Information technologies and the transformation of
nursing education
Diane J. Skiba, PhD, FAAN, FACMI
Helen R. Connors, PhD, RN, FAAN
Pamela R. Jeffries, PhD, RN, FAAN, ANEF
Higher education is facing new challenges with the
emergence of the Internet and other information and
communication technologies. The call for the transfor-
mation of higher education is imperative. This article
describes the transformation of higher education and
its impact on nursing education. Nursing education,
considered by many a pioneer in the use of educa-
tional technologies, still faces 3 major challenges. The
first challenge is incorporation of the Institute of Med-
icine’s recommendation of 5 core competencies for
all health professionals. The second challenge focuses
on the preparation of nurses to practice in informatics-
intensive healthcare environments. The last challenge
is the use of emerging technologies, such as Web 2.0
tools, that will help to bridge the gap between the next
generation and faculty in nursing schools. Nurse edu-
cators need to understand and use the power of
technologies to prepare the next generation of nurses.
O
ver a decade ago, Hooker proclaimed, “Higher
education is on the brink of a revolution.”1
Whether it is a revolution or an evolution, it is
obvious that the landscape of education has been
transformed, and this trend will continue as new tech-
nologies emerge. One early and noticeable change was
the emergence of corporate educational systems di-
rectly competing for the changing student population.
As Dolence and Norris noted, if the academy was to
meet the demands of the 21st century workforce, “ a
new campus would have to be opened every eight
Diane J. Skiba, PhD, FAAN, FACMI, is a Professor, University of
Colorado Denver College of Nursing.
Helen R. Connors, PhD, RN, FAAN, is Professor and Associate Dean
for Academic Affairs, University of Kansas School of Nursing, Kansas
City, KS.
Pamela R. Jeffries, PhD, RN, FAAN, ANEF, is Associate Professor
and Associate Dean of Undergraduate Programs, Indiana University
School of Nursing, Indianapolis, IN.
Corresponding author: Dr. Diane J. Skiba, University of Colorado
Denver School of Nursing, Campus Box C-288-03 Bldg P28, 13120 E.
19th Ave, PO Box 6511, Education 2 North, Room 4215, Aurora, CO
80045.
E-mail: Diane.Skiba@uchsc.edu
Nurs Outlook 2008;56:225-230.
0029-6554/08/$–see front matter
Copyright © 2008 Mosby, Inc. All rights reserved.
doi:10.1016/j.outlook.2008.06.012
S E P T E M B E R
days,”2 but were quick to add that the solution was not
the creation of more physical college campuses but the
emergence of services (facilitators, learning agents and
other intermediaries) that would provide competition
for the traditional academic setting. Their message was
considered “an information technology (IT) wake-up
call for thousands of higher education leaders.”3 More-
over, Dolence and Norris’ message highlights the major
impact IT had on the educational enterprise.
This transformation, according to Hooker, was “a
structural rather than a cyclical change and was the
result of the confluence of two forces”1—the informa-
tion and management revolutions. The information
revolution has shifted the economy to a knowledge-
based system where knowledge signifies the competi-
tive advantage. Although higher education plays a key
role in the facilitation of knowledge acquisition, the
information revolution was freeing knowledge from the
confines of the academy. At the same time, this shift
was being compounded by the management revolution
with its fundamental principle to produce a high quality
product in less time and at a cheaper cost. Today,
accountability and efficiency issues continue to be a
constant headache for higher education administrators
as they face scrutiny from the public as well as state and
federal legislators. Both the information and manage-
ment revolutions have made not only a significant but a
permanent impact on higher education.
INFORMATION TECHNOLOGY
EXPANDS LEARNING OPPORTUNITIES
There is no doubt information technology (IT) has
changed the way we live, work, learn and play. The
introduction of the Internet, especially the easy-to-use
web, democratizes access to knowledge and provides
opportunities for non-traditional providers (e.g., virtual
colleges and for-profit educational institutions) to offer
learning services that meet the life-long educational
needs of the workforce.2 This notion of leveling the
playing field with access to information and knowledge
on a global scale was brought to light in Friedman’s
concept of the “flattening the world.”4 The phenomenal
growth of the Internet has given “rise to a global
web-enabled playing field that allows for multiple
forms of collaboration—the sharing of knowledge and
/ O C T O B E R N U R S I N G O U T L O O K 225
Information technologies and the transformation of nursing education
work—in real time.”4 Information and knowledge, no
longer hidden behind the walls of the academy, are now
accessible to a variety of populations across the world.
This access not only fosters communication and con-
nections but also opens the door for the globalization of
education.
Perhaps one of the most obvious and significant IT
changes to the educational landscape was the introduc-
tion of online classes and programs. The most recent
Online Nation Report5 was released in October 2007.
The report, based on responses from 2500 colleges and
universities, provides answers to 5 specific questions
about online learning. There were 3.5 million students
who took an online course in the fall of 2006. A notable
finding is that “online enrollments have been growing
substantially faster than overall higher education enroll-
ments.”5 The most growth occurred in associate degree
schools, with the slowest growth in baccalaureate level
programs. According to the report, student access is the
top reason for offering online courses and programs.
Cost reduction is one of the least-supported reasons for
offering online courses or programs. In terms of future
growth, it is important to note that “approximately
one-third of higher education institutions account for
three-quarters of all online programs.”5 The growth will
continue as these institutions add new programs and
continue to grow their existing programs.
GENERATIONS DIVIDED
Another change in the landscape is the changing student
population. Two new student populations have entered
higher education with differing demands and expecta-
tions. The first is the non-traditional learner who is
older (ⱖ 25 years of age), working and attending school
part-time. According to the National Center for Educa-
tion Statistics, the enrollment of students ⬍ 25 years old
increased by 31% whereas there was only a 17%
increase for those students ⬎ 25 years during the years
from 1990 –2004.6 They also projected that college
enrollments will rise 11% for those students ⬍ 25 year
olds and increase by 15% for those students ⬎ 25 years
from 2004 –2014.
To further confuse the landscape, the ⬍ 25 year-old
student population is a new generation of students
unlike previous generations. This growing population
of digital natives,7 or millenials,8 is now entering the
higher education system. The digital natives represent a
new student population who differ in terms of their
technology savvy and their desire to learn using active
and interactive learning strategies. According to Skiba
and Barton, “the impact of the Net Generation is
particularly intense considering the complicating im-
pact of IT in higher education. Information technologies
have become so pervasive on campus, it is hard for
faculty not to embrace them in the instructional process.
In addition, colleges and universities must cope with the
growing demand to provide infrastructure support for
226 V O L U M E 5 6 ● N U M B E R 5 N U R S I N G
Skiba et al
learner’s personal technologies, such as wireless lap-
tops, PDAs, and IPods.”9
THE CHANGING PEDAGOGY
The education landscape is further compounded by
what Brown and Alder, have labeled a “brewing perfect
storm of opportunity.”10 The storm includes a variety of
new philosophies and teaching/learning strategies. It
consists of the movement in authentic learning11 and
social learning10 strategies coupled with Open Educa-
tional Resources (OER) phenomenon. Authentic learn-
ing or learn-by-doing focuses on real world, complex
problems and their solutions and makes use of a variety
of emerging technologies to provide a highly interac-
tive, collaborative and reflective learning environ-
ment.11 Social learning is best described by Brown and
Alder as being “based on the premise that our under-
standing of content is socially constructed through
conversations about the content and through grounded
interactions, especially with others, around problems or
actions. The focus is not so much on what we are
learning but how we are learning.”10 The OER move-
ment, such as the MIT OpenCourseWare project, pro-
vides access to a wealth of undergraduate and graduate
course materials for anyone who chooses. These move-
ments are highly dependent and interconnected with the
growing use of Web 2.0 tools to facilitate and create
virtual communities of learning.
NURSING EDUCATION
TRANSFORMATION SUCCESSES
The landscape in higher education has indeed changed
and these changes will shape the way nursing education
is delivered to prepare our next generation of nurses.
Nursing, in comparison to other healthcare professions,
is often seen as an early adopter of educational innova-
tions. Nurse educators have taken major steps to transform
their curriculum and make use of a variety of educational
technologies to facilitate learning. Nursing schools in
particular have struggled with multi-generational stu-
dent populations and the selection of the most appro-
priate teaching strategies for these differing student
populations.
Simulation
During the past decade, the use of simulations as a
teaching-learning intervention in nursing curricula has
increased greatly. Nursing students, clinicians, and
educators alike appear to be strongly in agreement
about the importance of incorporating simulations as a
teaching practice into the nursing curriculum. Simula-
tion development and implementation draws from the
expertise and clinical experience of faculty that possess
both creative and technological skills. Successful inte-
gration of simulation stems from the fervor of innova-
tive faculty embracing student-centered learning and a
commitment of the institution. Simulation involves
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Information technologies and the transformation of nursing education
curricular consideration; appropriate faculty develop-
ment; detailed preparation; and collaborative efforts
between faculty, staff and administration. However, as
this new technology is moving into the curriculum, not
all educators feel prepared for this type of teaching
strategy. Learning to develop, implement, and evaluate
simulations is not a skill set nursing educators feel
prepared to utilize in their courses unless they engage in
some kind of professional development. Nor do they
understand the potential impact that adopting this edu-
cational method has on student learning.12 For faculty
to increase their knowledge and ability to design,
implement, and evaluate simulations, information and
skill development are needed so the pedagogy can be
delivered in the method desired in order to obtain
optimal student learning outcomes. At times, nurse
educators are placed in a learning environment where
they have to teach students using simulations without
being prepared to facilitate learning in this innovative,
student-centered approach. As schools purchase simu-
lators to support and enhance clinical education, it is
imperative for faculty to be prepared for the challenge
and paradigm shift. The challenge is: how can educators
be prepared for this transformational pedagogy in such
a way as to assure a level of comfort and skill in
teaching while maximizing the learning outcomes?
E-learning and Other Interactive
Technologies
Nursing education has opened learning opportunities
for many through the early adoption of web-based
courses and, in some cases, entire online degree pro-
grams. Nursing schools used web-based programs as a
means to extend their campus to different student
populations, transcending traditional barriers of time,
geography, and physical space. The different student
populations included rural students, ethnically diverse
students, and older non-traditional students. Schools of
Nursing were able to accommodate new learners with
their “clicks and bricks” programs. Although there are
limited statistics noting the use of online programs for
nursing, a quick scan of web sites like AllNursing-
Schools indicates a wealth of online program opportu-
nities. For the last decade, the Health Resources and
Services Administration’s Division of Nursing has
funded a large number of online Registered Nurse-
to Bachelor of Science (RN-BS) completion and ad-
vanced nursing education programs. Despite the in-
creasing numbers of online courses and programs, there
is large variation in the design of online courses—from
simple dissemination format of lecture slides and 2
discussion questions per week to podcast lectures to
highly interactive and dynamic learning environments.
All fall under the rubric of web-based courses. Again
the question arises, how do we insure that faculty
members have the necessary preparation for designing
and teaching in online environments?
S E P T E M B E R
Skiba et al
There is also a growing group of nurse educators
who have successfully integrated the use of various
educational technologies into the classroom, creating
active learning environments that engage students. It is
commonplace for faculty to use slides to accompany
lectures. Many classrooms are now wireless and pro-
vide connections to the web, allowing faculty and
students to access the web for additional information
and knowledge resources. Faculty members are now
using audience response technologies also known as
“clickers” in the classroom to create more interactive
and participatory learning environments. Although
there has been much progress in the use of these
technologies in the classroom, there are relatively few
articles in the nursing literature referring to use of
emerging technologies, such as Web 2.0 tools, in
nursing curricula.
A recent study by Carnegie Foundation for the
Advancement of Teaching examined the education of
professionals in nursing, medicine, law, engineering,
and the clergy.13 One finding of the study was that
“universities need to instill in their professional stu-
dents ‘the three habits:’ the habit of mind, teaching to
help students understand content; the habit of hand,
providing the opportunity to practice what they learn;
and the habit of heart, instilling a sense of values and
commitment to service.”13 The results of the study
identified 7 general principles for signature teaching
methods across the professions. The principles13 are:
1. routine, habitual and pervasive
2. involve a need for public performance from stu-
dents
3. instill a sense of interdependence
4. mirror practices of uncertainty
5. are not emotionless
6. have a sense of character and a sense of value
7. instill a sense of personal responsibility
NURSING EDUCATION CHALLENGES
As pointed out earlier, although nursing education has
been on the leading edge in some educational arenas,
there are still many challenges to face. This is particu-
larly true in 3 specific areas.
First, nursing and other health care professions have
been slow in incorporating the 5 core competencies set
forth by the Institute of Medicine (IOM).14 In this
report, the demand to completely overhaul the educa-
tion for health care professionals was very clear in the
statement that “clinical education has not kept pace
with patient demographics or desires, changing health
system expectations, evolving practice requirements,
staffing arrangements, new information, focus on qual-
ity improvement or new technologies.”14 The IOM
vision states “All health professional should be edu-
cated to deliver patient-centered care as members of an
interdisciplinary team, emphasizing evidence-based
/ O C T O B E R N U R S I N G O U T L O O K 227
Information technologies and the transformation of nursing education
practice, quality improvement approaches and infor-
matics.”14 Today, there are relatively few schools of
nursing that have incorporated these core competencies
into their nursing curriculum.
A recent initiative, Quality and Safety Education for
Nurses (QSEN),15 is helping faculty to provide students
and new health professionals with the knowledge,
skills, and attitudes to continuously improve the health
care systems. This initiative, funded by the Robert
Wood Johnson Foundation, explicates the knowledge,
skills, and attitudes needed in each of the 5 competency
domains. Fifteen schools of nursing are participating as
pilot schools to integrate these competencies into their
pre-licensure curriculum and share their resources, such
as learning activities with others. This project will
jumpstart nursing education efforts to incorporate not
only these core competencies but to introduce a new
generation of nurses to a culture of quality and safety.
A similar need exists in terms of preparing practicing
nurses to use informatics tools to “communicate, man-
age knowledge, mitigate error and support decision
making.”16 As informatics-intensive care delivery de-
velops in the clinical arena, nursing education needs to
grapple with how best to prepare nurses to practice in a
transformed healthcare environment. According to
Skiba, “schools of nursing will begin to experience a
new type of digital divide. Faculty who do not have
access to the various clinical information systems that
nurses will use as integral components of practice will
have difficulty understanding how the nursing curricu-
lum needs to change.”16
Although there is much written about informatics in
nursing education, there is relatively little integration of
the principles into the nursing curriculum. A recent
study by the National League for Nursing of faculty and
administrators in schools of nursing documented that,
although computer competency and information liter-
acy were integrated in almost 50% of schools, infor-
matics competencies were not addressed.17 In fact,
informatics competencies were often confused with
computer and information literacy skills, and with the
use of educational technologies to deliver educational
experiences. For many, using simulations and taking
online courses were considered methods to learn about
informatics. There were relatively few schools that had
incorporated knowledge, skills, and attitudes related to
the use of informatics tools to facilitate communication
among the interdisciplinary team and with patients,
manage knowledge, diminish error, and support clinical
decision-making. However, the American Association
of Colleges of Nursing has identified competency in the
use of information systems and patient care technology
as an essential component of doctoral education for
advanced nursing practice (i.e., the Doctor of Nursing
Practice).18 Similarly, information management and
application of patient care technology will be included
as an expected competency in the revised Essentials of
228 V O L U M E 5 6 ● N U M B E R 5 N U R S I N G
Skiba et al
Baccalaureate Education for Professional Nursing
Practice.19 More recently, the National League for
Nurses (NLN) Position Statement on “preparing the
next generation of nurses to practice in a technology-
rich environment” drives the informatics agenda even
further.20 As an outcome of these initiatives, we are
likely to see a great deal of curriculum revision as
schools of nursing attempt to meet these criteria for
preparing the future nursing workforce.
Although some schools are making the transition to
incorporate the IOM competencies in their curriculum,
there are relatively few exemplars. The University of
Kansas, in collaboration with Cerner Corporation, has
developed an Academic Education Solution that utilizes
clinical information systems throughout the curriculum
to foster the development of informatics competencies.
This Simulated E-hEalth Delivery System (SEEDS)
Project used by both nursing and medical students, is an
evidenced-based approach to learning that promotes
critical decision-making skills and enhances students’
access to state-of-the-art technology used in clinical
practice settings.21–23 The Cerner Academic Solutions
has already spread to other schools of nursing at St.
Scholastica,24 University of Utah, the University of
Maryland, and a consortia of schools in the Kansas City
area. Another exemplar is the work at Johns Hopkins
University School of Nursing and Eclipsys Corporation
that re-engineered the nursing curriculum using clinical
information technology.25 The clinical information sys-
tem was integrated into the 3 simulation labs in the
school and is incorporated in each of the undergraduate
courses. The goal is to increase the healthcare informa-
tion technology competence of their nursing graduates
and to design new ways of delivering safe and efficient
health care utilizing healthcare information technology.
Other models used in schools of nursing include
forming a partnership with one of their clinical agencies
and their clinical information systems vendor. The Ohio
State University College of Nursing partnered with its
vendor to develop an academic version of its intelligent
charting solution at The OSU Medical Center and
specially designed version of the CIS within the class-
room.26 This clinical system simulated the clinical
practice environment through faculty-developed patient
cases. These cases were integrated throughout the
baccalaureate curriculum and connected to the use of
high fidelity human simulators. Other examples include
Ball State University, who uses McKesson27 and Wake
Forest State University.28
The last challenge focuses on the use of emerging
technologies into nursing education. Schools of nursing
have struggled to keep pace with emerging educational
technologies. Many schools of nursing are just begin-
ning to use a variety of tools associated with the
emergence of Web 2.0. The web is transforming from
an information dissemination platform to a web that
is more interactive, customizable, social- and media-
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Information technologies and the transformation of nursing education
intensive. The web is shifting to a platform in which
content is created, shared, remixed, repurposed, and
passed along.29 Web 2.0 is all about connecting people
to boost their knowledge and their ability to learn. Web
2.0 tools are focused on communication, collaboration,
interactivity, connecting with people, and creating
value through the sharing of ideas and making use of
the collective wisdom of the web community. Web 2.0
tools include the use of social writing, booking and
networking tools as well as data visualization tools,
mashups, virtual worlds, and user-generated tools to
create podcasts and videos.30 –34 The slow response of
faculty to the integration of these tools in curriculum
highlights the expanding divide between the digital
natives (millenials) and the digital immigrants (educa-
tors) in our schools of nursing. This chasm between the
digital natives and immigrants will continue to widen in
the upcoming years.35 This notion is echoed in the
recent Horizon Report that summarized 7 metatrends
observed over the last 5 years.35 The metatrends include
the following:
1. Communication between human and machines
2. Collective sharing and generation of knowledge
3. Games as pedagogical platforms
4. Connecting people through the network
5. Computing in three dimensions
6. Shifting content production to users
7. Evolution of a ubiquitous platform
There is no doubt these metatrends will significantly
impact not only how we teach and how students will
learn, but how the higher education landscape will
continue to evolve over the next decade.
Solutions
Although challenges remain, there are many solu-
tions to help faculty implement educational transforma-
tion. One solution is the HRSA Faculty Development
Initiative (Faculty Development: ITNEP) that provides
support for faculty development.36 The purpose of this
initiative is to help faculty gain knowledge and skill to
use information and other technologies to expand the
capacity of schools of nursing to educate students for
21st century healthcare practice.36 Information, tools,
and other technologies in nursing education and prac-
tice include informatics, telehealth, mannequin-based
and patient simulators, computer-based instructions,
virtual simulation, interactive simulated case studies,
advanced 3D graphics, and e-learning technologies. To
date, 4 collaboratives have been funded. Duke Univer-
sity’s Technology Integration Program for Nursing
Education and Practice (TIP-NEP) was funded in 2006
as a collaborative effort between Duke University
School of Nursing, Western Carolina University, and
Fayetteville State University. Also funded in 2006 was
the University of Wisconsin statewide faculty develop-
S E P T E M B E R
Skiba et al
ment program, Wisconsin Technology Enhanced Col-
laborative Nursing Education.
In 2007, two additional grants were awarded to the
University of Pittsburgh and the University of Kansas.
The University of Pittsburgh created the ELITE
(Emerging Learning and Integrated Technologies Edu-
cation) Faculty Development Program. The University
of Kansas formed an educational collaborative with the
University of Colorado Denver, Indiana University, and
the National League for Nursing. This collaborative
developed a partnership with the QSEN initiative to
incorporate their work as an underlying framework for
this educational collaborative. This collaborative, Health
Information Technology Scholars (HITS) project, is de-
signed to reach the following goals:
● Transform teaching and learning in the 21st century—
Merge informatics, telehealth, simulation, and e-
learning to create powerful learning environments.
● Improve Nursing Education and Practice—Develop
faculty to integrate IT in curricula to educate future
practitioners.
● Expand Infrastructure for Clinical Learning
Processes—Educate a cadre of well-informed faculty
who focus on real-world applications of technologies
in their education practices.
● Optimize Patient Safety and Drive Improvements in
Healthcare Quality—Better educate future workforce
with competencies to provide safe, quality, and
efficient health care through use of technologies.
SUMMARY
It is important for nursing education to remain at the
forefront of this transformation in higher education.
Nurse educators need to continue their lifelong learning
to keep pace with the technological changes not only in
the classroom but also in the practice arena. It is
incumbent upon the members of the academy to use the
power of emerging technology tools to create learning
communities for sharing and exchanging ideas, re-
search, and knowledge about nursing education.
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