Identify Nurse Manager’s sources of best practices for planning, implementing, and evaluating distance

education program

I. Licensure and entry into practice

The National Council of State Boards of Nursing (NCSBN) has been working to promote consistency,
among the boards of nursing (BONs), with the state approval of prelicensure distance education programs.
Before we talk about this initiative, a little background on why BONs are involved in nursing education is
important for you to understand.

In the U.S., prelicensure nursing programs are approved by their BONs before the students can take
nursing’s licensure exam (the NCLEX). Nurse licensure in the U.S. is based on a 2-pronged model.
First the faculty from a BON approved program must sign off that their student is clinically
competent and able to take the NCLEX.
Then the board of nursing will make the student eligible to take the NCLEX, which is a computer
adapted exam.
When the student passes the NCLEX, he/she can be licensed to practice nursing. As part of the
approval process, BONs evaluate and approve all nursing programs, including those that offer both
traditional and distance education programs.

Issues in the Oversight of Distance Education Nursing Programs

Two national reports in nursing have recommended that nurses advance their education (Benner,
Sutphen, Leonard & Day, 2010; IOM, 2011). Distance education programs provide tremendous
opportunities for nurses to further their education, particularly by offering quality programs in small
communities or rural areas where nursing programs don’t exist or by allowing flexibility for those students
who otherwise couldn’t attend a program. However BONs have reported issues with distance education
programs and some educators have complained about the varying BON regulations of the “host” states
(where the student is located) with which they must comply. Therefore, NCSBN’s Board of Directors
convened a committee of our membership which met from 2012-2014 to identify the issues that boards
of nursing and prelicensure nursing education programs face because of distance education and to
develop some recommendations.

Some of the issues the committee identified included:

Core education requirements for approving distance education programs are needed so that
states/jurisdictions are consistent when approving programs for having students in host states.
There is a need for licensure clarification, particularly with faculty who only teach didactic courses, though
there was consensus that preceptors or clinical faculty who work with patients be licensed in the host
state where the patients are located.
BONs in certain states want to know when students from out-of-state programs take clinical experiences
in their state.
Host states want assurance that students participating in clinical experiences in their states are being
supervised by qualified faculty or preceptors.
BONs report that the quality of online programs is more varied than with traditional programs and they
have requested information on specifics on how to evaluate the quality of distance education programs.
Educators are worried about complying with all the different regulations from Boards of Higher Education
as well as BONs.
To answer these concerns, the committee members took several steps. First, we developed relevant
definitions:

Distance education – Instruction offered by any means where the student and faculty are in separate
physical locations. Teaching methods may be synchronous or asynchronous and shall facilitate and
evaluate learning in compliance with BON approval status/regulations.
Home state – Where the program has legal domicile.
Host state – State/jurisdiction outside the home state where students participate in clinical experiences
or didactic courses.

Changing the Need for Approval in Every Host State

Then, after conducting interviews, conference calls and surveys with our BONs, educators, and with
representatives of the new National Council of State Authorization Reciprocity Agreement (NC-SARA)
organization, we developed guidelines for BONs that were translated into model administrative Rule/Act
language[2] and adopted at NCSBN’s 2014 annual meeting. The summarized guidelines are:

Distance education programs must meet the same approval guidelines as any other program.
Only the home state approves distance education programs.
Home state ensures faculty supervision over clinical students in the host states.
(a) Clinical faculty or preceptors are licensed where the patients/students are located. (b) Faculty who
only teach didactic content are licensed in the home state. Model licensure exemption language was
developed to allow for this.
BONs will include a question on their annual reports on whether students are engaging in clinical
experiences in host states.
The committee encouraged the BONs to make these changes by 2020, which is in line with other national
nursing education recommendations (IOM, 2011). We developed a model (Figure 1, below) that clearly
depicts the role of the home and host state with these new guidelines. A major difference is that there
will need to be more collaboration among the home and host states for program approval and for allowing
programs to enroll students in host states. Please see Lowery & Spector (2014) for a more comprehensive
discussion of this committee work.

Venn diagram with "Collaboration for Public Protection" in the middle. The role of Home and Host states
is in the circles on each side.
Figure 1: Role of the home and host state in new NCSBN guidelines.
Website and Virtual Conference for Further Information

To support these efforts, NCSBN has developed a Distance Education web page with resources for BONs
and educators. This web page has a link for host states distance education requirements that educators
have found valuable: https://www.ncsbn.org/6662.htm. NCSBN is also planning a virtual conference on
April 28, 2015, for its BONs, which will feature Dr. Diane Skiba as a keynote presenter on the future of
distance education and Dr. Diane Billings talking about quality indicators for distance education programs.
There will be plenty of time for dialogue, as well as panel discussions on the issues. A special session will
highlight the NC-SARA initiatives and Case Western Reserve’s new massive open online course (MOOC)
on quality improvement.

What’s Next?
For next steps, NCSBN’s Board of Directors has convened a second committee, the APRN Distance
Education Committee, which will develop guidelines for graduate programs with distance education
courses. With that new initiative, we will also develop a web page that will list all host state requirements
for graduate nursing programs. That work should be completed by August 2015.

It is imperative for BONs and educators to work together to promote excellent learning outcomes with
distance education, which in turn will improve the quality and safety of patients. Authentic conversations
will be essential as we move forward together.

Reference: https://wcetfrontiers.org/2014/11/14/nursing-regs-for-distance-ed/

II. Educational level and patient outcomes

“More Education for Nurses Equals Better Outcomes for Patients” (March 13, 2018)

The most obvious example of this is lower patient mortality. An oft-cited 2014 study, developed by the
Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia, notes
that for every 10 percent increase in the number of nurses with a BSN, there is a seven percent decline in
mortality following common surgery. A Nurse.com article on the study characterizes it as a "causal
linkage," saying that the increased education allows those nurses to care more knowledgeably for their
patients.

The Robert Wood Johnson Foundation, in an article the same year, advocated for more educated nurses
to navigate a more complex healthcare system.

"Experts recognize the tremendous contributions made by registered nurses prepared at the associate-
degree and diploma levels," the authors began, "but say more highly educated nurses are needed to
navigate an increasingly complex health care system and ensure that patients -- who are living longer, and
sicker, often with multiple chronic conditions -- have access to highly skilled, patient-centered care across
the entire care continuum."

There is a longstanding call for more nurses with BSNs to enter healthcare in the United States. According
to the Institute of Medicine's landmark 2010 report, the number of nurses with BSNs in the United States
should expand to 80 percent by 2020.

There are two main reasons for this call. First, it acknowledges there is a growing, aging population, and
given that one or more chronic illnesses can complicate any diagnosis, it's essential to have educated
nurses to meet those challenges. Second, it accounts for the momentous changes taking place in
healthcare technology; educated nurses can help entire hospitals and healthcare systems navigate the
new healthcare landscape.

A-State's RN to BSN program factors in both of those aims, with a program that allows nurses to:

Increase knowledge in clinical areas for professional development.

Strengthen nursing leadership and management skills.
Enhance decision-making and critical thinking skills.
Use evidence-based data to strengthen and improve client care via comprehensive, efficient and cost-
conscious care.
By developing in these areas, nurses gain the education that most helps improve patient outcomes.

The decision-making and critical thinking component is particularly important; as the Nurse.com article
on the Center for Health Outcomes and Policy Research study noted:

Professional nurses are called upon to quickly synthesize a large amount of clinical information about
acutely ill patients, process this information in the context of scientific evidence, reach evidence-based
conclusions, communicate salient information and their conclusions to physicians, and act in the absence
of a physician at the bedside, which is most of the time.

While the nursing education and evidence-based practice all contribute to modern healthcare, the focus
on decision-making and critical thinking is especially geared toward today's demands, not just in a
healthcare setting, but in processing the flood of information we take in on a daily basis.

A-State helps nursing students develop into RNs with BSNs, positioned to improve patient outcomes
wherever they are, in as few as 12 months.

Reference: https://degree.astate.edu/articles/nursing/more-education-better-outcomes-patients.aspx

“The Value of Education for Patient Outcomes” (October 15, 2018)

It’s no secret that quality patient care is tied to a well-educated nursing workforce. In fact, research has
shown that lower mortality rates, fewer medication errors, and positive patient outcomes are all related
to nurses prepared at the baccalaureate and graduate degree levels. In May 2014, The Lancet published
a study titled “Nurse Staffing and Education and Hospital Mortality in Nine European Countries: A
Retrospective Observational Study.” The study found that patients experiencing complications after
surgery are more likely to survive if treated in hospitals with adequate staffing and higher numbers of
baccalaureate-prepared nurses.

Patient education at the core

So, we know that nursing education positively impacts patient outcomes, but what about patient
education? At the core of health care reform is the call to have educated patients interacting with
responsive health care teams. For education to be successful, patients need to be engaged to understand
the benefits of health education. Research shows that when patients are engaged in their health care,
there are significant improvements in health outcomes, patient safety, and health care quality. Moreover,
patient engagement also leads to lower health care costs.

What is patient engagement? Patient engagement combines the patient’s ability, knowledge, skills, and
willingness with interventions that are designed to increase positive patient behavior – behavior that
ultimately improves health and patient outcomes.

In the past, patient education consisted of discharge planning and limited print materials distributed by
nursing staff. Since that time, patient education has advanced significantly with the advent of interactive
patient engagement solutions. New information technology (IT) solutions are used not only to improve
patient education concerning their conditions and encourage greater involvement in care decisions, but
to inform patients about community health programs, address health literacy challenges, provide
communication access with health care team members, support treatment strategies, and support
individualized discharge planning. New IT solutions are also being used to educate patients about ways to
change health behaviors and take better care of themselves. For example, fitness apps are used to
measure the amount of exercise a patient gets each day. Nutrition apps help patients track their nutrition.
Special devices track trends in heart rate and blood pressure.

Interactive technologies allow health care facilities to educate patients about items such as advanced
directives, nutrition, chronic care, and safety equipment. For example, patients can log into the system to
order their meals and learn about their dietary restrictions at the same time. Patients can also access
multi-cultural health libraries that contain educational videos about their conditions.

Face-to-face
As you can see there have been many advances that enhance patient education and engagement.
However, interactive technologies and IT solutions aren’t the only elements necessary to help educate
patients about their health. Individualized education delivered face-to-face by health care team members
is also valuable. Patient education using teach-back methods to evaluate education and comprehension,
combined with interactive care, is an ideal method for identifying patient knowledge gaps that can then
be a focus for review.

Power in knowledge
So as the adage goes, there is power in knowledge. By empowering patients with education and
knowledge about their health, you can improve patient outcomes, patient safety, and health care quality,
and at the same time improve patient satisfaction. Patient education has been found to positively affect
Hospital Consumer Assessment of Healthcare Providers scores, especially surrounding medication
administration and communication with staff. So patient education not only benefits patients but the
health care facility as well.

” The Impact of Education on Nursing Practice”

The American Association of Colleges of Nursing (AACN), the national voice for baccalaureate and
graduate nursing programs, believes that education has a significant impact on the knowledge and
competencies of the nurse clinician, as it does for all health care providers. Clinicians with Bachelor of
Science in Nursing (BSN) degrees are well-prepared to meet the demands placed on today's nurse. BSN
nurses are prized for their skills in critical thinking, leadership, case management, and health promotion,
and for their ability to practice across a variety of inpatient and outpatient settings. Nurse executives,
federal agencies, the military, leading nursing organizations, health care foundations, magnet hospitals,
and minority nurse advocacy groups all recognize the unique value that baccalaureate-prepared nurses
bring to the practice setting.

AACN encourages employers to foster practice environments that embrace lifelong learning and offer
incentives for registered nurses (RNs) seeking to advance their education to the baccalaureate and higher
degree levels. We also encourage BSN graduates to seek out employers who value their level of education
and distinct competencies.

Different Approaches to Nursing Education

There are three routes to becoming a registered nurse: a 3-year diploma program typically administered
in hospitals; a 3-year associate degree usually offered at community colleges; and the 4-year
baccalaureate degree offered at senior colleges and universities. Graduates of all three programs sit for
the same NCLEX-RN© licensing examination.
Baccalaureate nursing programs encompass all of the course work taught in associate degree and diploma
programs plus a more in-depth treatment of the physical and social sciences, nursing research, public and
community health, nursing management, and the humanities. The additional course work enhances the
student’s professional development, prepares the new nurse for a broader scope of practice, and provides
the nurse with a better understanding of the cultural, political, economic, and social issues that affect
patients and influence healthcare delivery. For more than a decade, policymakers, healthcare authorities,
and practice leaders have recognized that education makes a difference when it comes to nursing
practice.

In September 2013, the Robert Wood Johnson Foundation (RWJF) released an issue of its Charting
Nursing’s Future newsletter titled “The Case for Academic Progression,” which outlined how patients,
employers, and the profession benefits when nurses advance their education. Articles focus on the
evidence linking better outcomes to baccalaureate and higher degree nurses, educational pathways, and
promising strategies for facilitating academic progression at the school, state, and national levels. See
www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407597.

In September 2012, the Joint Statement on Academic Progression for Nursing Students and Graduates
was endorsed by the American Association of Colleges of Nursing, American Association of Community
Colleges, Association of Community Colleges Trustees, National League for Nursing, and the National
Organization for Associate Degree Nursing. This historic agreement represents the first time leaders from
the major national organizations representing community college presidents, boards, and program
administrators have joined with representatives from nursing education associations to promote
academic progression in nursing. With the common goal of preparing a well- educated, diverse nursing
workforce, this statement represents the shared view that nursing students and practicing nurses should
be supported in their efforts to pursue higher levels of education. Read the statement at
www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Academic-Progression.

In October 2010, the Institute of Medicine released its landmark report on The Future of Nursing: Leading
Change, Advancing Health, initiated by the Robert Wood Johnson Foundation, which called for increasing
the number of baccalaureate-prepared nurses in the workforce to 80% by 2020. The expert committee
charged with preparing the evidence-based recommendations in this report state that to respond “to the
demands of an evolving health care system and meet the changing needs of patients, nurses must achieve
higher levels of education.”

In May 2010, the Tri-Council for Nursing (AACN, ANA, AONE, and NLN) issued a consensus statement
calling for all RNs to advance their education in the interest of enhancing quality and safety across
healthcare settings. In the statement titled Education Advancement of Registered Nurses, the Tri-Council
organizations present a united view that a more highly educated nursing workforce is critical to meeting
the nation’s nursing needs and delivering safe, effective patient care. In the policy statement, the Tri-
Council finds that “without a more educated nursing workforce, the nation's health will be further at risk.”

In December 2009, Dr. Patricia Benner and her team at the Carnegie Foundation for the Advancement of
Teaching released a new study titled Educating Nurses: A Call for Radical Transformation, which
recommended preparing all entry-level registered nurses at the baccalaureate level and requiring all RNs
to earn a master’s degree within 10 years of initial licensure. The authors found that many of today’s new
nurses are “undereducated” to meet practice demands across settings. Their strong support for high
quality baccalaureate degree programs as the appropriate pathway for RNs entering the profession is
consistent with the views of many leading nursing organizations, including AACN.
www.carnegiefoundation.org/elibrary/educating-nurses-highlights

On September 30, 2008, the Foundation for California Community Colleges and Kaiser Permanente
announced grant funding for a new program aimed at creating a better-educated nursing workforce in
California through collaboration between two-year and four-year nursing programs. Funding will be used
to develop demonstration models of collegiate partnerships that seamlessly provide a baccalaureate
degree to nurses educated in two-year programs. The grants are an outcome of a study conducted by
California Institute for Nursing & Health Care (CINHC) that called for transforming California's nursing
education system. Study director Dr. Jan Boller said: "Recent studies clearly demonstrate that a higher
prevalence of baccalaureate- and masters-prepared RNs at the bedside positively impact patient
outcomes." https://healthimpact.org/programs/california-collaborative-model-for-nursing-education-
ccmne

In February 2007, the Council on Physician and Nurse Supply released a statement calling for a national
effort to substantially expand baccalaureate nursing programs. Chaired by Richard "Buz" Cooper, MD and
Linda Aiken, PhD, RN, the Council is based at the University of Pennsylvania. In the statement, the Council
noted that a growing body of research supports the relationship between the level of nursing education
and both the quality and safety of patient care. Consequently, the group is calling on policymakers to shift
federal funding priorities in favor of supporting more baccalaureate nursing programs. This call was
reaffirmed in a new statement released in March 2008. www.physiciannursesupply.com/Articles/council-
meeting-release.pdf

In March 2005, the American Organization of Nurse Executives (AONE) released a statement calling for all
RNs to be educated in baccalaureate programs in an effort to adequately prepare clinicians for their
challenging, complex roles. AONE’s statement, titled Practice and Education Partnership for the Future,
represents the view of nursing’s practice leaders and a desire to create a more highly educated nursing
workforce in the interest of improving patient safety and nursing care.

The National Advisory Council on Nurse Education and Practice (NACNEP), policy advisors to Congress and
the Secretary for Health and Human Services on nursing issues, has urged that at least two-thirds of the
nurse workforce hold baccalaureate or higher degrees in nursing. Currently, only 55 percent of nurses
hold degrees at the baccalaureate level and above according to HRSA’s 2013 report on The U.S. Nursing
Workforce: Trends in Supply and Education.

NACNEP found that nursing’s role calls for RNs to manage care along a continuum, to work as peers in
interdisciplinary teams, and to integrate clinical expertise with knowledge of community resources. The
increased complexity of the scope of practice for RNs requires a workforce that has the capacity to adapt
to change. It requires critical thinking and problem solving skills; a sound foundation in a broad range of
basic sciences; knowledge of behavioral, social and management sciences; and the ability to analyze and
communicate data. Among the three types of entry-level nursing education programs, NACNEP found that
baccalaureate education with its broader and stronger scientific curriculum best fulfills these
requirements and provides a sound foundation for addressing the complex health care needs of today in
a variety of nursing positions. Baccalaureate education provides a base from which nurses move into
graduate education and advanced nursing roles.
There is a growing consensus in the higher education community that a liberal arts education should be
embedded in all the professional disciplines. Graduates with a liberal education are prized by employers
for their analytical and creative capacities and demonstrate stronger skills in the areas of communication,
assessment, cultural sensitivity, resourcefulness, the ability to apply knowledge, and scientific reasoning.
Though some arts and science courses are included in ADN programs, the BSN provides a much stronger
base in the humanities and sciences.

There are 747 RN-to-BSN and 230 RN-to-MSN programs that build on the education provided in diploma
and associate degree programs and prepare graduates for a broader base of practice. In addition to
hundreds of individual agreements between community colleges and four-year schools, state-wide
articulation agreements exist in many areas including Florida, Connecticut, Texas, Iowa, Maryland, South
Carolina, Idaho, Alabama, and Nevada to facilitate advancement to the baccalaureate. These programs
further validate the unique competencies gained in BSN programs.

Registered nurses today work as a part of an interdisciplinary team with colleagues educated at the
master’s degree or higher level. These health professionals, including physicians, pharmacists, and speech
pathologists, recognize the complexity involved in providing patient care and understand the value and
need for higher education. For example, Occupational Therapists (OT) require education at the master’s
level, while OT Assistants are prepared at the associate degree level. Since nurses are primarily
responsible for direct patient care and care coordination, these clinicians should not be the least educated
member of the healthcare team.

According to a study published by Dr. Betty Rambur and her colleagues in the July/August 2003 issue of
Nursing Outlook, increasing the proportion of baccalaureate prepared nurses in the registered nursing
population may be essential to stabilizing the nursing workforce. Nurses prepared at the BSN level were
found to have higher levels of job satisfaction which is key to nurse retention.

Recognizing Differences Among Nursing Program Graduates

There is a growing body of evidence that shows that BSN graduates bring unique skills to their work as
nursing clinicians and play an important role in the delivery of safe patient care.

In an article published in the March 2013 issue of Health Affairs, nurse researcher Ann Kutney-Lee and
colleagues found that a 10-point increase in the percentage of nurses holding a BSN within a hospital was
associated with an average reduction of 2.12 deaths for every 1,000 patients—and for a subset of patients
with complications, an average reduction of 7.47 deaths per 1,000 patients. The study is titled “An
Increase in the Number of Nurses with Baccalaureate Degrees is Linked to Lower Rates of Post-surgery
Mortality.”

In the February 2013 issue of the Journal of Nursing Administration, Mary Blegen and colleagues published
findings from a cross-sectional study of 21 University Healthsystem Consortium hospitals to analyze the
association between RN education and patient outcomes. The researchers found that hospitals with a
higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure
mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary
embolism and shorter length of stay. This study is titled “Baccalaureate Education in Nursing and Patient
Outcomes.”
In the October 2012 issue of Medical Care, researchers from the University of Pennsylvania found that
surgical patients in Magnet hospitals had 14% lower odds of inpatient death within 30 days and 12% lower
odds of failure-to-rescue compared with patients cared for in non-Magnet hospitals. The study authors
conclude that these better outcomes were attributed in large part to investments in highly qualified and
educated nurses, including a higher proportion of baccalaureate prepared nurses.

In a January 2011 article published in the Journal of Nursing Scholarship, Drs. Deborah Kendall- Gallagher,
Linda Aiken, and colleagues released the findings of an extensive study of the impact nurse specialty
certification has on lowering patient mortality and failure to rescue rates in hospital settings. The
researchers found that certification was associated with better patient outcomes, but only when care was
provided by nurses with baccalaureate level education. The authors concluded that “no effect of
specialization was seen in the absence of baccalaureate education.”

In an article published in Health Services Research in August 2008 that examined the effect of nursing
practice environments on outcomes of hospitalized cancer patients undergoing surgery, Dr. Christopher
Friese and colleagues found that nursing education level was significantly associated with patient
outcomes. Nurses prepared at the baccalaureate-level were linked with lower mortality and failure-to-
rescue rates. The authors conclude that “moving to a nurse workforce in which a higher proportion of
staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse
outcomes for patients.”

In a study released in the May 2008 issue of the Journal of Nursing Administration, Dr. Linda Aiken and
her colleagues confirmed the findings from her landmark 2003 study (see below) which show a strong link
between RN education level and patient outcomes. Titled “Effects of Hospital Care Environment on
Patient Mortality and Nurse Outcomes,” these leading nurse researchers found that every 10% increase
in the proportion of BSN nurses on the hospital staff was associated with a 4% decrease in the risk of
death.

In the January 2007 Journal of Advanced Nursing, a study on the “Impact of Hospital Nursing Care on 30-
day Mortality for Acute Medical Patients” found that BSN-prepared nurses have a positive impact on
lowering mortality rates. Led by Dr. Ann E. Tourangeau, researchers from the University of Toronto and
the Institute for Clinical Evaluative Sciences in Ontario studied 46,993 patients admitted to the hospital
with heart attacks, strokes, pneumonia and blood poisoning. The authors found that: "Hospitals with
higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our
findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated
with 9 fewer deaths for every 1,000 discharged patients."

In a study published in the March/April 2005 issue of Nursing Research, Dr. Carole Estabrooks and her
colleagues at the University of Alberta found that baccalaureate prepared nurses have a positive impact
on mortality rates following an examination of more than 18,000 patient outcomes at 49 Canadian
hospitals. This study, titled The Impact of Hospital Nursing Characteristics on 30-Day Mortality, confirms
the findings from Dr. Linda Aiken’s landmark study in September 2003.

In a study published in the September 24, 2003 issue of the Journal of the American Medical Association
(JAMA), Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link
between higher levels of nursing education and better patient outcomes. This extensive study found that
surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of
nurses educated at the baccalaureate or higher degree level. In hospitals, a 10 percent increase in the
proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5
percent. The study authors further recommend that public financing of nursing education should aim at
shaping a workforce best prepared to meet the needs of the population. They also call for renewed
support and incentives from nurse employers to encourage registered nurses to pursue education at the
baccalaureate and higher degree levels.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the
report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate
studies conducted in 1996 – one by the state of New York and one by the state of Texas – clearly show
that significantly higher levels of medication errors and procedural violations are committed by nurses
prepared at the associate degree and diploma levels as compared with the baccalaureate level. These
findings are consistent with findings published in the July/August 2002 issue of Nurse Educator magazine
that references studies conducted in Arizona, Colorado, Louisiana, Ohio and Tennessee that also found
that nurses prepared at the associate degree and diploma levels make the majority of practice-related
violations.

Chief nurse officers (CNO) in university hospitals prefer to hire nurses who have baccalaureate degrees,
and nurse administrators recognize distinct differences in competencies based on education. In a 2001
survey published in the Journal of Nursing Administration, 72% of these directors identified differences in
practice between BSN-prepared nurses and those who have an associate degree or hospital diploma,
citing stronger critical thinking and leadership skills.

Studies have also found that nurses prepared at the baccalaureate level have stronger communication
and problem solving skills (Johnson, 1988) and a higher proficiency in their ability to make nursing
diagnoses and evaluate nursing interventions (Giger & Davidhizar, 1990).

Research shows that RNs prepared at the associate degree and diploma levels develop stronger
professional-level skills after completing a BSN program. In a study of RN-to-BSN graduates from 1995 to
1998 (Phillips, et al., 2002), these students demonstrated higher competency in nursing practice,
communication, leadership, professional integration, and research/evaluation.

Data show that health care facilities with higher percentages of BSN nurses enjoy better patient outcomes
and significantly lower mortality rates. Magnet hospitals are model patient care facilities that typically
employ a higher proportion of baccalaureate prepared nurses, 59% BSN as compared to 34% BSN at other
hospitals. In several research studies, Marlene Kramer, Linda Aiken and others have found a strong
relationship between organizational characteristics and patient outcomes.

The fact that passing rates for the NCLEX-RN©, the national licensing exam for RNs, are essentially the
same for all three types of graduates is not proof that there are no differences among graduates. The
NCLEX-RN© is a multiple-choice test that measures the minimum technical competency for safe entry
into basic nursing practice. Passing rates should be high across all programs preparing new nurses. This
exam does not test for differences between graduates of different entry-level programs. The NCLEX-RN©
is only one indicator of competency, and it does not measure performance over time or test for all of the
knowledge and skills developed through a BSN program.

III. Employer’s view and preferences

“Debate Continues on Nursing Degrees” – December 22, 2017

A proposed policy statement has reignited the question of whether the associate or bachelor's degree
should be the entry-level requirement in the nursing profession.
The argument over which degree should be the decisive credential for entry into the nursing profession
has been going on for years.

Should the associate degree in nursing or the bachelor of science in nursing give entry into the profession?
While different groups have come out one way or the other on the question, the American Association of
Colleges of Nursing, which represents four-year and graduate nursing educators, is bringing the issue
forward again.

Although AACN has not issued an official statement, it is circulating a draft position called “The
Baccalaureate Degree as Entry-Level Preparation for Professional Nursing Practice” in an effort to solicit
public opinion on the topic.

The draft paper says the AACN “strongly believes that registered nurses should be minimally prepared
with the bachelor of science in nursing or equivalent nursing degree.”

“This statement does not say that nurses cannot enter the profession with an associate degree,” said
Robert Rosseter, chief communications officer for AACN, in an email. “The focus here is on academic
progression -- moving nurses on to higher levels of education.”

However, more associate-degree nursing graduates receive state licenses than those who have gone the
bachelor’s-degree route. Currently, state licensure boards license graduates with either degree. According
to the Organization for Associate Degree Nursing, in 2016, 81,633 associate-degreed nurses received their
licenses compared to 72,637 bachelor's-degreed nurses. While many of the associate-degreed nurses will
go on to receive their bachelor’s and graduate nursing degrees, the associate-degree route is seen as an
important and affordable entry into the field.

The AACN draft does acknowledge the historical role associate degree in nursing programs have played in
bringing new recruits into the field, especially as university programs have struggled to expand their
capacities to meet the demand for more health-care professionals. But registered nurses entering the
profession with a bachelor’s degree see “faster salary growth and higher lifetime earnings over the course
of their careers. They also have greater opportunities for employment …” The position paper found that
72 percent of nursing directors identified differences in practice between B.S.N.-prepared registered
nurses and those with an associate degree or hospital diploma. The paper also cited research that B.S.N.-
prepared nurses had better patient outcomes.

Rosseter said the position paper will be reviewed and edited in January and member institutions will vote
in March whether to endorse or dismiss the statement.

AACN’s Academic Progression Task Force has been reviewing several models with a goal of increasing the
education level of registered nurses as a response to a national call for increasing the education of the
country’s nurses. In 2010, the former Institute of Medicine, which is now the National Academy of
Medicine, published a report recommending the percentage of registered nurses with a B.S.N. increase
to 80 percent by 2020.

Still, the draft led to a joint statement in opposition from the American Association of Community Colleges
and the Association of Community College Trustees.
Both groups stated, “While the [AACN] Academic Progression Task Force’s position statement includes
good rationale that supports the value of the baccalaureate degree in nursing, we have seen no evidence
that the associate degree as the credential for entry into the nursing profession is not preparing students
to successfully handle the responsibilities of the job, and that the baccalaureate degree, with its focus on
general education courses, will better prepare a nurse.”

ACCT and AACC also pointed out that the associate degree plays an important role particularly in rural
communities, doctor’s offices, nursing homes, and urgent- and acute-care facilities.

The community college groups also noted that the associate-degree route helps address critical nursing
shortages. “These programs have educated 39 percent of the 2.6 million registered nurses practicing in
rural and urban health care settings across the nation,” according to the statement. The Bureau of Labor
Statistics estimates that more than 1.2 million additional registered nurses will be needed in coming years.

The majority of the nation’s community colleges offer associate-degree nursing programs. More than 800
out of 1,100 two-year institutions offer the degree path to becoming a registered nurse.

Donna Meyer, chief executive officer of the Organization for Associate Degree Nursing, said she didn’t see
anything new in AACN’s statement, that that’s been their view for a long time, and while OADN respects
their view, they instead believe the associate degree is also an entry into the field.

“We totally support academic progression,” Meyer said. “Many of the people that teach in the community
colleges with doctoral degrees started at the A.D.N. level. It’s a pathway and not everyone can leave their
community and go on to university.”

Nursing is just one of a number of allied health fields that have been posing the question of whether or
not to increase entry-level credentials into their respective fields, said Mike Hansen, president of the
Community College Baccalaureate Association, which promotes four-year degrees at community colleges.
For instance, the Accreditation Council for Occupational Therapy Education is currently considering
increasing entry-level degree requirements for occupational therapist assistants from an associate to a
bachelor’s degree.

Even outside health care, there is a shift in increasing credentials. Earlier this year a new regulation in the
District of Columbia increased entry-level credentials for a child-care center director to at least a
bachelor’s degree.

Hansen said while the CCBA doesn’t weigh in on the direction these industries take in deciding their
requirement standards for entry, it does want the ability for community colleges to respond to the
changes.

“The truth of the matter is that for a larger number of students, they have two barriers to obtaining a
B.S.N.,” he said. “One is geographic. They don’t live anywhere near where a traditional university
baccalaureate degree is available … and the second issue is finances. For many students, the tuition at a
traditional four-year university is not something they will be able to afford.”
So, to address those concerns, CCBA is in favor of strong transfer and articulation agreements between
community colleges and four-year institutions, creating distance-learning initiatives between institutions,
or, more controversially, allowing community colleges to offer those four-year degrees, Hansen said.

The AACN paper also posits that the growth of community colleges’ offering bachelor’s degree nursing
programs “underscores the national need for more programs to raise the education level of the nursing
work force.”

While OADN supports two-year colleges that are moving in the direction of offering bachelor’s degrees in
nursing, less than 5 percent of community colleges are doing so, mostly because of legislative barriers,
Meyer said.

As of 2015, Education Commission of the States counted 23 states that allowed community colleges to
award bachelor’s degrees, however, only a few institutions in those states could offer the programs. The
main arguments against allowing community colleges to offer nursing bachelor's-degree programs have
been the competition it could create with universities and the potential to disrupt existing transfer
agreements.

But the demand for registered nurses is only increasing. According to the Bureau of Labor Statistics,
employment of registered nurses is projected to grow 15 percent from 2016 to 2026 -- faster than the
average for all occupations.

“There are going to be a lot of nurses that retire, and health care is so much more complex,” Meyer said.
“That’s why the associate-degree pipeline is important.”

There are some hospitals, mostly in major cities, that are requiring the B.S.N. for employment, but
registered nurses -- regardless of whether they have an associate or bachelor’s degree -- are in high
demand and will continue to be so, she said.

Despite multiple organizations coming down on the side of the associate degree or the bachelor’s as the
entry-level credential into nursing, the final decision resides with the National Council of State Boards of
Nursing, which is responsible for developing nursing licensure examinations and allows graduates of either
degree program to sit for exams.

Reference: https://www.insidehighered.com/news/2017/12/22/battle-over-entry-level-degree-nursing-
continues

“What Employers Think About Your Online Nursing Degree” – February 23, 2016
After applicants receive their initial training in person, employers will accept subsequent degrees earned
online, experts say.
For James Gregory, a graduate of the University of South Carolina's adult gerontology acute care nurse
practitioner master's degree program, online education seemed like a natural choice, as he was able to
attend class on a more flexible schedule, he says. Then, when he was applying for jobs, some employers
asked him during interviews whether the quality of his online degree was equivalent to what he would
have received in person. He says it was.
The online degree program was "very challenging and far different, of course for me, than the days of
going and having to be at class at 8, 10:15, or whatever, but the expectation was the same," says the 54-
year old, who now works as an acute care nurse practitioner in South Carolina.

Like Gregory, nurses today, who often work on erratic schedules, turn to online learning to boost their
careers and attain greater authority over patient care, experts say. One 2015 survey conducted by
Aslanian Market Research and the Learning House identified nursing as the second most popular major
among both undergraduate and graduate online learners, following business administration at both
levels.

As with any application process, employers evaluate nursing job candidates based on more than just
where – and in what format – they earned their degree. But an applicant's education still plays a large role
in the process, and most employers have favorable views of degrees earned online.

However, online nursing degrees are generally geared toward those who already have their licenses, as
the initial training needed to become a registered nurse should be completed in person in order to build
a foundation of clinical experience, experts say.

[Discover questions employers ask about job applicants with online degrees.]

However, employers who don't know as much about online degrees may ask an applicant for information
to verify a degree's legitimacy, says James Kinneer, vice president of people and organizational
development at the Indiana Regional Medical Center in Pennsylvania.

"I think most employers are accepting of them," he says. "I think most employers are looking at the
candidate as a total package. And really, they're less concerned with where did the degree come from
than just what are their overall skills and their ability to perform."

Still, employers who are aware that a degree was earned online may have some additional questions.

For instance, they will likely want to verify an online program's accreditation, especially for institutions
that don't have a physical campus or aren't well known. Programs should be accredited by either the
Commission on Collegiate Nursing Education or the Accreditation Commission for Education in Nursing.

"Accreditation is essential because a third-party agency assures the quality and integrity of a program,"
says Ruth Tarantine, dean of nursing at Colorado Technical University, which offers online nursing degree
programs.

[Know how to tell if an online program is accredited.]

An employer may also ask job candidates with online degrees about their in-person clinical experience –
an essential component in a field that requires a lot of hands-on work. Online programs may allow
students to complete the clinical requirement on the school's physical campus or in a location of their
choosing.

"When you look at what people's concerns are with online degrees for nursing, it's really about what kinds
of hands-on clinical experience was part of the program," Kinneer says. "It's an area where awareness can
help acceptance of those programs."
From a human resources standpoint, Kinneer says, an employer may also wish to determine whether a
student gained skills such as human interaction, teamwork and problem solving.

"I think often they're just trying to understand exactly what was this process and how did it work," he
says, "and how did you obtain an experience that is equivalent to that face-to-face experience."

Nurses have historically worked shifts at hours around the clock, so many employers understand that an
online program may be the only possibility for them to advance their career, experts say.

But there are very few institutions that offer what they consider an online prelicensure program. In
prelicensure programs, nurses are essentially learning "how to take care of other people" through clinical
experience, Tarantine says.

Sharon Roth Maguire, chief clinical quality officer at the health services staffing agency BrightStar Care,
says that it's a very different scenario when nurses pursue online education to further their career when
they already have their license, compared with if they have no experience at all and still need to build that
foundation.

"They would want to know, where are you getting this practical hands-on experience which is so
important in nursing?" she says, of employers.

[Learn about what to ask when choosing an online graduate nursing program.]

When it comes to employers' views of online nursing degrees for candidates who already have their
licenses, institutions generally hope that employers view these programs no differently from on-campus
education, which is typically the case.

In fact, many faculty and career advisers in online programs encourage students to simply put the name
of the institution on their resume without necessarily emphasizing the "online" aspect, though it likely
wouldn't be an issue either way, especially in the digital age, Roth Maguire says.

Reference: https://www.usnews.com/education/online-education/articles/2016-02-23/what-
employers-think-about-your-online-nursing-degree

“What Health Care Employers Think of Your Online Degree”

Many employers accept them for nonphysician roles, though they may ask about a candidate's hands-on
experience, recruiters say.

When Michael Dawar interviewed for his current job in the health care industry, the fact that he pursued
his degree online wasn't viewed as a negative.

The 27-year-old believes employers valued the self-discipline he demonstrated throughout his health care
administration master's program at Colorado State University—Global Campus. Shortly after graduating
in March, he received a job offer for a project lead position at Blue Cross and Blue Shield of Kansas City, a
health insurance provider in Missouri.
"It showed that I had taken the initiative to continue my education outside of working hours and
continued performing at a high level at all of the jobs I had worked during that time," the Kansas resident
says.

[Explore why to develop self-motivation skills before starting online courses.]

Dawar might be on to something. Experts say employers overall have become more accepting in recent
years of accredited online degrees for nonphysician careers in the health care industry, which may include
administrative, nursing, technical and allied health roles – though some are still a bit wary given the often
hands-on nature of certain positions.

Recruiters say employers hiring for health care jobs that involve regular interaction with patients or others
may ask a candidate why he or she decided to complete the degree program online and whether there
were opportunities for face-to-face interaction. Both questions came up during Dawar's interviews, he
says.

"Health care is very much hands on, personal, must make the person feel safe and give them a lot of
comfort; the bedside manner, if you will," says Jim Wilhite, co-founder of the National Coalition of
Healthcare Recruiters. That's why, he says, "You’re not going to see an online degree for physicians. They
have to have a residency and so forth."

While some medical schools incorporate elements of online learning into their classes, there currently
aren't any accredited, fully online options offering an M.D. or D.O.

At the undergraduate level, 31 percent of ranked online colleges that submitted data on majors cited
health and related professions as the most popular during the 2015-2016 school year, according to U.S.
News data. There are also many online graduate programs in the field.

Steven Snyder, director of talent acquisition for the University of Virginia Health System, says he
encounters online degrees fairly regularly from potential employees – more and more each year.

"An online program is really treated as any other program," says Snyder, who recruits for nonphysician
roles. "We don't hold it against anyone; I think we consider it to be a viable option. We then consider a
person's entire background that goes along with it, so I would say an online degree is not going to
negatively reflect on someone."

[Discover 10 things employers think about online degrees.]

Oftentimes, experts say, health care employers won't instantly realize that a job candidate earned a
degree online, unless the school is highly recognizable as a primarily online academic institution, such as
the for-profit University of Phoenix. Otherwise, the subject may come up during a job interview or follow-
up conversation.

"I think if they're made aware of it, there may be still some negative connotation to it. I think the bottom
line is, as long as it’s an accredited degree, they really don’t care where they come from, has been my
experience," says Robert Eskridge, president of the health care staffing firm Eskridge & Associates in
Texas.
Whether employers will accept an online health care degree also depends on the position they are hiring
for, recruiters say.

Travis Dommert, president of Jackson Health IT, a health care tech staffing firm with offices in Seattle and
Atlanta, says recruiters at the company are generally more open to hiring IT professionals who have online
degrees than he personally may be when hiring recruiters in the field.

"I think it's considered more neutral for our IT consultants because education is generally less of a
consideration in their candidacy, because their experience is so important," he says. If he sees a job
candidate for a health care recruiter role earned a degree online, "It's going to cause me to want to go
deeper and understand: Where have they worked with people directly? Where have they been on
teams?"

[Learn the do's and don'ts of online group work.]

AnnMarie Papa, vice president and chief nursing officer at Einstein Medical Center Montgomery in
Pennsylvania, says she encounters nursing applicants who earned graduate degrees online daily. But for
aspiring nurses, very few schools provide online prelicensure programs. Experts recommend checking
whether a desired health care job requires that a specific degree be earned face to face.

"I would say a majority of your secondary degrees, like your master and your doctoral degrees, have at
least some component of online," she says.

Snyder, of the UVA Health System, recommends that prospective online students thoroughly research
their options before choosing a program and select the degree format that works best for them.

"When you look at the preference of our own workforce towards online programs, it's really mixed – you
don't have a strong preference for that," he says. "It meets certain individuals' lifestyles and interests; in
others it doesn't."

Reference: https://www.usnews.com/higher-education/online-education/articles/2017-07-13/what-
health-care-employers-think-of-your-online-degree

“How Do Employers View Online Degrees?”

While distance education has existed since the nineteenth century when correspondence courses arose
in Western Europe, there are still questions about online learning’s effectiveness and a generalized feeling
that it’s not the same as a traditional brick-and-mortar experience. For prospective online students, one
major concern is how future employers will view a degree achieved online. An oft-cited analogy is online
dating, which had a scandalous reputation at its inception. Slowly but surely, however, as services
multiplied and people started attending weddings of couples who met on the internet, that perception
has evolved. Similarly, online degrees are gaining respect, especially among people with exposure either
personally or through accounts of friends and family.

One of the factors contributing to the increased exposure is the growing pool of distance-based students.
In its annual survey titled Tracking Online Education in the United States (Feb. 2016), the Babson Research
Group found that more than 25 percent of all students in higher ed were enrolled in at least one online
course, and a total of 2.8 million students were enrolled in fully online programs. There’s been a trend
toward not-for-profit and public institutions, which increased their online student enrollments 26 and 9
percent, respectively, between 2012 and 2014. During that same time, for-profit enrollments dropped 10
percent. One of the most striking findings in the thirteen years of this survey has been the shifting attitude
within academia. In 2003, 57.2 percent of chief academic officers and leaders rated the outcomes of online
education as the same (or superior) to traditional instruction; by 2015, this figure had swelled to 71.4
percent.

There’s no denying that online education is still dogged by an image problem (note: content may be
paywalled), largely due to skyrocketing student debt at the hands of exploitative for-profit schools.
Despite these headwinds, there are several forces contributing to the continued popularity of online
programs. Not only has new technology facilitated people’s access to distance-based degrees, but also a
growing number of established, regionally accredited, public and private universities are now offering a
full-slate of online degree programs. By illustration, the University of North Carolina, Georgetown
University, Penn State University, Arizona State University, and UC Berkeley, among others, made several
graduate degree programs available online.

This article includes nine exclusive interviews with company executives on their perceptions of online
education, the negative and the positive. It closes with a discussion of what aspiring online students
should look for to ensure that their academic background is taken seriously in a hiring context.

Meet the Interviewees: Nine CEOs and Executives

The interviewees come from a range of industries, including technology, finance, medicine, marketing,
government, and scientific research. Here is a description of each interviewee’s title, what their company
does, and a quote from their exclusive interview with OnlineEducation.com in 2017:

Robert Armstrong, CEO of AppStem

AppStem is a cutting-edge software design and development company in San Francisco which creates
mobile apps, games, and backend services for companies around the world.

I don’t want to be too harsh here, but not only would I not interview someone who went to an
unaccredited online university, I would say that would even be a strike against them.

Matt Beaudet, CEO of NemaMetrix

NemaMetrix is a growing biotechnology company which provides scientific testing equipment and
services. It’s a ‘darn good place to work,’ according to CEO Matt Beaudet, who has hired approximately
100 people for businesses over the past 20 years.

Overall I view online degrees as like a partial degree. It carries a sheen of not being that hard to get and
not being a good indicator of an actual good education.

Jose Galindo, CEO & Founder of MoneyMio

MoneyMio is a resourceful bilingual website which educates people on investments, credit cards,
retirement planning, and other facets of personal finance.

Tradition and familiarity might cause an employer to be biased against online degrees, but things change.
Stephen Graves, Operations Section Chief at the Department of Homeland Security & FEMA
Mr. Graves works with DHS/FEMA’s National Incident Management Assistance Team, which is deployed
to assist states in the event of natural disasters, terrorist attacks, and other serious incidents.

I am not convinced that traditional brick-and-mortar institutions deliver a better curriculum compared to
distance programs.

Nathan Gustafson, CTO & Founder of Manage My Co-Op

Manage My Co-Op is a software company which creates tools for buying clubs and cooperatives to
facilitate customer ordering, administration, and customer service.

While I am unsure if this is true, I generally assume that an online degree is going to be more specific and
lack much of the liberal arts education available at a traditional campus.

Lauren Karasek, Executive Director of Social Media at Spark Growth

Spark Growth is a marketing firm which helps businesses create engaging websites, email campaigns,
social media strategies, and other facets of a successful digital presence.

The internet is removing geographic boundaries to commerce and interpersonal relationships, and it will
certainly impact education as well.

Trevor Leb, Chief Marketing Officer of BoardVitals, Inc.

BoardVitals, Inc. is a comprehensive training resource for online medical and healthcare certifications,
providing study materials for exams and continuing education across more than 50 specialty areas.

I’m a bit skeptical of online degrees as a candidate’s only form of education largely because the market
hasn’t validated online programs to be equivalent of traditional campus-based programs.

Misha Leybovich, CEO at Flippy (made by Meograph)

Flippy is an entertainment app with a vast library of material to create personalized parodies of famous
YouTube clips, music videos, and more.

Our perspective on alternatives to traditional campus-based education is that we are open to those
candidates, but generally find that they need to have a fair amount of not-just-homework experience to
be able to contribute.

Jim Spearman, President & CEO at Consensys Imaging Service, Inc.

Consensys Imaging Service, Inc. provides diagnostic imaging equipment in several modalities, including
MRI, CT, mammography, and ultrasound machines.
In general, I don’t view online degrees any less favorably than in-residence learning. However, somewhere
along the way there should be some in-residence formal learning experience.

Employer Perceptions of Online Education

In the first three months of 2017, the nine executives with hiring experience graciously weighed in with
their perceptions of online education. They responded to three questions in a mix of telephone and email-
based interviews:

What is your general perception of degrees earned online?

Does your view of a job candidate change if he or she received an online degree as opposed to a traditional
campus-based degree?
Do you think these perceptions will change over time? Under what conditions?
While these employers had widely varying views on distance-based education, there were some
consistent themes, both negative and positive.

Positive perceptions of online degrees included:

If an institution is rigorous and well-regarded, it doesn’t matter if it was an online program.
A person’s job candidacy depends on many factors, not just education.
When an online program has a physical campus, employers may assume that the candidate has a
traditional degree.
Online graduate degrees such as MBAs can indicate someone is self-starting and motivated.
Online schools democratize access to education.
Online programs better prepare graduates for a modern workplace.
The acceptance of online degrees is spreading.
Negative perceptions of online degrees included:
There’s a stigma associated with online education, especially at the undergraduate level.
Online education doesn’t offer the best preparation for some fields.
Getting an online degree is easier and less rigorous than attending a physical campus.
The scope of an online degree is more limited than a traditional degree.
There are a lot of substandard online institutions.
Online degree-holders don’t have as much hands-on experience.
Positive Perceptions of Online Degrees
Perception 1: If an institution is rigorous and well-regarded, it doesn’t matter if it was an online program.
Seven of the nine interviewees indicated that the accreditation and reputation of a school were more
important than whether or not a degree was earned online. Mr. Galindo stated directly, “My perception
of online education hinges more on the reputation of the educational institution and not the fact that it
is online.” Echoing that sentiment, Ms. Karasek said, “I don’t think of online degrees collectively—just like
any other education institution, some are more and less rigorous, some are more and less reputable.”

Perception 2: A person’s job candidacy depends on many factors, not just education.
Nearly all of the executives pointed out that notwithstanding a job candidate’s type of degree, academic
experience is just one facet of a person’s hireability. Often a person’s experience, portfolio, and other
employment-ready demonstrations are more important, particularly in science and technology. Mr.
Leybovich put it bluntly: “Basically, if someone has built some cool stuff on their own volition, regardless
of the structure of their degree, we take it as a good sign.” Mr. Beaudet also mentioned, “Degrees held
and which university someone attended are tertiary criteria. I usually look for recommendations,
accomplishments, or even interesting things about a person first.” In the same vein, Mr. Galindo reported
that, “An employee’s performance and skill-set are measured during an interview and at the job
regardless of the type of educational instruction they received.” Finally, Mr. Gustafson summarized the
point eloquently: “In the information technology field, where your degree comes from, or even if you have
one is not nearly as significant as if you are proficient at the needed tools of the trade and if you have a
good portfolio to share.”

Perception 3: When an online program has a physical campus, employers may assume that the candidate
has a traditional degree.
In a hiring context, many employers won’t even ask a candidate directly if they attended an online
university, especially if the school is well-known and has a physical campus. In hiring for his San Francisco
technology company, Mr. Armstrong spoke about resumes: “I don’t think there’s an asterisk that says
‘online’ or anything like that. From an employment standpoint, I don’t think that would come up in an
interview. It’s very possible that an employer just wouldn’t know.”

Perception 4: Online graduate degrees such as MBAs can indicate someone is self-starting and motivated.
Especially at the graduate degree level, many hiring executives softened their skepticism surrounding
distance-based education. Online master’s degrees and MBAs in particular were perceived favorably as
proof of a candidate’s discipline and initiative. For instance, Mr. Beaudet said, “This is where I have found
online degrees to be a positive indicator, such as someone who obtained a traditional scientific degree
but then went and sought out an online MBA or a degree in project management. At this point I have
viewed the online degree as an indication of drive—they got their education but used the online degree
program as an efficient tool to increase their knowledge or skill level.” Mr. Leb spoke to a similar point,
mentioning, “If someone has an online graduate level degree, such as an online MBA, I’ll often look at that
a bit differently since that person supplemented their education with an online program. I’ll view online
certificates for additional skills as favorable to a candidate with a traditional campus-based degree
because that signals to me that this person is actively looking to improve their knowledge and skillset.”

Perception 5: Online schools democratize access to education.

Two of the interviewees pointed out that the existence of distance-based schools has allowed institutions
to compete for the best, most suitable students regardless of geographical or other constraints. Ms.
Karasek stated persuasively, “The internet is removing geographic boundaries to commerce and
interpersonal relationships, it will certainly impact education as well. In that sense, online education
actually allows schools to compete for the best students regardless of geography and students can attend
the best school for them worldwide.” Looking at it from a similar angle, Mr. Graves summarized his view
poignantly: “I am a fan of distance delivery because it is an equal opportunity educational system that
does not limit based on economics or socio-economic factors (e.g., single parent or principal caregiver
roles) that make brick-and-mortar institutions an impossible option for someone who is managing life
while trying to earn a degree.”

Perception 6: Online programs better prepare graduates for a modern workplace.

Given the explosion of distance-based careers and the world’s growing reliance on technology to
coordinate business, several interviewees admitted that pursuing a degree online may behoove
contemporary job-seekers by exposing them to the challenges of modern working environments. Mr.
Spearman shared, “Many business teams are virtual these days, especially global. In the latter case,
experience with online learning would actually be an asset…versus a competing candidate for a role who
has no online group dynamic experience.” Ms. Karasek revealed how an online education could help
prepare someone to work at her company: “In some cases, online degrees can indicate that the student
pursued education while attending other responsibilities at home or at work. The prioritization and
multitasking skills necessary to achieve academically while also succeeding at work or at home are
extremely valuable in a fast-paced agency environment like that at Spark Growth and other digital
marketing agencies.”

Perception 7: The acceptance of online degrees is spreading.

Overall, a majority of the hiring executives felt that impressions of online degrees were trending positively.
Mr. Galindo noted, “As with anything new, the perception should change over time. The adoption of
online learning by leading academic institutions will help build trust in that educational method.” Also,
several interviewees pointed out that prestigious schools are reshaping people’s perceptions of online
learning. For instance, Mr. Beaudet said, “Already some of the top-tier universities are putting out some
amazing online courses and my understanding is that the newer ones do a better job of integrating things
like office hours, after-class discussion, lab work, etc.” In the same current, Mr. Leb commented, “There
are now several online programs from reputable campus-based institutions and I’d expect that to
continue to grow. Having these traditional programs put their name and reputation behind online
education helps validate the value of these degrees.” Ms. Karasek expressed a similar sentiment: “With
well-regarded universities offering MOOCs, online MBAs and more…we’re only going to see online
education become more and more common, academically challenging, and respected.” Mr. Spearman
added, “Online learning has come a very long way in today’s digital age and the quality of the coursework
has significantly improved since I took online courses at Carnegie Mellon 25+ years ago.” Lastly, Mr. Graves
summarized the point well, demonstrating the improvements to online education at varied levels: “I
believe perceptions of online education are currently changing and generally in a positive direction. Online
and distance institutions have proven that they can develop a competitive curriculum that builds core
competencies in undergraduate programs and critical reasoning and decision making in graduate-level
programs.”

Negative Perceptions of Online Degrees

Perception 1: There’s a stigma associated with online education, especially at the undergraduate level.
Most of the hiring executives were aware of a generalized negative impression of degrees earned online.
For some of the interviewees, the unfavorable perception stemmed from long-held beliefs about the
experience of higher education. For example, Mr. Galindo revealed, “Tradition and familiarity might cause
an employer to be biased against online degrees.” In a similar line of reasoning, Mr. Graves mentioned
employers’ bias toward recognizable, typically traditional schools: “Employers place greater emphasis on
branded names that are generally considered to be synonymous with curricula content and quality.”
Other interviewees pointed out specific factors which influenced their negative views such as
accreditation status or the type of degree. Mr. Armstrong said forcefully, “I don’t want to be too harsh
here, but not only would I not interview someone who went to an unaccredited online university, I would
say that would even be a strike against them.” Furthermore, Mr. Leb revealed a general preference in
hiring people with campus-based undergraduate degrees: “If the online degree is [the job candidate’s]
only bachelor’s degree then I’ll typically pass on them if they don’t have some other extraordinary skills
or experience.”

Perception 2: Online education doesn’t offer the best preparation for some fields.
Several of the executives paid thought to the types of positions for which online training isn’t adequate.
For instance, Mr. Gustafson stated, “If I am hiring to fill a position in marketing or finance, then I am going
to be more focused on degrees that come from a traditional campus-based institution, but would consider
everyone based on their work experience.” A vice president of a prominent tech company who chose to
remain anonymous added that for the type of white collar employees he manages, he’d be skeptical of
candidates with an online degree, although he’d be more open to those in technical occupations such as
programming.
Perception 3: Getting an online degree is easier and less rigorous than attending a physical campus.
As part of the generalized negative impression of online degrees, there’s an assumption that distance-
based education isn’t as difficult as a more traditional college experience. Mr. Beaudet spoke to this point
and revealed, “Overall I view online degrees as like a partial degree. It carries a sheen of not being that
hard to get and not being a good indicator of an actual good education.”

Perception 4: The scope of an online degree is more limited than a traditional degree.
Several interviewees shared their impression that online schools don’t provide the same scope of
knowledge and learning opportunities as a brick-and-mortar program. By illustration, Mr. Gustafson said,
“While I am unsure if this is true, I generally assume that an online degree is going to be more specific and
lack much of the liberal arts education available at a traditional campus.” In the same train of thought,
Mr. Leybovich stated, “Not all traditional degree candidates even have [hands-on experience], but they’re
often more likely to because of side projects and activities they work on while on campus.”

Perception 5: There are a lot of substandard online institutions.

Given recent news coverage on rapidly rising student debt and fraudulent for-profit colleges—many of
them online—there’s a sense that distance-based schools aren’t guaranteed to offer the same quality of
education as an on-campus institution. For instance, Mr. Beaudet shared, “The main issue, for me, remains
how to help communicate the quality programs from the crap, the Stanford University from the Trump
University.” Mr. Armstrong seconded this and spoke at length about subpar engineering training running
rampant in the Silicon Valley: “What we do see in San Francisco a lot are these bootcamps. You might
have someone who went to college and got a non-engineering degree who completes one of these
software engineer bootcamps and they teach you how to write iOS apps in eight weeks. These courses
can cost tens of thousands of dollars, and graduates get promised that they’ll secure a job after the
program because there’s a shortage and a demand. We don’t even interview people who went to these
bootcamps and we get a lot of those resumes.”

Perception 6: Online degree-holders don’t have as much hands-on experience.

Justifiably, many employers are concerned that online schools don’t offer as much empirical experience
as on-campus institutions. As proof of point, Mr. Graves said, “Typical brick-and-mortar institutions also
include informal opportunities to expand on knowledge either by chance such as knowledge exchanged
during casual conversations between classmates or through formally organized tutorial sessions. By
contrast, distance delivery requires students to assess their limitations and independently research the
material necessary to close the knowledge gap.” Mr. Spearman felt the same way and stressed the
importance of having some real experience to complement online learning: “Somewhere along the way
there should be some in-residence formal learning experience. For example, an MBA should have at least
some in-residence component because there are social interaction skills that are needed to function
properly in group settings in an office environment.” Lastly, Mr. Leybovich indicated the importance of
‘not-just-homework experience,’ the extracurricular opportunities which really enhance a person’s job-
readiness: “Our perspective on alternatives to traditional campus-based education is that we are open to
those candidates, but generally find that they need to have a fair amount of not-just-homework
experience to be able to contribute to a small development team where everyone needs to wear multiple
hats.”

Conclusions: What to Consider Before Enrolling in an Online Program

I think a strong performance by online-educated employees will be key to changing the perceptions.
Jose Galindo, CEO of MoneyMio
As mentioned in the introduction and reflected in the interviews above, an employer’s perception of an
online education is influenced in part by his or her exposure to distance-based learning, either personally
or through the experiences of friends and family. Drawing from the knowledge of the nine company
executives who were generous to grant interviews to OnlineEducation.com, here’s a summary of what
aspiring students are advised to consider before enrolling in an online program:

Accreditation: There are various organizations which accredit online colleges and programs, but all entities
are not created equal. Be sure to seek out institutional accreditation from one of the regional
organizations recognized by the US Department of Education’s Council for Higher Education Accreditation
(CHEA). These include the Higher Learning Commission (HLC), the Middle States Commission on Higher
Education (MSCHE), and the New England Association of Schools and Colleges (NEASC-CIHE), among
others.
Reputation of the school: As several interviewees mentioned, whether an online program came from a
recognizable, respected school makes a huge difference. Schools typically have better standing if they
have a long history, high student retention, high graduation rates, and a solid endowment. Also, not-for-
profit schools are generally better regarded than for-profit schools.
Existence of a physical campus: Related to reputation, whether or not the school boasts a physical campus
is an important consideration for some employers.
Opportunities for social development: One reason there’s a stigma for online education (particularly at
the undergraduate level) is that there’s an assumption that these programs don’t afford students the
same opportunities for teamwork, collaboration, or interactions with faculty and peers. Especially in fields
related to business and the social sciences, demonstrating an ability to work well with others and
communicate effectively are paramount skills for employers.
Technology, methods, and resources used: These variables can make or break an online student’s
experience. Slate (Sept. 2016) published a piece with scathing complaints about ‘digital hand-raising,’ a
seemingly endless electronic queue of distance-based students waiting to make comments during live
lectures. According to Slate’s Rachel Cusick, the technology impeded the flow of classroom discussions
and highlighted the difficulty of creating community in online spaces. Other platforms may be more
effective to this end.
The field and degree level: Again, several hiring executives revealed nuanced impressions of online
education, showing a preference for distance-based degrees at the graduate level or in computer-based
occupations as opposed to in scientific or people-facing careers. Trevor L. shared, “At this point in time,
online degrees are great for supplemental education like certificate programs, skill training, or potentially
graduate degrees if earned from a reputable program.”
Reasons for attending an online program: Finally, employers may ask why a job candidate chose to pursue
an online education. Responses to this question should move beyond the convenience and flexibility of
web-based learning, perhaps focusing instead on some of the benefits such as the relative autonomy, self-
motivation, and requisite time management skills, in addition to the rigors and structure of the program
itself.
Overall, as the number of reputable online degree programs continues to swell and employers become
more exposed, questions about the credibility of distance-based education are expected to diminish in
importance. Ms. Karasek put it perfectly: “Independent third parties, like media outlets, can speed
acceptance of online education by creating reputable and clear information about the focus and academic
rigor of online programs.” And perhaps with imminent advances in virtual reality technologies, the
prospect of having an enriched classroom experience from one’s living room will become a reality,
obscuring the line between traditional brick-and-mortar and online education.
Reference: https://www.onlineeducation.com/features/how-employers-view-online-degrees

“Employers on online education” – March 29, 2010

Going back to school is an appealing option for many people, but they can't afford to quit their jobs to be
a full-time student. If this sounds familiar, there might be a solution that allows you to go to school and
continue working: an online or distance-learning program.

Online colleges and distance-learning programs are ideal for full-time professionals because they can earn
a degree without driving to a campus or attending classes, and they can learn on their own schedule.

While all of this sounds alluring, there are a few things to consider before starting online classes. How long
will it take to earn the degree? How much will it cost? How do I know if a school is legitimate? And most
importantly, how will employers perceive it?

What do employers say?

To many people, a degree is a degree -- but to others, there can be an issue of trust, or lack of reputation
and familiarity, says Marc Scheer, a career counselor and educational consultant based in New York City.

"Traditional programs have been around for hundreds of years, but online programs are relatively new
[and] employers tend to be less familiar with them," he says.

Employers are getting there, however. In a survey done by online institution Excelsior College and Zogby
International, 61 percent of CEOs and small business owners nationwide said they were familiar with
online or distance learning programs.

Not only are they familiar with them, but 83 percent of executives in the survey say that an online degree
is as credible as one earned through a traditional campus-based program. Employers said such factors as
the accreditation of the college or university, the quality of its graduates and the name of the institution
awarding the degree were among other things they considered to make an online degree more credible.

Dannie McClain, a category manager for Town and Country Linen, says she thinks getting a degree from a
school with both online and traditional programs has helped employers view her degree as credible.
Initially hired without a degree, McClain now has a double online degree in marketing and business from
Michigan-based Baker College, which also has online programs.

"I think gaining my degree from a 'true' college that offers online courses in addition to regular ground
courses helps in my employer seeing this as a 'true' degree," she says.

Not all employers feel the same way, however. Brandon Mendelson, a former business owner, says he
wouldn't consider an applicant with an online degree -- even if he had everything he was seeking. He says
he thinks that students get only a fraction of the learning experience online.

"I want someone who made the full commitment," he says. "These days, there are no excuses. Your job
will pay for school; colleges have day-care facilities that are usually free; so actually going to the school
gives a candidate the edge in my book."
The online advantage

But what about those who don't have time to make it to school every day? Luckily, one of the biggest
perks of earning an online degree accommodates that very issue.

"Online degree programs are designed to help adult learners with busy lives earn their degree without
being tied down to class times and without having to go to campus," says Jeff Caplan, dean of strategic
enrollment management at American Sentinel University, an online university.

Michael Rogich, director of the center of online learning at Saint Leo University, based in Florida, says
studying online is just as effective as studying traditionally, and in some sense is more powerful.

"With adult students, your options are either part time or online," Rogich says. "Online, the student has
more access to a good program and is constantly connected to instructors and fellow classmates."

Tom Johansmeyer, who earned his MBA online and is currently working on his doctorate, is a perfect
example. He says an online program was his only option for going back to school.

"I was working as a management consultant and spending 40 weeks a year on the road," he says. "With
that kind of travel schedule, it would have been impossible for me to get to a classroom."

Indeed, online learning can benefit some students more than classroom learning. For example, some
students might not learn as well in a classroom if they are shy or disengaged in group settings. In this case,
Scheer says online students may benefit from their programs by interacting with students like themselves.
Additionally, online discussions can be more inclusive and productive than classroom debates, especially
because online forums offer more opportunity for participation.

Disadvantages to online learning

Not having face-to-face interaction with a teacher, however, can be seen as a disadvantage for some
students.

"Being able to attend when you want means you have no face-to-face, so there are no real-time answers
to questions you have," McClain says. "You either have to wait for someone to reply to a forum, e-mail
the instructor or hope that there is someone on IM that can answer you."

Scheer says it's easy for online programs to be fraudulent and nonaccredited, so there's the possibility of
being scammed or unable to transfer credits to another school. Finally, some employers simply don't
accept online degrees from any school, accredited or not.

Tips for finding a quality online degree

Are you interested in going to back to school online? Here are six things to consider when looking for a
quality online degree program:

1. Reputation
Is it an institution that provides only online degrees or does it have physical locations as well? Having
actual campuses helps to establish credibility. A red flag would be the existence of only a post office box
or suite number.

2. Accreditation

The Department of Education says that researching the accreditation is essential. Diploma mills are usually
accredited by fake agencies. It's important to make sure the accrediting agency is one recognized by the
department or the Council for Higher Education Accreditation.

3. Accessibility

Does the school offer technical help and easy access to speak with advisers, professors and the help desk?

4. How quickly can you earn the degree?

A red flag would be earning a bachelor's degree in just months.

5. Program fees

Students should pay as they go and be charged per credit hour, rather than per program.

6. How hard is the work?

Diploma mills require very little work and often take life or work experience into account. Legitimate
programs require the same amount of work one would expect attending class on a campus.

Reference:
http://edition.cnn.com/2010/LIVING/worklife/03/29/cb.employers.online.education/index.html

IV. Shifting healthcare delivery and required competency

“Transformational Healthcare Leadership Competencies” – February 13, 2018

An important truism in healthcare today is that change is the only constant. Indeed, it seems as if the
entire world is changing at warp speed. The external and internal environment seems to be populated
with a whole new set of rules, regulations, devices, diseases, and demands. Consider the following set of
terms added to the healthcare landscape: MACRA, population health management, accountable care,
retail medicine, value based purchasing, bronze/silver/gold/platinum plans, Zika, personalized medicine,
consumerism, big data, and augmented reality. To quote the late Dr. Ken Cohn, the tectonic plates (of
healthcare) are shifting.
Whether by incremental movement or in large, unexpected jolts, the environmental forces confronting
healthcare leaders today are creating conditions that pose significant challenges to even the most
experienced executives. But the healthcare is not alone. Most sectors of the economy in the United States
are facing similar rapid changes in their environments. Technology, consumer demand, globalism, supply
chain, and workforce challenges are forcing nearly every industry to rethink their business model and
make rapid adjustments to their operations. Those who fail to do so become obsolete and soon disappear
from sight. Those who adapt live to fight another day.

Case in Point
Let’s consider the case of healthcare delivery to examine how the industry has responded to the
environmental forces affecting organizations. While there has been consolidation in the industry,
healthcare delivery in the United States is still concentrated on hospitals and independent practitioners
(recognizing that many physicians are moving into group practices that are affiliated with hospitals) that
are paid by some variation of traditional fee-for-service reimbursement.

Physicians are still trained using a template that was first put forth in 1910 within the Flexner Report.
Nurse education continues to be fragmented between associate degrees, bachelor degrees, and master’s
degrees. And despite the presence of policies, procedures, rules, regulations, and overwhelming good
intentions, estimates are that 400,000 people die in U.S. hospitals every year due to medical errors, and
between 10-20 times that number are harmed but do not die as a result of the error.

Meanwhile, information technology that makes up the backbone of almost every other industry sector
has been slow to adoption in healthcare. Many physicians continue to use paper-based medical records.
Organizations that have bought in electronic health record (EHR) systems find that patient records don’t
always “talk” with the EHR from a different vendor. The key point here is that healthcare delivery in both
the out-patient and in-patient settings continue to operate in ways that were effective 30 years ago.

Call for New Competencies

If the healthcare industry is going to survive and thrive in the years to come, leaders need to quickly adopt
a new set of competencies and personal practices. Here are five essential competencies required by
healthcare leaders in the new world of healthcare.

#1. Emotional intelligence

For too long, we assumed that intelligence as measured by IQ was the critical measure of leadership and
organizational success. If we filled the management ranks with the smartest and most insightful among
us, all would be well. As we know, though, that is not the case. Indeed, with so many intelligent members
of the workforce, why is healthcare still in such a mess.

My observation is that in healthcare delivery, emotional intelligence (EQ) is probably more important than
IQ. In Emotional Intelligence, Daniel Goleman notes that there are five key elements to EQ: knowing one’s
emotions, managing emotions, motivating oneself, recognizing emotions in others, and handling
relationships. Given the centrality of human interactions at all levels in healthcare delivery all five of these
skills are vital for healthcare leaders. The good news is that rather than IQ, which is relatively fixed, it is
possible to improve on each of the five elements of EQ.

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#2: Systems Thinking
Healthcare delivery organizations are by their nature, complex organizational forms with multiple layers
of management. Too often, within a single organization, healthcare operates as multiple silos, with each
member of that silo isolated from others outside their domain. As expected, members of a
group/department/division typically work to optimize their world without consideration for how others
might be affected. Experts refer to this as sub-optimization.

While not inherently bad, sub-optimization tends to detract from the function of the whole system. The
challenge for highly effective healthcare leaders is to create organizations where the walls of the hardened
silos are transformed into semi-permeable membranes that allow for the free flow of information and
best practices out of one part of the organization into another. Collaboration and cooperation between
and among departments is the key to highly effective systems.

#3. Enhanced Conversation Skills

Human relationships are based in large part on the quality of conversations we have with one another.
Assuming that none of us are truly telepathic, conversations require three elements: a sender, a message,
and a recipient. But conversations go beyond a simple sharing of information, and generally suggest that
the sender and receiver are genuinely interested in one another and the quality of the message being
delivered. Conversations imply a back and forth in which both parties are interested in the welfare of the
other.

Healthcare organizations are made up of a whole series of conversations. Some are short, some are long.
Some are highly complex, some are relatively simple. Some are easy to engage in, some are extraordinarily
difficult. It is incumbent on healthcare leaders to have conversations that matter. This includes a number
of important attributes, including carefully listening to others, clear and unambiguous language, checking
for understanding, and assuring that commitments made are carried out.

#4. Change Management

For most of us in healthcare, change is hard—and often met with resistance, hostility, and downright
anger. If we accept the premise that the only constant in healthcare is change, then how do we help others
and ourselves deal effectively with change along with our own emotional reaction when confronted with
change that is imposed on us by some outside group or agency?

Effective healthcare leaders need to start by accepting the fact that when encountering change, everyone
is giving up something no matter how large or small. There is an emotional response that is automatically
triggered and varies depending on the scope and intensity of the change at hand. It is not enough to tell
staff to “simply get over it and get back to work.” Although there are multiple change models in the
business literature, healthcare workers must be given a compelling reason for the change, a clear sense
of hope, and optimism for the outcome of change—and then given the time to make whatever is changing
part of the new normal.

While change is constant, the human response to change is also constant. Healthcare leaders need to
lead change with the understanding that change management is an ongoing and continuous process.

#5. Embrace Chaos and Complexity

No doubt, some days our organizations seem to be a chaotic and complex mess that is completely out of
control. This observation actually aligns with how the universe actually works. Chaos and complexity are
the norm. Organizations try to manage chaotic and complex behavior by imposing rules and regulations
or policies and procedures. But how well are those working for you?

There is a compelling body of scientific and organizational literature that suggests over controlling a
complex system (like a healthcare organization) has little chance of lasting success. An alternative is to
present a few simple rules that apply throughout the organization and then consistently put them into
operation. While full control might not be possible, healthcare leaders who adopt this perspective can get
all staff moving in the same direction and working with a common purpose.

Next Steps
It is worth noting that none of these competencies fall into what I refer to as the typical healthcare
buckets, such as finance, IT, legal, and so forth. Many would characterize these competencies as soft skills,
which by their name are typically not considered as important as those things that we consider hard skills.
From my perspective, I would prefer to think of the competencies mentioned as “essential skills,” which
must be part of the tool kit of every healthcare leader who wants to make a real difference in their
organization.

The challenge for all of us is how do we learn about these competencies? What’s more, how do we
continually improve in our daily practice? The consistent execution of the competencies will make a
profound difference in the performance of healthcare organizations now and into the future.

Reference: https://www.td.org/insights/transformational-healthcare-leadership-competencies

V. Entry level and professional studies

The nursing profession is challenged to meet evolving health care needs of populations, while maintaining
the standards and integrity of the profession. Limited resources in health care and nursing education
compelled the nursing profession to embrace distance education as a way of upgrading the qualifications
of large numbers of nurses in a timely manner without disrupting service delivery. All distance education
programmes in nursing are post-basic programmes and are presented at certificate, diploma and degree
level. Accessibility to higher education for further studies and affordability are primary purposes of
distance education programmes for nurses. An increased participation of local and international private
higher education institutions in distance education, a diverse body of learners and the impact of
technology on teaching, learning and assessment further contributed to a shift in delivery within contact
and distance education institutions.

The dynamic changes in society demand that qualified people return to higher education to keep abreast
with innovation and change. Distance education provides opportunities to combine family and work
responsibilities while engaging in continuous professional development. Despite the advantages, distance
education in higher education is confronted with challenges that relate to student support, lack of
computer literacy and inaccessibility of electronic media and the Internet in some areas. Scientific writing
and reading skills, a reading ‘culture’ and study skills are often lacking in the students. Remedial teaching
in this regard could be a problem, especially where students do not have easy access to communication
media.

Education is a major key to leadership development and the development of the nursing profession. The
modern knowledge-driven society requires that people upgrade their knowledge and skills in order to
remain competitive and competent in a fast-changing environment. Distance education is a suitable way
of ensuring opportunities for all to engage in continuous professional development and lifelong learning

Degrees by type : https://nursejournal.org/articles/types-of-nursing-degrees/

https://nursejournal.org/articles/entry-level-nursing-options/

https://www.gcu.ac.uk/study/courses/details/index.php/P02627/Professional_Studies_in_Nursing?utm
_medium=web&utm_campaign=courselisting

https://www.nursingcenter.com/journalarticle?Article_ID=3847923&Journal_ID=54013&Issue_ID=3847
797

https://www.allnursingschools.com/articles/nursing-program-types/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876405/

https://www.aacnnursing.org/Nursing-Education-Programs/Baccalaureate-Education

VI. Shortages and entry level requirements

VII. Professional Oganization and advising body linking BSN programs

VIII. Differentiated Nursing Practice