In nursing education, online formats stand as a growing platform for educational delivery, offering flexibility to educational institutions and consumers. Despite the growing acceptance and presence of online delivery in higher education, the quality of online programs continues to be scrutinized (Allen & Seaman, 2016). As with traditional campus-based programs, evidence-based structures for assuring program quality are necessary to drive desired outcomes delivered through fully online platforms.
A quality assurance (QA) initiative is a daunting process for any education program. Online QA programs may introduce new standards and guidelines for course design, requiring change and adaptation from the faculty community. Furthermore, the implementation of external standards can threaten faculty satisfaction; Vican et al. (2020) identified perceived increased managerial control as a strong driver of faculty dissatisfaction. An additional concern is that standards and guidelines for course design may be interpreted by faculty as limiters to academic freedoms. Research findings indicate that increased workloads and perceptions of decreased control erode faculty well-being (Mudrak et al., 2018).
It is possible to bolster faculty well-being and satisfaction in the implementation process of QA standards. By combining interventions that promote a supportive environment and professional development, programs can meet QA standards while preserving faculty well-being and partnership.
BACKGROUND
Programmatic quality is assessed in a variety of ways within nursing education. It is assessed by standards identified by nursing-specific accreditors, and it is subject to the standards of higher education institutional accreditors, such as the Higher Learning Commission. Commission on Collegiate Nursing Education accreditation standards require that online courses and programs be substantially equivalent to face-to-face offerings (Commission on Collegiate Nursing Education, 2018; Higher Learning Commission, 2019).
The literature fails to endorse one ascribed set of standards of quality for online education, but elements commonly associated with online quality are evident. In a review of six prominent online course assessment tools, Baldwin et al. (2018) found common areas of emphasis, including clarity in objectives and alignment, intuitive navigation, interactive elements, contact points for instructors, use of grading rubrics, and links to institutional services. These attributes are inherent elements of nationally recognized QA structures for the promotion of quality in online education (Garrison et al., 2010; You et al., 2014). Use of a set of standards drives course and program quality through the alignment of each individual course's features.
Implementing online QA standards typically requires revision in course design, a process that can be time-consuming and daunting for faculty. Thomas et al. (2019) discussed the impact of present demands on nursing faculty, noting that teaching and service expectations, research requirements, increased workloads, and life balance concerns create stress and contribute to burnout. Institutional drives toward QA inevitably increase faculty workload demands as course review and revisions are completed. Despite the common vision of faculty for quality in the delivery of education and appreciation for QA, demands to meet standards may be perceived as excessive managerial control and a factor in faculty dissatisfaction (Mudrak et al., 2018). Any initiative to support QA must also support a sense of self-determination in faculty members.
THE JOURNEY TO QUALITY ASSURANCE
Within the context of an RN-to-BSN program at a private, single-purpose nursing college, a QA initiative was successfully implemented through the cultivation of faculty ownership. First, to ensure faculty governance, the mechanisms of QA were approved through a democratic process. Furthermore, faculty were encouraged to serve in peer mentoring roles for achieving QA in individual courses. Finally, approaches from behavioral economic theory helped create a background context that promoted a unified drive toward success.
Behavioral economics is a field that studies how small interventions, often in language use, can have large impacts on group behavior (Behavioral Insights, 2017). One particularly powerful tool within behavioral economics is social comparison, which operates much like peer pressure and provides a backdrop that helps drive success in widespread adoption of QA standards. For example, when a course meets quality standards, a public celebration creates a social environment that incentivizes more courses to meet standards. Behavioral economics theory also indicates that explanations help boost compliance; any adopted QA standards must be justified with evidentiary statements.
Quality Matters(TM) (QM) is a widely used online QA program developed through educational research; the organization is a nonprofit certifying entity, with more than 1,500 institutional members. Achieving QM certification for a course requires that its design meet 42 standards expressed on a rubric as determined through a peer review process (QM, 2021). Each standard within the QM Higher Education Rubric is based on research, with evidence for the standard accessible through QM materials.
A QM certification initiative was brought before the online faculty council (all online faculty hold membership and voting rights within this council). The stated goal was for each course to be revised to meet requirements for certification and then gain official certification from QM, with reviews conducted using external QM review teams to reinforce the integrity of the results. The initiative was approved unanimously. To avoid scheduling burdens, faculty development programs designed to support the initiative and encourage ongoing discussion of the evidence supporting QM design standards were integrated into routine faculty meetings. Some faculty members also completed the certifying organization's peer reviewer course. Upon completion of this course, these faculty were positioned as internal auditors to serve as mentors and provide informal reviews of peer course redesign. The feedback and hands-on coaching they provided assisted colleagues in revising their respective courses to meet QA standards for external review.
Faculty who were early adopters of QA standards emerged as role models within the program. As the first to participate in external QA reviews, these champions ignited the momentum for course redesign toward quality standards across the faculty team. Announcements of official course certifications were met with program-wide celebration at faculty meetings, enhancing social support for meeting the standards. Those who completed course certification disclosed both successes and challenges with peers, building a path that made it easier for colleagues to achieve QA standards. Ultimately, templates that were based on successful course certifications were developed and distributed to help support course revision. In serving as auditors, role models, course designers, and mentors, faculty themselves led the change that ultimately led to program-wide QM course certifications.
RESULTS AND DISCUSSION
All courses offered by the program received certification within 18 months of project launch. Following the initiative, a precipitous improvement in student evaluations was noted. The program observed improvements in 25 areas of evaluation, which included 83 percent of areas surveyed, inclusive of questions about instructional organization, feedback, and professionalism. Improvements were recorded for every instructor in every course. Notably, the most significant improvements documented through student feedback were related to faculty effectiveness in teaching and learning.
Equally important is the perspective of the RN-to-BSN program faculty who were involved in the quality improvement process and who achieved QM certification. Within the context of anonymous survey questions, some challenges to success were identified: 64 percent of faculty indicated they were initially concerned or somewhat concerned about course redundancy because of the revisions process, and 55 percent were initially somewhat or very concerned about whether the revision effort was worthwhile. However, upon completion of the initiative, 90 percent of faculty indicated that the peer-supported improvement process was helpful or very helpful, and all indicated they were satisfied with their certified course. Qualitative feedback was characterized by general satisfaction with revised coursework and the QA project. Satisfaction may also be measured by nursing faculty retention. Fang and Bednash (2014) reported a one-year national nursing faculty attrition rate of 11.8 percent. Four years after our initiative launched, all faculty who participated remain as active faculty members in the online program.
With online delivery, a growing platform for educational delivery in nursing education, evidence-based structures for assuring program quality are necessary to drive desired outcomes and learning experiences. Although a QA initiative is a daunting process for any education program, it is possible to bolster faculty well-being and satisfaction in the implementation process of QA standards. A set of tools that includes professional development, peer auditors, templates, and behavioral economics theory can help programs meet QA standards while preserving faculty well-being and partnership in QA processes.
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