather in-depth information from participants regarding their perspectives or opinions on the feasibility of offering online nursing education in a vocational setting. The setting of the study was Midwestern Iowa Community College (MICC). One of the 15 community colleges in the state, the college began operation in the mid-1960s and has an enrollment of approximately 1,200 students. The college is known for its strong arts and sciences program as well as an array of vocational and technical programs. The average age of the student body is 24.5 and women comprise 56 percent of the total enrollment. The college is a member of the Iowa Community College Online Consortium.

The data collection procedure entailed two phases. The first phase began during the summer and fall 2003 semester when audio-taped, one-on-one interviews were conducted with selected participants. The purposive sampling technique was used to select the convenient sample of participants. Two out of the six administrators of MICC, two past and present nursing administrators were interviewed at the college, along with the two college instructors from other Iowa community colleges who teach pharmacology online for the Iowa Community College Online Consortium. In the second phase, surveys were sent by email in fall 2003 to all ten faculty members teaching online at MICC. The survey probed instructors' perspectives or opinions regarding personal experiences with online teaching and nursing education online. These participants were selected because they could provide valuable input regarding what type of classes are best for online instruction. They also could give their experiences regarding successes and failures with online teaching. To provide additional input, two nursing instructors currently teaching pharmacology at other community colleges in Iowa completed the survey.


Four major themes emerged from the data: 1) nursing and online education; 2) feasibility of online course in nursing programs; 3) student motivation and online education; and 4) success with online teaching.

Nursing and Online Education

This theme emerged from research question one. It is not only feasible, but necessary to offer online classes for nursing students. Today students are diverse. Students are single parents, must work or live in rural areas and are more vocal about their educational needs. Students can enroll and meet students from across the country. One interesting point mentioned from faculty was that students with different abilities may have easier access to college classes. For example, a student with a physical disability that wants to take a college class may find it less problematic online. "This would be a great way for students with physical disabilities to receive collegiate opportunities."

Feasibility of Online Course in Nursing Program

This theme emerged from research questions one, two and four. Instructors were in favor and felt it was feasible for online nursing classes; however, instructors had opinions as to which classes were best delivered online. The results of the study showed that faculty overwhelmingly believed that lecture based courses were the best option. Also, elective courses were favored. The majority of faculty believed that elective courses were the best option because many of these classes are lecture based, and open to all types of students. Many core classes in nursing require the student to learn "bands on." Faculty believed this would be difficult and unsafe for students to learn these concepts online. Faculty and administration firmly believed pharmacology was a positive option for online classes. Pharmacology has been successfully implemented through the Iowa Community College Online Consortium. The instructors teaching these courses have had success with classes and were very positive about their outcomes. It was interesting because the two pharmacology instructors that teach their pharmacology online reported pharmacology is an elective in one program and a core course in the other program. It is offered through the Iowa Online Consortium in spring semester. Both courses are available to any type of student.

Pharmacology is taught in the fall semester at MICC and is a core class. This is certainly an issue that MICC faculty would need to research. Should our pharmacology course become an elective? If we offered an online pharmacology course, would we limit the class to our students? These were concerns of the nursing chairs. At MICC, pharmacology is a required, core class. It is only offered in fall semester, and only available to our nursing students. Certainly, changes would have to be made in the fall curriculum. One instructor did voice concerns regarding pharmacology online. Because proper pronunciation of drug names is so important, how would a student learn to correctly pronounce the drug names from an online class? When pronouncing or taking a doctor's order over the phone regarding a medication, would a student be able to understand and administer medication safely? Another concern voiced by nursing administration was if a student could take pharmacology online, would there be certain time limits to when the student could take the class? For instance, if a student took pharmacology online, because of the class being primarily memorization and recall, how soon would the content be forgotten? One suggestion was to allow the student to take the class only one semester prior to enrolling into the nursing program. This issue would need to be discussed by faculty and administration. However, with increased technology and faculty knowledge in developing classes, faculty should continue to look to the future to offer high quality online classes.

Student Motivation and Online Courses

This theme emerged from research questions two and three. Administration and faculty, overwhelmingly, believed that students best suited for online classes were self motivated. This may be one reason why some faculty and administration believed that online classes for nurses are best in the advanced degree programs. Many students obtaining advanced degrees are already self motivated and this adds to the success of online learning. Attrition is high in online. It was reported by the Iowa Community College Online Consortium that withdrawal remains consistently at 15 percent from 2000-2003. The success rate remains approximately at 66 percent. Students cannot be procrastinators. This is detrimental to both students and faculty. Faculty has learned to make specific deadlines for class assignments. For example, make assignments due at intervals throughout the course to ensure students are keeping on task with assignments. Faculty did believe that online classes offered students an opportunity to go back and review the material at anytime. The class content is always available, whereas in the traditional classroom the specific content, is covered and then the instructor moves onto the next topic. Students may not have grasped the subject matter and students have the option to go back and review content online.

Success with Online Teaching

This theme emerged from research question three and four. Online instructors were very positive about teaching online. The pharmacology instructors were overwhelmingly positive regarding their classes. However, an instructor must enter into online teaching well prepared. All believed online preparation took additional time. Learning to develop a high quality class took time, and developing a good interactive class was a good challenge for the instructors. Instructors should look at all the technological opportunities when developing online classes. Adequate technology was a must. Faculty and students' frustration were lessened when all went well with technology in online classes. An instructor would want to know they have appropriate technological support before developing an online class. Adequate technological support would also benefit the students.

In the surveys and literature review, instructors voiced their challenge with answering student emails. "It can be difficult for an instructor to be faced with fifty emails from students." Suggestions from instructors relayed setting limits. One instructor reported, "Set guidelines that you will respond to emails within 48 hours." Nursing administration believed that online was certainly an opportunity, but one must look at how it fits into a vocational teacher's load. All faculties' schedules are tightly woven together in the vocational arena. Concerns about adding an online course to one's faculty schedule could affect all other nursing faculties' schedules. Another concern of faculty administration, would an online course add to the complexity of acceptance into the nursing program? Currently there is a one year waiting list to be accepted into the nursing program. How would offering an online pharmacology course fit into the curriculum? At present, pharmacology is offered as a three semester hour course in the nursing curriculum. Only nursing students can take this course once they are admitted into the program. Would an online course complicate the process? This was one reason why one of the pharmacology instructors offered their class as an elective. Students could take this prior to admission into the nursing program. An online pharmacology course may be a benefit for the college and the student. Offering another online course may increase student enrollment for MICC. Also, if the student was unsure if they wanted to pursue nursing as a career, they could take pharmacology online before admission to the program.

Conclusion and Implications

The purpose of this study was to examine the feasibility of offering an online pharmacology course in the nursing department at a rural community college in Iowa. The study focused on pharmacology and online faculty, administration, and nursing administrations' opinions and experiences regarding online education. Since most of the research literature focuses on online education with regards to arts and sciences, this inquiry provides new ways of understanding the feasibility of an online pharmacology course in a vocational nursing program. Another goal of this study was to examine the online experiences of community college faculty, what are the benefits and barriers of an online instruction, and gather information from administration about their opinions regarding online education. The implications of the study were to investigate viewpoints of college faculty and administration regarding offering pharmacology online in the nursing department. This study explored the feasibility and provoked dialogue among college administration and nursing faculty at MICC to develop and offer online courses in the nursing program. However, nursing faculty admit they must be careful when considering changes in their nursing curriculum because of their present successful high pass rates for nursing licensure. Pharmacology is an important class in the nursing curriculum; nursing educators want to make the correct decision when making a curriculum change that will affect the student and the public.

The findings of this study can be useful to administration and faculty to implement programs that benefit students. The results of this study will add to current literature for nursing education. Future research should be continued with interviewing and surveying students that have taken an online course. Students who have completed a nursing course online could provide useful information. Finally, all nursing faculty should be interviewed. Faculty work closely together in the vocational setting, and any change in curriculum or faculties teaching load may affect other faculties work load, all faculty should have input. Based on the results of the study, the recommendations for future research include: 1) survey nursing faculty to receive their input regarding offering pharmacology online; 2) survey students who have taken an online course regarding their satisfaction with online instruction; 3) survey pharmacology nursing students regarding their interest in taking an online pharmacology nursing class; and 4) collect additional data regarding how a pharmacology course is successfully implemented into a nursing program in the vocational setting.


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Billings, D. (2000). A framework for assessing outcomes and practices in web-based courses in nursing. Journal of Nursing Education, 39(2), 60-67.

Billings, D. & Bachmeier, B. (1994). Teaching and learning at a distance: A review of the literature. In L. R. Allen (Ed.), Review of Research in Nursing Education, (pp. 1-32). New York: National League for Nursing.

Billings, D., Connors, H., & Skiba, D. (2001). Benchmarking best practices in Web-based nursing courses. Advances in Nursing Science, 23(3),41-52.

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Christianson, L., Tiene, D., & Luft P. (2002). Examining online instruction in undergraduate nursing education. Distance Education, 23(2),212-229.

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Langford, D., & Hardin, S. (1999). Distance learning: Issues emerging as the paradigm shifts. Nursing Science Quarterly, 12(3), 191-196.

Mills, A.C., & Hrubetz, J. (2001). Strategic development of a maser's program on the world wide web. Journal of Professional Nursing. 17(4), 166-172

Predko, J. (2001). Use of distance technology for education, practice and research. (McCloskey Dochterman, J. & Kennedy Grace, H. (Eds.) Current Issues in Nursing.(6th ed.). St. Louis: Mosby.

Reinert, B., & Fryback, P. (1997). Distance learning and nursing education. Journal of Nursing Education, 36(9), 421-427.

Ross, J., &, Schulz, R. (1999). Using the world wide web to accommodate diverse learning Styles. College Teaching, 47(4)123-129.

Short, S. (2000). Online learning: Ready, set, click.RN,63(11)28-32.

Vrasidas, C., & McIsaac, M. (1999). Factors influencing interaction in an online course. American Journal of Distance Education, 13(3), 22-36.

Brenda Lee Krogh, Southwestern Community College

Frankie Santos Laanan, Iowa State University

Krogh, M.Ed., is a nursing instructor at Southwestern Community College, and Laanan, Ph.D., is assistant professor of higher education at Iowa State University.
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Author:Laanan, Frankie Santos
Publication:Academic Exchange Quarterly
Geographic Code:1USA
Date:Jun 22, 2005
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