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Background
Competence is defined as having the necessary knowledge, skills, and capability to perform the job.2,5 Competency is achieved by gaining the appropriate education and applying that knowledge through actual job performance in the work environment according to the role and the organization’s standards.2,5 The educational part can be obtained through educator-controlled and/or through self-directed methods of learning (see Table
).
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Computer-based training has been in use since monitoring equipment with simulated rhythms taught users how to interpret dysrhythmias.16 For nurses, computer-based training is as effective as10,19,20 or more effective than19,20 lecture (or traditional training methods), and a blend of the 2 approaches offers the most cognitive improvement.10 Educators who have researched online learning cite cost-effectiveness,11,17,19,21 time efficiency,12,13,17,19–22 accessibility,11–13,17,21,22 use of different instructional strategies,11–13,17,19–21 and providing consistent information12,13 as advantages of computer-based training.
A myriad of barriers can prevent educators and bedside nurses from providing and achieving competency and professional development in a timely fashion. These barriers include unsupportive managers,23–25 staff issues,23–25 availability of programs,23 work pressure,25–28 costs,23–27 access to programs,23–26,28,29 family commitment,25,28 and having to participate on the learner’s "own time."24,26 These factors must be acknowledged and considered when professional development programs are created. Educators are discovering the benefits of blending educator-controlled and self-directed methods of education to deal with these factors.
Online Learning
Online learning is defined as content presented via a computer over the Internet or an intranet (an online system accessible only by those within the facility or organization). The benefits of online learning10–13,17,19–22,30 are similar to those of other programs designed on the basis of adult learning theories and a self-directed learning model:
Online learning can be used for regulatory and mandatory topics, orientation information, and any topic offered in a self-directed learning approach. Online learning may assist educators in communicating content in a consistent, nonjudgmental manner, and many programs offer feedback and online help.11–15,20,22,30,31 Learners can test their knowledge in a format in which positive and corrective feedback clarifies any misunderstanding. Feedback motivates learners to continue until the content has been mastered (eg, a passing score on a test). Answers to frequently asked questions, e-mail support, online support systems, glossaries, and other tools are available to assist learning. In the following material, I address how online learning may help resolve the educational challenges facing health-care professionals today.
The Challenge of the Shortage of Staff
As the shortage of nurses has continued to increase, with turnover rates as high as 21.3%, facilities have used strategies such as unlicensed assistive personnel, temporary staff, foreign nurses, and cross-training to fill the gaps.32 Releasing nurses from the bedside to obtain traditional methods of education has become difficult to impossible. Online training is an alternative to classroom-style education in which large numbers of staff are not simultaneously pulled away from patients’ care to participate.
The flexibility of online learning offers a solution to staffing problems. Online learning is available 24 hours a day, 7 days a week. The modules can be taken anywhere Internet access is available. Nurses do not have to leave the clinical area to participate. Content is usually broken into smaller modules, thus reducing the amount of time required for any single session. In one study,20 participants finished content in less time than it took to cover the topic in a lecture format. Finally, educational content is provided in a consistent manner, and both the night shift and the day shift have equal access to the same material.
The Challenge of Efficiency
With online learning, educational content can be updated in a single location and distributed to all end users on an ongoing basis. Links to resources such as internal policies and reference materials can be easily updated and are available to users wherever Internet access is available. The costs of printing and distributing training material are reduced. Time spent by managers scheduling, administering, and monitoring training programs is also reduced. In addition, time spent by educators scheduling rooms, arranging speakers, and keeping records is decreased. Educators then have time available to manage overall staff development and provide one-on-one instruction of new critical care nurses. Online learning of regulatory and core critical care content allows educators time to work with nurses at the bedside or provide in-service programs on unit-specific topics.11,12,14,15,31
Most commercial online learning systems collect and report learner data. These systems can generate reports that confirm training and education have occurred. Many systems offer transcripts or a report of content taken, continuing education credits earned, and the completion of any required course work. This information can be used for a professional portfolio, career or educational advancement, and monitoring for annual performance appraisals.11,14,33,34
The Challenge of Costs
Because of overall decreases in available funds, facilities have cut their orientation, in-service training, and continuing education budgets. In 2000, new nurses received a mean of 30 days of training rather than the 3 months of hands-on training that had been provided 5 years earlier.35 Online access to reference materials such as policy and procedure manuals, pharmacy indexes, and nursing procedure protocols can easily be updated and is instantly accessible by using an intranet system. This practice eliminates the labor-intensive process of distribution and the cost of production. Other associated costs that can be decreased by using online learning include remuneration paid to temporary and overtime staff to relieve nurses from the bedside for attendance at traditional educational forums.
The initial start-up costs of online learning include those for hardware, software, and technical support. A facility must evaluate its current capabilities to determine what systems are available that work with existing equipment and the capability of the information technology staff to work with clinically based programs. The costs of many commercial online programs are similar to those of other self-paced continuing education programs such as journals and books. In many instances, healthcare facilities are paying for all the costs associated with the online programs and offer the continuing education credit as a fringe benefit. Cost savings can also be achieved by purchasing an entire online system and/or the facility producing the online learning.11,17,19,21
Other Advantages of Online Learning
Online learning can provide preliminary or prestudy opportunities to establish core competence on set topics.30,36 Learners can "test out" of content, allowing them to spend time acquiring new knowledge rather than reviewing information already known.30 Online learning does not require scheduling or the availability of a classroom or an educator.
Cultural diversity is another challenge facing educators today. The issue of English as a second language can be bridged by working to provide online content in learners’ native languages when such content is available. Educators can work with content companies or staff/educators to have online content converted to other languages or can blend online programs with other training methods to assist staff members who speak English as a second language.
With any change, resistance and challenges occur. Fear and lack of basic computer skills may intimidate nurses from accessing online learning.13–16 Some nurses may not be comfortable with being personally responsible for their learning. Assessing an organization’s readiness for online learning is important. Employees may require training in computer skills before online learning can occur. Critical care educators may also feel uncomfortable using computers in training and may need the opportunity to talk with peers who have added online programs to professional development offerings.
Because online learning appears to be so effective, educators may fear being replaced.31,33 Educators must adjust to the change from being a teacher to being a facilitator, a mentor, and a coach. Online learning should be viewed as a tool to assist educators in their roles and should be integrated into current programs, not replace the programs.
Conclusion
Staffing issues, time constraints, and costs are some of the reasons given for reduced participation in and support of professional development. Online learning can be used as an adjunct to traditional educator-controlled methods of education and can reduce some of the barriers to professional development facing nurses today. The advantages of online learning include a learner-centric, cost-effective, easily accessible, and measurable means of providing nurses educational opportunities. Healthcare educators should evaluate their educational plan and consider incorporating online learning into their current methods of professional development.
Acknowledgments
I thank J. Celeste Kallenborn for sharing her expertise and for her help in preparing this article.
References
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