What is the future for online teaching and learning in nursing education: An NLNTEQ interview with Diane M. Billings

Teaching and learning in an online environment has evolved as an integral component of the nurse educator’s role. This interview with Dr. Diane M, Billings, Chancellor’s Professor Emeritus at the Indiana University School of Nursing, Indianapolis, discusses the developmental milestones that have brought online education in nursing to its current state. Dr. Billings explores the future in the context of today’s health care and learning environments.

What are the significant milestones in your work in nursing education?

The focus of my work in nursing education is developing and testing best practices for teaching and learning in online communities. The milestones in my work parallel the evolution in online teaching and learning across the United States.

In the mid-1980s, computers and software applications were increasingly available to support teaching and learning in higher education. At that time, our school of nursing, like many others, was an early adopter of this technology and took a number of steps to move forward: 1) We placed a computer on the desk of every faculty and staff member. 2) We learned basic computer skills and recognized applications for teaching and learning. 3) We obtained administrative support and funding for large-scale implementation. 4) We developed our faculty and oriented our students. 5) We tested the outcomes of teaching and learning using the technology.

Our first foray into the use of computers in nursing education was to use computer-assisted instruction (think floppy disks, CD-ROMs) and ultimately videodiscs, all of which set the stage for our entry into online learning. Then, in the early 2000s, the university purchased an online learning management system (LMS), and we once again went through the steps of acquiring and learning software, preparing faculty, staff, and students to use it, and developing our first online courses. This round of innovation required a new level of administrative and technology support that involved an instructional designer, webmaster, and programmer, who helped faculty learn to teach in an online environment.

6_things_online_teaching_software_must_haveAt this same time, early adopters at other schools of nursing were dealing with similar issues. The National League for Nursing had an interest group in educational technology, and there I met Diane Skiba and Helen Connors, who were leading their faculty, staff, and students through the same maze of adoption of new technologies. We also networked with Mary Ann Rizzolo, who was developing educational software for interactive video. We instantly bonded and provided support and encouragement for one another.

There were now a sufficient number of schools of nursing and leaders in online learning who could implement the last step of the adoption-of-innovation process: to test outcomes and develop best practices for teaching and learning in online learning environments. Helen, Diane, and I partnered with the research team of the Teaching Technology Roundtable group to develop and test an instrument to identify best practices for teaching and learning online. Using Chickering and Gamson’s 7 Principles of Best Practice in Education as the framework for our research, we conducted several multi-site studies and learned that when good teaching/learning practices are the foundation of online courses, students attain outcomes similar to on-campus courses and are able to become socialized to the profession.

What do you see as significant trends or gaps in online learning in nursing education, from your perspective as an expert in this area?

For the next two decades our small group of early adopters was joined by increasing numbers of faculty who used the power of online learning to offer courses and even entire programs, to make learning accessible for students worldwide. During this time, learning management systems improved, teaching online became embedded in faculty skill sets, and students increasingly expected, chose, and often preferred to learn online. Results of numerous studies continued to indicate that there was “no significant difference” between on-campus and distance-accessible online learning. Today, studies continue to provide evidence for best practices in teaching in online courses and for forming communities of professional practice in online learning communities.

The development of “apps” and the use of mobile devices are trending. Students, and their patients as well, can truly now learn anytime and anywhere. We will continue to see more health-related apps and capabilities to influence changes in patients’ health management practices, and our students and nurses must be prepared to participate in designing and using these apps.

The one gap I would identify is the lack of preparation for faculty who are “putting” their course online. Courses, when offered in an online environment, need to be redesigned to take advantage of the tools of the learning management system and utilize appropriate teaching/learning strategies. Faculty development and team support from an instructional designer and webmaster are essential to make this transition effective.

What insights can you share about the value of online learning in nursing education for schools of nursing and health care organizations, now and in the future?

The value of online learning has become increasingly apparent as schools of nursing now offer full programs online, from prelicensure to doctoral degrees. Online learning makes nursing education accessible while also preparing students with the skills for lifelong learning and collaborating in an online environment. A hidden value results when faculty reexamine their on-campus courses and integrate the best practices of good education they learned when adapting courses for online teaching.

An additional value of online learning is evident when faculty take advantage of the capabilities of online learning management systems and integrate LMS learning tools into their on-campus courses. This happens when faculty use LMS tools to “flip” their courses, embed learner assessment, and use learner analytics to individualize student learning.

Health care organizations also appreciate the value of online learning in both professional development and continuing education. Some organizations take advantage of the ability to provide easy access to education and the competency-tracking capabilities of the LMS to offer residency programs, orientation programs, and staff development programs in an online environment.

What advice do you have for nurse educators in the context of today’s health care and learning environments?

Regardless of the technology (and the “next best thing” is just around the corner!), my advice is to embrace change, keep the focus on students and patients, and determine the best ways to facilitate learning. I also urge faculty to work with product developers and technology support staff at their institution to request changes in software that will improve teaching and learning. Tools such as telehealth and mobile devices for connecting patients, students, and nurses are increasingly prevalent and will enhance the connection between the classroom and clinical practice, not only in health care facilities, but also in patients’ homes. Ultimately, online learning will link well-prepared nurses who can provide high quality and safe care to patients and their families to improve health worldwide.


Diane M. Billings, EdD, RN, FAAN

dianebillingsDiane Billings is Chancellors’ Professor Emeritus at Nursing at Indiana University School of Nursing, Indianapolis, IN where she was the Associate Dean for Teaching, Learning and Information Resources and developed and taught the masters/doctoral level Teacher Education Certificate courses. She has published widely in nursing and higher education journals in the area of using information technology to support teaching and learning. She is the recipient of the Sigma Theta Tau International Founders Award for Excellence in Teaching, the Award for Outstanding Leadership in Nursing Education from the National League for Nursing, and is a Living Legend in the American Academy of Nursing. Recent projects include serving as the project director for the Faculty Preparation Program of the RWJF/New Jersey Nursing Initiative, participating on tasks forces at the NLN to develop vision statements for The Changing Faculty Role: Preparing Students for the Technological World of Health Care and Doctoral Preparation for Nurse Educators. She serves on the editorial boards of five nursing journals. Her current research focuses on benchmarking the best practices in teaching and learning.

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