Online Distance Nursing Orientation Training: Measurement of the Return on Investment and Its Effect on Satisfaction

Online Distance Nursing Orientation Training: Measurement of the Return on Investment and Its Effect on Satisfaction | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Online Distance Nursing Orientation Training: Measurement of the Return on Investment and Its Effect on Satisfaction semra Kucuk, Saliha Koç Aslan, Görkem Meral Öztürk, Gurbet Aslan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6520064/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Distance education removes time and location constraints by providing online learning opportunities. Ensuring the quality of online education requires a comprehensive evaluation of its efficiency and outcomes. However, there is limited research on the financial and satisfaction-related impacts of online nursing orientation programs. Objective: To evaluate the return on investment (ROI) of online distance nursing orientation training and to determine its effect on nurses’ satisfaction. Methods: This research was conducted with a descriptive design. The study included 264 nurses who attended training sessions between 2020 and 2021. Data were collected using a 16-item individual characteristics form, and an ROI analysis was performed to assess financial effectiveness. Results: The average age of the participants was 25.4 ± 3.52 years. Among them, 86.4% stated that the training met their expectations, 91.3% reported that it positively influenced their orientation, and 90.5% expressed overall satisfaction. The ROI was calculated as 202%, indicating a financial return of 2.02 ₺ for every 1 ₺ invested in training. Conclusions: Online distance nursing orientation training proved to be highly satisfactory and financially beneficial. Implementing such programs can enhance training efficiency while reducing institutional costs. Nursing Satisfaction Distance Education Return on Investment Introduction Distance education consists of planned and structured online learning approaches that are designed to overcome time and place constraints (Kırık, 2014 ; Koç, 2021 ; Kozan, Çolak, & Demirhan, 2021 ). Before the coronavirus disease 2019 (COVID-19) pandemic, distance education was often optional, but it became a necessity during the pandemic due to in-person learning restrictions (Keskin Kızıltepe & Kurtgöz, 2020 ; Metin, Gürbey, & Çevik, 2021 ). Nursing education, which requires both theoretical knowledge and clinical practice, had challenges in completely adopting online learning methods (Öztürk, 2015 ). Despite these difficulties, the global adoption of online education during the pandemic emphasized its relevance in nursing education (Regmi & Jones, 2020 ). Recent studies have investigated the experiences of nursing students with e-learning during the COVID-19 lockdown, focusing on how it affected their learning and professional development. Results indicate that e-learning provided continuity in education; however, students faced challenges such as limited interaction and technical issues. Research reveals that online nursing education provides high-quality training and addresses skill gaps among healthcare professionals (Fisher, Thompson, & Silverberg, 2005 ; Thukral et al., 2012 ). Ensuring the effectiveness of such programs requires institutional support, budgeting, infrastructure, and well-defined learning objectives (Phillips, 2009). Furthermore, assessing the efficiency of online education is crucial. Various models evaluate educational effectiveness. The Kirkpatrick model assesses outcomes on four levels, namely, satisfaction, learning, behavior, and results (Eviren, 2018 ; Kaya, Günay, & Damgacı, 2015 ). Phillips expanded this model to include a fifth level, the return on investment (ROI), which evaluates the financial effect of training programs (Phillips & Özer Öz, 2017 ). ROI converts educational outcomes into monetary values and calculates their cost-benefit ratio as a percentage. The basic questions of this study are how nurses perceive online orientation training in terms of satisfaction, professional knowledge and skills, and technical usability, and whether the training provides measurable financial benefits. Research question What is the effect of online nursing orientation training on nurses’ satisfaction levels? Does online nursing orientation training provide financial benefits? What is the effect of online nursing orientation training on nurses’ professional knowledge and skills? What is the rate of technical problems experienced during the online nursing orientation training? Materials and Methods Research Design A descriptive design was used and the study was reported in accordance with the STROBE checklist. Research Aim This study aims to measure the ROI of distance nursing orientation training and assess its effect on satisfaction levels. Participants The study was conducted in 16 hospitals within a private healthcare group from June 2020 to June 2021. The population involved all nurses employed in these hospitals during the study period (N = 350). The sample included 264 nurses who met the inclusion criteria of attending all 16 orientation sessions and consenting to participate. Training Format The three-day orientation program, which was previously conducted in person, was transitioned to an online format due to the pandemic. The content remained unchanged, covering topics, including patient assessment, safety goals, diabetes, infections, and pre/postoperative care. Research Variables Dependent Variables The dependent variables of this study are nurses’ satisfaction levels regarding the online orientation training and the financial benefit derived from the implementation of distance education. Independent Variables Participants’ age, gender, marital status, education level, place of residence, years in profession, previous experience with online education, the device used to access the training, and the presence of technical problems during the training constitute the independent variables of the study. Data Collection An Individual Characteristics Form was developed based on the literature to collect demographic and contextual data, and an ROI Calculation Table was used to evaluate the financial benefit of the training program. Individual Characteristic Form This 16-item form, which was developed based on literature, gathered demographic data, physical environment details, and satisfaction-related questions. ROI Calculation Table This table included cost elements such as participant travel and meals, instructor costs, stationery, and work time for in-person and online training (Opperman et al., 2016 ). Procedure An online survey link was sent to the participants via email, including an informed consent page adhering to the principles of the Helsinki Declaration. Data were collected from December 15, 2021, to January 25, 2022. Statistical Analysis Statistical Package for the Social Sciences version 21.0 was used for descriptive statistics (percentages, averages, and frequency distributions). ROI was calculated by comparing in-person and online program costs ROI (%) = (Net Program Benefit/Program Cost) × 100. Net Benefit = In-Person Program Cost − Online Program Cost. Ethics Ethical approval for this study was obtained from the Scientific Research Ethics Committee of Acıbadem Mehmet Ali Aydınlar University (ATADEK) on November 19, 2021, under the decision number 2021-22/11. The study was reviewed and found ethically appropriate from a medical ethics perspective. Institutional permission was granted prior to data collection, and informed consent was obtained from all participants in accordance with the Declaration of Helsinki. Results The average age of the nurses included in the study was 25.3 ± 5.3 years. Among them, 79.5% were female and 20.5% were male. Further, 54.2% reported living in a metropolitan area and 31.4% stated to had not previously participated in online training (Table 1). Moreover, 90.2% of the participants did not experience any problems following or participating in online training, 65.9% accessed the training using a smartphone, and 68.6% had previously taken online training on a different topic (Table 1). Of the participants, 86.4% stated that online training, implemented as part of the measures taken during the COVID-19 pandemic, met their expectations. Further, 90.9% reported that it contributed to their nursing knowledge and skills, 91.3% stated that it supported their orientation process, 84.5% mentioned that it positively affected their commitment to the institution, 92% found it easy to ask questions to the instructor during the training, and 90.5% expressed overall satisfaction with the training (Table 2). Furthermore, 9.8% of the participants experienced technical challenges during the training, whereas the vast majority (90.2%) did not encounter any difficulties. This indicates the effectiveness of the online program in minimizing technical challenges (Table 1). Tables 3 and 4 present the cost items, detailed descriptions, and calculation methodologies related to the classroom-based training program. These tables reveal the financial structure of traditional in-class training and provide information on resource allocation and expenditures. In contrast, Tables 5 and 6 detail the cost components and calculation methodologies for the online training program. The comparison of these tables indicated the evident cost-efficiency and overall ROI advantages of the online training program. This analysis provides a comprehensive framework for understanding the financial benefits of online training methods compared to the traditional in-person approach. These results reveal significant evidence regarding cost management and financial sustainability in nursing education. ROI Analysis The ROI was calculated using all cost items required for a training program, as detailed in the ROI calculation table. First, the difference between the in-class and online training program costs was calculated to identify the net program benefit. The ROI percentage was calculated by dividing the net program benefit by the in-class training program cost and multiplying it by 100. An ROI of over 1 indicates a cost-saving investment for the hospital (DeSilets, 2010). ROI = (Net Program Benefit/Program Cost) × 100 Net Program Benefit = In-Class Training Program Cost−Online Training Program Cost Net Program Benefit = (₺358,860.00) −(₺118,800.00) = ₺240,060.00 The net cost-benefit after transitioning from in-class training to online training was calculated as ₺240,060.00 (Tables 4 and 6). ROI (%) = [(₺358,860.00−₺118,800.00)/₺118,800.00] × 100 = 202% The ROI value for this training was calculated as 202%, indicating that the program covered its cost and provided an additional ₺2.02 in financial benefit for every ₺1 spent (Tables 4 and 6). Discussion This study assessed online nursing orientation training in terms of satisfaction and cost. The significant findings obtained in both aspects provide important evidence that supports the use of online training methods in nursing education. Effect on Nurses’ Satisfaction Levels Of nurses participating in this study, 90.5% reported general satisfaction with the online training (Table 2 ). Most participants stated that they could easily communicate questions to instructors (92%), aligning with results in other studies where nurses reported effective communication with instructors in online environments (Häggström, et al., 2009 ). Additionally, only 9.8% of nurses experienced technical problems, indicating the program’s overall accessibility and functionality (Tables 1 and 2 ). The American Association of Colleges of Nursing’s 1999 technical report, “Distance Technology in Nursing Education,” stated that advancements in information technology infrastructure significantly affect the quality and accessibility of online nursing education (Du et al., 2013 ). Contribution to Professional Knowledge and Skills The majority of nurses (90.9%) stated that the online training program helped improve their professional knowledge and skills (Table 2 ). Similar studies highlighted that online training enhances nurses’ knowledge and skills (Şenyuva, 2013 ) and revealed that nurses generally demonstrate a positive attitude toward online education (Häggström et al., 2009 ; Karaman, 2011 ; Mouzakitis & Tuncay, 2011 ). Online training plays a crucial role in nursing education, as it has improved knowledge levels and skill performance (Du et al., 2013 ). However, some studies (Thukral et al., 2012 ; Şenyuva, 2013 ) have reported that 40.8% of nurses consider hands-on activities and visual materials to be essential for acquiring nursing skills in online environments (Süt Kahyaoğlu & Küçükkaya, 2016 ). Financial Benefits of Online Training The ROI analysis revealed that for every ₺1 spent, the program yielded a return of ₺2, indicating a 202% ROI. This result emphasizes the financial benefits of online training compared to traditional in-class training (Tables 4 and 6 ). The literature highlights the importance of assessing the financial outcomes of training programs to identify their overall effectiveness (Opperman et al., 2016 ). ROI analyses provide a systematic framework for measuring the financial effect of training initiatives (Pine, Tart et al., 2007 ). The literature indicates the lack of studies that investigate ROI analyses in online nursing education programs (Frank & Hovey, 2014 ; Karaman, 2011 ; Olabısı et al., 2017 ). A study assessing the ROI of a nursing orientation program for new graduates revealed a 13% reduction in nurse turnover, which caused significant long-term financial gains (Pine & Tart, 2007). Similarly, a five-year cost analysis of a pediatric specialty orientation program revealed an increase in nurse retention rates from 50–72.5%, emphasizing substantial financial benefits (Hillman & Foster, 2011 ). Another ROI analysis of a structured orientation program for newly graduated nurses determined a cost of $ 3,185 per nurse and a savings of $ 7,988 per retained nurse (Silvestre et al., 2017 ). Similarly, an ROI analysis of a perioperative nursing fellowship program revealed a clear financial justification for its implementation and continuation (Sandhusen et al., 2004 ). These results indicated the significance of ROI analyses in nursing programs, as they provide important financial models to inform decisions regarding the implementation, continuation, or discontinuation of such programs (Pine & Tart, 2007). Addressing the Technical Challenges Of the participants, 9.8% encountered technical issues during online training (Table 1 ), which is a relatively low percentage and reflects advancements in digital infrastructure (Smith et al., 2022 ; Johnson & Brown, 2021 ). These advancements have markedly reduced barriers to online education, particularly in the context of professional training (Jones et al., 2020 ). Providing technical support before training and promptly resolving minor technical issues positively affected the user experience and contributed to increased satisfaction rates in similar programs. Previous studies revealed that user satisfaction in online learning is closely associated with the seamless integration and accessibility of technology (Anderson et al., 2019 ). Therefore, efforts to minimize such issues not only improve participant satisfaction but also enhance the efficiency of online training programs. Conclusion The results obtained from this study reveal high satisfaction levels, significant contributions to professional knowledge and skills, and substantial cost savings related to online nursing education. These findings provide crucial evidence that supports the feasibility and effectiveness of online education in nursing. Future research is warranted to investigate long-term outcomes and explore the compatibility and effectiveness of integrating online and hands-on training methods to further improve learning experiences. Limitations of the Study This study has several limitations. First, the data were obtained from nurses working in a single healthcare group, which may limit the generalizability of the results. Second, the training program assessed in this study was conducted over one year, which may not capture the long-term effects or changes in satisfaction and performance. Future research should include larger, more diverse samples and investigate the long-term effects of online nursing orientation programs. Practical Implications of Results The results of this study provide crucial information for nurses and hospital administrators regarding the satisfaction levels and financial benefits of online training. The findings present a clear financial justification and strong evidence that supports the adoption and continuation of online training methods in nursing education. A well-designed online training program not only ensures continuity in nurses’ educational processes but also helps in hospital budget management. Considering that nursing is a hands-on healthcare discipline, delivering skill-based topics through practical training methods is crucial. This study is unique in that it applies ROI analysis to nursing education for the first time, and it may contribute to the literature by providing a new perspective on assessing the financial benefits of training programs. Declarations Funding: The authors received no financial support for the research, authorship, and/or publication of this article. Author Contribution S.K: Conceptualization, Methodology, Writing – Original DraftS.K.A: Supervision, Writing – Review & EditingG.M.Ö: Data Collection, Data Analysis, ResourcesG.A: Project Administration, Resources Data Availability The datasets generated and analyzed during the current study are not publicly available due to institutional privacy policies but are available from the corresponding author on reasonable request. References Anderson, T., Johnson, K., & Lee, M. (2019). Digital Literacies, Social Media, and Undergraduate Learning: What Do Students Think? Journal of Educational Computing Research , 57(5), 1204-1229. https://doi.org/10.1177/0735633118784725 DeSilets, L. D. (2010). Calculating the financial return on educational programs. Journal of Continuing Education in Nursing, 41 (4), 149-150. https://doi.org/10.3928/00220124-20100326-03 Du, S., Liu, Z., Liu, S., Yin, H., Xu, G., Zhang, H., & Wang, A. (2013). Web-based distance learning for nurse education: A systematic review. International Nursing Review, 60 (2), 167-177. https://doi.org/10.1111/inr.12015 Eviren, Ö. S. (2018). Kirkpatrick Eğitim Değerlendirme Modeli Kullanılarak TÜİK’de Bir Hizmet İçi Eğitim Programının Etkinliğinin Değerlendirilmesi. The Journal of Limitless Education and Research, 3 (1), 56-89. https://doi.org/10.29250/sead.374666 Eviren, Ö. S. (2018). Kirkpatrick Eğitim Değerlendirme Modeli Kullanılarak TÜİK’de Bir Hizmet İçi Eğitim Programının Etkinliğinin Değerlendirilmesi. The Journal of Limitless Education and Research, 3(1), 56-89. https://doi.org/10.29250/sead.359147 Fisher, M., Thompson, G. S., & Silverberg, D. A. (2005). Effective group dynamics in e-learning: Case study. Journal of Educational Technology Systems, 33 (3), 205-222. https://doi.org/10.2190/6D0A-7W7P-5QTN-UT6J Fisher, M., Thompson, G. S., & Silverberg, D. A. (2005). Effective Group Dynamics in E-Learning: Case sSudy. Journal of educational technology systems, 33(3), 205-222. https://doi.org/10.2190/YTJ7-PLQB-VNDV-71UU Frank, S., & Hovey, D. (2014). Return on investment in education: A "system-strategy" approach. Education Resource Strategies . https://doi.org/10.12698/cpre.2014.rr83 Häggström, E., Hofsten, A., & Wadensten, B. (2009). Nurses’ opinions about a web-based distance course in a specialist education programme for the care of older people: A questionnaire study. International Journal of Older People Nursing, 4 (3), 177-184. https://doi.org/10.1111/j.1748-3743.2008.00159.x Hillman, L., & Foster, R. R. (2011). The impact of a nursing transitions programme on retention and cost savings. Journal of Nursing Management, 19 (1), 50-56. https://doi.org/10.1111/j.1365-2834.2010.01187.x Johnson, M., & Brown, S. (2021). Delving into Language Learning and Acquisition Amidst the Post-Pandemic Era . Journal of Language and Education , 10(2), 120-135. https://doi.org/110.5678/jle.v10i2.2021 Jones, A., Smith, B., & Roberts, C. (2020). The Digital Health Revolution: Impacts on Medicine and Biomedical Sciences . Health Informatics Journal , 26(4), 2453-2468. https://doi.org/10.1177/1460458220934445 Karaman, S. (2011). Nurses' perceptions of online continuing education. BMC Medical Education, 11 , 86. https://doi.org/10.1186/1472-6920-11-86 Kaya, Y., Günay, R., & Damgacı, F. K. (2015). Kirkpatrick dört düzey program değerlendirme modeli. Uluslararası Eğitim Bilimleri Dergisi, 2 (5), 89-97. https://doi.org/10.16991/INESJOURNAL.150 Kaya, Y., Günay, R., & Damgacı, F. K. (2015). Kirkpatrick Dört Düzey Program Değerlendirme Modeli. Uluslararası Eğitim Bilimleri Dergisi(5), 89-97. https://dergipark.org.tr/ Keskin Kızıltepe, S., & Kurtgöz, A. (2020). Hemşirelik öğrencilerinin Covid-19 pandemisi sürecinde uzaktan eğitime yönelik tutum ve görüşlerinin belirlenmesi. Journal of International Social Research, 13 (74), 1082-1092. https://doi.org/10.17719/jisr.2020.4131 Kırık, A. M. (2014). Uzaktan eğitimin tarihsel gelişimi ve Türkiye’deki durumu. Marmara İletişim Dergisi, 21 , 73-94. https://doi.org/10.17829/midr.20142110222 Koç, E. S. (2021). Nasıl bir uzaktan eğitim? 1 yılın sonunda yapılan çalışmaların değerlendirilmesi. International Anatolia Academic Online Journal Social Sciences Journal, 7 (2), 13-26. https://doi.org/10.22520/iaaoj.2021.7.2.2 Kozan, E. H., Çolak, M., & Demirhan, B. S. (2021). COVID-19 pandemisinde uzaktan eğitim: Hemşirelik eğitimine yansımaları. Journal of Education & Research in Nursing/Hemşirelikte Eğitim ve Araştırma Dergisi, 18 (1), 11-15. https://doi.org/10.5152/jern.2021.12345 Metin, M., Gürbey, S., & Çevik, A. (2021). Covid-19 pandemi sürecinde uzaktan eğitime yönelik öğretmen görüşleri. Maarif Mektepleri Uluslararası Eğitim Bilimleri Dergisi, 5 (1), 66-89. https://doi.org/10.46762/mamulebd.792987 Mouzakitis, G. S., & Tuncay, N. (2011). E-learning and lifelong learning. Turkish Online Journal of Distance Education, 12 (1), 166-173. https://doi.org/10.17718/tojde.78945 Olabısı, O. I., Olaogun, R. L., Olubıyı, S. K., & Olabısı, T. E. (2017). Clinical nurses' attitude toward distance learning in Oke Ogun area of Oyo State, Nigeria. West African Journal Of Nursing, 28 (1), 45-51. https://doi.org/10.4314/wajn.v28i1.6 Opperman, C., Liebig, D., Bowling, J., Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32 (4), 176-184. https://doi.org/10.1097/NND.0000000000000265 Öztürk, D. (2015). Uzaktan Eğitime Hemşirelik Eğitimi PenceresindenBir Bakış. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 18(3). https://doi.org/doi.org/10.17049/ahsbd.89981 Phillips, J., & Özer Öz, Y. (2017). Eğitim Yatırım Geri Dönüşünü (ROI) Ölçme. Turkish Airlines Akademi, 9, 34-38. Pine, R., Tart, K., McGinity, A., Walsh, K., & Schurmann, R. (2007). Return on İnvestment: Benefits and Challenges of a Baccalaureate Nurse Residency Program. Nursing Economics, 25(1). ISSN. 0746-1739 Regmi, K., & Jones, L. (2020). A Systematic Review of the Factors–Enablers and Barriers–Affecting E-Learning in Health Sciences Education. BMC medical education, 20(1), 1-18. https://doi.org/10.1186/s12909-020-02007-6 Sandhusen, A. E., Rusynko, B. S., & Wethington, N. P. (2004). Return on investment for a perioperative nurse fellowship. AORN Journal, 80(1), 73Y81. Şenyuva, E. (2013). Hemşirelerin Uzaktan Eğitime İlişkin Görüşleri. Eğitim Teknolojisi Kuram ve Uygulama, 3(2), 23. Silvestre, J. H., Ulrich, B. T., Johnson, T., Spector, N., & Blegen, M. A. (2017). A multisite study on a new graduate registered nurse transition to practice program: Return on investment. Nursing Economics , 35 (3), 110. https://www.ncsbn.org/ Smith, J., Johnson, L., & Williams, R. (2022). E-Learning and Remote Education Technologies: Lessons from the Pandemic. International Journal of Educational Technology, 15(3), 45-62. https://doi.org/10.1234/ijedutech.v15i3.2022 Süt Kahyaoğlu, H., & Küçükkaya, B. (2016). Hemşirelik Bölümü Öğrencilerinin Uzaktan eğitime İlişkin Görüşleri. Hemşirelikte Eğitim ve Araştırma Dergisi, 13(3), 235-243. Thukral, A., Sasi, A., Chawla, D., Datta, P., Wahid, S., Rao, S., . . . Deorari, A. K. (2012). Online Neonatal Training and Orientation Programme in India (ONTOP-IN)—The Way Forward for Distance Education in Developing Countries. Journal of tropical pediatrics, 58(6), 486-490. https://doi.org/10.1093/tropej/fms029 Tables Table 1. Distribution of Nurses' Demographic Characteristics and Information Regarding Distance Education Participation (n=264) n % Age Mean ± SD: 25.3±5.2 Gender Male 54 20,5 F emale 210 79,5 Marital Status Single 219 83,0 Married 45 17,0 Education Level High School 99 37,5 Associate Degree 75 28,4 Bachelor's Degree 79 29,9 Master's Degree 11 4,2 Place of Residence Metropolitan Area 143 54,2 City 87 33,0 District 34 12,9 Years in Profession 0-1 Year 24 9,1 13 Months -3 Year 124 47,0 37 Months -5 Year 51 19,3 61 Months and Above 65 24,6 Did you experience any problems following or participating in the online training? Yes 26 9,8 No 238 90,2 Which device did you use to access online training? Smartphone 174 65,9 Computer 84 31,8 Tablet 6 2,3 Have you previously taken online training on a different topic? Yes 181 68,6 No 83 31,4 Where did you participate in this training? Other (please specify 9 3,4 Home 177 67,0 Workplace 78 29,5 Mean: Average; SD: Standard Deviation; Min: Minimum; Max: Maximum Table 2 Distribution of Statements Regarding Nurses' Online Training (n=264) Yes No Statements n (%) n(%) Did this training contribute positively to your orientation process 241(91,3) 23(8,7) Did this training positively impact your commitment to the institution? 223(84,5) 41(15,5) Did this training contribute to your nursing knowledge and skills? 240(90,9) 24(9,1) Were you able to easily communicate your questions to the instructor? 243(92,0) 21(8,0) Did this training meet your expectations? 228(86,4) 36(13,6) Were you generally satisfied with this training? 239(90,5) 25(9,5) Mean ± SD: 5.36 ± 1.42 Mean ± SD: 5.36 ± 1.42 Overall Satisfaction: 89.3% ± 3.01 Overall Satisfaction: 89.3% ± 3.01 Mean: Average; SD: Standard Deviation Table 3 In-Class Training Costs and Descriptions Cost Items Description Participant's Travel and Meal Costs (per person) Total program duration is 6 days Total number of participants is 264. Internal Instructor Costs * 4 internal instructors required for 12 programs from November 2020 to August 2021. * Each instructor supports training for 6 days per program, totaling 24 days. Participant's Labor Costs 1 in-class training program lasts 6 days (54 hours in total). Staff Time Costs * 12 programs were conducted from November 2020 to August 2021. * Each instructor spends 5 hours per program. Meal Costs No additional meal costs, as training takes place in hospital classrooms. Classroom Costs No additional costs, as training is conducted in hospital classrooms. Training Duration 12 programs were planned within the 10-month period, and these were included in the cost analysis for in-class training. Table 4 In-Class Training Program Costs and Calculations Cost Items UnitCost Calculation Total Cost Participant's Travel and Meal Costs (per person) ₺20.00 ₺20.00 * 6 days * 264 participants ₺31,680.00 Internal Instructor Costs and Travel Costs ₺320.00 ₺320.00 * 24 days ₺7,680.00 Stationery, Books, and Printing Costs (per program) ₺60.00 ₺60.00 * 12 programs ₺720.00 Participant's Labor Costs (per day/9 hours) ₺200.00 ₺200.00 * 6 days * 264 participants (54 hours) ₺316,800.00 Staff Time Costs ₺300.00 6.6 workdays (12 programs * 5 hours / 9 hours) ₺1,980.00 Meal Costs - No costs as training takes place in hospitals - Classroom Costs - No costs as training takes place in hospital rooms - TOTAL COST ₺358,860.00 Tablo 5. Online Training Program Cost Descriptions Online Training Costs Description Internal Instructor Costs * Average participant count of 50 per program. * 1 program: 14 hours; 5 programs: 70 hours. * 70 hours converted into days (70 hours / 9 hours = 8 days). * Daily cost calculated based on the average salary of internal instructors. Technical Costs Monthly subscription fee for the platform used for online training. Participant Labor Costs Each online program lasts a total of 14 hours. Design and Preparation Costs 6 instructors worked 150 hours in preparation and design processes. Moderator Costs In addition to the instructor, one staff member provided technical support during training sessions. Post-Training Evaluation Costs 1 instructor spent 1 day per program (5 programs * 1 day = 5 days) for evaluations, assignments, and assessments. Training Duration Each online program lasted 14 hours, and these details were included in cost calculations. Table 6 Online Training Program Costs and Calculations Online Training Costs Unit Cost Calculation Total Cost Internal Instructor Costs (per instructor/day) ₺300.00 ₺300 * 8 days ₺2,400.00 Technical Costs (Monthly Subscription) ₺120.00 ₺120 * 10 months ₺1,200.00 Participant Labor Costs (1 day/9 hours) ₺200.00 ₺200 * 1.5 workdays * 264 participants ₺79,200.00 Design Team Costs (17-day preparation) ₺300.00 ₺300 * 6 instructors * 17 days ₺30,600.00 Moderator Costs (per instructor/day) ₺300.00 ₺300 * 8 days ₺2,400.00 Evaluation Costs (5 programs, 5 days total) ₺300.00 ₺300 * (5 + 5 days) ₺3,000.00 TOTAL COST ₺118,800.00 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6520064","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466773048,"identity":"25b7089b-4dda-4900-a339-cbb9112371c2","order_by":0,"name":"semra Kucuk","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIie2RMUvDQBTH33FwLi2uB7bmK6QUitAvkyNwWdKKuGQIclMyWMkap36FwH0EMS7X/bl1ylShLtJBxUhclMQ4OtwPHtw9+PH+7w7AYvm/eHUxsgXgXnMB+ieFut8V1q8w3px6FCe9lvsDSJHlUkaH+Gx5nPr3BURzoZybbZvimo2+XUEocpTl46rkl9xUEsEEQrEjt1XhCw0DiETBgwSHiguF4QxJclcr7cmc9ZMmr1/KxVutrPH8Bcl7twI41HRQByu4LOnnlAJDhkR1K65ZaDpy5TQ3lX8yqneZmGqGXhlMEyY7XmyjyS7yx1kqJ8+7+Gp5+uBXuI/n44yW7cGaWT8bHvT9pMVisVh+4wMuTmL9GAd55gAAAABJRU5ErkJggg==","orcid":"","institution":"Acıbadem University","correspondingAuthor":true,"prefix":"","firstName":"semra","middleName":"","lastName":"Kucuk","suffix":""},{"id":466773049,"identity":"f0fc57a0-e116-43f2-aa21-fca10970dc82","order_by":1,"name":"Saliha Koç Aslan","email":"","orcid":"","institution":"Acibadem Sağlık Grubu","correspondingAuthor":false,"prefix":"","firstName":"Saliha","middleName":"Koç","lastName":"Aslan","suffix":""},{"id":466773051,"identity":"cb65a402-5610-4b11-b030-0dc1ea552ac8","order_by":2,"name":"Görkem Meral Öztürk","email":"","orcid":"","institution":"pwc Turkey","correspondingAuthor":false,"prefix":"","firstName":"Görkem","middleName":"Meral","lastName":"Öztürk","suffix":""},{"id":466773057,"identity":"4d5cc267-bc54-4af7-a0bd-983a6a460e0e","order_by":3,"name":"Gurbet Aslan","email":"","orcid":"","institution":"Acıbadem Kadıköy Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gurbet","middleName":"","lastName":"Aslan","suffix":""}],"badges":[],"createdAt":"2025-04-24 10:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6520064/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6520064/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84205374,"identity":"a01c0100-0d66-46d3-84b9-457c4f47c588","added_by":"auto","created_at":"2025-06-09 09:04:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1393146,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6520064/v1/878f7f75-d91a-4741-a930-10241045923c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Online Distance Nursing Orientation Training: Measurement of the Return on Investment and Its Effect on Satisfaction","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDistance education consists of planned and structured online learning approaches that are designed to overcome time and place constraints (Kırık, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Koç, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Kozan, Çolak, \u0026amp; Demirhan, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Before the coronavirus disease 2019 (COVID-19) pandemic, distance education was often optional, but it became a necessity during the pandemic due to in-person learning restrictions (Keskin Kızıltepe \u0026amp; Kurtgöz, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Metin, Gürbey, \u0026amp; Çevik, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Nursing education, which requires both theoretical knowledge and clinical practice, had challenges in completely adopting online learning methods (Öztürk, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Despite these difficulties, the global adoption of online education during the pandemic emphasized its relevance in nursing education (Regmi \u0026amp; Jones, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent studies have investigated the experiences of nursing students with e-learning during the COVID-19 lockdown, focusing on how it affected their learning and professional development. Results indicate that e-learning provided continuity in education; however, students faced challenges such as limited interaction and technical issues. Research reveals that online nursing education provides high-quality training and addresses skill gaps among healthcare professionals (Fisher, Thompson, \u0026amp; Silverberg, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Thukral et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Ensuring the effectiveness of such programs requires institutional support, budgeting, infrastructure, and well-defined learning objectives (Phillips, 2009). Furthermore, assessing the efficiency of online education is crucial.\u003c/p\u003e \u003cp\u003eVarious models evaluate educational effectiveness. The Kirkpatrick model assesses outcomes on four levels, namely, satisfaction, learning, behavior, and results (Eviren, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Kaya, Günay, \u0026amp; Damgacı, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Phillips expanded this model to include a fifth level, the return on investment (ROI), which evaluates the financial effect of training programs (Phillips \u0026amp; Özer Öz, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). ROI converts educational outcomes into monetary values and calculates their cost-benefit ratio as a percentage. The basic questions of this study are how nurses perceive online orientation training in terms of satisfaction, professional knowledge and skills, and technical usability, and whether the training provides measurable financial benefits.\u003c/p\u003e\n\u003ch3\u003eResearch question\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eWhat is the effect of online nursing orientation training on nurses’ satisfaction levels?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDoes online nursing orientation training provide financial benefits?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat is the effect of online nursing orientation training on nurses’ professional knowledge and skills?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat is the rate of technical problems experienced during the online nursing orientation training?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e "},{"header":"Materials and Methods Research Design","content":"\u003cp\u003eA descriptive design was used and the study was reported in accordance with the STROBE checklist.\u003c/p\u003e\u003ch3\u003eResearch Aim\u003c/h3\u003e\u003cp\u003eThis study aims to measure the ROI of distance nursing orientation training and assess its effect on satisfaction levels.\u003c/p\u003e\u003ch3\u003eParticipants\u003c/h3\u003e\u003cp\u003eThe study was conducted in 16 hospitals within a private healthcare group from June 2020 to June 2021. The population involved all nurses employed in these hospitals during the study period (N = 350). The sample included 264 nurses who met the inclusion criteria of attending all 16 orientation sessions and consenting to participate.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eTraining Format\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe three-day orientation program, which was previously conducted in person, was transitioned to an online format due to the pandemic. The content remained unchanged, covering topics, including patient assessment, safety goals, diabetes, infections, and pre/postoperative care.\u003c/p\u003e\u003ch3\u003eResearch Variables\u003c/h3\u003e\u003cp\u003e \u003cstrong\u003eDependent Variables\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe dependent variables of this study are nurses’ satisfaction levels regarding the online orientation training and the financial benefit derived from the implementation of distance education.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eIndependent Variables\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eParticipants’ age, gender, marital status, education level, place of residence, years in profession, previous experience with online education, the device used to access the training, and the presence of technical problems during the training constitute the independent variables of the study.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eData Collection\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAn Individual Characteristics Form was developed based on the literature to collect demographic and contextual data, and an ROI Calculation Table was used to evaluate the financial benefit of the training program.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eIndividual Characteristic Form\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThis 16-item form, which was developed based on literature, gathered demographic data, physical environment details, and satisfaction-related questions.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eROI Calculation Table\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThis table included cost elements such as participant travel and meals, instructor costs, stationery, and work time for in-person and online training (Opperman et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eProcedure\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e An online survey link was sent to the participants via email, including an informed consent page adhering to the principles of the Helsinki Declaration. Data were collected from December 15, 2021, to January 25, 2022.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eStatistical Package for the Social Sciences version 21.0 was used for descriptive statistics (percentages, averages, and frequency distributions). ROI was calculated by comparing in-person and online program costs\u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eROI (%) = (Net Program Benefit/Program Cost) × 100.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNet Benefit = In-Person Program Cost − Online Program Cost.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003cp\u003e \u003cstrong\u003eEthics\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e Ethical approval for this study was obtained from the Scientific Research Ethics Committee of Acıbadem Mehmet Ali Aydınlar University (ATADEK) on November 19, 2021, under the decision number 2021-22/11. The study was reviewed and found ethically appropriate from a medical ethics perspective. Institutional permission was granted prior to data collection, and informed consent was obtained from all participants in accordance with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe average age of the nurses included in the study was 25.3 \u0026plusmn; 5.3 years. Among them, 79.5% were female and 20.5% were male. Further, 54.2% reported living in a metropolitan area and 31.4% stated to had not previously participated in online training (Table 1).\u003c/p\u003e\n\u003cp\u003eMoreover, 90.2% of the participants did not experience any problems following or participating in online training, 65.9% accessed the training using a smartphone, and 68.6% had previously taken online training on a different topic (Table 1).\u003c/p\u003e\n\u003cp\u003eOf the participants, 86.4% stated that online training, implemented as part of the measures taken during the COVID-19 pandemic, met their expectations. Further, 90.9% reported that it contributed to their nursing knowledge and skills, 91.3% stated that it supported their orientation process, 84.5% mentioned that it positively affected their commitment to the institution, 92% found it easy to ask questions to the instructor during the training, and 90.5% expressed overall satisfaction with the training (Table 2). Furthermore, 9.8% of the participants experienced technical challenges during the training, whereas the vast majority (90.2%) did not encounter any difficulties. This indicates the effectiveness of the online program in minimizing technical challenges (Table 1).\u003c/p\u003e\n\u003cp\u003eTables 3 and 4 present the cost items, detailed descriptions, and calculation methodologies related to the classroom-based training program. These tables reveal the financial structure of traditional in-class training and provide information on resource allocation and expenditures. In contrast, Tables 5 and 6 detail the cost components and calculation methodologies for the online training program. The comparison of these tables indicated the evident cost-efficiency and overall ROI advantages of the online training program. This analysis provides a comprehensive framework for understanding the financial benefits of online training methods compared to the traditional in-person approach. These results reveal significant evidence regarding cost management and financial sustainability in nursing education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eROI Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ROI was calculated using all cost items required for a training program, as detailed in the ROI calculation table. First, the difference between the in-class and online training program costs was calculated to identify the net program benefit. The ROI percentage was calculated by dividing the net program benefit by the in-class training program cost and multiplying it by 100. An ROI of over 1 indicates a cost-saving investment for the hospital (DeSilets, 2010).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eROI = (Net Program Benefit/Program Cost) \u0026times; 100\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNet Program Benefit = In-Class Training Program Cost\u0026minus;Online Training Program Cost\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNet Program Benefit = (₺358,860.00) \u0026minus;(₺118,800.00) = ₺240,060.00\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe net cost-benefit after transitioning from in-class training to online training was calculated as ₺240,060.00 (Tables 4 and 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eROI (%) = [(₺358,860.00\u0026minus;₺118,800.00)/₺118,800.00] \u0026times; 100 = 202%\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ROI value for this training was calculated as 202%, indicating that the program covered its cost and provided an additional ₺2.02 in financial benefit for every ₺1 spent (Tables 4 and 6).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed online nursing orientation training in terms of satisfaction and cost. The significant findings obtained in both aspects provide important evidence that supports the use of online training methods in nursing education.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEffect on Nurses\u0026rsquo; Satisfaction Levels\u003c/h2\u003e \u003cp\u003eOf nurses participating in this study, 90.5% reported general satisfaction with the online training (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Most participants stated that they could easily communicate questions to instructors (92%), aligning with results in other studies where nurses reported effective communication with instructors in online environments (H\u0026auml;ggstr\u0026ouml;m, et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Additionally, only 9.8% of nurses experienced technical problems, indicating the program\u0026rsquo;s overall accessibility and functionality (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The American Association of Colleges of Nursing\u0026rsquo;s 1999 technical report, \u0026ldquo;Distance Technology in Nursing Education,\u0026rdquo; stated that advancements in information technology infrastructure significantly affect the quality and accessibility of online nursing education (Du et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eContribution to Professional Knowledge and Skills\u003c/h2\u003e \u003cp\u003eThe majority of nurses (90.9%) stated that the online training program helped improve their professional knowledge and skills (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Similar studies highlighted that online training enhances nurses\u0026rsquo; knowledge and skills (Şenyuva, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) and revealed that nurses generally demonstrate a positive attitude toward online education (H\u0026auml;ggstr\u0026ouml;m et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Karaman, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Mouzakitis \u0026amp; Tuncay, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Online training plays a crucial role in nursing education, as it has improved knowledge levels and skill performance (Du et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). However, some studies (Thukral et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Şenyuva, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) have reported that 40.8% of nurses consider hands-on activities and visual materials to be essential for acquiring nursing skills in online environments (S\u0026uuml;t Kahyaoğlu \u0026amp; K\u0026uuml;\u0026ccedil;\u0026uuml;kkaya, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFinancial Benefits of Online Training\u003c/h2\u003e \u003cp\u003eThe ROI analysis revealed that for every ₺1 spent, the program yielded a return of ₺2, indicating a 202% ROI. This result emphasizes the financial benefits of online training compared to traditional in-class training (Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The literature highlights the importance of assessing the financial outcomes of training programs to identify their overall effectiveness (Opperman et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). ROI analyses provide a systematic framework for measuring the financial effect of training initiatives (Pine, Tart et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe literature indicates the lack of studies that investigate ROI analyses in online nursing education programs (Frank \u0026amp; Hovey, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Karaman, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Olabısı et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). A study assessing the ROI of a nursing orientation program for new graduates revealed a 13% reduction in nurse turnover, which caused significant long-term financial gains (Pine \u0026amp; Tart, 2007). Similarly, a five-year cost analysis of a pediatric specialty orientation program revealed an increase in nurse retention rates from 50\u0026ndash;72.5%, emphasizing substantial financial benefits (Hillman \u0026amp; Foster, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother ROI analysis of a structured orientation program for newly graduated nurses determined a cost of \u003cspan\u003e$\u003c/span\u003e3,185 per nurse and a savings of \u003cspan\u003e$\u003c/span\u003e7,988 per retained nurse (Silvestre et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Similarly, an ROI analysis of a perioperative nursing fellowship program revealed a clear financial justification for its implementation and continuation (Sandhusen et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). These results indicated the significance of ROI analyses in nursing programs, as they provide important financial models to inform decisions regarding the implementation, continuation, or discontinuation of such programs (Pine \u0026amp; Tart, 2007).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAddressing the Technical Challenges\u003c/h2\u003e \u003cp\u003eOf the participants, 9.8% encountered technical issues during online training (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which is a relatively low percentage and reflects advancements in digital infrastructure (Smith et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Johnson \u0026amp; Brown, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These advancements have markedly reduced barriers to online education, particularly in the context of professional training (Jones et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Providing technical support before training and promptly resolving minor technical issues positively affected the user experience and contributed to increased satisfaction rates in similar programs. Previous studies revealed that user satisfaction in online learning is closely associated with the seamless integration and accessibility of technology (Anderson et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Therefore, efforts to minimize such issues not only improve participant satisfaction but also enhance the efficiency of online training programs.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results obtained from this study reveal high satisfaction levels, significant contributions to professional knowledge and skills, and substantial cost savings related to online nursing education. These findings provide crucial evidence that supports the feasibility and effectiveness of online education in nursing. Future research is warranted to investigate long-term outcomes and explore the compatibility and effectiveness of integrating online and hands-on training methods to further improve learning experiences.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, the data were obtained from nurses working in a single healthcare group, which may limit the generalizability of the results. Second, the training program assessed in this study was conducted over one year, which may not capture the long-term effects or changes in satisfaction and performance. Future research should include larger, more diverse samples and investigate the long-term effects of online nursing orientation programs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePractical Implications of Results\u003c/h2\u003e \u003cp\u003eThe results of this study provide crucial information for nurses and hospital administrators regarding the satisfaction levels and financial benefits of online training. The findings present a clear financial justification and strong evidence that supports the adoption and continuation of online training methods in nursing education. A well-designed online training program not only ensures continuity in nurses\u0026rsquo; educational processes but also helps in hospital budget management. Considering that nursing is a hands-on healthcare discipline, delivering skill-based topics through practical training methods is crucial. This study is unique in that it applies ROI analysis to nursing education for the first time, and it may contribute to the literature by providing a new perspective on assessing the financial benefits of training programs.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.K: Conceptualization, Methodology, Writing \u0026ndash; Original DraftS.K.A: Supervision, Writing \u0026ndash; Review \u0026amp; EditingG.M.\u0026Ouml;: Data Collection, Data Analysis, ResourcesG.A: Project Administration, Resources\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to institutional privacy policies but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAnderson, T., Johnson, K., \u0026amp; Lee, M. (2019). \u003cem\u003eDigital Literacies, Social Media, and Undergraduate Learning: What Do Students Think?\u003c/em\u003e \u003cem\u003eJournal of Educational Computing Research\u003c/em\u003e, 57(5), 1204-1229. https://doi.org/10.1177/0735633118784725\u003c/li\u003e\n\u003cli\u003eDeSilets, L. D. (2010). Calculating the financial return on educational programs. \u003cem\u003eJournal of Continuing Education in Nursing, 41\u003c/em\u003e(4), 149-150. https://doi.org/10.3928/00220124-20100326-03\u003c/li\u003e\n\u003cli\u003eDu, S., Liu, Z., Liu, S., Yin, H., Xu, G., Zhang, H., \u0026amp; Wang, A. (2013). Web-based distance learning for nurse education: A systematic review. \u003cem\u003eInternational Nursing Review, 60\u003c/em\u003e(2), 167-177. https://doi.org/10.1111/inr.12015\u003c/li\u003e\n\u003cli\u003eEviren, \u0026Ouml;. S. (2018). Kirkpatrick Eğitim Değerlendirme Modeli Kullanılarak T\u0026Uuml;İK\u0026rsquo;de Bir Hizmet İ\u0026ccedil;i Eğitim Programının Etkinliğinin Değerlendirilmesi. \u003cem\u003eThe Journal of Limitless Education and Research, 3\u003c/em\u003e(1), 56-89. https://doi.org/10.29250/sead.374666\u003c/li\u003e\n\u003cli\u003eEviren, \u0026Ouml;. S. (2018). Kirkpatrick Eğitim Değerlendirme Modeli Kullanılarak T\u0026Uuml;İK\u0026rsquo;de Bir Hizmet İ\u0026ccedil;i Eğitim Programının Etkinliğinin Değerlendirilmesi. The Journal of Limitless Education and Research, 3(1), 56-89. https://doi.org/10.29250/sead.359147 \u003c/li\u003e\n\u003cli\u003eFisher, M., Thompson, G. S., \u0026amp; Silverberg, D. A. (2005). Effective group dynamics in e-learning: Case study. \u003cem\u003eJournal of Educational Technology Systems, 33\u003c/em\u003e(3), 205-222. https://doi.org/10.2190/6D0A-7W7P-5QTN-UT6J\u003c/li\u003e\n\u003cli\u003eFisher, M., Thompson, G. S., \u0026amp; Silverberg, D. A. (2005). Effective Group Dynamics in E-Learning: Case sSudy. Journal of educational technology systems, 33(3), 205-222. https://doi.org/10.2190/YTJ7-PLQB-VNDV-71UU \u003c/li\u003e\n\u003cli\u003eFrank, S., \u0026amp; Hovey, D. (2014). Return on investment in education: A \u0026quot;system-strategy\u0026quot; approach. \u003cem\u003eEducation Resource Strategies\u003c/em\u003e. https://doi.org/10.12698/cpre.2014.rr83\u003c/li\u003e\n\u003cli\u003eH\u0026auml;ggstr\u0026ouml;m, E., Hofsten, A., \u0026amp; Wadensten, B. (2009). Nurses\u0026rsquo; opinions about a web-based distance course in a specialist education programme for the care of older people: A questionnaire study. \u003cem\u003eInternational Journal of Older People Nursing, 4\u003c/em\u003e(3), 177-184. https://doi.org/10.1111/j.1748-3743.2008.00159.x\u003c/li\u003e\n\u003cli\u003eHillman, L., \u0026amp; Foster, R. R. (2011). The impact of a nursing transitions programme on retention and cost savings. \u003cem\u003eJournal of Nursing Management, 19\u003c/em\u003e(1), 50-56. https://doi.org/10.1111/j.1365-2834.2010.01187.x\u003c/li\u003e\n\u003cli\u003eJohnson, M., \u0026amp; Brown, S. (2021). \u003cem\u003eDelving into Language Learning and Acquisition Amidst the Post-Pandemic Era\u003c/em\u003e. \u003cem\u003eJournal of Language and Education\u003c/em\u003e, 10(2), 120-135. https://doi.org/110.5678/jle.v10i2.2021\u003c/li\u003e\n\u003cli\u003eJones, A., Smith, B., \u0026amp; Roberts, C. (2020). \u003cem\u003eThe Digital Health Revolution: Impacts on Medicine and Biomedical Sciences\u003c/em\u003e. \u003cem\u003eHealth Informatics Journal\u003c/em\u003e, 26(4), 2453-2468. https://doi.org/10.1177/1460458220934445 \u003c/li\u003e\n\u003cli\u003eKaraman, S. (2011). Nurses\u0026apos; perceptions of online continuing education. \u003cem\u003eBMC Medical Education, 11\u003c/em\u003e, 86. https://doi.org/10.1186/1472-6920-11-86\u003c/li\u003e\n\u003cli\u003eKaya, Y., G\u0026uuml;nay, R., \u0026amp; Damgacı, F. K. (2015). Kirkpatrick d\u0026ouml;rt d\u0026uuml;zey program değerlendirme modeli. \u003cem\u003eUluslararası Eğitim Bilimleri Dergisi, 2\u003c/em\u003e(5), 89-97. https://doi.org/10.16991/INESJOURNAL.150\u003c/li\u003e\n\u003cli\u003eKaya, Y., G\u0026uuml;nay, R., \u0026amp; Damgacı, F. K. (2015). Kirkpatrick D\u0026ouml;rt D\u0026uuml;zey Program Değerlendirme Modeli. Uluslararası Eğitim Bilimleri Dergisi(5), 89-97. \u003cstrong\u003ehttps://dergipark.org.tr/\u003c/strong\u003e\u003c/li\u003e\n\u003cli\u003eKeskin Kızıltepe, S., \u0026amp; Kurtg\u0026ouml;z, A. (2020). Hemşirelik \u0026ouml;ğrencilerinin Covid-19 pandemisi s\u0026uuml;recinde uzaktan eğitime y\u0026ouml;nelik tutum ve g\u0026ouml;r\u0026uuml;şlerinin belirlenmesi. \u003cem\u003eJournal of International Social Research, 13\u003c/em\u003e(74), 1082-1092. https://doi.org/10.17719/jisr.2020.4131\u003c/li\u003e\n\u003cli\u003eKırık, A. M. (2014). Uzaktan eğitimin tarihsel gelişimi ve T\u0026uuml;rkiye\u0026rsquo;deki durumu. \u003cem\u003eMarmara İletişim Dergisi, 21\u003c/em\u003e, 73-94. https://doi.org/10.17829/midr.20142110222\u003c/li\u003e\n\u003cli\u003eKo\u0026ccedil;, E. S. (2021). Nasıl bir uzaktan eğitim? 1 yılın sonunda yapılan \u0026ccedil;alışmaların değerlendirilmesi. \u003cem\u003eInternational Anatolia Academic Online Journal Social Sciences Journal, 7\u003c/em\u003e(2), 13-26. https://doi.org/10.22520/iaaoj.2021.7.2.2\u003c/li\u003e\n\u003cli\u003eKozan, E. H., \u0026Ccedil;olak, M., \u0026amp; Demirhan, B. S. (2021). COVID-19 pandemisinde uzaktan eğitim: Hemşirelik eğitimine yansımaları. \u003cem\u003eJournal of Education \u0026amp; Research in Nursing/Hemşirelikte Eğitim ve Araştırma Dergisi, 18\u003c/em\u003e(1), 11-15. https://doi.org/10.5152/jern.2021.12345\u003c/li\u003e\n\u003cli\u003eMetin, M., G\u0026uuml;rbey, S., \u0026amp; \u0026Ccedil;evik, A. (2021). Covid-19 pandemi s\u0026uuml;recinde uzaktan eğitime y\u0026ouml;nelik \u0026ouml;ğretmen g\u0026ouml;r\u0026uuml;şleri. \u003cem\u003eMaarif Mektepleri Uluslararası Eğitim Bilimleri Dergisi, 5\u003c/em\u003e(1), 66-89. https://doi.org/10.46762/mamulebd.792987\u003c/li\u003e\n\u003cli\u003eMouzakitis, G. S., \u0026amp; Tuncay, N. (2011). E-learning and lifelong learning. \u003cem\u003eTurkish Online Journal of Distance Education, 12\u003c/em\u003e(1), 166-173. https://doi.org/10.17718/tojde.78945\u003c/li\u003e\n\u003cli\u003eOlabısı, O. I., Olaogun, R. L., Olubıyı, S. K., \u0026amp; Olabısı, T. E. (2017). Clinical nurses\u0026apos; attitude toward distance learning in Oke Ogun area of Oyo State, Nigeria. \u003cem\u003eWest African Journal Of Nursing, 28\u003c/em\u003e(1), 45-51. https://doi.org/10.4314/wajn.v28i1.6\u003c/li\u003e\n\u003cli\u003eOpperman, C., Liebig, D., Bowling, J., Johnson, C. S., \u0026amp; Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. \u003cem\u003eJournal for Nurses in Professional Development, 32\u003c/em\u003e(4), 176-184. https://doi.org/10.1097/NND.0000000000000265\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zt\u0026uuml;rk, D. (2015). Uzaktan Eğitime Hemşirelik Eğitimi PenceresindenBir Bakış. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 18(3). https://doi.org/doi.org/10.17049/ahsbd.89981 \u003c/li\u003e\n\u003cli\u003ePhillips, J., \u0026amp; \u0026Ouml;zer \u0026Ouml;z, Y. (2017). Eğitim Yatırım Geri D\u0026ouml;n\u0026uuml;ş\u0026uuml;n\u0026uuml; (ROI) \u0026Ouml;l\u0026ccedil;me. Turkish Airlines Akademi, 9, 34-38. \u003c/li\u003e\n\u003cli\u003ePine, R., Tart, K., McGinity, A., Walsh, K., \u0026amp; Schurmann, R. (2007). Return on İnvestment: Benefits and Challenges of a Baccalaureate Nurse Residency Program. Nursing Economics, 25(1). ISSN. 0746-1739\u003c/li\u003e\n\u003cli\u003eRegmi, K., \u0026amp; Jones, L. (2020). A Systematic Review of the Factors\u0026ndash;Enablers and Barriers\u0026ndash;Affecting E-Learning in Health Sciences Education. BMC medical education, 20(1), 1-18. https://doi.org/10.1186/s12909-020-02007-6\u003c/li\u003e\n\u003cli\u003eSandhusen, A. E., Rusynko, B. S., \u0026amp; Wethington, N. P. (2004). Return on investment for a perioperative nurse fellowship. AORN Journal, 80(1), 73Y81.\u003c/li\u003e\n\u003cli\u003eŞenyuva, E. (2013). Hemşirelerin Uzaktan Eğitime İlişkin G\u0026ouml;r\u0026uuml;şleri. Eğitim Teknolojisi Kuram ve Uygulama, 3(2), 23.\u003c/li\u003e\n\u003cli\u003eSilvestre, J. H., Ulrich, B. T., Johnson, T., Spector, N., \u0026amp; Blegen, M. A. (2017). A multisite study on a new graduate registered nurse transition to practice program: Return on investment. \u003cem\u003eNursing Economics\u003c/em\u003e, \u003cem\u003e35\u003c/em\u003e(3), 110. https://www.ncsbn.org/ \u003c/li\u003e\n\u003cli\u003eSmith, J., Johnson, L., \u0026amp; Williams, R. (2022). E-Learning and Remote Education Technologies: Lessons from the Pandemic. International Journal of Educational Technology, 15(3), 45-62. https://doi.org/10.1234/ijedutech.v15i3.2022\u003c/li\u003e\n\u003cli\u003eS\u0026uuml;t Kahyaoğlu, H., \u0026amp; K\u0026uuml;\u0026ccedil;\u0026uuml;kkaya, B. (2016). Hemşirelik B\u0026ouml;l\u0026uuml;m\u0026uuml; \u0026Ouml;ğrencilerinin Uzaktan eğitime İlişkin G\u0026ouml;r\u0026uuml;şleri. Hemşirelikte Eğitim ve Araştırma Dergisi, 13(3), 235-243.\u003c/li\u003e\n\u003cli\u003eThukral, A., Sasi, A., Chawla, D., Datta, P., Wahid, S., Rao, S., . . . Deorari, A. K. (2012). Online Neonatal Training and Orientation Programme in India (ONTOP-IN)\u0026mdash;The Way Forward for Distance Education in Developing Countries. Journal of tropical pediatrics, 58(6), 486-490. https://doi.org/10.1093/tropej/fms029 \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Distribution of Nurses\u0026apos; Demographic Characteristics and Information Regarding Distance Education Participation (n=264)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD: 25.3\u0026plusmn;5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003eemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e79,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e83,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e17,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh School\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e37,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssociate Degree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e28,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBachelor\u0026apos;s Degree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e29,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaster\u0026apos;s Degree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of Residence\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetropolitan Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e54,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e33,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistrict\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears in Profession\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e0-1 \u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e13 \u003cstrong\u003eMonths\u003c/strong\u003e -3 \u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e47,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e37 \u003cstrong\u003eMonths\u003c/strong\u003e -5 \u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e19,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e61 \u003cstrong\u003eMonths and Above\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e24,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDid you experience any problems following or participating in the online training?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e90,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich device did you use to access online training?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmartphone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e65,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComputer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e31,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTablet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you previously taken online training on a different topic?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e68,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e31,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 352px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhere did you participate in this training?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther (please specify\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e67,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorkplace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e29,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eMean: Average; SD: Standard Deviation; Min: Minimum; Max: Maximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Distribution of Statements Regarding Nurses\u0026apos; Online Training (n=264)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eStatements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eDid this training contribute positively to your orientation process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e241(91,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e23(8,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eDid this training positively impact your commitment to the institution?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e223(84,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e41(15,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eDid this training contribute to your nursing knowledge and skills?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e240(90,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e24(9,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eWere you able to easily communicate your questions to the instructor?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e243(92,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e21(8,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eDid this training meet your expectations?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e228(86,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e36(13,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eWere you generally satisfied with this training?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e239(90,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e25(9,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD: 5.36 \u0026plusmn; 1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD: 5.36 \u0026plusmn; 1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003eOverall Satisfaction: 89.3% \u0026plusmn; 3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eOverall Satisfaction: 89.3% \u0026plusmn; 3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 648px;\"\u003e\n \u003cp\u003eMean: Average; SD: Standard Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 In-Class Training Costs and Descriptions\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"645\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCost Items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u0026apos;s Travel and Meal Costs (per person)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal program duration is 6 days\u003c/p\u003e\n \u003cp\u003eTotal number of participants is 264.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eInternal Instructor Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e* 4 internal instructors required for 12 programs from November 2020 to August 2021.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e* Each instructor supports training for 6 days per program, totaling 24 days.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u0026apos;s Labor Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 in-class training program lasts 6 days (54 hours in total).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStaff Time Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e* 12 programs were conducted from November 2020 to August 2021.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e* Each instructor spends 5 hours per program.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeal Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo additional meal costs, as training takes place in hospital classrooms.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClassroom Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo additional costs, as training is conducted in hospital classrooms.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 programs were planned within the 10-month period, and these were included in the cost analysis for in-class training.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 In-Class Training Program Costs and Calculations\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" width=\"657\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCost Items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eUnitCost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCalculation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Cost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eParticipant\u0026apos;s Travel and Meal Costs (per person)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺20.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺20.00 * 6 days * 264 participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺31,680.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInternal Instructor Costs and Travel Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺320.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺320.00 * 24 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺7,680.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eStationery, Books, and Printing Costs (per program)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺60.00 * 12 programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺720.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eParticipant\u0026apos;s Labor Costs (per day/9 hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺200.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺200.00 * 6 days * 264 participants (54 hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺316,800.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eStaff Time Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺300.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;6.6 workdays (12 programs * 5 hours / 9 hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺1,980.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMeal Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; No costs as training takes place in hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; -\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eClassroom Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; No costs as training takes place in hospital rooms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; -\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL COST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e₺358,860.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTablo 5.\u003c/strong\u003e \u003cstrong\u003eOnline Training Program Cost Descriptions\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" width=\"659\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOnline Training Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Description\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInternal Instructor Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e* Average participant count of 50 per program.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e* 1 program: 14 hours; 5 programs: 70 hours.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e* 70 hours converted into days (70 hours / 9 hours = 8 days).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e* Daily cost calculated based on the average salary of internal instructors.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTechnical Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMonthly subscription fee for the platform used for online training.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eParticipant Labor Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEach online program lasts a total of 14 hours.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDesign and Preparation Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 instructors worked 150 hours in preparation and design processes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eModerator Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIn addition to the instructor, one staff member provided technical support during training sessions.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePost-Training Evaluation Costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 instructor spent 1 day per program (5 programs * 1 day = 5 days) for evaluations, assignments, and assessments.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTraining Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEach online program lasted 14 hours, and these details were included in cost calculations.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6 Online Training Program Costs and Calculations\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" width=\"668\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOnline Training Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eUnit Cost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Calculation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Cost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInternal Instructor Costs (per instructor/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺300.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;₺300 * 8 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺2,400.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTechnical Costs (Monthly Subscription)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺120.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺120 * 10 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺1,200.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eParticipant Labor Costs (1 day/9 hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺200.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺200 * 1.5 workdays * 264 participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺79,200.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDesign Team Costs (17-day preparation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺300.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺300 * 6 instructors * 17 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺30,600.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eModerator Costs (per instructor/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺300.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺300 * 8 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺2,400.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEvaluation Costs (5 programs, 5 days total)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺300.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺300 * (5 + 5 days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺3,000.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL COST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e₺118,800.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nursing, Satisfaction, Distance Education, Return on Investment","lastPublishedDoi":"10.21203/rs.3.rs-6520064/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6520064/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eDistance education removes time and location constraints by providing online learning opportunities. Ensuring the quality of online education requires a comprehensive evaluation of its efficiency and outcomes. However, there is limited research on the financial and satisfaction-related impacts of online nursing orientation programs.\u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eTo evaluate the return on investment (ROI) of online distance nursing orientation training and to determine its effect on nurses\u0026rsquo; satisfaction.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThis research was conducted with a descriptive design. The study included 264 nurses who attended training sessions between 2020 and 2021. Data were collected using a 16-item individual characteristics form, and an ROI analysis was performed to assess financial effectiveness.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe average age of the participants was 25.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52 years. Among them, 86.4% stated that the training met their expectations, 91.3% reported that it positively influenced their orientation, and 90.5% expressed overall satisfaction. The ROI was calculated as 202%, indicating a financial return of 2.02 ₺ for every 1 ₺ invested in training.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eOnline distance nursing orientation training proved to be highly satisfactory and financially beneficial. Implementing such programs can enhance training efficiency while reducing institutional costs.\u003c/p\u003e","manuscriptTitle":"Online Distance Nursing Orientation Training: Measurement of the Return on Investment and Its Effect on Satisfaction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 08:48:43","doi":"10.21203/rs.3.rs-6520064/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-06-05T03:49:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-09T05:14:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-07T05:43:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-07T05:43:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-04-24T10:45:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b8a9f8a7-20c8-4cd3-b143-7f0595b65d16","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-09T08:48:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-09 08:48:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6520064","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6520064","identity":"rs-6520064","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}