Remember poring over the college course catalog every semester, piecing together a schedule of classes like a jigsaw puzzle? If the first class on Mondays, Wednesdays and Fridays is at 7:40 a.m., there's room for an elective at 9:40, which leaves an hour for lunch, study and commuting to "Introduction to Something-or-Other" at 12:40 and that dovetails into work at 3 p.m. Then on Tuesdays and Thursdays …

Pam Thomas, RN, is missing those memories as she pursues a BSN degree at the University of Kansas. But chances are a 7:40 wouldn't fit into her schedule, nor would a 9:40.

There's the matter of her job performing insurance assessments and benefit determinations for residents of a long-term care facility, helping her husband in the family business and home-schooling their 12-year-old son. Not to mention that it's a real pain making it to lectures and labs at the university. The medical center campus is half a block from the Missouri state line in Kansas City, Kan., and more than 400 miles east of Thomas' home in McDonald, Kan.

She was on campus for the first time in mid-May for induction into Sigma Theta Tau, the nursing honor society. "We are full-time farmers," Thomas said. Fortunately for her nursing career, though, the Internet has plowed new ground in education. She may be isolated on the prairie of western Kansas, but she also is among thousands of students going online for college degrees.

"We bought our computer 10 days before my first class," Thomas said. "I was completely computer illiterate." But with the staff of a help desk at the university and tutoring from her pastor and a friend, she mastered the technical skills to use the Internet. Now, at age 50, she has her sights set on becoming a family nurse practitioner and doing it all online.

Forty-four percent of two- and four-year institutions offer distance learning, the U.S. Department of Education said in a report based on 1997-98 data, the latest available. The department's National Center for Education Statistics pegged enrollment in college-credit online courses at 1,343,580, up from 753,640 in the fall of 1995. Health sciences is the third most popular curriculum, behind English/humanities/social sciences and business, the report said.

"We don't have any research yet to show that nursing courses online are as good as-or better than-nursing courses face-to-face," said Thomas Nolan, Ph.D., RN, a professor at Sonoma State College in Rohnert Park, Calif. "There's a lot of research, however, showing that online education in the generic is at least as good as if not superior to face-to-face," he said.

"People who raise the argument that it's not as good assume that face-to-face is for everybody. The face-to-face model was developed in the 1500s. It was a monastic model, frankly, that has not really changed a whole lot since then. There are many learning styles."

Distance education simply is different. Different for students, different for faculty, different in its approach. But nursing school administrators agree that it has irrevocably changed the face of nursing education. It's here to stay and it's growing.

The University of Kansas in 1998-three years after its first online nursing courses-phased out its traditional RN-to-BSN program because of low enrollment and now offers it exclusively online, said Helen Connors, Ph.D., RN, FAAN, associate dean of academic affairs. "When we had a traditional RN-to-BSN, we had very few students," despite attempts to bunch classes a couple of days a week to accommodate working nurses. We couldn't afford to offer it in a traditional classroom."

Online, however, RN-to-BSN enrollment stands at nearly 100 students, up 53 percent from last year, she said, not counting students taking prerequisites but not yet admitted to the college of nursing.

Master's degree courses are offered online and in the traditional setting, but Connors said online classes fill up faster. For example, one online course that has 31 students (the university anticipated 20) will be offered in a traditional setting in the fall. As of late June, only four students had registered for it.

Four community colleges in Michigan are breaking ground, too, seeking approval for what is believed to be the first entirely online associate degree RN program. "We're the first ones to try to deal with students who don't have any pre-licensure coming in," said project manager Ann Ivers, MS, RN, of Northwestern Michigan College.

The schools-Northwestern in Traverse City; Kellogg Community College in Battle Creek; Jackson Community College in Jackson; and St. Clair County Community College in Port Huron-have asked to start with 40 students beginning in January.

"Some students believe it's just going to be an easier way to do a nursing program and that's not true," Ivers said. "If anything, it's probably harder in terms of independence and their role in it." Besides the academics, "We'll have four regional labs available for practice of skills," she said. "There will still be a hands-on component. In fact, it's as many hours as it would be in a traditional program."

Online RN-to-BSN programs typically handle clinicals with faculty-approved preceptors wherever students happen to live and work.

For students at every level, convenience is paramount. Online education gives them the option of attending class, so to speak, at noon, 10 p.m. or 4 a.m.-whenever it's convenient-and sometimes working several weeks ahead of classmates. Such freedom, though, takes self-motivation to keep from falling behind.

"We find that most students keep up with the work," Connors said. As a practical matter, schools almost universally keep online curricula within the confines of semesters as opposed to being completely learn-at-your-leisure.

Nine master's-prepared medical center staff work with Kansas faculty to put courses online. Together, they know the content, what the students are to accomplish and how to make it happen on the computer. "They unleash a lot of creativity," Connors said.

Computer-based courses typically involve simulated cases, gaming, slide presentations, discussions-real time and asynchronous-and exercises. In one exercise, Connors said, students view computer screens of rhythm strips and have to interpret the meanings. "We don't want to just put text on a screen that they have to sit there and read," she said. "We don't want to [use] all video, either, because that's passive learning."

Jan Martin, Ph.D., RN, said that after teaching nursing research online at the University of Northern Colorado in Greeley, she added an Internet component to the on-campus offering because it encourages participation. Those who tend to be quiet in class are absolutely invisible online if they don't join in exercises, group projects and what are known as "threaded discussions," in which students are required to post comments and questions and further the conversation in an electronic forum.

"Quiet people can be quiet and the loud people are going to be loud no matter what," Martin said. "On the Internet it doesn't matter. It's a great equalizer in a lot of ways. By the end of the semester, you say 'discuss' and everybody's doing it," rendering her start-of-the-semester mandate for participation moot.

Sonoma State's Nolan said he, too, finds that online students are more engaged with course and content because "they have to be looking at it and thinking about it all the time. I have their noses anchored to a grindstone. The beauty of it is I can track at a moment's notice every single person's performance and contribution."

There are downsides to distance learning, however, and one is the same as the benefit: class always is "percolating" as Nolan puts it. Students who don't regularly "see" faculty assume they always are available. When it comes to e-mail, which along with message boards is how questions are handled, "They want an answer right now, not tomorrow. It's a 24-7 model, that's for sure."

Another drawback, Nolan said, is that there is no substitute for face-to-face contact.

"Nursing students like to hang around faculty offices and schmooze and stand in the doorway while you're eating your sandwich and trying to get something done and talk. Perhaps it's part of nursing's caring. We facilitate it, and you can't do that online."

Furthermore, "You can't see winks or raises of an eyebrow or tongue in cheek. That's a major limitation."

But that doesn't seem to interfere with students' opinions of courses, Connors said.

"When you ask them, 'All things being equal would you take a course like this again?' most of them are saying, 'Oh, yes, you bet!' and they'd recommend it to others."

Throughout the country, nursing schools are finding their niches in distance learning.

The majority of Kansas' online learners live within 30 miles of campus. But the BSN program has universal appeal because, although there is a fee for "off-campus" classes, it is far less expensive than out-of-state tuition. One student moved to Paris and continued to attend the university as if she were on campus, Connors said.

The University of Northern Colorado mainly bridged the Continental Divide with its first class. Eight of 10 students were from the western slope. But now in the fourth year and near its maximum enrollment of 25 students, it has crossed state lines.

"I'm starting to interest people who are traveling nurses," Martin said. "You know travelers always figure they can never go back for their degree because they never stay anywhere long enough. But they can keep doing this and be able to travel as they want in their jobs," as long as they stay in one place long enough to do their clinicals, she said.

California State University, Dominguez Hills, is exploring the Internet as a way of expanding its nursing program internationally. "We have a significant number of students who are in the military or some kind of overseas assignment," said Carole Shea, Ph.D., RN, FAAN, chair of nursing.

In the meantime, Shea said, "I can see the live courses continuing with a much more technological component."

Sixty percent of the school's 1,100 baccalaureate and master's students have expressed an interest in online courses, Shea said. "I think our students are giving us the message that these online courses are really serving their needs. I consider them pioneers."