This study empirically tests the relation between the instructional design elements and the overall meaningful interactions among online students. Eighteen online graduate nursing courses are analyzed using bivariate and multivariate analysis techniques. Findings suggest that the quantity of meaningful interaction among learners can be improved by dividing the students into smaller groups, using introduction sections, increasing social interaction among students, and limiting participation from the instructor. We also find that grades assigned to discussions and the use of synchronous communication tools does not improve the interactive quality of an online nursing course. The results of this study can be useful for practitioners, designers and instructors who are designing, developing, or teaching online nursing courses.