Online Courses Help Nursing School Reach Underserved Areas

The School of Nursing is using online course delivery to offer innovative curricula and train students living in medically underserved areas.

Of the school's 369 graduate and undergraduate students, 174 learn primarily through online courses and off-campus clinical placements. That's an increase from 12 online students in the school's first online course in 1997.

Two Caswell County residents are taking advantage of the school's online Master of Science in Nursing program.

"It's rural with a capital 'R,'" Kelly Cobb, 43, said about her hometown of Yanceyville, which is an hour away from the Duke campus. She and cousin-in-law Diana Cobb are both enrolled in the Duke program and live on farms with their husbands and children. "There's nothing out here but cows and tobacco." The area lacks health care providers -- Caswell County has been designated as medically underserved by the U.S. Department of Health and Human Services.

Kelly Cobb, who is studying to become a family nurse practitioner, said traveling back and forth to Durham would have been a struggle for both her and her family.

Diana Cobb, 47, said the online courses suit her style of learning. "I can hit the back button and listen to a lecture as many times as I need to; and that is a real plus for me, especially being an older learner."

After the two cousins graduate in May, they both plan to stay in Caswell County.. Kelly plans to work as a family nurse practitioner at one of two area health centers or the local health department -- or start her own practice. Diana plans to teach online nursing courses, possibly at North Carolina Central where she is doing her residency.

"This whole notion of targeting health professional shortage areas and recruiting people in their home communities with the idea that they'll stay and practice there has been wildly successful; it really works," said Mary Champagne, dean of the School of Nursing.

The school launched its online programs aimed at reaching rural nurse practitioner, nurse midwife and physician assistant students in 1998 as part of its Partnerships for Training program, which was funded by the Robert Wood Johnson Foundation, The Duke Endowment and the North Carolina Area Health Education Centers.

In addition to reaching students in rural communities, teaching courses online allows the school to select applicants from across the country and around the world.

"You've got to get creative if you want to work with the brightest and best," said Professor Linda Goodwin, director of the Nursing Informatics program and the Center for Information Technology and Distance Learning. In 1997 Duke became the first school in the country to offer an online nursing informatics degree.

In 2001 the school was part of a $1.5 million federal grant awarded to the Medical Center to develop and implement a genetics education program for educators around the country. Duke's national reputation in genetic research and established distance learning program were instrumental in winning the grant.

"Distance education is a great way to gather a critical mass of students," said Lynne O'Brien, director of Duke's Center for Instructional Technology. "And Duke's hallmark has been a strong interplay between campus courses and distance ed."

However, distance learning does not work for every program. At Duke, only advanced-degree courses for students who already have nursing licenses and clinical experience are taught online, and those courses are typically supplemented by clinical internships.

Also, not every pedagogical method that works in a face-to-face class succeeds online, said Professor Nancy Short. "Group projects can be very unwieldy online," she said. "I've taken online courses as a student, so I've used that experience to guide me when designing my own online courses."

Teaching a significant portion of courses online has affected the school's culture. "We are a much more savvy group in terms of how we think about education," Champagne said, citing the use of online tools in on campus courses. For example, instructors now post case studies online in advance of a class, so that class time is spent critiquing studies instead of presenting them.

Students too have to adjust to a new culture with learning outside the social context of a classroom. While Diana said that she finds it easier to build relationships with classmates online, cousin-in-law Kelly says she misses the "connection and camaraderie" of being consistently on campus.

Kelly tries to participate as much as possible in Duke events, so she can have a taste of campus life.

"I camped out for basketball tickets -- didn't get any, but that's OK; I camped out," she said and noted she was old enough to be the mother of most of her fellow campers. "I've been to a football game; I want to go to a basketball game. I want to do the Duke things. I want to know the campus. I want to have memories."