Since nurses are the primary providers of direct patient care in the United States, a shortage in any community can impact the quality of health care available. Rural areas were among the first to be affected by the current nursing shortage. Further challenges to the rural nurse supply include a lack of access to nursing education, particularly baccalaureate education. Both distance and online education options allow for the increased reach of higher education to rural areas. Existing nursing education literature focuses on graduate nurse education and baccalaureate completion education. The pre-licensure nursing student is mostly absent from the existing literature concerning nursing education in distance or online formats. This study used social constructivism as a theoretical framework. Constructivism asserts that learning is an active process, that students construct knowledge as they interact with instructors, students, and content in educational settings. This study used a retrospective quasi-experimental, two group (treatment and comparison) design. The treatment group met synchronously online with the instructor each week and participated actively with classmates in the synchronous online forum. The comparison groups completed the same course activities in an asynchronous online format via discussion boards. Health Education Systems, Inc (HESI) specialty exam scores and Online Student Engagement (OSE) scores were compared between the two groups. A convenience sample of 132 students enrolled in a traditional Bachelor of Science nursing program at a public university in the intermountain west region of the United States was used. Related to the three research questions asked, statistical analyses demonstrated that 1) no significant difference between HESI specialty exam scores and online education delivery method (synchronous or asynchronous) was identified; 2) no significant difference between OSE scale scores and online education delivery method (synchronous or asynchronous) was found; and, 3) a small correlation between HESI specialty exam scores and OSE scores was identified. The small sample size resulted in insufficient statistical power to determine conclusively whether the online delivery method (synchronous or asynchronous) impacted HESI specialty exam scores or OSE scores. Findings suggest that pre-licensure nursing students can learn essential didactic content in an engaging online environment. These findings have implications for nursing education delivery to rural or remote areas, where geography or distance limit access to higher education. Findings are also relevant given the current need in higher education for distancing between students during a time of pandemic. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]