Nurse entrepreneurs are nurses who have control over and responsibility for
an increased proportion of indirect processes of care in their roles. Nurse
entrepreneurs have the capability to plan, organize, finance, operate their own
businesses, and they work outside of an organization (Ieong, 2005). An advanced
practice nurse entrepreneur is an individual who can identify a patient's need
and find a way for nursing to respond to that need in an effective way,
formulate and execute a plan to meet that need (Dayhoff et.al, 2003). Nurse
entrepreneur has new opportunities in the world of business and need to assemble
the resources necessary to successfully exploit that opportunity- money, people
and organization (Allen, 2001). A professional nurse entrepreneur thinks
globally, makes decisions by consensus, knows the business, thinks big, and
conducts business using a business plan (Dayhoff et.al, 2002). Nurse
entrepreneurship is one of the ways for nurses to increase their visibility,
reclaim their power and direct their creativity and determination
(Driscoll,1999). Today, nurse entrepreneurs have established themselves in
various care specialties, like acute care, gerontology and home health. (Ieong,
2005). Excellent interpersonal skills, critical thinking skills,
collaboration skills, and credibility are essential for a successful nurse
entrepreneur. Nurse entrepreneurship is very rewarding with financial stability,
freedom, flexibility, status, enhanced patient and professional satisfaction
(Roggenkamp et.al, 1998).
Lack of nurse's knowledge and skills to operate in a successful business-like
and profitable manner (Mackey et al, 2005), higher cost of malpractice
insurance, inability to obtain hospital privileges for some, criticism of
physicians about the independent role of nurses (Pearson,2001), statutory
limitations, start-up costs for the practice, cash-flow and financing an ongoing
practice, accounting practices, billing, and collection of receipts, general and
malpractice insurance for the practice and individual providers, and hiring,
training, and retraining competent, enthusiastic personnel (Pollachek, 2004) are
some of the barriers nurses need to overcome to become successful nurse
entrepreneurs. A study using a process model of entrepreneurship to gather
information from nursing professionals through focus groups convened to discover
the barriers to starting a business has shown that a lack of knowledge and
concern for legal issues as significant barriers to nurses starting new business
ventures. Access to finance and support from formal institutions, lack of basic
skills like reading an income statement or balance sheet ,lack of financial
resources and the capabilities to acquire resources have been identified as
potential factors inhibiting nurses from starting a business (Elango et.al,
Factors Influencing Nurse Entrepreneurship
Nurse entrepreneurs should have specific personal characteristics, excellent
interpersonal skills, and business acumen. Personal characteristics of nurse
entrepreneurs include independence, flexibility, assertiveness, accountability,
creativity, and vision. Nurse entrepreneurs should also have a drive to achieve,
ability to accept and thrive on change, ability to handle stress, an appetite
for hard work, discipline, good judgment, independence, and self confidence. The
ability to be alone, work alone, make decisions alone, and manage their time
alone with a high level of energy, enthusiasm, and commitment to their work
shape nurse entrepreneurs (Porter-O'Grady, 1998).Interpersonal skills include
excellent communication skills, capability to listen, and the ability to manage
conflict, the ability to market oneself and telephone skills (Porter-O'Grady,
1998). Nurse entrepreneurs have to combine nursing skills with business acumen
that is not emphasized or taught in nursing or medical schools. Partnerships and
practice management skills are essential (Porter-O'Grady, 1998). Another study
to investigate the factors that influence nurse entrepreneurship has shown that
contextual factors like healthcare legislations, professional experience and
demographic factors have a profound influence (Vari Drennan et.al, 2007).
Another study has highlighted the fact that a lack of collaborative working
practices between health-care professionals and nurses makes the nurse task
being constrained and Health-care organizations need to provide an environment
in which the entrepreneurial skills of nurse specialists can be capitalized
(Austin et.al, 2006). Technological advancements have taken an important role in
the domain of health care and hence, technical skills do give strong advantages
to nurse entrepreneurs.
Factors Governing Nurse Entrepreneurs
Nurse entrepreneurs are of course governed by factors like legal obligations,
ethical obligations and social obligations. Nurse entrepreneurs are liable to
pay compensatory and punitive damages on account of medical litigations which
punish nurses under the tort or personal injury law (Zwemer, 1995). A nurse, by
profession, is constantly in situations that pose an ethical or moral conflict.
This includes various core aspects like the patient's Right to Life, Right to
Choose, Right and Ability to give Consent to treatment, End of life treatment
options and the Right to end life. Patient care is based on the universal
principles of Beneficence. Beneficence is the concept where human participants
are treated in an ethical manner by maximizing benefits and minimizing possible
The cultural background of patients does play an important role in the
success of nurse entrepreneurs. For instance, Hispanics are not accustomed to
the profession of nurses or social workers for support and help. Whereas, the
Middle East population on the other perceive nurses as helpers, not health care
professionals, and their suggestions and advice are not taken seriously at all
Nurse entrepreneurs today are a wonderful population of liberated
professionals. Factors like subordination of nurses to the medical profession,
frequent schedule changes, overloads, burnout, shift work, lack of appreciation
by superiors and colleagues, lower wages, short staffing and poor working
conditions have contributed towards a reduction of nursing professionals in USA
and an increase in opportunities for nurse entrepreneurs. In the past two
decades there has been commercial opportunities of enormous magnitude in the
patient care segment and various factors like, respecting patient's goals,
preferences and choices, attending to the medical, emotional, social and
spiritual needs of the person have been identified, using strengths of
interdisciplinary resources, acknowledging and addressing concerns and building
mechanisms and systems of support.
The success stories of the comprehensive lower extremity assessment health
services intrapreneurial foot clinic established, The Ed4Nurses established by
David Woodruff (2003), to improve patient care by enhancing the knowledge of
staff nurses needed to solve patient care problems and oncology home-based
nursing consultation business established by Schulmeister(Schulmeister,1999),
The Clinical Solutions LLC founded by Dayhoff & Moore (Dayhoff and
Moore,2002) to provide educational services and products for patients and
providers and to improve outcomes of care of adults with chronic diseases,
Kathleen Vollman's Prone Positioner (Vollman,2004), and Esther Muscari's
Lymphedema Therapies elucidate the potential of nurse entrepreneurship
and show the various types of business structures in which nurse entrepreneurs
operate. The evolutionary trend is from that of a sole proprietorship firm to
that of a general partnership, limited liability Company, or limited liability
partnership Company (Dayhoff et.al, 2003).
- Ann J. Zwemer (1995).Professional Adjustments and Ethics for Nurses in
India", 6th edn, B.1 Publications, India.
- Austin L, Luker K & Ronald M (2006). Clinical nurse specialists as
entrepreneurs: constrained or liberated. Journal of Clinical Nursing 15,
- Dayhoff, Nancy E, Moore, Patricia S (2004). CNS Entrepreneurs:
Innovators in Patient Care. Nurse Practitioner.
- Dayhoff, NE, Moore, PS (2002). Entrepreneurial clinical nurse specialists:
Innovators of patient care. Clin Nurs Spec 16:274-276.
- Dayhoff, NE, Moore, PS (2003). Entrepreneurship: Start-up questions. Clin
Nurs Spec 17:86-87.
- Elango et.al (2007). Barriers to nurse entrepreneurship: A study of the
process model of entrepreneurship. Journal of the American Academy of Nurse
Practitioners. 19 (4); 198-204.
- Galanti G.A (1991).Caring for Patients from Different Cultures. University
of Pennsylvania Press, Philadelphia.
- Lukacs, KS, Kelechi, TJ (1993). An intrapreneurial approach to foot care.
Clin Nurs Spec 7:326-329.
- Muscari, E (2004). Lymphedema: Responding to outpatients' needs. Onc Nurs
- Pearson, L (2001). Annual legislative update. The Nurse Practitioner
- Pollachek, J. (2004) Starting a practice and practice management.
Advanced practice nursing: Essentials for role development. Philadelphia,
PA: F. A Davis Company. p. 577-611.
- Roggenkamp, SD, White, KR (1998). Four nurse entrepreneurs: What motivated
them to start their own businesses? Health Care Management Review 23:
- Sao Lan "Jennifer" Ieong (2005). Clinical Nurse Specialist
Entrepreneurship. The Internet Journal of Advanced Nursing
- Schulmeister, L (1999). Starting a nursing consultation practice. Clin
Nurs Spec 13:94-100.
- T Porter-O'Grady (1996), "The business of partnership," Advanced Practice
Nurse Quarterly 2; 81-82.
- T Porter-O'Grady (1998) "The making of a nurse entrepreneur," Seminars
for Nurse Managers 6; 34-40.
- Vollman, KM (2004). Nurse entrepreneurship: Taking an invention from birth
to the marketplace. Clin Nurs Spec; 18: 68-71.
- Woodruff, D (2003). The metamorphosis of a CNS entrepreneurial business.
Clin Nurs Spec 17:290-291.
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