MOOCs and More: Expanding Online Access for Nurses

It is one thing to offer an online degree program; it's quite another to build a successful program designed to fit the unique needs of traditional and nontraditional students while also preserving high quality, academic integrity, instructional independence, and the prerogatives of a university and its faculty. When the University of Texas at Arlington's College of Nursing decided in 2008 to radically redesign how its Bachelor of Science in Nursing completion program could be more accessible, to exponentially expand and meet the needs of working registered nurses, it embraced all the advantages this disruptive technology has demonstrated. As Harvard University Professor of Business Administration Clayton M. Christensen noted, online learning allows "more people to learn ever-more sophisticated things at lower cost than ever before."¹

The redesign challenges, however, were myriad. The program had to be convenient, affordable, and attractive to its target audience. It had to preserve the academic integrity and primacy of the college's faculty and be consistent with the mission and values of the college and the university. It also had to be flexible enough to continuously absorb the latest innovations in online learning, such as the use of a massive open online course (MOOC) as a gateway to the degree program. Finally, with only about 50 percent of the nation's registered nurses prepared at the baccalaureate level, the program had to be scalable to meet the increased demand for degreed nurses. In 2010, the Institute of Medicine recommended that 80 percent of registered nurses have bachelor's degrees by 2020.²

When we started our redesign in 2008, UT Arlington's College of Nursing's RN-to-BSN program was admitting approximately 150 students annually. We considered various ways to expand this program, including adding additional distance sites and enhancing existing online course offerings. However, because the Dallas-Fort Worth area encompasses more than 9,000 square miles — an area larger than Rhode Island and Connecticut combined — even local students experience barriers to participating in on-campus classes. As we reviewed our options, it was clear that none of the expansion models offered the opportunity for the exponential growth that we needed.

Why a Public-Private Model?

Historically, less than 18 percent of registered nurses with associate degrees have gone on to further their education. Therefore, our College of Nursing joined forces with a higher-education service provider to form a public-private partnership aimed at studying the practical barriers that prevent diploma and associate-degree holding registered nurses from continuing their education and obtaining a BSN.

To achieve its goal of producing an innovative, highly-accessible, affordable, and scalable program, the college chose to team with Academic Partnerships, a global higher education company based in Dallas that assists public universities in converting traditional degree programs to online delivery, as well as in recruiting and retaining qualified students through graduation.

Accessibility

Mid-career nurses with diplomas or associate degrees rarely have the time or the financial resources to travel to a campus to attend full-time RN-to-BSN programs. At the same time, most state universities have neither the space nor the faculty capacity to expand in order to meet the demand for BSN-prepared nurses in the traditional manner. Average state funding per student has dropped over the past five years, falling by 9 percent in the 2012 fiscal year alone, according to the State Higher Education Executive Officers Association.³

Our partnership addressed the problem of access by providing all prerequisite courses online and offering multiple start dates during the year. The online RN-to-BSN program that emerged delivers the nursing college's curriculum in five-week sessions instead of traditional 15-week semesters. This allows students to begin the program eight times a year rather than wait to begin classes once or twice a year, as in typical semester-designed programs. With classes running in five-week durations, the program employs a "carousel model" that lets students step off the carousel for a five-week term if needed to accommodate their schedules. Students do not have to wait three to nine months for the next semester to begin before they can start taking another course.

Affordability

The UT Arlington–Academic Partnerships model increased affordability by offering a course-by-course payment structure that both minimizes student nurses' monetary outlays and offers a competitive tuition. Many healthcare facilities offer their nurses tuition reimbursement that covers some portion of or all tuition costs; however, they typically pay only after a course is successfully completed. Under the online RN-to-BSN payment program, students can begin their studies for the cost of a single course. Reimbursement for their first course covers their second course, and so on to the end of the program.

Scalability

By keeping the fixed costs of additional students low, the model applies economies of scale not often realized in traditional academic settings. In education, scalability is key to affordability. The current UT Arlington online program tuition is $8,995 compared to $22,000 at some for-profit online programs and is 6.8 percent lower than the college's traditional program.

The program keeps overall costs in check by using academic coaches to scale up instructional delivery. These coaches are master's-prepared nurses who work under the direction of the course's assigned faculty member to provide support for sections of approximately 30 students. The coaches support students in learning and meeting course deadlines, while also supporting the faculty's engagement with the students. The model has allowed the College of Nursing to enroll thousands of new students while minimizing the number of new faculty positions.

Program Implementation

Coordination of effort and clear, frequent communication are key to systemically restructuring any program. In this case, college faculty and administrators coordinated with Academic Partnerships through cross-functional team meetings and provided input on all aspects of the company's services, including marketing and recruiting strategies. Student retention and progression to graduation are supported by the expertise of both partners, a collaborative model that was essential to our success throughout the restructuring process.

Course and Curriculum Building

At first, some College of Nursing faculty members were skeptical about creating a scalable online program. Moreover, they were concerned about losing control of the content and quality of their programs. Reassured that they would retain academic control over their courses — as well as the program's overall quality — the faculty responsible for the RN-to-BSN program collaborated with Academic Partnerships' online instructional design experts to identify the issues and the evidence-based methods to specifically address the challenges of managing online classes with hundreds of students. The coaching model was discussed and approved as a strategy to effectively enhance the student learning experience and progression and allow for large class enrollments while keeping the highly personal student experience the faculty valued.

By design, both the College of Nursing and Academic Partnerships exercise their core competencies in the partnership, which worked to allay faculty concerns and maintain quality. The college ensures academic quality by controlling all aspects of teaching, curriculum and course content, qualifications for faculty and coaches, admissions, grading, student advisement, tuition, and student aid.

Effective online instruction requires identifying the essence of course content and the methodologies needed to ensure that students synthesize the information and can apply it effectively. Academic Partnerships brought expertise in online instructional design and comprehensively assisted the faculty in transforming their courses for online success. Leveraging state-of-the-science instructional methods and best practices, the program was designed to meet the same teaching objectives as the college's traditional course offerings. Course faculty met as a group on a weekly basis to design each individual course and the program's overall flow in the five-week format.

Administration and Recruiting

On the administrative side, the university needed to retool its admissions, registrar, and bursar procedures to accommodate multiple start dates and large enrollment numbers. In addition, the College of Liberal Arts and the College of Science needed to convert all of their traditional prerequisite courses to the online format, with courses running in five- and eight-week schedules.

State universities such as UT Arlington often do not have the infrastructure or expertise to recruit large numbers of students and expand their geographic reach. Academic Partnerships provided a variety of marketing and recruiting strategies to identify qualified prospective students and convert them to applicants. It also introduced digital marketing and search-engine optimization methods that the college had never employed before.

Building on Success: The MOOC2Degree Initiative

Well-known professors at prestigious universities around the world have embraced MOOCs as an idealistic approach to university study. In most cases all a student needs to participate in a MOOC is interest and a web connection. Adding a pragmatic twist to the concept, Academic Partnerships' MOOC2Degree initiative uses a MOOC as the initial step toward a degree, offering students a learning experience that is free, open, and for credit on proof of competency. Building on the online program's success, the College of Nursing is introducing MOOC2Degree for its RN-to-BSN degree completion program (see figure 1).

Figure 1. Academic Partnerships' MOOC2Degree home page

The free MOOC makes the college's program for nurses completely approachable. Students have the opportunity to test their interest and ability to manage an online course risk-free before making a financial commitment. They can assess whether they can commit to a full degree program and the process of online study, which is a novel experience for many adults. At the same time, the college will have another pipeline of students for its RN-to-BSN program that will help it meet the national need for BSN-prepared nurses. "This is exactly the spot in a market where successful disruptions always take root," said Professor Clayton Christensen, referring to the foothold students gain by taking a MOOC for credit toward a degree.⁴

Author Beth Mancini describes how faculty and students interact in the online RN-to-BSN Program, including the MOOC (3:10 minutes).

The nursing college's MOOC is taught by one of the program's faculty members, and the content focuses on inter-professional collaboration and patient safety, which will enhance the practice of any nurse who takes the course. If students successfully complete the MOOC, pass a comprehensive online proctored exam, and meet the university's admissions criteria, they will receive credit for a required upper-division nursing course in the RN-to-BSN degree program at UT Arlington.

Results

In four years, the College of Nursing's RN-to-BSN program has grown from 137 students on campus to more than 5,000 students online nationally, making it one of the largest and fastest-growing state university nursing programs in the country (see figure 2). As of February 2013, the program has admitted more than 10,000 students, with approximately 350 to 550 new students starting every eight weeks. As of May 2013, the program has graduated 3,593 students. Persistence rates remain high, with approximately 90 percent of students who started the program graduating or actively progressing through their coursework.

Figure 2. UT Arlington College of Nursing online RN-to-BSN program enrollment distribution (2013)

Participant Satisfaction

Faculty members, students, and health-care institutions have responded positively to our program. Rosemary Luquire, senior vice president and corporate chief nursing officer at Baylor Health Care System, says the UT Arlington–Academic Partnership program lets her staff members pursue their education in a way that fits their busy schedules. "They are intellectually stimulated, and their excitement is demonstrable," said Luquire. "Several of our staff set goals to complete their BSN, yet they are now continuing to pursue their graduate degrees. This innovative program is clearly contributing to the lifelong learning of our staff and will help us reach our goal of a highly educated workforce."

Cole Edmonson, vice president and chief nursing officer of Texas Health Resources: Presbyterian Dallas, discusses the benefits to his organization of the BSN program (2:33 minutes).

Carylin Holsey, past president of the National Student Nurses Association and 2011–2013 chair of the International Council of Nurses Student Network, said she was able to complete the rigorous program and graduate in 10 months while serving as NSNA president. She credited the program's flexibility and "extensive student support." She also said the program's "high quality and effectiveness" have prompted her to recommend it to approximately 30 RNs who have since completed their degree or are currently enrolled.

Tinkie Williams, graduate of the UT Arlington RN-to-BSN Program, talks about her experience with it (1:11 minutes).

Program Expansion

The success of the online RN-to-BSN program has brought demand from hospitals and healthcare systems to expand the model and offer additional nursing programs. In 2010, the College of Nursing expanded enrollment and more than doubled its capacity in its initial licensure BSN program using the Academic Partnership model at partner hospitals. These additional new graduate nurses will help alleviate what is predicted to be a long-term nursing shortage. In addition, the College of Nursing has added Academic Partnership tracks to the master's degrees in both the Nursing Administration and Nursing Education programs.

The college currently is enrolling nurses from more than 335 healthcare/hospital systems nation-wide, including Baylor, Texas Health Resources HCA, Memorial Hermann, M.D. Anderson, U.S. Oncology, California Pacific Medical Center, Children's Hospital Los Angeles, and the University of California–Irvine Medical Center.

Institutional Prestige and Market Value

The prestige of a degree from a highly regarded state university and the advantages it confers in the job market give the program a competitive advantage. UT Arlington's College of Nursing is accredited by the Commission on Collegiate Nursing Education, and its programs are highly rated by state and other ranking systems. Its initial licensure BSN program is recognized as "high performing" by the Texas Higher Education Coordinating Board (THECB), with 90 percent of students progressing to graduation and passing the RN licensure exam. The THECB honored the RN-to-BSN program and its successful partnership model with a Texas Higher Education Star Award in October 2012 as part of its Closing the Gaps by 2015 initiative, an effort to expand student participation and success in higher education.

Conclusion

Embracing Clayton Christensen's notion of disruptive innovation, the public-private partnership between UT Arlington and Academic Partnerships has allowed the College of Nursing to achieve remarkable growth and generate incremental revenue while retaining academic quality (see figure 3). With the introduction of MOOC2Degree, access to the RN-to-BSN program has been widened even further.

Figure 3. Results of UT Arlington's College of Nursing and Academic Partnerships public-private partnership

The time is ripe for other disciplines and universities to challenge their core beliefs about online education and see what can be accomplished when equally committed partners come to the table with a common goal of providing increased access to high-quality, affordable education.

Acknowledgment

Author Elizabeth Poster has transitioned from her role as Dean of the School of Nursing at the University of Texas at Arlington (for 18 years) to being a professor. She will begin teaching in the Academic Partnerships RN-to-BSN program in the fall of 2014.

1. Clayton Christensen, e-mail to the authors, September 21, 2011.
2. Institute of Medicine of the National Academies, The Future of Nursing: Leading Change, Advancing Health, October 5, 2010, p. 173.
3. State Higher Education Executive Officers Association, State Higher Education Finance Report, March 7, 2013, p. 19.
4. "Academic Partnerships Launches MOOC2Degree Initiative," PR Newswire, January 23, 2013.