This module explores online nursing education and the opportunities for alternative program curricula delivery by nurse educators.
Course preview
Nursing Education at a Distance
Disclosure Statement
This module explores online nursing education and the opportunities for alternative program curricula delivery by nurse educators.
Upon completion of this module, learners should be able to:
- explore online education and its implications for nursing
- consider the advantages and disadvantages of online nursing education
- explain the basic elements of an online classroom
- examine special circumstances in nursing education and online learning opportunities
Providing effective and efficient nursing education can be challenging for educational institutions. Nursing practice utilizes clinical reasoning when caring for complex patients, with a movement toward education that promotes developing competency in nursing students. Well-educated nurses are essential for improved patient outcomes. As the US population ages, more people are living with chronic health conditions requiring more complex nursing care. The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) defines chronic diseases as conditions that last more than 1 year, either limiting activities of daily living (ADLs) or requiring ongoing medical attention. Chronic disease is the leading cause of death and disability in the United States, with 75% of adults ages 35–64 experiencing at least one chronic medical condition. This prevalence is higher, at 90%, among adults aged 65 or older. Patients often experience two or more chronic conditions. Chronic conditions such as heart disease, cancer, chronic lung disease, diabetes mellitus (DM), Alzheimer's disease, and chronic kidney disease (CKD) significantly contribute to the increasing complexity of care in the clinical environment (Imes et al., 2025; NCCDPHP, 2025).
New-graduate nurses entering a clinical setting encounter various challenges in delivering safe and effective patient care. Almost half of the routine tasks performed by nurses demand knowledge in clinical judgment. Recent studies estimate that only 23% of novice nurses exhibit entry-level competencies. A lack of clinical judgment can lead to poor patient outcomes; medication errors and adverse events may be directly related to judgment and decision-making skills. The novice graduate nurse must receive focused training and gain clinical insight to identify patient needs promptly and appropriately. Experienced nurses have acquired clinical judgment over time and are able to foster positive patient outcomes by recognizing patient needs and acting appropriately. To ensure that novice nurses are prepared for these demands on entering the clinical setting, faculty must strategically develop clinical judgment in students during their education (Delle et al., 2023; Hensel & Billings, 2020; Rose, 2020).
Nursing turnover is a significant concern for most health care organizations. Even before the COVID-19 pandemic, nursing shortages were prevalent. The American Association of Colleges of Nursing (AACN) has projected that the employment growth rate for RNs will be 5% through 2031. This is largely due to increased demand for care from the aging population and more than 25% of RNs reporting they plan to retire or leave nursing in the next five years (AACN, 2024b). In 2011, a continued shortage of nurses worldwide led the World Health Organization (WHO) to note that nursing retention should be a priority across the globe. Subsequently, in 2020, the WHO published the first State of the World's Nursing (SOWN) report, which estimated that the global nursing workforce was 27.9 million, with an estimated shortage of 5.9 million nurses. In 2025, the Health Resources and Services Administration (HRSA) published Nurse Workforce Projections, 2023–2038. This report has projected that by the year 2028, the United States will experience an 8% shortage of RNs, a deficit of 267,000 nurses. It is projected that this shortage will decrease to 108,000 nurses by 2038. Properly educating the substantial number of students needed to meet these goals is of paramount importance (HRSA, 2025; WHO, 2020).
According to the National Council of State Boards of Nursing (NCSBN), as of 2026, there are currently 5.9 million RNs working in the United States across various health care settings. The projection for nursing shortages and the role of nursing degree programs to educate the increasing nursing enrollment trend is hampered by nursing faculty shortages. In 2023, US nursing schools turned away over 65,000 qualified applicants from baccalaureate and graduate nursing programs. In a survey of 922 nursing schools across the United States, 1,977 faculty vacancies were identified (7.8%). This faculty shortage is due to budget constraints, faculty salaries, aging faculty, and a preference for doctorally prepared nurses in higher education. The average age of doctorally prepared nursing faculty is increasing, with the age of master's prepared nurses slightly younger. It is expected that as much as one-third of nursing faculty will be retiring before the end of this decade. In addition to clinical experience, nursing faculty must also be adequately prepared in evidence-based teaching pedagogy, developing curricula, and accurately assessing students (AACN, 2024a; Bakewell-Sachs et al., 2022; NCSBN, 2026).
Educational institutions have been called on to implement changes to address nursing shortages while also graduating nurses with a solid foundation in critical thinking and clinical judgment. Online learning or distance education is a solution that many health care organizations have initiated to meet these demands. However, online nursing education can be complicated as students enrolled in these programs can span multiple generations, and the technological skills of these varied generations (both faculty and students) can present a challenge. Many students have taken a nontraditional route by delaying their entry into higher education rather than enrolling immediately after high school or returning to education to start a second career in nursing. This trend has brought to the classroom a combination of new and experienced learners. Current technology allows educators to integrate new methods of learning to meet all students’ needs. Online learning opportunities have addressed some of the needs of nontraditional learners; however, faculty inexperience and a lack of infrastructure often persist. In addition, educational institutions providing online education must find ways to ensure that critical thinking and clinical judgment develop, along with skill acquisition (Herrman, 2020).
Terminology varies among faculty and students, but the following definitions of learning are universally accepted (Guertin et al., 2024; Zhang, 2025):
- In-person learning is based on coursework completed synchronously with faculty and students together in the same physical space. Students will still individually study course materials out of the classroom, but the formal teaching takes place as one group.
- Online learning consists of coursework...
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eted asynchronously inside a learning management system (LMS) instead of in a physical classroom. The didactic component occurs entirely online. Asynchronous learning encourages students to think independently as they read, analyze, and apply the concepts in the course materials. Remote learning activities are varied, engaging students in shared discussions or group assignments. An online class can be accessed anywhere, anytime.
Blended or hybrid learning includes both synchronous in-person classroom learning as well as asynchronous online activities. In a standard semester, students will have learning activities in a physical classroom combined with information delivered asynchronously throughout the alternate weeks.Distance education is learning and teaching from a distance. Some programs may have an online synchronous element involving which online instruction of students and faculty in the LMS at specific times during the week. This enables the students and faculty to talk to each other although not in the same location. This type of learning allows the faculty and students to experience a classroom without traveling to a campus.
Learning from a distance is not new in nursing education. As early as the mid-1990s, online nursing education developed as an effective teaching modality. In 2010, a large expansion of online education emerged in the form of video conferencing, recorded lecture material, and asynchronous discussion forums for interactive instruction participation. The COVID-19 pandemic created a necessary and urgent shift to online delivery methods despite lack of experience among most faculty with online delivery of content. Improvements in delivery methods increased student engagement and positive feedback (Guertin et al., 2024).
Traditionally, many educators have preferred the live experience in a classroom over online teaching and have viewed a live lecture as the gold standard for delivering educational material. However, the COVID-19 pandemic forced colleges and universities to switch immediately from in-person classroom education to entirely online, often without adequate infrastructure or preparation. Nurse educators and students were skeptical about delivering effective nursing education virtually, and many challenges arose. Nurse educators had to adapt quickly to unfamiliar technologies to provide content and evaluate knowledge. Students had to use these technologies and become more self-directed, which is an essential nursing skill. During this initial transition to online education, cheating and intellectual dishonesty (copying, plagiarism, literary theft) often occurred among students (Jeffries et al., 2022; Molato & Sehularo, 2022). As educational institutions adapted to these challenges, ensuring more robust evaluation measures, student engagement increased. At the start of the pandemic, only 49% of nurse educators believed that online learning was effective; however, nurse educators who received sufficient support and training discovered that online education was an effective pedagogy. Even after the COVID-19 pandemic restrictions have eased, many educational institutions have continued with a hybrid approach to nursing education (Jeffries et al., 2022; Molato & Sehularo, 2022).
The Basics
To participate in a course online, students and faculty must have access to the necessary technology. This typically means a personal computer (PC), laptop, tablet, or another device that can access the Internet, and specific software requirements to access the LMS that will house the school's courses. Most schools have access to an LMS such as Canvas, Blackboard, or Moodle, which houses the course syllabus, handouts, documents, and grade book. At a minimum, the faculty should have a syllabus, assigned readings from textbooks, course schedules, assignments, and methods for submitting required work loaded into the LMS. Faculty may be tempted to use social media as a platform for courses. However, the colleges' approved LMS is preferred due to concerns about privacy and requirements of the Family Educational Rights and Privacy Act (FERPA). Furthermore, students should have access to technical support from the institution if issues arise while using the LMS that may not be available with other social media platforms (Gilliard, 2020; Molato & Sehularo, 2022). New faculty members who are unfamiliar with the online delivery of courses should carefully consider the following (Farmer et al., 2022; Molato & Sehularo, 2022):
- How will the course be delivered?
- How many assignments should be given online versus in an in-person setting?
- How will course and program learning outcomes be evaluated?
Many of these crucial details are established by carefully developing the course syllabus that defines the program outcomes, course outcomes, and weekly learning objectives. The basic framework is the same as in-person learning, where faculty must develop learning plans, a course calendar, and other necessary learning assessments. Other concerns about online delivery are related to academic integrity in assessments and assignments completed outside of a proctored environment. The following three principles of online pedagogy should be noted (Farmer et al., 2022; Molato & Sehularo, 2022):
- Student active participation, such as engaging in assignments, discussions, and student presentations, is vital to independent learning.
- Interactivity is the heart of effective asynchronous learning.
- Faculty members should strive for presence.
Being available and providing the support that facilitates students' learning is foundational to success in the online environment. However, an online course does not mean a student-driven course. Even though there is no traditional classroom lecture, students still need faculty guidance. To be successful, students need adequate access and orientation to technology and the LMS software, as well as essential interaction between faculty and other students (e.g., virtual office hours) to provide adequate performance feedback. In addition to recorded lectures, faculty should facilitate interactive activities among students (Farmer et al., 2022; Molato & Sehularo, 2022).
Advantages and Disadvantages of Online Education
The apparent benefits of online education include its superior flexibility for both students and faculty. Participants may not live close to the campus, and the online opportunity saves them the time or expense of commuting to campus. The absence of a physical building can make distance learning less costly. Students can choose how to access course materials, as e-books provide prompt and easy access. Learning can continue despite local weather conditions, allowing consistent completion of coursework without loss of valuable time. Online classrooms have less structure than a traditional campus, requiring students to remain focused and responsible for completing their coursework. This is why student engagement is vital in distance learning. Technologies with virtual reality and gamification can engage students, while online web-conferencing platforms allow for real-time discussions (Elias et al., 2025; Jeffries et al., 2022; Molato & Sehularo, 2022).
The disadvantages of online education vary with each student. When educational institutions are unprepared to transition to online education, significant distress can occur for both educators and students. Faculty and students commonly have misconceptions about online education, such as the assumption that online students are more likely to procrastinate and avoid doing their coursework than students in a conventional classroom. However, students choosing an online environment are often independent, high performers who just need more flexibility due to scheduling conflicts. Some challenges to online education include increased technological preparation needed for faculty and students and a lack of technological support for troubleshooting. Students and faculty may feel isolated without the human interaction that prevails in a traditional classroom environment (Shorey et al., 2022). Students struggling with isolation report a desire to feel that they "belong" in the educational environment as well as a learning space that is nonjudgmental. A greater sense of belonging leads to a higher rate of student retention in a course (Montague et al., 2025). Sacco and Kelly (2021) evaluated the experiences of nurse educators during the transition to online education during COVID-19. They found that 75% of nurse educators reported this transition affected their well-being and required additional support from their institution. Online nursing education can be effective and offer many advantages for educators and students. However, educational institutions must provide the necessary resources to ensure the success of these courses (Shorey et al., 2022).
Learning Management Systems
Online classes are typically housed within a software or a platform through the academic institution called the LMS. This platform functions for both in-person and online courses and includes ways to communicate, deliver content, and assess students. Positive student experiences with LMS use include ease of access and the presence of institutional instructional support (Alkhuzaimi et al., 2025; Jeffries et al., 2022). Typically, the following elements and functions are contained in a school's LMS (Kennedy, 2017):
- file storage area
- webpages that allow a syllabus, lessons, and videos or recorded lectures to be uploaded
- assessment tools such as testing software
- a site to submit assignments, such as an uploading tool
- modules or tabs that allow weekly or topical division of coursework
- discussion forums to stimulate conversations on significant topics
- a grade book with all graded assignments for both student and faculty tracking
Course Elements
Syllabus
The syllabus is either created as a Word document and loaded into the course files or as a webpage with all the necessary information required by the individual school. Syllabi usually include a course title and description, a course number, course objectives, credit hours, any pre- or co-requisites, faculty contact information, and virtual office hours. Required and optional textbooks should be listed, along with any policies regarding late assignments, class attendance, and other expectations. This document serves as the course contract between the faculty and students. If a conflict arises, it can usually be resolved through the syllabus. Many institutions require a specific legal disclaimer to be included in the syllabus regarding policies and procedures (Kennedy, 2017).
Course Setup
Most LMS programs have a navigation bar with tabs such as the syllabus, learning modules, grades, or announcements. The tab names may be predetermined by the school's technology or educational departments or populated by the faculty. Most of the course activities are located under the learning modules tab. Modules may be organized chronologically (i.e., weekly) or by topic area. The modules should be ordered sequentially and contain all the materials needed to complete the learning activities for that specified time frame or topic. For example, if the first module is for Week 1 and the course calendar covers oxygenation during that week, then any lectures, discussions, videos, learning activities, or assessments regarding oxygenation should be included in that module. In some LMS forms, the module tab opens into another page that allows for loading various weeks or topics. Modules may open into a page with a folder/section for each week/month. Each of those may open into another page with tabs for lessons, discussions, assignments, and files (or any other areas the faculty may want to cover). Consistency is essential regardless of the layout so that students can find the necessary coursework to complete all requirements (Kennedy, 2017; Morgan, 2018).
A course calendar is essential to guide the students through the coursework since most courses are completed asynchronously. Tasks should be listed for a specific time frame on the calendar. However, the student should be free to complete the task as their schedule permits during the determined time frame. Occasionally, a live webinar or other synchronous activity may be scheduled, requiring everyone in the class to attend simultaneously. There should be recordings, when possible, to give anyone unable to attend the live event the opportunity to listen at a later time. Faculty members can also set virtual office hours through a webinar platform (e.g., Zoom or Webex) or phone calls during specified times. They should post an announcement listing their availability and contact information (Kennedy, 2017; Morgan, 2018).
Course assignments should have detailed instructions, just as in a traditional classroom. Rubrics can support student success by providing guidance regarding expectations. Discussions and assignments should align with the course outcomes to facilitate competency of the knowledge and skills required in a particular course. Many faculty members create videos explaining assignments to students and post them within the virtual classroom as part of the guidelines. Best online education practices include weekly announcements that guide the students through the upcoming week's expectations and a summary closing the previous week with encouraging messages. During the week, faculty members should access the online classroom daily and respond to student questions promptly. Students should be aware of the grading schedule, and the faculty should complete grading in the established time frame. The most successful online faculty are those who are present in the virtual classroom. Students are most likely to be present in the classroom when they encounter engaged faculty. Just as faculty and students enjoy interactions in a hallway or office of a traditional campus, online interactions can be equally engaging. The interactions may come through phone calls, texts, video chats, or whatever technology platform is chosen. Privacy and communication are vital in traditional classrooms, so the same consideration should be given online. Faculty should consider their tone and etiquette in written material and avoid feedback that is overly negative or harsh (Kennedy, 2017; Morgan, 2018).
Students may become confused, miss assignments, or fail to locate all the expected work for a week. To avoid this frustrating situation, faculty members should give clear directions regarding the expected work and send regular reminders. This is much like the reminders posted outside the classroom or on bulletin boards in the hallway of traditional schools. It is crucial to set up the course materials in a way that is easy to navigate and place directions throughout the course, including in hyperlinks or lists. When possible, courses should be visually appealing, through the use of approved clipart and attractive fonts, as well as links to approved websites or videos. Faculty members should discuss the use of outside resources with institutional leadership to avoid copyright issues. Student examples of assignments, such as completed presentations or written papers, can be posted for additional clarity. This can offer the student a starting point to work on their assignments and may limit compromises with academic integrity that would occur if they used others' work that may be available online (Kennedy, 2017; Morgan, 2018).
Assessments
Assessments in a virtual classroom can include quizzes, exams, written papers, or presentations. Since most students have access to video equipment through their smartphones or computers, many faculty members create assignments requiring a student presentation that is recorded and uploaded. Having quizzes, questions, or case studies within the lessons or at the end of specific portions is good practice. For instance, the faculty may teach infection control and then ask several questions that allow the student to demonstrate competency. These may or may not contribute to the student's overall grade for the class but are used to facilitate learning and assess competency with the content. Exams and quizzes should be protected to ensure academic integrity. This can be achieved through testing software or online proctoring. Most LMS programs have exam software as an option in course delivery. Lockdown browsers require the test taker to stay within the exam and stop the exam if they navigate outside the testing window. Webcams allow the faculty to proctor students in real time. Regardless of the software or tools utilized, instructors must clarify exam expectations to the students at the start of the exam. Academic integrity is a concern with online exams, but one method of maintaining the integrity of test questions includes variable exam items (test questions) that assess the same competency. These questions can be alternated among students in the same class or traded so that students cannot share the questions with the next class. In addition, most testing software allows for the randomization of questions (i.e., each student receives the questions in a different order). Some experts suggest that online tests are excluded from summative assessments since they are at risk of publication online or sharing among students. Research articles or projects offer a demonstration of competency with less risk. Regardless, quizzes and exams can be valuable tools for assessing competency and may be used throughout each course in some capacity (Kennedy, 2017).
Academic Integrity
Nursing has consistently been ranked very high for ethical and honest behavior. Having integrity indicates that the person adheres to a moral value, which is the basis of nursing practice. Integrity in academics is as important as in nursing practice. Unfortunately, the pressure to succeed has led to academic misconduct in students. New students enrolled in higher education may not be aware of plagiarism concepts. Unlimited access to online information can help students to use someone else's work. Faculty members may use specific plagiarism detection tools sanctioned by their educational institution. There are several online plagiarism detectors such as Turnitin, Grammarly, SafeAssign, or iThenticate. Students may not be aware that what they are doing is unacceptable and may require support from faculty to understand the proper way to cite information, paraphrase, or synthesize their thoughts. In addition, nurse educators should disclose to students that they are using plagiarism detection software and grant students access to these reports. Students can then check the report themselves and correct any areas identified as plagiarism before submitting. The academic institution and faculty need to discuss the risk of plagiarism and how it can relate to the use of artificial intelligence (AI) in completing assignments. Activities utilized to enlighten students about academic integrity occur in the form of honor codes, written academic integrity policies, and a student conduct review process. Academic integrity applies to online education as much as to in-person programs. Students benefit from course syllabi that clearly provide both the academic integrity information as well as a clear statement of the misconduct process and potential consequences. Academic integrity violations can be prevented with student learning modules on the subject as well as the utilization of plagiarism detection software for evaluation of student assignments. Assignments should have a clear notation of the acceptable threshold of plagiarism (typically a percentage) that will be allowed. In addition, faculty need to receive instruction on the institutional academic integrity policies and process for violations to ensure understanding and consistency among faculty and students. Confidentiality in the misconduct process is vital (Jared et al., 2023; Solmon, 2018).
Being Successful in Online Education
While many educators have become accustomed to developing and delivering lectures on a specific topic and may add a video or other media (e.g., PowerPoint), they are not as comfortable creating an online lesson. Long lectures are not as stimulating as short, focused ones. In addition to lecture-style presentations, using a diverse strategy of instruction with case-based learning and game-based learning improves student engagement (Elias et al., 2025). To promote student interest in their online classroom, faculty members should consider the following:
- incorporate learning activities, interactive tools, media, and visuals
- streamline the course organization and make it visually attractive and easy to navigate
- keep interactions optimistic in the discussions and announcements
- demonstrate caring and compassion for online learners and consider their busy schedules
- respect time expectations by limiting synchronous activities and notifying students well in advance
- promote communication between faculty and students (Elias et al., 2025)
Feedback is essential to student growth in the learning process and should be given on formative work to encourage student progress prior to the final summative evaluations. Lack of feedback can lead to an emphasis solely on grades rather than student learning. Feedback in an online environment is vital, as face-to-face interaction is limited. Feedback should support the learning environment of the student. Students value feedback that is comprehensive (rather than short and focused explanations) and provided in a timely manner. Faculty feedback should also be individualized and purposeful and delivered with an overall tone of caring. Providing a rubric of grading with feedback assists the student in understanding specific areas where they may improve (Lammey et al., 2025).
The COVID-19 pandemic accelerated the online education movement for health professions, including nursing. Although there are many advantages to online or hybrid educational courses, there are also some barriers to effective education with these modalities. Given the need to educate more nurses and the demand for flexibility in education, educational institutions must embrace online education as part of the new normal. To be successful in moving more nursing education to an online or hybrid format, the following recommendations should be considered (Jeffries et al., 2022):
- Embrace online education as a modality to increase efficiency while maintaining student engagement and learning; hybrid classes may offer the best of both worlds.
- Ensure faculty have the technology, training, instructional design support, and technical support for success.
- Address potential inequities in online or hybrid learning, including access to the tools and technology needed.
- Establish systematic, ongoing evaluations to assess and monitor courses.
- Expand online repositories of valuable educational resources.
Special Situations
Prelicensure nursing programs require many clinical and lab hours to allow students experiential learning that leads to safe and effective patient care. This can be accomplished in a hospital or a lab or an online setting. Simulations have been added to most nursing curricula as an adjunct to the clinical day. Most boards of nursing currently allow simulation activities to satisfy a portion of the clinical requirements for nursing programs in that particular state. There are many resources for predeveloped simulation experiences online, such as the National League for Nursing's (NLN's) vSim. This program offers the opportunity to assess clinical learning by students outside of a clinical setting (NLN, n.d.). In 2025, the International Nursing Association for Clinical Simulation and Learning (INACSL) published updated Healthcare Simulation Standards of Best Practices for simulation activities. Simulation activities allow the student to practice skills in a low-risk environment prior to actual clinical settings involving real patients. Faculty should encourage learners to explore knowledge without fear of the consequences of mistakes. Simulation can improve patient safety when an evidence-based framework is utilized to emphasize research and practice concepts. Prebriefing and debriefing activities should be included in the simulation activity to promote further student learning (INACSL Standards Committee, 2025).
Conclusion
An educator may feel intimidated by the technology or process of an online classroom and may be hesitant to ask for help. However, online courses are designed like in-person courses and should follow the same outcomes-based process. The greatest challenge comes with embracing the tools available and maximizing their use to create exciting and informative materials for students as they learn to care for patients safely and responsibly. Reflection can be a powerful tool and should be used by both students and faculty members to gain insight into future opportunities in teaching and learning.
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