Lecturer:

Ms. Pek Yah San

Nursing Programme
University Kuala Lumpur
Royal College of Medicine Perak

Subject Code and Name:

RND20603 COMMUNITY HEALTH NURSING

Written Assignment Title in Full:

Summary of Article entitled “Entrepreneurship in Nursing
Education” and “Rising to the Challenge of Healthcare Reform with
Entrepreneurial and Intrapreneurial Nursing Initiatives”

Student Name and Matrix No:

Xxxxxxxx

Due Date:
01 April 2020
TABLE OF CONTENTS

1.0 INTRODUCTION....................................................................................................1

2.0 SUMMARY OF ARTICLES......................................................................................2

2.1. Definition of Entrepreneurship..............................................................................2
2.2. Entrepreneurship in Nursing and Nursing Education...........................................2
2.3. Intrapreneurship in Nursing..................................................................................3
2.4. Global Challenges................................................................................................3
2.5. Barriers to Self-Employment................................................................................4
2.6. Healthcare Reform and the Future of Nursing.....................................................5
2.7. Setting for Nurse Entre/Intrapreneurship.............................................................5
2.7.1. Primary Care..................................................................................................5
2.7.2. Secondary Care.............................................................................................5
2.7.3. Tertiary Care..................................................................................................5

3.0 CONCLUSION.........................................................................................................6

4.0 REFERENCE...........................................................................................................7
1.0 INTRODUCTION

A health infrastructure that is adequately funded delivers relevant care and is

supported by a workforce suited to the population’s health care needs is,
therefore, essential to the delivery of high-quality care. In spite of the immense and
significant role that nurses play in the health care system, they are seldom
considered equal partners in multidisciplinary health care teams.

However, in order to deliver these outcomes, it is essential for nurses to

practice to the full extent of their knowledge and training while transforming the
way in which health care is provided by entering into full partnerships with other
health care professionals. These expanded roles have been implemented in
multiple care settings across the continuum of care from community or public
health services and primary care, to acute care, and supportive or long-term care.
For this purpose, by generating opinions for resolving the health problems and
integrating new opinions, entrepreneurship principles must have been used in the
studies of health improvement and disease prevention (Dolu et al.,2016).

Nurses who are the practitioners of all levels of the health care
system (protection, improvement, treatment, care and rehabilitation of health) are
required to renew themselves in accordance with the scientific, technological,
economic, social and social changes and improvements in order to fulfil these
requirements (ICN 2009). Nursing education has become compulsory in order to
carry out entrepreneurship strategies to raise qualified nurses who are capable of
fulfilling the requirements in changes and improvements (Başar et al., 2015; Dil et
al., 2012; Şen et al., 2013).

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2.0 SUMMARY OF ARTICLES

2.1. Definition of Entrepreneurship

When we examine the literature, it is seen that many definitions of

entrepreneurship have been made. Entrepreneurship has been defined by
many researchers in the field of economy, sociology and psychology.
Entrepreneurship is defined as the institutionalization or the development
of something in order to provide benefits to the individuals and society .
Entrepreneurship is also defined as the fact that the entrepreneurs take
risks, look for the opportunities, cover the entire process of innovation .
With regard to the widely used definition of the European Commission ,
Entrepreneurship represents the ability of an individual to transform
opinions into action. That is to say, it involves creativity, innovation and
risk taking in addition to the ability to plan and manage projects to reach
the objectives

2.2. Entrepreneurship in Nursing and Nursing Education

The healthcare system with a great variety of areas enables nurses to

provide professional services and to provide a variety of activities as
experts. Thus, nurse entrepreneur is not a new concept . Nurses worked
freely to provide patients with at the beginning of the 20th century. The
patient care practices have changed in the later years. The focus of
nursing has extended since the mid-1960s. The nursing profession has
contributed to the protection, development and correction of health in
addition the knowledge, skills and confidence required to combine medical
administration. Within the context of the health services, entrepreneurial
nurses may be regarded as health and social care professionals who take
innovative steps, develop the outcomes of patient care and decrease the
health care costs. Among many definitions about the entrepreneurs nurses
in the literature, patient care and practice with the nurse control are the
most important definitions.

A professional nurse entrepreneur is a person who determines a

patient's requirement and envisages how that requirement can be
responded by nursing effectively, and then formulates and implements a
plan to fulfil that requirement. As entrepreneurs, nurses are innovative
powers within the healthcare sector for developing and producing new
approaches to fulfil patients' requirements. It was considered by nurse
teachers that entrepreneurship education was important in nursing

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 education.

It has been stated by Diekelmann that the majority of nurse

trainers keep going to teach the same subjects that no longer have places
within the health care system despite the significant changes in the health
care systems and nursing practices. Hence, a remarkable reform and
innovation should be made in nursing education leadership in the future
nursing practices. With respect to the utilization of entrepreneurship
principles in resolving the health problems, innovative and creative nurse
entrepreneurs along with the early identification of health problems and
the application of efficient care approaches, entrepreneurial education in
the nursing curriculum is significant. The fact that the nursing education
programs should produce entrepreneurial professional development that
will allow nurses to introduce programs, that will contribute to enhanced
health and health care was stated in the crucial The Future of Nursing
report in the United States.

2.3. Intrapreneurship in Nursing

Within the context of the health services, entrepreneurial nurses may be

regarded as health and social care professionals who take innovative
steps, develop the outcomes of patient care and decrease the health care
costs. As entrepreneurs, nurses are innovative powers within the
healthcare sector for developing and producing new approaches to fulfil
patients' requirements. Several types of nurses’ entrepreneurs are
available in various specialties such as acute care, gerontology, ostomy-
wound and home health. Nursing entrepreneurship provides nurses with
self-employment opportunities which allow them to pursue their personal
vision and passion to improve health outcomes using innovative
approaches.

Combining these characteristics with advanced or specialist skills and

knowledge, at the very least, entrepreneurial nurses are advanced
practice nurses who create products or services which they can market to
external sources entrée/ intrapreneurial nurses will generally operate at an
advanced level due to the application of a highly developed set of
knowledge and skills a nurse intrapreneur is a salaried employee, often of
a government run health service, who develops, promotes, and delivers an
innovative health or nursing service within a health care setting, such as
hospital or nurse-led clinic entrée- and intrapreneurship is defined
differently across professions and countries.

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 In contrast to an entrepreneur, a nurse intrapreneur is a salaried
employee, often of a government run health service, who
develops, promotes, and delivers an innovative health or nursing service
within a health care setting, such as hospital or nurse-led clinic . Nurse
intrapreneurs develop innovative health practices from within the
organisational framework in which they work, and consequently share the
risks and benefits associated with this innovative practice with their
employer. Intrapreneurs are often motivated by the needs of their patients
to identify gaps in service that can be addressed through the determined
work of a health care team that may or may not include themselves.

2.4. Global Challenges

The need for healthcare reform globally remains a priority. Nevertheless,

the largest group of health providers – the nursing and midwifery
workforce – is, on a global level, understaffed, undertrained, and poorly
deployed. Nursing’s scope encompasses: autonomous and collaborative
care of individuals of all ages, families, groups and communities, sick or
well and in all settings. Consequently, nurses are well able to be frontline
service providers acting both as individuals and as members and
coordinators of interprofessional teams. In spite of the breadth of services
provided by nurses, nursing insight into health needs across the
continuum, and recognition that nurses and midwives are pivotal to health
services, nurses and midwives are not often identified as key stakeholders
in the development of health policy.

2.5. Barriers to Self-Employment

For nurses to be full partners with other health professionals, ignorance

and confusion about their role and relationship with other care providers,
fiscal issues affecting fee setting and client reimbursement, and legal
issues need to be addressed. Studies undertaken in 2002, and 2004
indicated that research into entrepreneurial nursing remains limited and
insufficient to inform changes to health policy and nurse education.
Barriers to self-employment for nurses remain. Lack of recognition such as
that afforded to other self-employed health service providers continues
along with professional isolation, lack of a safety net, and resistance or
hostility from colleagues.
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2.6. Healthcare Reform and the Future of Nursing

The Future of Nursing report identified that nurses, working at the forefront

of patient care, can play a vital role in helping to realize objectives to make
health care accessible, acceptable, and affordable. Before this can
occur, barriers to prevent nurses from responding effectively to rapidly
changing health care settings and an evolving health care system need to
be addressed. Then nurses will be even better positioned to lead change
and advance health. Barriers include nurses’ inability to practice to their
full extent, lack of access to an education system that allows for seamless
progression to higher levels, and lack of opportunity for full partnership
with other healthcare professionals.

Other needs are improved research, better data collection, and

information infrastructure on health care workforce requirements.

2.7. Setting for Nurse Entre/Intrapreneurship

Three paradigms encompass the health care services provided across the
continuum of care. An arrangement of preventive public health
services, primary care outpatient clinics, local general hospitals, and
regional hospitals with intensive and specialty care units is embedded in
the array of services. Within each of these health care sectors, there are a
range of services available both internally and, to a lesser
extent, externally to address community health and wellness
needs. Although many individuals access these services in one
setting, there are few populations which benefit from care across the three
settings in a short period of time.

Older persons often suffer from co-morbid and chronic

illnesses and therefore require access to services across this continuum of
care. These services may often be initially delivered through home health
agencies, followed by assisted living, and then care in a skilled nursing
facility as the patient’s health declines. In practice, the services may
overlap, especially primary and secondary care settings, and this patient
may access care in a more circular fashion depending on need for
services.

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2.7.1. Primary Care

Nurses play a vital role throughout the continuum of care and work in both
entrepreneurial and intrapreneurial roles to serve the primary care needs of
the community. In the context of global population aging, with increasing
numbers of older adults at greater risk of chronic, non-communicable
diseases, rapidly increasing demand for primary care services is expected
around the world. In primary care, intrapreneurial nurses work in the local
community as a first point of consultation, providing routine health
screening, preventive care, and health education to avoid the occurrence of
disease. In primary care, nurses with advanced or specialist qualifications
often provide care through nurse-led community health clinics.

Nurse intrapreneurs have been involved in producing more

effective primary care through programs such as that developed by Mary
Naylor and Karen Buhler-Wilkersen who developed an innovative program
for improving elder care in their community. The success of this program is
indicative of the power that intra- and socially entrepreneurial nurses have in
building and sustaining primary care services. The effectiveness of
intra/entrepreneurial nurses working in primary care has been demonstrated
in studies which found that 93 to 100% of clients were completely or very
satisfied with the quality of care provided. The introduction of entre- and
intrapreneurial roles into the primary care setting is expected to result in
even more timely access to services.

This will thereby increase the efficiency and economy of this first
step in the health care system and subsequently reduce pressure on the
system at higher levels of care. One way that health care reform efforts in
multiple countries are moving toward this goal is through the introduction of
nurse practitioners to expand the primary care workforce. These initiatives
have been recognised as a feasible and effective solution to ease the
shortage of primary care physicians in many countries. An additional
consideration is that patients report more satisfaction with using primary
care practice settings than secondary care services to treat non-life
threatening conditions.

2.7.2. Secondary Care

Secondary care may be provided in the community or in a hospital and

similar settings. The focus of this care is typically treatment for short-term
acute illnesses, injury, or other health conditions in order to diagnose and
treat disease in the early stages before it causes morbidity. Case finding is

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 performed using a simple screening assessment completed by the primary
or triage nurse followed by an in-depth interview by a geriatric clinical
nurse specialist. Patients with unmet medical, social, or health needs are
referred to their primary physicians, to outpatient geriatric evaluation and
management centres, or to community agencies.

These clinics offer an increased connection to everyday care by

locating in easy to access locations and operating outside normal
business hours. Every Smart Clinic NP holds a Masters of Nursing
degree, nurse practitioner endorsement, and is registered with the
Australian Health Practitioner Regulation Agency. The care patients
receive at Smart Clinics is purportedly underpinned by current evidence-
based clinical guidelines, all of which are defined by their Chief Medical
Officer.

2.7.3. Tertiary Care

Tertiary care is specialized consultative health care, usually for inpatients

in a facility such as an acute hospital that has personnel and facilities for
advanced medical investigation and treatment. Nurses in tertiary care
generally do not have first contact with patients, and services may include
cardiology clinics, urology, oncology, and burn treatment, and elder care
facilities. A systematic review summarising the evidence of seven
randomised controlled trials reported that, although there were no harmful
effects identified in patients with coronary heart disease exposed to a
nurse-led clinic, inconsistencies in the interventions used made
comparison difficult. The major intervention consisted of health
education, counselling behaviour change, and promotion of a healthy
lifestyle.

To provide services that meet individuals’ needs, and are equitable and

economical, both of these approaches are required. One issue for
intrapreneurial nurses working within an organization where tertiary care is
provided is dealing with a hierarchy in which doctors are over represented
in policy formation and senior management positions.

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3.0 CONCLUSION

These examples of nurse entre- and intrapreneurs working in primary,

secondary, and tertiary care demonstrate potential benefits to patients and the
variety of settings for nurse entre/ intrapreneurs. Patients value the problem
solving approach and advocacy that nurses provide, while nurses feel support for
their care and enjoy providing continuity of care (Caffrey, 2005).

Some nurses are already working in entre- and intrapreneurial roles

which demonstrate the positive outcomes that can be achieved when nurses
meet their full potential. Some nurses are already working in entre- and
intrapreneurial roles which demonstrate the positive outcomes that can be
achieved when nurses meet their full potential.

It seems obvious that entrepreneurial nursing roles are forging the way
for this type of partnership by examples of nurses conducting clinics in primary
and secondary care and as specialists to manage exacerbations of chronic
illness in tertiary care settings. Given the full potential scope of nurses' practice,
the success of health system reforms (such as those in the United States and
Australia) depend on a nursing workforce that is appropriately educated and
supported for innovative practice roles in multiple settings.

When the results of these studies are taken into account, the programs
regarding creativity and entrepreneurship in patient care should be included in
nursing education curricula for the development of entrepreneurship in nursing,
and it should be ensured by nursing education that students are provided with
the opportunity to develop the necessary knowledge and skills.

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4.0 REFERENCE

Culha, Yeliz, Karaman Turan, & Kaya, Hatice. (2017). Entrepreneurship in nursing
education. Pressacademia. 4. 50-53. 10.17261/Pressacademia.2017.516.
Wilson, A., Whitaker, N., Whitford, D. (May 31, 2012) "Rising to the Challenge of Health
Care Reform with Entrepreneurial and Intrapreneurial Nursing Initiatives" OJIN: The
Online Journal of Issues in Nursing Vol. 17, No. 2, Manuscript 5. Retrieved from
https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJI
N/TableofContents/Vol-17-2012/No2-May-2012/Rising-to-the-Challenge-of-Reform.html