At 10 p.m., Mary, a nurse assistant at a rural long term care center, puts her son to bed, then sits on her bed with her laptop to finish an educational program that she needs to complete her certification requirements.
Two days later, her colleague, John, eats his lunch and reviews a program about pressure ulcers on his tablet. He had completed the program previously, but the center recently admitted two residents with pressure ulcers, and he wants to brush up on the topic.
Elsewhere, at a care center 1,200 miles away, a new certified nurse assistant (CNA) at a national skilled nursing center chain is studying the same program to gain the knowledge she needs to care for her residents.

The Distant Past

Twenty or even 10 years ago, these scenarios would have been unlikely, if not impossible. Few nurse assistants or even nurses had widespread access to computers. Even if they had a desktop model or laptop at home, they likely had to share it with their spouses and children.

As computer prices have dropped over the years and many can afford a laptop, tablet, or phone with internet access, online education has become a common and popular way for long term care centers to train CNAs, nurses, and others.

Just last year, the nursing department at Bethel University and technology vendor Academic Platforms asked the American Health Care Association (AHCA) if it could utilize its “How to be a Nurse Assistant” curriculum for an online education initiative. The plan was for Bethel to put the content into an online format that nursing students could access as a baseline course.

Now that the curriculum is online, AHCA is offering it to providers who want an online training course for their CNAs.

Evolution Of Online Learning

As the cost of technology has dropped and adult learners increasingly have sought at-home learning opportunities, online education has become a popular option. The U.S. National Center for Education Statistics says that more than half of all two- and four-year degree-granting institutions offer online learning courses for all types of students.

The growth of online course offerings between 2004 and 2005 alone is estimated at 35 percent. A 2013 report by Babson Survey Research documented that more than 6.7 million post-secondary students were enrolled in at least one online class in 2011, compared with 1.6 million in 2002. Today, many colleges and universities offer entire degrees via online programs. The advantages of online learning for CNAs and other staff include scheduling flexibility and the ability of learners to control their study time and focus more on the topics they need or want to address. People who are more introverted may feel more comfortable interacting with instructors via online discussions or messaging.

Online communication also eliminates the wait for office hours or instructor availability to ask questions and discuss issues. Interestingly, the U.S. Department of Education has suggested that students in online courses perform better than those in live classes.

New CNA Training Program

The course from AHCA includes a complete curriculum with lesson plans, practice tests and study guides, and new competency-based skills checklists. It also offers scheduled in-person clinical training with qualified instructors, a customizable online learning platform, options to integrate the care center’s culture and materials to complement the lessons, and instructional lectures and discussions led by qualified nursing faculty members.

The benefits of this online program include learning flexibility, a reduced need for physical class space, interactivity via offerings such as videos and discussion groups, and the ability to take quizzes or tests and get scores immediately.
Because the curriculum is accessible from computers, tablets, and smart phones, users can learn with whatever technology they have.

“This presents a great learning opportunity for CNAs everywhere, but particularly for those in rural markets where they don’t have a lot of access to community colleges and other places to pursue education,” says Jon-Patrick Ewing, AHCA senior director of marketing.

“It’s also helpful for large corporations that have many employees and must constantly do training. This enables them to provide consistent quality education for employees, regardless of their location. It creates a solid base of knowledge that is shared by everyone.”

Consistent Training an added benefit

Consistency is one of the major advantages of online learning. Catherine Kelly, director of learning programs for Brookdale Senior Living, says, “Online learning provides an opportunity for training in a consistent, measurable way time and time again. Across the board, we can deliver the same messages, enabling users to meet the same goals and objectives.”

Brookdale offers a variety of online learning programs and activities for staff, including frontline caregivers. These are designed to supplement, support, and expand on inservice programs and live training events.

John Reinhart, president and chief executive officer of Academic Platforms, which hosts AHCA’s “How To Be” curriculum, agrees about the value of consistency.

“We had conversations with nursing leaders across the country who say there is a variation in the quality of education and educators. We wanted to produce something that enables consistent, high-quality training for everyone from one end of the country to the other.”

Reinhart says, “Working on the ‘How To Be’ curriculum presented an opportunity to produce a hybrid program that starts with excellent content from books developed for instructors and students that could be translated into an e-book and online training effort. Clinical learning is done onsite with their instructors and equipment.”

Personalizing Training

While it is useful to have standardized content that provides consistent, appropriate, and up-to-date knowledge and information, Reinhart says, it also is important to personalize clinicals to the center’s needs and practices and the skill level of personnel.

Technology has come a long way over the years, and care centers need to keep up, says Ewing. “More than ever, people are pursuing learning on the go—with their iPads and other mobile devices. As more millennials enter the long term care workforce, they increasingly will expect to use technology,” he says.

For the center, budget and staffing limitations make it challenging to take CNAs and educators off the floor for training, and many communities don’t have the physical space for classes.

“This is one of the biggest things we hear from a center. This is a particular challenge when centers have a lot of turnover and need to provide quality education while lowering costs,” says Ewing.

Variety is important. “We have a huge library of programs and topics. Some are assigned, such as those related to regulatory issues,” Kelly says. However, CNAs can access whatever programs they need for their own certification requirements and personal learning needs and goals.

Backup Programs

While technology is more generally accessible than ever, some CNAs still may have limited access to computers. Therefore, Ewing says, “We have to have paper-based information and materials as well. There should be a balance to ensure that everyone has an opportunity to pursue the education and training they want and need.”

Balance is especially important, he says, as people learn in different ways. This means having a program that blends lectures and videos with interactive efforts such as discussion groups.

Ensuring that training accounts for those who don’t have access to technology or simply prefer paper-based education is key, Reinhart says.

“One early suggestion we received was to convert the content to an audio book as well as an e-book.” At the same time, one size doesn’t necessarily fit all when it comes to technology.

“We want to make sure our content is friendly for all platforms—from laptops and desktops to smart phones and tablets,” he says.

Online learning will likely play a growing role in education and training moving forward. However, Ewing cautions that it isn’t a blanket solution.

“There are many state-specific rules and regulations regarding education, training, and certification. It is important to know requirements and limitations in your state before introducing or promoting any online learning opportunities to CNAs and others,” he says.

Care centers that provide online learning opportunities are likely to reap the dividends in terms of happier, more skilled employees. As Kelly says, “The majority of staff enjoy the opportunity to participate in training that enhances their competencies and confidence. They like to learn and appreciate the opportunity to grow.”

Joanne Kaldy

Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa. She can be reached at (240) 527-9848 or