Designing and Teaching Online Courses in Nursing

Online Learning – An Overview

Today, online education is upon us as evidenced by the rise in popularity of online RN to bachelor of science in nursing (BSN), master’s, doctor of nursing practice (DNP), and PhD programs. Driven by economic issues, the nursing shortage, adult learners with responsibilities beyond their careers, and technology, more and more nursing educators—like it or not—are faced with teaching online.

As with teaching in the classroom, the assumption has been that teaching online will just come naturally. After all, most of our current nursing educators learned to teach by the apprenticeship method; they learned from a seasoned educator. This has worked for decades, but the philosophy of teaching and the educational theories that support it have changed — or, more accurately, we are now becoming aware of and working to implement these changes.

Although lecturing has been the teaching method used for decades, we can no longer ignore constructivism, social constructivism, and findings from cognitive psychology research that have recently been translated and made understandable for the average educator.

Online education has made it possible not only to operationalize a constructivist learning environment, but also to create learning opportunities that recognize and build upon the knowledge and skills the adult learner brings to it. However, most nursing educators must rely on their commitment to lifelong learning to become proficient with strategies available for teaching online. If they are fortunate, they can learn from a seasoned online educator. The apprenticeship method remains alive and well.

I see as necessary to accomplish the call to transform nursing education, specifically, contextualizing knowledge and understandings (knowing that) with knowing how, when, and why to mimic the complexities of nursing practice, be that from a clinical, research, administrative, or educational perspective. As a result of their education, students must be able to employ multiple ways of thinking consistent with their new role, extract salient information in changing and unstable situations, and develop an evidence-based plan and see it through. We must not only teach the knowledge, skills, and attitudes necessary to accomplish this, but also help students gain the ability to use these tools in flexible ways.

This transformation will require more than simply replacing the lecture with online discussions. It will involve rethinking how we teach, moving away from a content-focused, teacher-driven perspective to one that is outcome focused and learning driven. The process must begin by changing how objectives are written and how we view teaching and assessing. Not-so-recent research from cognitive psychology can guide us, and you might be surprised how.

I have drawn from my experience working as an instructional designer teaching faculty how to teach online. Most of these educators had little theoretical background in educational theories, models, and concepts and lacked a solid understanding of how to operationalize these online. Research from cognitive psychology has been difficult to interpret, and then translate into effective teaching strategies, until recently with the understandable synthesis of research.

When planning an online course, backward is best. By that I mean using the process of Backward Design to design your online course, starting with outcomes instead of covering content. This approach maintains your focus on learning, not teaching, and puts assessment in a prominent place that shares its position with teaching methods, as the two cannot be separated when teaching online.

Teaching and assessment are one activity when teaching online; they are not separate activities and cannot be considered as two unrelated processes. This is an important concept to grasp, especially if you are a seasoned classroom instructor accustomed to creating separate assessments that add to your workload.

Online small group discussions serve as both formative and summative assessment; these discussions are engaging for students as they wrestle with complex questions and real-life case studies that have them thinking like a nurse practitioner, administrator, researcher, or educator— whichever role they aspire to. Creating engaging discussion questions and case studies is your job, which is so vital to teaching online.

Grading is an important function that drives learning and deserves some attention, as I think we have lost our way to some degree when assess- ing what constitutes academic achievement. Rubrics have replaced other grading strategies, but not all meet the expectation of greater objectivity in grading, which is their initial intent.

A hot topic in online education that relates to workload is the expectation of faculty presence in an online course from both faculty’s and the student’s perspective. What is currently recommended may shock you, but if my recommendations are followed when designing your online course, daily presence is not so daunting. To help you be present in your course, meet students’ expectations, yet not become the center of the discussion while facilitation strategies.

For many faculty, technology adds an often unwanted challenge when starting to teach online. Learning management systems (LMSs) that house online courses have similar functionality, so if you learn one, learning the next is not as difficult. Create a user-friendly course with consistent navigation so students can focus on learning and not spend hours trying to find information.

Also, Converting a classroom-based course to the online environment can be a time-consuming task when you do not have some guidance as to where to start. Online education is more than uploading your classroom lectures into the LMS. Lengthy lectures, particularly those that reiterate the assigned readings, simply have no place online. However, they can be useful in planning learning activities and assessments.

For the first time in history, students from three generations could conceivably be found taking classes in college. These generations are the baby boomers, Gen-Xers, and millennials. Much has been written about the Gen-Xers and millennials with regard to personality traits, expectations of life, how they learn, and other dimensions on how they differ from previous college students. I have been tempted to reiterate the information.

However, other, more relevant forces are at work in higher education, such as moving education from the classroom to the online environment, a change that many faculty are ill-prepared for from a theoretical and practical perspective; recent findings about how the brain works with relation to learning; the use of handheld technology as peripheral cognitive storage; and the not-so-recent understandings from the field of cognitive psychology that are being translated into practice in higher education. Thus, I will resist the urge to summarize what has been written about these groups as the information seems to be a moving target. Instead, let me place these generations in perspective chronologically.

Before providing a brief overview of the three generations, sans characteristics, understanding what the terms traditional and nontraditional learners mean is in order. Not specifically defined, but almost universally understood without using the term “traditional,” these students enrolled full time in college immediately after graduation from high school and were financially dependent upon others, typically their parents.

Conversely, the concept of the nontraditional student has been the focus of research on persistence and risk of attrition, although a consensus for a definition of the “nontraditional” student has not been reached. Studies completed for the National Center for Education Statistics used the following characteristics to identify undergraduate nontraditional learners:

  • Delaying college enrollment until age 24
  • Part-time enrollment
  • Working full time while attending school
  • Financially independent (i.e., not reliant on support from their parents) Responsible for at least one dependent
  • Being a single parent
  • Earning a general equivalency diploma instead of a high school diploma

The distinction between traditional and nontraditional students may have greater implications for teaching and learning than generational differences. Most online nursing programs involve either RN to bachelor of science in nursing (BSN) or graduate students. These students will, most likely, fit the definition of the non-traditional learner because they work more than 35 hours each week and are financially independent. They may also be single parents. This characterization has implications for the time they can devote to studying, which encourages faculty to choose teaching strategies and assessments strategically, as well as to design the learning management system (LMS) for intuitive navigation.

Baby Boomers

The baby boomers were born between 1945 and 1964, which means the youngest members of this group turned 50 in 2014. Some of these students may very well return to college for a second career or graduate study. Most likely, they are traditional learners who were taught in the classroom, where lecture was the main educational strategy used.
Many nursing faculty belong to this generation. Recent national statistics indicate that the average age of doctorally prepared nursing faculty, regardless of rank, and the average age of full professors at 61.6 years old (American Association of Colleges of Nursing [AACN], 2014). In addition, 50% of RNs—and therefore potential students—are older than 50 years of age, according to a survey by the National Council of the State Boards of Nursing.


Gen-Xers, the children of the baby boomers, were so named because some authors felt, as a group, they lacked a generation-defining event (Wilson, 2002). Sandwiched in-between the boomers and millennials, they are considered traditional learners even though they grew up with technology. Although authors differ on exact dates, the Gen-Xers were born from the mid-1960s to the early 1980s. The oldest members of this group turned 50 in 2015.


The millennials were born between the early 1980s and 2004, although some authors are less solid on the dates. Technology has been with this group their entire lives, with many using computers from a very early age. The oldest members of this group are in their early 30s, the youngest in middle school.
A plethora of writing has been published on the Net Generation (Gen-Xers and millennials), much of it in disagreement, leaving the educator with few solid strategies to advise teaching.

Instead of attempting to customize our teaching to meet disparate characteristics of our learners, our focus should be on applying effective learning theories, models, and concepts, regardless of how long they have been around; using teaching strategies that support how the mind learns, regardless of how old or what generation that mind belongs to; and using technology effectively and efficiently to support all of this. Thus, the focus of this chapter is on the learners and how they learn, introducing concepts that have been around for a while, but perhaps may be less familiar to nurse educators. In addition, I discuss perhaps even less familiar concepts to promote learning from cognitive science research.

The Net Generation

Another means of identifying traditional and nontraditional learners is how they learn, which for the Gen-Xers and millennials is technology based, leading many to prefer the more descriptive term of Net Generation for these two generational groups. Although not true for all members of the Net Generation, they have come to rely on technology in all aspects of their lives, including learning, which led Rosen (2011) to define a subgroup of the Net Generation born in the 1990s that he calls the iGeneration.

For this group, technology is not something special to be used under specific circumstances. Instead, all forms of technology—laptops, tablets, smartphones, e-readers, and so forth—are extensions of who they are; a very different perspective from how the telephone was thought of by the baby boomers. In Rosen’s (2011) view, members of the iGeneration “don’t question the existence of technology and media. They expect technology to be there, and they expect it to do whatever they want it to do. Their WWW doesn’t stand for World Wide Web; it stands for Whatever, Whenever, Wherever”

This perspective has the potential to forever alter how we teach and the definition of learning in general. Having the answer to almost any question a few clicks away by using a handheld device of some sort, learners have essentially added external brain capacity. This may alleviate the need to teach many facts and concepts, instead shifting the focus of education to critical thinking, critical appraisal, and the ability to distinguish reliable resources from those that are not. With this somewhat radical thought in mind, a review of what is currently known about how we learn is in order.


Learning occurs because of the interaction among attention, thinking, and memory. One cannot learn for the long term without attending to the lessons, engaging cognitive and metacognitive processes, and encoding and storing whatever was attended to in long-term memory (LTM). Our under- standing of how learning occurs has shifted from what Miller (2014) refers to as the three-box theory of memory, specifically working memory, short- term memory (STM), and LTM, to that of the relationship of attention to memory.


The value assessments hold as additional teaching strategies has not been maximized in nursing education, which is largely due to the timing of assessments during a course and the overemphasis on summative assess- ment. Multiple-choice tests are typically scheduled at midterm and the end of the course to assess learning with little time available for test review, which is a valuable way for students to learn from what they answered cor- rectly (validate learning) or from their mistakes (formative assessment).

Faculty’s perceived need to cover ever-expanding content also impacts time available for test review. This results in faculty setting aside office hours to review tests on an individual student basis, which is not only an inefficient approach, but one that takes even more of faculty’s precious time.

Another concern with reviewing a test with the entire class is test integrity and the ability to reuse test questions in future classes, which leaves faculty with a dilemma as to the best course of action. Although this is a realistic concern, it relates back to the timing of assessments and the overemphasis on one single test—or two if the final test is cumulative—to assess whether students have learned the content. This will be discussed in more detail later in this chapter in the section From Cognitive Science Research. At this juncture, understanding the difference between formative and summative assessments is important in order to begin to grasp how assessments can be used as teaching methods.

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