Abstract
Since the 1990s, online learning and distance learning have proliferated rapidly. The purpose of this study was to explore recruiters' perceptions regarding nurses with online degrees versus face-to-face (f2f) degrees at the baccalaureate level. This study used a qualitative research approach with a phenomenological research design. A total of ten nurse recruiters were recruited to participate in online Zoom interviews. Thematic analysis was used to analyze the findings. Eight themes representing recruiters' perceptions regarding nurses with online degrees versus f2f degrees at the baccalaureate level emerged from the qualitative data. Participants perceived that the nurses with online degrees tended to be technologically savvy, had critical thinking skills, and could accomplish tasks autonomously. Participants had different perceptions regarding the advantages of online education based on their own experiences of taking online classes.
Background
Online and distance learning have increased more rapidly than all other student categories in higher education since the 1990s. This is especially true since technology has changed higher education by evolving the traditional ways of delivering education and learning (Curran et al., 2017; Deng et al., 2017). Furthermore, students today are more likely to enroll in online or blended learning programs over traditional face-to-face (f2f) programs due to the COVID-19 pandemic (Bao, 2020; Cao et al., 2020; Lee, 2020), ease of use (Hickland et al., 2020; Sandars & Patel, 2020), or lower costs resulting from new and effective ways of learning (Zhai & Du, 2020).
However, perceptions of the presumed inferiority of online degrees have existed and continue to exist (Curran et al., 2017). That is, with technology having changed the landscape of learning delivery modes, online education is viewed by employers, educators, and students as inferior when compared to f2f learning (Curran et al., 2017; Kung, 2017). For example, Kung (2017) conducted interviews among 12 online degree students and found that stereotypes existed in which online degrees are considered less valuable than f2f degrees. Overall, while online education and learning are growing in popularity, employer perceptions of online nursing degrees merit further exploration (Engel, 2019). Furthermore, research is lacking on the professional outcomes of online education graduates, specifically in terms of their employment rates, salaries, licensure, and domains of practice (Curran et al., 2017; Figuera et al., 2019).
Within the nursing profession, there is a continuous demand to meet the needs in the healthcare industry. Demands are exacerbated by the increased need for significantly more doctors and nurses to combat the COVID-19 outbreak, which recorded 32,191,342 cases in the US alone (Centers for Disease Control and Prevention, 2021). Similarly, according to Cameron (2013), expanding nursing programs to online education and learning is important, as this may help increase enrollment in nursing schools. To summarize, research suggests the nursing shortage may be solved through the development of online and web-based programs (Cameron, 2013; Kinneer, 2014).
Recent research on this topic has shown various benefits of students obtaining an online education (Dumford & Miller, 2018; Shatri, 2020; Srivastava, 2019). For example, Shatri (2020) found that students are more communicative in online classes than in the f2f context. Dumford and Miller (2018) found similar results when studying students enrolled in higher education institutions, noting that students who are enrolled in online classes have better problem-solving skills when facing challenges in the classroom or their lives. Further, Srivastava (2019) argued that students in an online classroom were better "encouraged to increase their capacities of analysis, imagination, critical synthesis, creative expression, self-awareness, and intentionality" than in the f2f context (p. 22). While there are overall benefits to online learning, there is still a definitive lack of knowledge regarding employer perceptions toward online nursing degree programs (Engel, 2019). The existence of less than favorable employer perceptions toward online nursing degrees merits further exploration, especially in the nursing industry, where the nursing shortage is critical (Engel, 2019; Kinneer, 2014).
Current literature on the topic of online nursing education indicates additional challenges and issues specific to the nursing discipline. Implementing a well-planned nursing curriculum is vital in achieving the success of academic and employment outcomes, especially in developing high-quality skill sets and knowledge (Huisman‐de Waal et al., 2018; McNally et al., 2019). While online degree programs are becoming widely available for nursing students, some studies have also shown that students enrolled in online degree programs have reported lower engagement (Huisman‐de Waal et al., 2018; McNally et al., 2019). Nursing students in online classes have also reported the need for more support from their educators when using teaching technology in class (McNally et al., 2019). Furthermore, McNally et al. (2019) and Huisman‐de Waal et al. (2018) noted that students from the Netherlands and Australia, who are enrolled in online degree programs lack basic nursing skills. Students have noted that minimal support from educators in online learning has contributed to their lack of skill development (Huisman‐de Waal et al., 2018; McNally et al., 2019). As such, researchers have identified a need for more research regarding perceptions of nursing education (Engel, 2019; Huisman‐de Waal et al., 2018; McNally et al., 2019).
The study aimed to answer the following research question: What are recruiters’ perceptions regarding the hiring of nurses with online baccalaureate nursing degrees compared with those of nurses with f2f baccalaureate nursing degrees? The sub-research questions were: 1. How do recruiters perceive the rigor of online baccalaureate nursing degrees compared to f2f baccalaureate nursing degrees? 2. How do recruiters perceive the job performance of nurses with online baccalaureate nursing degrees as compared to nurses with online f2f nursing degrees? 3. How do the personal educational experiences of recruiters inform decisions in hiring nurses with online baccalaureate nursing degrees as compared to hiring nurses with f2f baccalaureate degrees?
Methods
Design, Sample, and Setting
A qualitative approach with a phenomenological research design was used in this study. This design was selected to determine the complexity of nursing recruiters' perceptions and experiences regarding online versus f2f baccalaureate nursing training. During data collection, nurse recruiters employed at skilled nursing facilities (SNFs) or hospitals in the United States that employ registered baccalaureate nurses were recruited through purposeful sampling. For this research, nurse recruiters were defined as the professionals who interview and ultimately select nurses for employment on behalf of the health care organizations they represent. The researchers used the following inclusion criterion for the participants of this study: (a) over 18 years old, (b) a nursing recruiter with at least three years of experience and employed at a SNF or hospital in the United States that employs registered baccalaureate nurses, and (c) directly responsible for the recruitment of baccalaureate level registered nurses. Nurse recruiters who did not meet all inclusion criteria were excluded from the study. The first ten participants who met the selection criteria and returned their signed informed consent form were automatically selected and thus included in the sample. Hence, in the current study, a total of 10 nurse recruiters participated in this study. Of the 10 recruiters in the sample, six were recruiters with nursing degrees and four were recruiters who were not nurses.
Procedure
A researcher-developed interview protocol was used for data collection. Throughout the data collection process, the researcher made field notes of non-verbal communication such as gestures and impressions gained while the participant responded (Phillippi & Lauderdale, 2018). Then, using the Dragon NaturallySpeaking voice recognition software, the researcher transcribes the audio and audiovisual recorded interviews. After transcription, member checking was employed to ensure the trustworthiness of the results. That is, the researcher sent the summary of the transcribed interview to the participants via email and allowed ten working days for their responses regarding amendments for accuracy.
The researcher completed the CITI certification and obtained Institutional Review Board approval from a private Mid-Western university. The purpose of the research, type of research, procedures, voluntary nature of participant selection, risks, benefits, and confidentiality measures were all explained on the emailed informed consent form. This form also explained that participation in the study was voluntary and that the participants could withdraw from the study at any time without consequences. The signed informed consent form was a requirement for all participants in the study, providing the researcher's personal contact information for any clarifications regarding the study.
Instrumentation
The instrumentation used in this research focused on collecting in-depth and rich data using a researcher-developed interview protocol. To collect more in-depth information on recruiters' perceptions regarding hiring nurses with online baccalaureate nursing degrees compared with f2f baccalaureate nursing degrees, the researcher-developed interview protocol which contained open-ended questions aligned with the research question of this study.
Data Analysis
Data analysis was conducted using the Thematic Analysis Method. More specifically, the researcher utilized Braun and Clarke's (2013) six-step thematic analysis of qualitative data. First, the researcher analyzed the transcribed data gathered from the interviews conducted with the participants by reading and rereading the transcripts. Next, the researcher carefully read and coded each line of the interview transcript and field notes, identifying small meaning units or codes to note what was said and how it was said to gain insight into the participants' perceptions. This part of the process allowed the researcher to generate codes to emphasize the participants' unique perceptions regarding recruiting nurses with f2f and online degrees, instead of merely developing codes from literature (Noon, 2018). The researcher's field notes were also added to the relevant sections of the gathered data to bolster the information.
The NVivo 12 computer-assisted qualitative data analysis software was then utilized in storing, managing, organizing, and analyzing data. Emergent themes were then identified by using the annotated notes. This process resulted in the initial themes based on the findings. The researcher then linked the initial themes by identifying the similarities between themes and grouping the themes to form main and subordinate themes. The last three steps of the analysis consisted of reviewing the resulting themes, defining and naming the themes, and finally producing the report using the themes and subthemes identified in the analysis.
Results
After analyzing recruiters' responses to the open-ended questions using Thematic Analysis, eight themes emerged from the data to answer the research questions. Themes that emerged from sub RQ1 were: (a) Perceived lower rigor in online classes during the COVID-19 pandemic and (b) Perceived higher rigor in online classes in terms of developing 21st-century skills. The themes that emerged from sub-RQ2 were: (c) Candidate selection is pre-determined by meeting minimum job requirements, (d) Candidate selection is pre-determined through the selection interview, and (e) Candidate selection is pre-determined by meeting certain qualifications dictated by recruiters and hiring managers. Finally, the three themes that emerged from sub-RQ3 included: (f) Recruiters who have taken online classes tend to realize the advantages of online education, (g) Recruiters who have never taken online classes tend to be skeptical about online learning, and (h) Recruiters who have taken hybrid classes tend to think blended education has the most advantage.
This research concluded that differences exist among nurse recruiters and their perspectives regarding online nursing education in the United States. Online education was deemed rigorous when considering the development of 21st Century skills among new nurses. However, online education during the COVID-19 pandemic lacked rigor, especially compared to f2f and online education before the pandemic.
The major themes found in this research have significant implications for nursing practice, especially in approaches to education and curriculum design/delivery. Major findings are discussed in greater detail herein.
Theme 1: Perceived lower rigor in online classes during the COVID-19 pandemic
One of the key findings from this research was that of nurse recruiters’ perceptions of lower rigor within online baccalaureate nursing programs during the COVID-19 pandemic. This major finding underscored how practical clinical skills were more effectively learned in a physical setting than in a virtual class. This major theme is consistent with past literature on this topic. Previous researchers have found that nurse acquisition of knowledge in a traditional classroom or physical setting, was more effective than in an online setting (Rouleau et al., 2019; Stone et al., 2020). In addition, the acquisition of practical clinical skills is more effective in a physical setting than in a virtual class (Rouleau et al., 2019; Stone et al., 2020), also consistent with this study's findings. In addition, the current study adds to the extant literature on this topic, as no previous studies explored nurse recruiters' perceptions regarding the rigor of online baccalaureate nursing programs during the COVID-19 pandemic.
It is worth noting that the perceived low rigor in online nursing programs may be because instructors who required nursing materials for online instruction were not adequately prepared, due to the abrupt shift in teaching and curriculum delivery methods during the COVID-19 pandemic. Research has shown that instructors may have been inexperienced in online instructional delivery during the COVID-19 pandemic (Clark et al., 2020). It is also worth noting that f2f courses and desired outcomes do not readily transfer to online courses, as found in past research (Rouleau et al., 2019; Stone et al., 2020). Furthermore, the COVID-19 pandemic placed urgent market demands on the need for more medical personnel (Huehn et al., 2020). These factors, among others, may have influenced participants' responses regarding the perceived low rigor in online nursing.
Nonetheless, this major theme calls out to the leaders of nursing education to further examine and evaluate the nursing curriculum to better determine its rigor for nursing students, especially when there is high market demand. Further, nursing education program leaders need to focus on developing better strategies to hone the clinical skills of nursing students, regardless of the education modality, whether online or f2f learning. Examining this topic may have significant implications on the overall quality of care nurses render to hospitals and clinics, while aiming to enhance the rigor and practical clinical skills developed among nurses in online classes.
Theme 2: Perceived higher rigor in online classes in terms of developing 21st Century skills
The second key finding that emerged from this research is that there is increased rigor in online programs with respect to developing 21st Century skills, as perceived by nurse recruiters. These 21st Century skills included in the study are the following: the quality of technology skills, critical thinking skills, and autonomy among the nurse applicants. Azhiimah et al. (2021) and Octaberlina and Afif (2021) reported similar findings in their studies, where they found that online learning increases autonomy and positive attitudes of learners, especially during the COVID-19 pandemic. In addition, similar previous research determined that online learning increases learners' critical thinking skills (Dhawan, 2020; Oyarinde & Komolafe, 2020; Tsai et al., 2018). While this major theme is consistent with past research studies, this study's finding expounds on past literature on this topic. This finding has implications for nursing practice, especially in education, given the steady rise of technology and the need for critical thinking skills and autonomy among nurses (Dhawan, 2020; Labrague et al., 2019; Ludin, 2018; Tsai et al., 2018).
Theme 3: Candidate selection is pre-determined by meeting minimum job requirements
The third key theme from this research is that all nurse applicants were considered equally regardless of having an online or f2f degree at the baccalaureate level. This finding means that recruiters select nurses not based on the modality of learning, whether online or f2f, but on their ability to meet the minimum job requirements. According to Kinneer (2014), healthcare recruiters were more likely to hire nurses with f2f degrees over those with online degrees. However, Kinneer's (2014) study does not reflect the new realities of recruiter perceptions based on the demands brought about by COVID-19. As such, this study is the first to examine recruiters' selection of nurses as having an online or f2f degree at the baccalaureate level (Huisman‐de Waal et al., 2018; McNally et al., 2019). This study meets the call for more research on recruiters' perceptions of nursing education and whether nurses are hired based on either having an online or f2f degree at the baccalaureate level (Huisman‐de Waal et al., 2018; McNally et al., 2019). This major theme provides empirical information regarding the need for nursing program leaders to focus on specific job requirements within nursing curriculum. Another area worth exploring in future studies is with the alignment a synthesized version of nursing job requirements, especially nursing fundamentals such as basic nursing care, providing comparisons of nursing curricula in f2f, online, and hybrid courses.
Theme 4: Candidate selection is pre-determined through the selection interview
The fourth emergent theme from this research is that candidate selection is pre-determined through the selection interview. This finding means that recruiters select nurses not on the basis of modality of learning, either online or f2f, but on the job interview responses of the applicants. Wilson et al. (2018) reported in their research, that online nursing graduates have the same job performances as those graduating from f2f education programs.
Theme 5: Candidate selection is pre-determined by meeting certain qualifications dictated by recruiters and hiring managers
The fifth key theme from this research is that candidate selection is pre-determined by meeting certain qualifications dictated by recruiters and hiring managers. This finding illustrates that recruiters of nurses have great input in selecting candidates, highlighting the required skill set for the job, and thus translating it to their expected job performance. In this study, nurse recruiters emphasize the following skill sets when hiring new nurses: the ability to navigate technology systems, clinical rotation experiences, and qualifications based on the functions of the hospital or the department.
Overall, regardless of their modality of education, nurse recruiters place more weight on the nursing skill sets when selecting and hiring applicants. This finding is consistent with the third theme in this research: recruiters select nurses not based on the modality of learning, whether online or f2f, but on their ability to meet the minimum job requirements.
Theme 6: Recruiters who have taken online classes tend to realize the advantages of online education
The sixth key theme from this research is that nurse recruiters who have taken online classes tend to value the advantages of online education. This finding is similar and consistent with past studies that have studied perceptions of online learning, noting that faculty who have online learning experiences tend to have a more positive perception of online learning than faculty who have only had f2f learning experiences (Willett et al., 2019). Curran et al. (2017) similarly noted this among recruiters of new applicants. Curran et al. (2017) found that recruiters who have had a positive experience in hiring a candidate with an online degree, tended to have positive attitudes about hiring future candidates with online degrees. However, Curran et al. (2017) and Willett et al. (2019) did not focus on nursing recruiters and their perceptions of nursing applicants or new nursing graduates. This current study thus extends the present literature on recruiters' perceptions when hiring new nurses.
Theme 7: Recruiters who have never taken online classes tend to be skeptical about online learning
The seventh emergent theme is that recruiters who have never taken online classes tend to be skeptical about online learning. In this case, recruiters with no previous experience with online classes tend to be skeptical about online learning and thus prefer applicants with f2f degrees. This major theme is also consistent with past research, as recruiters who did not have experience with online learning also have misconceptions about the clinical, hands-on education requirements required in online degree programs (Curran et al., 2017). Given the sixth and seventh themes found in this study, recruiters' perceptions of online learning are significantly formed based on their own experience with online learning.
Theme 8: Recruiters who have taken hybrid classes tend to think blended education has the most advantage
The eighth and last key theme from this research is that recruiters who had taken hybrid classes tend to think blended education has the most advantage. Past literature has also found that blended learning and hybrid class are optimal in developing learning outcomes for students. The current study is the first to focus on the perceptions of nurse recruiters and not on the actual impact of hybrid classes on nurse learners.
Conclusions
This qualitative phenomenological analysis aimed to explore recruiters' perceptions of nurses with online degrees versus f2f degrees at the baccalaureate level. Through a qualitative phenomenological research approach, this study's findings showed significant differences in nurse recruiters' perceptions regarding online classes versus f2f degrees at the baccalaureate level, especially during the COVID-19 pandemic. Overall, this study found a perceived lower rigor in online classes during the COVID-19 pandemic. In comparison, there is a perceived higher rigor in online classes regarding developing 21st-century skills among nursing students. Further, recruiters' perceptions of online learning significantly differed based on their own educational experiences. That is, recruiters who have taken online classes tend to realize the advantages of online education. In contrast, recruiters who have never taken online classes tend to be skeptical about online learning.
In comparing f2f learning and online learning as educational approaches, previous research has regarded f2f learning as the most efficient educational approach to learning for students (Marold & Haga, 2003; Marold et al., 2000; Miliszewska, 2007). Although this comparison is well documented throughout extant literature, to the researcher's knowledge, the current study is the first to examine recruiters' perceptions regarding nurses with online degrees versus f2f degrees at the baccalaureate level for enrollment decision purposes. This is demonstrated by the lack of known studies available that specifically examine recruiters' perceptions regarding nurses with online degrees versus f2f degrees at the baccalaureate level, especially in light of the COVID-19 pandemic (Bao, 2020; Cao et al., 2020; Curran et al., 2017; Kinneer, 2014; Lee, 2020).
This study has presented limitations that cannot be avoided nor fully minimized. These limitations are inherent to this qualitative research. The results cannot be generalized to a broader population and the researcher will not know when participants present inaccurate memories, meaning that the interview data may not be completely accurate (Korstjens & Moser, 2018). However, these limitations are not envisaged to be significant.
Nonetheless, the results of this study shed light on the acceptability of online nursing education in the United States while also assessing the validity and impact of nursing education offerings (online, f2f, and hybrid) in consideration of nurse recruiters' perspectives. Identifying the recruiters' perceptions regarding nurses with online degrees versus f2f degrees at the baccalaureate level, especially in light of the COVID-19 pandemic, will help leaders in online nursing education to consider which nursing degrees, credentials, and skills are essential for nurse recruiters; help nursing students develop skill sets that are deemed essential to nurse recruiters, and draw the attention of nursing education institutions to the gaps in online learning.
Future researchers would do well to expand this study’s findings, specifically by increasing the sample size and scope of sampling, to effectively determine if the results could be replicated or transferred to other groups or areas. Also, the use of mixed methods research methodology is worth considering, as it may reveal more context and background regarding the topic, additionally utilizing quantitative data collection methods.
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