Post-Pandemic Expansion of Distance Education in Nursing

Rebecca Munday
Updated August 11, 2022
Find out how nursing programs are expanding the use of virtual learning in their curriculum and how you could complete your nursing degree virtually.
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Even before the pandemic made distance education essential, it was becoming more popular for nursing students to enroll in virtual programs. In fact, enrollment of master of science in nursing students in distance learning programs increased by 13.7% from 2015 to 2019, according to the American Association of Colleges of Nursing (AACN) in April 2021.

As nursing programs began returning to in-person coursework, nursing faculty continued to use more technology and virtual learning in the classroom. Distance learning has received support from leaders in nursing, such as the AACN and the National Society of Boards of Nursing (NCSBN). Yet, virtual and hybrid learning take a lot of resources for proper execution. Limited funding for educational technology and nursing faculty shortages slow the expansion of virtual learning in nursing education.

Growth of Distance Learning in Nursing Education

Many in nursing education credit the COVID-19 pandemic for the expansion of distance education in healthcare. However, the pandemic did not start the expansion of online nursing programs or the use of simulations to supplement or replace clinical experience.

Human simulation first appeared in nursing education in the late 1990s. By the mid-2000s, simulation’s popularity in nursing education grew, as students used it to practice skills, critical thinking, and clinical decision-making in a safe place.

In 2008, the NCSBN found that 917 nursing programs used mid-fidelity or high-fidelity patient simulation. As early as 2009, state Boards of Nursing (BON) considered allowing simulation to replace or supplement traditional clinicals, due to concerns over the quality and availability of clinical experiences.

The COVID-19 pandemic forced nursing programs to use more simulation and online learning experiences than were already in place. The pandemic required a plan to facilitate the remaining clinical hours necessary for associate degree in nursing and bachelor of science in nursing students through simulation.

In 2020, 87% of nursing programs used some form of virtual simulation, and 93% of them use some kind of virtual or online learning, according to Wolter Kluwers data. Support for simulation and online learning from state BONs, the NCSBN, and the American Association of Colleges of Nursing (AACN) encourages the growth of virtual learning in nursing education. However, limited funding, few resources, and nursing faculty shortages create challenges when nursing programs want to expand their virtual learning.

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Regulations Surrounding Distance Learning in Nursing

Distance learning in nursing education can affect two key areas: the nursing program’s accreditation status and the nursing student’s ability to complete clinical hours. If you attend an unaccredited program or cannot complete your clinical experience, you may not be able to sit for the NCLEX, transfer your license to another state, or find a job after graduation.

The AACN allows for virtual learning but requires nursing programs to fill out a substantive change form when the new virtual learning takes place in 25% or more of the program. Some state BONs have their own requirements for nursing programs that operate in their state. Nursing programs must meet the standards of the state where they operate and all states where students learn.

The NCSBN encourages nursing programs to add simulation to their curriculum, if they have the resources. However, only qualified faculty should teach simulation labs. The NCSBN Simulation Guidelines provide a checklist for faculty to complete before they start teaching simulation.

It also advises state BONs to consider factors, such as pass rates, retention rates, and clinical site availability before deciding how much of the clinical experience can be replaced with simulation.

Students must still complete a certain number of in-person clinical experiences to graduate, depending on whether they are in a registered nurse program or an advanced degree program. For undergraduate nursing students, the NCSBN says nursing programs can only replace up to 50% of their clinical hours with simulation.

Advanced practice registered nurse (APRN) students cannot replace any of their clinical hours that are required by their state’s Board of Nursing. At Texas Woman’s University, APRN students still had to complete all 500 hours of supervised direct patient care. The university could only substitute extra clinical hours tied to a class or required by the university.

The NCSBN requires nursing faculty who teach non-clinical courses to hold a non-restricted license in the program’s home state. However, clinical faculty and preceptors must hold a non-restricted license in the state(s) where their students live.

Pros and Cons of Online Nursing Education

Before applying, nursing students should consider the pros and cons of online nursing education. Distance learning may hold more benefits for nontraditional students or those living in rural communities. However, distance education requires considerable planning and resources from the nursing program to provide quality education that prepares nurses for their careers.


  • plus-circleMore access to nursing education
  • plus-circleEqual or increased ability to perform nursing skills
  • plus-circleAbility to practice nursing skills without risk to patients
  • plus-circleEqual or increased clinical decision-making, readiness for practice, and critical thinking


  • x-circleCan only replace 50% of clinical hours
  • x-circleStudents in APRN and graduate programs cannot use stimulation to substitute their clinical hours
  • x-circleRequires reliable technology and internet connection
  • x-circleClinical faculty and preceptors must hold a license in all the states where their students live
  • x-circleOut-of-state nurses may have trouble finding a clinical site

Quality of Distance Education in Nursing

NCSBN, AACN, and the Virginia Board of Nursing all wrote statements supporting the expansion of virtual learning in nursing education. However, they also provided guidelines on how to correctly add virtual learning or simulation to the existing curriculum.

Leaders in nursing education are no longer debating whether distance learning is as effective as in-person learning. AACN says all online nursing programs must meet the same accreditation standards as in-person programs. Now, they’re asking how they can incorporate virtual learning and simulation into the curriculum without sacrificing the quality of the education.

The NCSBN National Simulation Study found in-person and simulation based clinical experience can both prepare students for nursing practice. Depending on the course, students with more hands-on clinical experience score higher clinical ratings.

All averages for each group were above 90 in all the classes. However, students in the control group scored significantly higher than their peers in the 50% group in classes, such as fundamentals of nursing, maternal-newborn nursing, and mental health nursing.

Nursing students who live in a rural area and nontraditional students may consider online nursing programs because they provide more access to nursing education. If you’re considering an online nursing program, ask questions to make sure the programs you apply to include the following:

  • check-circleHolds current accreditation
  • check-circleMeets all the requirements of their state BON and your state BON
  • check-circleCan help you complete your clinical hours at a different location
  • check-circlePlans for any simulation in their curriculum with the right staff and equipment

Questions to Consider if You’re Thinking About an Online or Hybrid Nursing Program

If you’re considering applying for an online nursing program, ask questions to make sure you can complete all the requirements to sit for the NCLEX, receive a license in your state, and get a job after graduation.

question-mark-circleHow will I complete my clinical hours from another state or institution?
question-mark-circleHow will the university help me make sure I complete my clinical hours under the supervision of faculty and preceptors licensed in my state?
question-mark-circleIs there a cap to the number of out-of-state applicants the program accepts based on clinical requirements?
question-mark-circleHow will I arrange clinical experiences locally?
question-mark-circleHow much of the required clinical hours are supplemented with stimulation, if any?
question-mark-circleAre the faculty trained to teach simulations?
question-mark-circleWhat kind of simulations does the program use?

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