Faculty of Nursing & Midwifery Named for Doctoral Degree in Nursing Title:

Explaining Entrepreneurship Process in Nurses

ii Title: Explaining Nursing Entrepreneurship Process and Designing Appropriate Model Introduction: In
order to meet the increasing and emerging needs of people in the health sector, it is necessary for
nurses to expand their scope of work from hospital to community and to provide entrepreneurial roles
at different levels of care. The development of entrepreneurship culture among nurses and their success
in this field depends on proper education of nurses to enhance the skills, motivation and psychological
characteristics of entrepreneurship needed. But research findings to change nursing education in line
with innovation in Roles and R Practical tools for changing the world health systems are scarce.
Therefore, in order to identify the concept and process of nursing entrepreneurship, the present study
aimed to explain nursing entrepreneurship process and design a suitable model. Materials and Methods:
This study was conducted in two stages. ‫ ؛‬In the first phase, qualitative research was designed with the
contextual theory approach of Strauss and Corbin (1221) to explain the nursing entrepreneurship
process. Purpose-based sampling began theoretically and continued until information saturation. There
were individual interviews, field notes and documentation and bylaws. A total of 99 individual interview
participants were recruited. Then, in the second phase, based on the findings from the qualitative
phase, a suitable model was designed and presented using the three-step strategy of Walker and Evans
theory.Results: Results of the first phase of the study The three core categories were: Entrepreneurial
Idea Development, Idea Implementation and Sustainability and Sector Development. Based on the
experiences of the participants, they identified that their main concern was professional promotion
through innovation and in this way they were trying to Use different resources and mechanisms to
address this concern The stage, "Dynamic Efforts to Grow and Survive Entrepreneurial Activities," was
extracted as an underlying theory. After identifying the key concepts of the entrepreneurship process in
nurses from a field study and related literature review, the "Growth and Survival of Entrepreneurial
Activity" design pattern Conclusion: Dynamic Efforts to Grow and Survive Entrepreneurial Activities
Although entrepreneurial nurses' strategy was to achieve professional advancement through innovation,
the traditional nursing structure, bureaucracy, bureaucracy governing the system, and competition in
the health market caused That's right Nurses face many obstacles and obstacles in entering the field of
entrepreneurship, setting up independent businesses and their growth and development. Therefore,
efforts were made to integrate the applied components of these models with strategies and strategies
outlined in some similar studies. To optimize the pattern of growth and survival of entrepreneurial
activities and apply them to nurses and nursing students and make changes to the nursing curriculum
and policies for nursing businesses.Keywords: Entrepreneurship, Nursing Entrepreneurship, Nursing
Entrepreneur, patterns Entrepreneurship, the underlying theory

The first chapter deals with the importance of the research topic as well as the aims and questions of
the present study.1-1 The problem and importance of research in most countries of the world for
reasons such as rising costs of health care (1), population aging (9, 0). ), The prevalence of chronic
diseases (4) and the tendency for self-care (2), the pressure on health systems to meet people's health
needs in an efficient, economic and effective way is increasing. Concerns are raised about the
inadequacy of case skills There is a need for human resources in the area of health, recruitment and
retention problems. Patient-centered and need-based approaches The role of teamwork, as a principle
of providing integrated, affordable, quality and accessible care to all, is widely supported in health
systems. , A well-funded health infrastructure supported by human resources commensurate with the
health care needs of the population is an important principle for providing quality care (1). Nurses
account for more than 13% of the workforce (7) and Most countries and health services are recognized
as frontline employees in the health chain. By the Robert Wood Johnson Innovation Foundation Medical
Association 1 shows that nurses play an important part in building a health care system that addresses
the demand for safe, quality, patient-centric, accessible and affordable care (1). Consequences It is
imperative that nurses, in addition to developing their knowledge and education, change their care
practices by joining other health care professions (1) and embark on a path of innovation and
entrepreneurship. Nursing Entrepreneurship That brings them to their personal views and feelings To
pursue health outcomes using innovative approaches (1) Entrepreneur Nurse 0 identifies need and
creates a service to meet that need (2) and is recognized as a business owner whose nursing services are
of the nature of direct care, education, (2) They have attitudes that are transcendental and can actually
go beyond the environment.

and see situations with different lenses or other dimensions (13.) Therefore, Nurse Entrepreneurs 1 are
innovators who have the initial drive to change, modernize health systems, and display leadership (11).
Using creativity to develop a New ideas, improved services or methods of service delivery, new product
development or new ways of using existing products are the main attributes of entrepreneurs. By
combining these features with advanced or specialized knowledge and skills, it can be said that
entrepreneurial nurses are advanced nurses. Who produce products or services and can outsource them
(1) In addition to independent entrepreneurial nurses, organizational entrepreneurial nurses who are
actually employees of health care organizations are also able to provide innovative nursing or health
care services in that organization (19) and thus present the risks and benefits associated with this
innovative work. Share with other employees (10) Organizational entrepreneurs are affiliated with an
organization and do not consume personal resources such as their own money to make the proposed
change. Instead, they accept new ideas to better meet organizational goals. The existing system enters
the conversation and receives the necessary funding If independent entrepreneurs see the need for
change and are eager to expand the impact of change outside the support structure, they use personal
funds or money from outside sources to execute their projects (13). Social Entrepreneurship is another
category that has a good relationship with entrepreneurial nurses and provides opportunities for the
profession. Social Entrepreneurship is an approach in which innovative ideas and practical models for
achieving social benefit occur. (14, 12) Unlike traditional entrepreneurs, social entrepreneurs tend to be
social entrepreneurs. It focuses on social benefits. Therefore, the main goal of social entrepreneurs is to
achieve social and environmental goals (1). It should be noted that monetization does not conflict with
social entrepreneurship, and although social entrepreneurs are voluntarily active and have no material
vision, But it should not be overlooked in terms of income generation (11). In the last two decades, the
scope of nurses' work has expanded significantly at different levels of care with the development and
implementation of specialized and advanced nursing roles through new models of care. At the primary
care level, independent nursing and entrepreneurial nursing organizations In the field of community-
based care including health care, preventive care, training 1.Nurse entrepreneurs2.Advanced practice
nurses3.Nurse Intrapreneur

4 Health, maternal and child health care services such as family planning and vaccination (1). Also for
patients with common chronic problems such as hypertension, diabetes, asthma, chronic obstructive
pulmonary disease, depression and anxiety, low back pain, arthritis and thyroid dysfunction. Suffer,
provide care services (17.) The effectiveness of entrepreneurial nurses active in primary care is shown by
the studies, which found that 20 to 133% of clients were fully or very satisfied with the quality of care
provided (11, 12). The effectiveness and competence of entrepreneurial nurses in the second level of
care are also documented Establish small emergency room clinics (93), establish 1 public clinic in
Australia that provides both primary and secondary services using a full team of nurses, specialist
general practitioners, radiologists and dentists (91). And Australia's Smart9 clinics that are privately
funded and operated by nurses (1) reflect the activities of entrepreneurial nurses at secondary care
level, as well as tertiary care, including targeted care approaches that reduce the negative impact of
disease by restoring performance and The reduction in complications is related to, at heart clinics, a
Rheology, cancer and nursing care are provided by entrepreneurial nurses (90, 99). According to
estimates by the National Nurses Association, only 3.2% to 1% of nurses worldwide have
entrepreneurial roles (2.) The actual number in each country may be less or more. It is estimated that in
New Zealand this number is less than 3.1% (94%), in the United States 3.3% (14%) and in the United
Kingdom more than 11%. In Australia, the number is unknown, So in the Australian Health Workforce
Survey, there is no mention of self-employed nurses and their numbers seem to be low. The above
statistics show that throughout the history of nursing, there have been challenges and barriers to
nursing entrepreneurial innovation and organizational entrepreneurship (1). Ages, families, groups, and
communities, whether sick or healthy in all organizations, are often seen throughout the world as low-
level, less-educated, and less-developed workforce (92). Key to the development of health policies not
involved, health care teams not recognized as peer partners, and Self-employment barriers such as lack
of affordable, professional isolation, lack of secure and resistance and hostility from colleagues

Wilson's research has identified barriers to nursing entrepreneurship such as lack of role acceptance,
lack of public knowledge, lack of reimbursement of public and private insurance services costs, attitudes
of other professions, and other partners. Nurses 'private work, referral problems, lack of educational
support (91), service tariff problems and service recognition (97). In Leung's study, 9 high costs of
medical malpractice insurance, physicians' beliefs about the independent role of nurses, legal
restrictions ( 91) And in Austin's study 0 Problems introduce new ideas, lack of authority to change and
Adaptation to mechanisms such as developing relationships with empowered individuals and celebrities
has been proposed (92). In his study, Alango 4 identified three categories of barriers, including legal,
ethical and personal barriers, and knowledge barriers (03) and Sharp 2. In the field of nursing, business
skills, and the role of pay (01), the entrepreneurship process in Iran also faces many challenges. Despite
Article 44 of the Constitution, the government's role in reducing economic activities and transferring
them to the private sector is very challenging. (09), studies and comparisons of international statistics
show that overall the indicators of the Iranian business environment They are not favored and Iran can
be grouped into countries where the business environment is in poor condition. The ease of doing
business in recent years has always been a downward trend; Down from 131 in 9332 in 100 countries,
down 44 steps to 129 in 9314 in 112 countries. Seriously, the economy of the country needs the initial
support of the government and, in other words, the creation of an atmosphere Government greenhouse
is necessary and necessary for private sector (00.). Daryani et al. Consider entrepreneurship barriers in
Iran as legal, economic, marketing, supportive and technological, cultural and educational (4). In
Jafariannejad et al., Lack of sufficient knowledge of business management and management skills; Lack
of sufficient capital to start and maintain a business; Difficult to obtain essential information about
market, products and prices; Strict bank lending rules and difficulty in hiring staff. Good and reliable
have been identified as the most important barriers to entrepreneurship in Iran (02.) Navaseri and
colleagues studied two kinds of incentive and legal obstacles, including obstacles described as the most
important motivational barriers, fear of Loss of personal capital and of the most important legal barriers,
the strictness of traditional and banking laws and the complexity of state laws and regulations (01.) The
first step in the development of entrepreneurship is to promote entrepreneurial culture (07). It is a
culture of creativity, innovation, risk-taking, open communication, a clear vision, as well as ethical
leadership. Having these qualities in a team creates a powerful force that is the culture of
entrepreneurship (01). In other words, entrepreneurial culture is a collective planning by the mind in
which it is organized Value-orientated tendencies to entrepreneurial behaviors and traits (02.) This
culture advocates the need to change market economies and accept changes in demand, innovations,
products, opportunities, and technologies (43). Culture has been identified as one of the important and
effective factors in determining the level of entrepreneurship development in different societies (41), so
that cultural attitudes of individuals in different societies influence their entrepreneurial behaviors and
in some groups the relationship between culture and entrepreneurship. It is stronger (49.) in Iranian
society, despite many positive elements in religious ideal culture Where work is highly valued, there are
still values in the community that undermine work ethics and, consequently, entrepreneurship. The
importance of occupation and allocation of resources, the inheritance of family positions and the
utilization of resources. The rare, overwhelming value of dependence and personal loyalty on the
competence and expertise that constitutes the essence of the inherited political system in Iran are
among the factors at large levels of society and culture that conflict with work as a value in itself, and
entrepreneurship, creativity And it has weakened innovation, and the culture that wants to nurture
entrepreneurship has to be Also, the existence of values such as aristocracy, luxury, consumerism and
consumerism in the culture associated with the inherited political system have led to the death of
creativity and the birth of consumption, which should be the main cause of this wealth Nationalism and
its misguided and unjust use. On the other hand, in popular culture and religious beliefs, despite beliefs
such as disregard for worldly property, disparaging material motives, denouncing selfish behavior,
emphasizing worldly loyalty, and minimum subsistence, one cannot expect Extraordinary work and
effort like the countries of progress Also, economic flows in the past and people's access to the windfall
money during these changes have made money a commodity and a trophy that is not necessarily
achieved by doing business, but by intelligence, awareness, and more importantly. All "luck and fortune"
has more to do with it. These factors, along with oil revenues, have made money as a value.

7 self-sufficient and partly independent of work and more dependent on chance to undermine
entrepreneurship (40). Doreghie et al. Suggest that today many young people studying in universities
and science centers in the country They hope to enter the job market as soon as they graduate.
Unfortunately, the job market today has the minds of many young people and students in the country
with a number of predetermined positions, that is, a series of pre-made seats. Waiting for them in the
community setting (44.) In the study of Moghaddam et al. Social and cultural norms including the
tendency of the F Rad to Recruitment Jobs and Attitudes of Payroll Parents in this regard as cultural
barriers in Iran

self-sufficient and partly independent of work and more dependent on chance to undermine
entrepreneurship (40). Doreghie et al. Suggest that today many young people studying in universities
and science centers in the country They hope to enter the job market as soon as they graduate.
Unfortunately, the job market today has the minds of many young people and students in the country
with a number of predetermined positions, that is, a series of pre-made seats. Waiting for them in the
community setting (44.) In the study of Moghaddam et al. Social and cultural norms including the
tendency of the F Employment and the attitudes of paid parents have been identified as cultural barriers
in Iran (42). Culture change can be achieved through educational and promotional programs, and
positive attitudes to entrepreneurship in individuals need to be created in such a culture. Strengthen
(07.) Most scholars believe that entrepreneurship can be taught (41) and can be taught in different ways
and in different ways, that is, training is an important tool for transmitting entrepreneurial culture (47).
Entrepreneurship education, like the two open systems, affect each other, so that increasing
entrepreneurship education is more effective. Indicators of entrepreneurship culture result in the
growth and excellence of entrepreneurship and the institutionalization of its culture. On the other hand,
with the growth of entrepreneurship culture, the level of entrepreneurship education has also changed
and this interaction leads to economic growth and development (41). Or a set of activities that seek to
empower individuals to develop and develop their knowledge, skills, values, and understanding of
entrepreneurship and provide an introduction to entrepreneurship (Bohr and Porter, 47) believe that for
serious entrepreneurship development, Nursing, Nursing Education should Provide Opportunities to
Increase Students' Knowledge and Skills in Entrepreneurship They need traits such as being creative,
innovative, confident, motivated, energetic and hard-working and popular; and they need skills such as
planning, decision making, time management and communication skills (42 .) Liu and Danu 9 also believe
that nurses need training to enhance their skills in order to gain an equal working environment (23).
Therefore, training strategies should provide nurses with leadership roles for entrepreneurship and
organizational entrepreneurship. Prepare, coordinate, and deploy multidisciplinary approaches (1) but
study up to Ice shows in different periods of nursing development, design innovation and
entrepreneurship in nursing education have been avoided, because the dominant values of acceptance,
standardization and implementation of orders (21.) 1. Boore & Porter 2. Liu & D'Aunno

The 8 academic centers of medical education and related disciplines that nurture the potential resources
of the health system have a major responsibility for entrepreneurship development. Currently, the most
important ones in the country's academic system in general, and in medical universities in particular.
The approach and strategy is to change people's knowledge. In other words, universities are often
knowledge-based, meaning that students gain specialized knowledge in one area during their years in
universities. Developed countries to empower individuals to enter the business scene Entrepreneurial
teams are focused. The precondition for developing entrepreneurship in the health field is to equip
students and graduates with entrepreneurial skills and start-ups. The current situation is that students
of different medical sciences in the country, With a plethora of information and technical skills in their
field, they are coming to the market, but due to the limited capacity of public and private service centers
and lack of entrepreneurial and business skills, they have a long wait to find suitable jobs. There are
social, economic and emotional problems In general, the Entrepreneurial approach adopted by the Third
and Fourth Development Plans Laws to all devices has been partially overshadowed by job creation
programs at the country's medical universities, which are also affected by high unemployment rates. In
other words, entrepreneurial education, research, and promotion activities will not fade away, and the
results will not be the same. The surveys show the employment headquarters of medical sciences
universities that changed to entrepreneurship offices in 1012. Mainly in relation to providing financial
facilities Restricted to Medical Graduates (29.) Ahmadi and Najaf Abadi's research results showed that
19% of the sample of students who were undergraduates received no training in entrepreneurship.
Presentation by educators and current content is inappropriate to promote entrepreneurship and it is
imperative that new teaching methods be used to motivate and interest students instead of traditional
methods (20). In the study of Sharif et al., Entrepreneurs, managers, too. Entrepreneur and curriculum
specialists believed that head , Content, teaching and learning strategies, management practices and
monitoring and evaluation of entrepreneurship education is not in good condition

The development of entrepreneurship culture among nurses and their success in this area depends on
the proper education of nurses to enhance the skills, motivation and psychological characteristics of
entrepreneurship required. But studies by Wilson et al. The case of nursing entrepreneurship to make
informed changes in health policy and nursing education is limited (97, 22) and little research has been
done on the changes

There are 9 by entrepreneurial nurses in health organizations. There are also few research findings on
changing nursing education to innovate in the roles and practical guides to change in health systems
around the world (1). To identify the concept and process of nursing entrepreneurship, There is a need
for qualitative research with a basic theory approach to in-depth understanding of the entrepreneurship
phenomenon in nurses, in order to gain a basic and existing understanding of the nature or nature and
process of entrepreneurship in nurses. Effective to suit political, economic conditions, vol Such a model
can be a useful guide for nurses and nursing students to enter the entrepreneurial field, as well as a
suitable framework for nursing education planners to design nursing entrepreneurship curricula, and
health policy makers and planners. Provide policies and policies that facilitate and support the nursing
entrepreneurship process.

There are 9 by entrepreneurial nurses in health organizations. There are also few research findings on
changing nursing education to innovate in the roles and practical guides to change in health systems
around the world (1). To identify the concept and process of nursing entrepreneurship, There is a need
for qualitative research with a basic theory approach to in-depth understanding of the entrepreneurship
phenomenon in nurses, in order to gain a basic and existing understanding of the nature or nature and
process of entrepreneurship in nurses. Effective to suit political, economic conditions, vol Such a model
can be a practical guide for nurses and nursing students to enter the entrepreneurial field, as well as a
suitable framework for nursing education planners to design nursing entrepreneurship curricula, and
health policy makers and planners. Policies, policies and policies that facilitate and support the nursing
entrepreneurship process. Therefore, this study was conducted to "explain the entrepreneurship
process in Iranian nurses and provide an appropriate model in this field." - Explain Randy
Entrepreneurship in Nurses9-Designing the Entrepreneurial Model for Nurses2.2-1 Application
Objectives The practical purpose of this study is to design a suitable model of entrepreneurship for
nurses that will actually be an operational and applied form of theory developed.2-2-1 Research
Questions1-The Entrepreneurial Process in Nurses 9- What are the components and elements of the
Entrepreneurship Model appropriate for nurses?