Critical Care Online Training Resources: Valuable or Meaningless?

By Carol Alexander, Director of Nurse Accreditation/Lead Nurse Planner, HealthStream

The answer to the above controversial question is that it depends upon two critical factors: how effectively online educational courses are utilized by institutional leaders and educators that purchase and assign offerings to their constituents and how seriously individual users learn and apply the content to enhance their clinical competency and patient outcomes. 

Eight Benefits of Using Expert-Sourced Courseware

The benefits of online resources by the American Association of Critical Care Nurses (AACN) are numerous; but only if they are fully capitalized upon.   First, institutional leaders and educators, as well as individual healthcare users, must comprehend eight key advantages of using online resources generated by specialty organizations such as AACN:

1)      Quality content is based upon national Association standards of practice, current evidence based references/research studies, specialty clinical case scenarios, best practices, and desired patient outcomes.

2)      Content specific to critical care is generated by top-notch, clinical experts recognized by the specialty organization, thus ensuring accuracy, validity and reliability of educational design processes.

3)      Specialty content is presented in a consistent, objective manner designed to reduce instructor subjectivity and bias, as well as to ensure an interactive, online instructional format that allows users to profit from creative student centered learning methodologies.

4)      Access to online course materials is 24/7, thus giving institutions and users tremendous flexibility and convenience as to when, how (pace), and where courses are taken.

5)      Diversification of online course materials gives institutions and users choice as to which offerings are best to use in onboarding/orientation processes, ongoing annual maintenance of clinical competency, fulfillment of mandatory regulatory  requirements, and career enhancement activities such as becoming specialty certified.

6)      Just-in-time evaluative methods to determine student progress in satisfactorily completing course requirements are inherent in the online format, including the provision of certificates of completion and awardment of approved contact hours.  Many of the courses use clinical case scenarios to evaluate how users apply the cognitive knowledge they gain from online resources to address and solve complex clinical situations, thus improving critical thinking skills and positive patient outcomes.  Electronic user records can be maintained and compiled for statistical, data purposes.  Such documentation is essential for institutional reports.

7)      Cost effectiveness of online resources is usually much greater than costs associated with live offerings whereby instructors must repeat course content on a frequent basis in order to reach all constituents who need the education, plus incurring costs associated with logistics.

8)      Online education is effective.  According to a 2009 meta study from the Department of Education:  students who took all or part of their class online performed better, on average, than those taking the same course through traditional face-to-face instruction. Those who mixed online learning with traditional coursework (i.e. blended learning) did even better. Source: Evidence-Based Practices in Online Learning: A Meta-Analysis and Review of Online Learning Studies, United States Department of Education.

Understanding these benefits, allows leaders, educators, and users to be more selective and judicious about which resources they use at a given point in time to achieve specific goals relative to clinical competency and desired patient outcomes.  It also motivates people to overcome system and personal barriers that thwart e-learning.

The Importance of Planning When Implementing Learning Plans

Unfortunately, many organizations purchase online resources indiscriminately with no thought as to how the courses will complement an institutional master educational plan focused on helping healthcare practitioners to be effectively onboarded/oriented, maintain and enhance clinical competency on an ongoing basis, successfully fulfill identified mandatory, regulatory requirements, understand the impact of their performance on patient outcomes, and use of continuing education to further their careers.  Instead, they purchase numerous courses and assign them to users in a random, illogical “willy nilly” fashion.   They may also not compensate learners for the time it takes to complete required learning assignments using some realistic standardized formula as to how long it takes the average user to complete the assignment.  Some organizations demand that online courses be completed only at work on the unit during downtime; but where work interruptions can interfere with concentration and retention.  Usually, there is no overtime allowed even if there are valid reasons for exceptions to such a policy.  Some institutions do not allow staff to take the courses at home or at work in a quiet laboratory setting that facilitates knowledge retention but does require managers to adjust unit staffing patterns while users are off the unit.  Users become burdened with so many online assignments and institutional barriers/restrictions that they fail to see why the courses are relevant to patient care and job performance, let along their career trajectory.

Know What Training Learners REALLY Need

For example, the Essentials of Critical Care Orientation (ECCO) course by AACN consists of ten modules that provide a comprehensive introduction to critical care nursing using a body systems approach.  It allows educators to use the modular design, accessible in any order, to tailor information to specific lesson plans or individualized learner needs.  They can capitalize on a blended approach of live instruction, along with online resources, to enhance the orientation process for learners.  However, if educators fail to individualize the course to what a learner really needs, including the appropriate timing pace for users to complete assigned modules, they can overwhelm the user, generate frustration with online learning, and sabotage the overall effectiveness of e-learning.  In some rare instances, users are completely abandoned to their own endeavors with online courses with minimal mentorship, precepting, or guidance by nursing leaders and/or educators.  This can demoralize and alienate staff, especially those new to critical care nursing who need more support to integrate their cognitive learning into their daily clinical practice.  

On the other hand, I have seen learners use a variety of shortcuts when taking online courses that diminish the value of their own learning until the process becomes nothing but a meaningless obligation.  For example, when staff rush though a course without taking time to review links that amplify content, complete interactive exercises in a conscientious, thorough manner,  or analyze wrong answers on quizzes/tests to reinforce the knowledge that underlies accurate answers, online resources have little if no chance to be used effectively.  Some healthcare practitioners think complex clinical scenarios are too difficult; so they whiz through the different options without assessing in depth their clinical competency to institute best practices in terms of patient care, thereby making quality patient outcomes a priority.  They prefer elementary post-test questions that are easy to answer versus thought provoking questions what require advanced critical thinking skills.

Shortcuts and "Sharing" Answers Can Limit Training Effectiveness

Unfortunately, there are learners who give answers to post-tests to their colleagues; so that staff can cheat in terms of achieving passing scores without really studying and genuinely applying course content.  The latter behavior seems more prevalent with repetitive annual mandatory, regulatory offerings; but can even occur with excellent courses such as AACN’s 10 lessons on Basic ECG Interpretation or 11 modules on Basic Hemodynamic Monitoring.  Some users are so focused on “getting the course done quickly” that they compromise their ethics and cheat themselves of the gift of knowledge and wisdom.

In summary, leaders, educators, and individual healthcare practitioners that use online courses must commit to articulating the advantages of such learning resources to the overall success of an organization’s mission, goals, and outcomes in terms of quality patient care, staff clinical competency,  and career proficiency for every single employee.  System and personal barriers to ongoing learning must be acknowledged, addressed, and resolved, especially if online learning resources are to be utilized in a manner that makes a positive difference for learners.

Furthermore, institutions need to be learning organizations that showcase more advanced clinical offerings that give staff the choice of taking courses on their own time beyond basic, mandatory, regulatory offerings.   In critical care nursing, staff wants the opportunity to take AACN’s challenging case study tutorials, simulation scenarios, and cutting-edge topics, along with patient care modules based on body systems such as cardiovascular, endocrine, gastrointestinal, neurological, hematologic, pulmonary, and renal disorders.  Above all, nursing employees want innovative courses such as AACN’s Essentials of Nurse Manager Orientation, so they can expand career opportunities for themselves.  HealthStream makes AACN courses readily available to healthcare organizations and their constituents; but whether the online resources are used wisely is up to the people within the institution.  Be intentional about relevant learning via e-learning!