Advancing nursing entrepreneurship in the 21st century

Abstract

Nursing entrepreneurship represents an important, developing role for nursing that inspires innovation and advances scientific knowledge. In the 21st century, a growing aging population, prevalent chronic illness, advanced technology, higher demands for quality health care, limited resources, healthcare workforce shortages, inequities and disparities in healthcare delivery, as well as the COVID-19 pandemic challenge healthcare systems and impact population health. Nursing entrepreneurship offers an opportunity to respond to these trends, expand healthcare services and enhance health globally (Vannucci & Weinstein, 2017). Nurses often work on the front lines of healthcare delivery, including health promotion, disease prevention, treatment, and rehabilitation to meet the demand for safe, high-quality, patient-centered, and accessible care. Nurses are also becoming the drivers and leaders in population health management, helping to facilitate equal access to healthcare services and therefore well-positioned to consider new businesses, technology initiatives, and ways of working and thinking to support the healthcare system (Jakobsen et al., 2021). By using their nursing skills, knowledge and experience to start healthcare-related businesses, nurse entrepreneurs can be empowered to take on these leadership roles. However, the development of this important area of nursing practice and science currently needs more rigorous research evidence and nursing curricular content. The global healthcare industry is massive and continues to grow, with its market expected to reach to over $7,500 billion in 2022 and over $10,000 billion in 2026 (Reportlinker, 2022). Accordingly, entrepreneurship in healthcare plays a significant role in the economy, with healthcare businesses having a prominent role in the transformational changes taking place in the public and private healthcare sectors and many new start-ups being established. However, the prevalence of entrepreneurial nurses is only 0.5%–1% of all working nurses globally, which means there is an enormous potential for entrepreneurship in the nursing profession due to people's need for healthcare services and the capability of nurses to address these needs (Jakobsen et al., 2021). In addition, nurses are facing global changes in the healthcare industry, the nursing profession, and opportunities for innovation that did not previously exist. These opportunities enhance the personal and professional growth of nurses and can include the establishment of their own businesses or development of new equipment for patient care. A nurse entrepreneur is defined by the International Council of Nurses as “a proprietor of a business that offers nursing services of a direct care, educational, research, administrative, or consultative nature” (Sanders & Kingma, 2012, p.7). Nurse entrepreneurs can play an essential role in the healthcare system by supporting the development of targeted services such as nursing entrepreneurships or nursing businesses. Nurses can also enhance businesses to develop and distribute medical products or devices, offer direct patient care or patient advocacy, educate or train other professionals or community members, and provide healthcare-related consultations, among other functions (Vannucci & Weinstein, 2017). From a review of the existing literature, nurse entrepreneurs currently operate nursing businesses in the public and private healthcare sectors. Several types of nursing businesses exist, such as independent nursing practices, nurse-owned skilled nursing facilities, and consultancy agencies (Sanders & Kingma, 2012). Self-employed nurse leaders, focusing on establishing their businesses, are usually motivated by opportunity and need, as well as by profit. The challenges that nurse entrepreneurs face are essential to understand how nurses have shifted their perspectives to a nurse entrepreneur role, particularly in terms of empowering women to be nurse entrepreneurs in business. Nurse entrepreneurs, most of whom are women, argue that they can run or manage healthcare businesses, traditionally a man's enterprise, such that gender should not be a barrier to entrepreneurship. The empowerment of nurse entrepreneurs, particularly as women, has contributed to status changes and business improvements in the healthcare industry and system, promoting positive health outcomes for patients, and nursing service effectiveness (Vannucci & Weinstein, 2017). Nurse entrepreneurs are becoming empowered across the globe to build on their emerging role in business in response to population needs for quality health care. Launching and running a successful nursing entrepreneurship is not easy since various factors influence the transition from nurse to entrepreneur. Previous literature on nursing entrepreneurship reveals that nurses generally lack the necessary education, knowledge and skills for business, despite more traditional curricular content on leadership and management. These educational knowledge gaps, therefore, present significant challenges for the nurse transitioning to nurse entrepreneur, because basic nursing curricula do not currently address entrepreneurial knowledge and skills, and many nursing schools fail to provide coursework on nursing entrepreneurship or a business practicum, with limited faculty who are experts in nursing entrepreneurship. In addition, individual factors can impact the business performance of nurse entrepreneurs, such as their entrepreneurial personality, leadership skills, and self-efficacy (Melnyk & Raderstorf, 2019). As a predominately female profession, nursing's pervasive societal gender role norms and expectations can create barriers to entrepreneurial practices and limit the empowerment of nurses to pursue entrepreneurial endeavours due to gender limitations (Sanders & Kingma, 2012, p.7). Moreover, when establishing health service businesses, nurses must address the role of nursing services in health systems, policies, laws and regulations that differ geographically. For example, in 2019, the National Health Security Office (NHSO) in Thailand initiated a health policy to promote equal access to quality health services for Thai people, particularly those in rural communities. The policy was developed in response to the NHSO project with over 100 nursing and midwifery clinics across Thailand to provide primary healthcare services under the Universal Healthcare Program system, thereby enabling people access to services in the community without having to go to the hospital, saving on travel expenses and reducing congestion in the hospital. This healthcare policy addresses an essential need, but also helps to support the expansion of nursing entrepreneurship. Nurse entrepreneurs are being offered the opportunity to develop their nursing roles, where they serve as key change agents to enact health policy, address disparities, and improve accessibility to the healthcare. The study of nursing entrepreneurship is becoming an area of intense global interest for nursing educational programmes because it offers many benefits for nurse entrepreneurs motivated to enter into nursing entrepreneurships. However, based on the literature, scientific development of this field—and more evidence to support nursing entrepreneurship practice—to develop or enhance of novice or current nurse entrepreneurs to be effective in these roles. Therefore, it is imperative that this area be further explored to move forward in nursing entrepreneurship. Extensive knowledge and research in the nursing entrepreneurship field are needed to integrate appropriate knowledge of general business entrepreneurship with nursing principles, find emerging evidence in nursing science, and provide scientific support for new knowledge, skills, and standard guidelines. More rigorous research is needed to inform suitable health policy and prepare nurses interested in owning a successful nursing entrepreneurship. An effective nursing educational system is essential for preparing nursing students and qualified nurses in practice to enter the field of nursing entrepreneurship by creating or developing an appropriate training programme and curriculum. For example, introducing entrepreneurship content in basic programmes to enhance students' awareness of the opportunity and considerations and electives and/or specialized curricula at the undergraduate and graduate level could be offered to prepare them for actual enterprises. In addition, to bridge the nursing educational system gap in nursing entrepreneurship—business administration, healthcare administration, financial management, marketing and business planning should be included in the curriculum to help entrepreneurs become successful in business ventures (Melnyk & Raderstorf, 2019). Empowering nurse entrepreneurs is a key strategy for raising the expectation that high entrepreneurial activity will effectively launch and sustain a business. Examples of these efforts include programmes to promote women's empowerment as nurse entrepreneurs with support measures such as financial literacy, training and mentoring. There is increasing recognition of the competency of nurses—as entrepreneurial women and men—to develop their businesses with more confidence and expertise in emerging roles. Even though nursing entrepreneurship is a new focus for nursing science, research in this area is critical to clarify and identify evidence-based best practices entailed in developing the ability of nurses to adopt broader health perspectives and challenge more traditional nursing roles. Enhancing empowerment is essential for nursing entrepreneurship, particularly as nursing is a profession of predominantly women. Furthermore, nurse entrepreneurs' knowledge and skills can help bridge gaps in the healthcare system by increasing population access to healthcare services. In the future, more rigorous research is needed in this field to broaden the scientific basis for nursing entrepreneurship and its contribution to business performance. A response to this call for further research can support the development of entrepreneurship guidelines and training programmes, prepare qualified nurses for entrepreneurial roles, and develop health policy recommendations for nursing entrepreneurships, which will be important for expanding healthcare to underserved populations, and result in improved quality of life for the population while maintaining the high-quality care functions at the heart of nursing.

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