Int Entrep Manag J (2019) 15:733–748

https://doi.org/10.1007/s11365-018-0520-9

Effects of traits, self-motivation and managerial skills

on nursing intrapreneurship

Carla S. Marques 1 & Carlos P. Marques 1 &

João J. M. Ferreira 2 & Fernando A. F. Ferreira 3

Published online: 14 April 2018

# Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract Following the introduction of quasi-markets into publicly funded healthcare

systems, nurse intrapreneurs who create innovations within these systems have become
increasingly important to improving healthcare outputs. This study sought to examine
how self-motivation and managerial skills mediate the influence of entrepreneurial
traits on nurses’ intrapreneurial intentions in the Portuguese National Health Service.
A structural equation model was assessed using primary data collected from a sample
of 536 nurses working at seven public hospitals in Portugal. The results suggest that
nurses who are more determined to become intrapreneurs are more likely to take risks,
more self-confident about their managerial skills and slightly more self-motivated. In
addition, while innovativeness has no significant effect, proactivity contributes to
increasing nurses’ self-confidence in their own skills.

* João J. M. Ferreira
jjmf@ubi.pt

Carla S. Marques
smarques@utad.pt
Carlos P. Marques
cmarques@utad.pt
Fernando A. F. Ferreira
fernando.alberto.ferreira@iscte.pt; fernando.ferreira@memphis.edu

1
Department of Economics, Sociology and Management & CETRAD Research Unit, University of
Trás-os-Montes and Alto Douro, Vila Real, Portugal
2
Department of Business and Economics & NECE Research Unit, University of Beira Interior,
Covilhã, Portugal
3
ISCTE Business School, BRU-IUL, University Institute of Lisbon, Portugal & Fogelman College
of Business and Economics, University of Memphis, Memphis, TN 38152-3120, USA
734 Int Entrep Manag J (2019) 15:733–748

Keywords Individual entrepreneurial orientation . intrapreneurial intention . nursing

intrapreneurship . entrepreneurial skills . self-motivation

Introduction

Intrapreneurship is fundamental to the survival of organizations through constant

innovation that translates into, among other options, the development of new products
and services or the conquest of new markets. In this context, organizations must have
employees with intrapreneurial behaviors and recognize their staff’s entrepreneurial
potential, attitudes and contributions to entrepreneurship within the organization.
Understanding how these employees intend and decide to show these behaviors and
how organizations can facilitate them has become increasingly important for managers.
In organizations that provide health services, particularly in countries where the
public sector is crucial in healthcare, intrapreneurship has become increasingly impor-
tant following the introduction of quasi-markets into the public sector (Ennew et al.
1998). Nursing practices are still changing due to the evolution of medicine, policy
directives, priorities of what to alter in health and advances in medical research and
nursing. Therefore, entrepreneurial nurses are needed to improve the quality of
healthcare outputs within the health system. Healthcare organizations need to encour-
age nurses’ autonomy and development of ideas without fear of failure and with the
support of top management (Boore and Porter 2011).
The concept of intrapreneurship started to become popular about 30 years ago and,
although still underexplored, it has become increasingly widespread and valued in
organizations and empirical studies (Rodrigues 2010). A wide range of studies carried
out over the last 15 years have focused on researching the nature and dimensions of
intrapreneurship, as well as its antecedents and implications for organizational perfor-
mance (Antoncic and Hisrich 2003; Huse 2007; Teng 2007; Kearney et al. 2008; Zahra
and Hayton 2008; García-Morales et al. 2014).
Many organizations over the past few years have sought to renew themselves by
taking advantage of the rapid development of new technologies, new customer require-
ments for services and higher quality products and patterns in the intensified globali-
zation of markets. Organizations that are ready for the new and constant challenges of
their market have more skills to deal with sustained global competitiveness (Ascalon
and Moriano 2008; Jaén and Liñan 2013; Rojas et al. 2013). In this context of increased
demands, intrapreneurship has gained importance as a natural consequence of entre-
preneurship, which is promoted as a healthy response to the business challenges of the
new millennium (Bosma et al. 2010; Dabić et al. 2011; Urbano et al. 2013).
One of the definitions that best fits the term entrepreneur is an individual who starts
and/or operates a business to carry out a personal idea or project, taking risks and
responsibilities and innovating continuously (Gartner 1989). However, the entrepreneurial
spirit is also present in all people who, even without starting businesses, are interested in
and focused on taking risks and innovating continuously. These individuals are intrapre-
neurs (Sayeed and Gazdar 2003; Parker 2011; Gündoğdu 2012). The idea of being an
entrepreneur without creating a company was developed by Pinchot (1985), who argued
that employees with a higher propensity to innovate and create can do this in a more
favorable environment with the right human, material and financial resources, and that this
Int Entrep Manag J (2019) 15:733–748 735

can happen without starting a new company. To the cited author, intrapreneurs are
Bdreamers who do^, combining a long-term vision with a strong disposition to act.
Manion (1990) defines a nurse intrapreneur as Bone who creates innovation within
the healthcare organization through the introduction of a new product, a different
service or simply a new way of doing something^ (p. 2). For intrapreneurship to flourish
in healthcare organizations, management must be supportive of initiative, innovation
and change (Lages et al. 2017). Notably, early papers on nurse intra- and entrepreneur-
ship pointed out that entrepreneurship (i.e. leaving the organization) could be the result
of a poor work climate and unsupportive management. Intrapreneurship (i.e. staying
with the organization) may result from management’s recognition and reward of nurses’
intrapreneurial attitudes and behaviors (Cornell 1987). Besides organizational facilita-
tors and constraints, a disposition to intrapreneurship may also depend on sociocultural
variables and individual factors, such as demographics, psychographics and particularly
personality traits (Sinha and Srivastava 2013; Marques et al. 2018).
The interesting idea that some personality dispositions favor entrepreneurship has
led to diverse studies resulting in contradictory conclusions that may be due to
theoretical and methodological divergences. These include trait selection, mediation
effects, moderations from situational contingencies and definitions of outcomes as
intention, behavior or performance (Rauch and Frese 2007). The present study adopts
the conceptualization linking specific personality traits to business creation and venture
success (Baum and Locke 2004; Rauch and Frese 2007). On the one hand, we
particularize the approach by choosing the traits (i.e. entrepreneurial orientation) and
the mediators (i.e. individuals’ motivational factors and perceptions of their own skills).
One the other hand, we generalize the approach by extending the application and
explain intrapreneurial intentions in public organizations. The subjects are nurses who
work at seven public healthcare organizations in northern Portugal.
This article comprises five sections. In the second, we explain the theoretical basis of
the relationship between traits, motivations, skills and intentions. The third section
describes the methodology. In the fourth section, we present the results, while the last
section addresses the main conclusions and implications of this research.

Relationship between intrapreneurial traits and intentions

Several authors (e.g. Zhang et al. 2008; Zahra et al. 2009; Burgess 2013) have
discussed the factors that influence the implementation of intrapreneurship. Despite
the lack of consensus in the previous studies, the respective contributions can be
grouped into two categories. These are: (1) organizational factors related to organiza-
tional culture and management practices that favor knowledge-sharing, creativity,
innovation and change; and (2) individual factors mainly related to attitudes and skills
that result in innovation and change at the level of work teams, departments or even
organizations. The present study only addresses individual antecedents of intrapreneur-
ial intentions based on the theoretical relationship between traits and intentions, either
directly or through the mediating effect of motivations and skills.
Early work on entrepreneurship and intrapreneurship in nurses reported that these
professionals are traditionally regarded as tending to have the traits usually associated with
intrapreneurial intention, such as devising creative ways to reduce costs and making
736 Int Entrep Manag J (2019) 15:733–748

suggestions to improve care (Cornell 1987). One of the first books specifically dedicated to
this subject (Manion 1990) emphasizes that nurse intrapreneurs are innovative, risk-taking
(i.e. traits) and self-motivated (i.e. motivation), and they need to be good time managers,
negotiators and leaders (i.e. management skills). More recent research has examined the
idea that competencies and other individual factors such as motivations and attitudes
mediate the influence of personality traits on intrapreneurial behavior. For example, in a
comparative study, Bager et al. (2010) point out that intrapreneurs are more action-oriented
and competent than entrepreneurs. However, Douglas and Fitzsimmons (2013) suggest
that intrapreneurs may lack entrepreneurial self-efficacy; that is, they feel less able to
control the factors involved in business creation.
To operationalize the ideas developed for the present study, we designated not
intrapreneur behavior, but instead intention as a dependent variable. This can be defined
in this research context as nurses’ willingness to engage in entrepreneurial behaviors
while employed by healthcare organizations (Douglas and Fitzsimmons 2013). We
believe that this intention may depend on the same specific personality traits that favor
entrepreneurship, namely, individual entrepreneurial orientation (IEO) (Vantilborgh
et al. 2015) and nurses’ perceptions of their self-motivation and management skills.
This conceptualization is consistent with the results of the meta-analysis performed by
Zhao et al. (2010), who showed that entrepreneurial intentions are positively influenced
by some general traits such as emotional stability, but that this intention is much more
strongly influenced by specific traits, including risk-taking.

IEO

Entrepreneurial orientation (EO) has been studied at the organizational and individual
levels. In organizations, it can be defined as organizational decision-making proclivities
favoring entrepreneurial activities (Covin and Wales 2012). Risk-taking, proactivity
and innovativeness have been the main dimensions used to measure organizational EO
(Lumpkin and Dess 1996; Zahra and Neubaum 1998; Cools and Van den Broeck 2007;
Ferreira 2010; Pearce et al. 2010). Some other facets such as autonomy and market
aggressiveness (Lumpkin and Dess 1996; Pearce et al. 2010) have occasionally been
added to these three core dimensions.
IEO, in turn, is conceptualized as a set of specific personality traits (Rauch and Frese
2007) that favor intra or entrepreneurial behaviors. The dimensions are the same as
those used to measure EO in organizations, but measurement items have been adapted
for personality traits. Vantilborgh et al. (2015) used the five dimensions described
above and came to the conclusion that risk-taking, proactivity and innovativeness
differentiate entrepreneurs from non-entrepreneurs, while autonomy and competitive-
ness do not. Similarly, Bolton and Lane (2012), when validating their scale for
measuring IEO, dropped the two latter dimensions and concluded that innovativeness,
risk-taking and proactivity are the only valid and reliable facets of IEO.
The research relating EO to individual traits has tended to demonstrate that person-
ality, along with other traits such as workers’ cognitive styles, influences EO (Cools
and Van den Broeck 2007). This idea was recently applied in the context of healthcare
organizations by Lages et al. (2017) and Marques et al. (2018). However, when
studying IEO, personality needs to be considered an antecedent of both intention
(Bolton and Lane 2012; Koe 2016) and behavior (Vantilborgh et al. 2015). On a
Int Entrep Manag J (2019) 15:733–748 737

conceptual level, IEO logically plays a key role in the development of intrapreneurship.
As suggested by Wiklund (1998), individual entrepreneurial behavior affects organi-
zational innovation. In addition, IEO leads workers to recognize, explore and develop
business opportunities within organizations (Kollmann et al. 2007). Thus, we formulate
the following research hypothesis:

H1: IEO positively affects nurses’ intrapreneurial intentions.

Self-motivation

Several motivational theories and factors have been used to explain antecedents of
entrepreneurial intentions and behaviors (Edelman et al. 2010; Solesvik 2013; Fayolle
et al. 2014). In the case of intrapreneurship, self-motivation and autonomy have been
highlighted as facilitating factors, although other variables linked to incentives are also
frequently studied (Wunderer 2001; Amo 2006; Franco and Pinto 2017). Chan et al.
(2017) found that intrapreneurial motivation is dependent on self-directed career
motivation, namely the motivations to develop expertise and be a respected
professional, and to lead and control. Wunderer (2001) specifically underlines the great
importance of self-related variables – namely, employees’ ability to use self-initiative,
self-organization and self-motivation – as enablers of entrepreneurial attitudes and
behaviors. These findings led to the second research hypothesis:

H2: Self-motivation positively affects nurses’ intrapreneurial intentions.

Most studies on IEO applied to the health sector present motivation as an antecedent
of IEO (e.g. Lages et al. 2017; Malik et al. 2016; Marques et al. 2018). However, the
present study was based on Vantilborgh et al. (2015) approach and especially Baum and
Locke’s (2004) model, so we focused on the relationship between specific traits and
entrepreneurial outcomes. We therefore reversed this relationship to develop the fol-
lowing hypothesis:

H3: IEO positively affects nurses’ self-motivation.

If IEO positively influences motivation, and this in turn positively influences

intrapreneurial intention, part of IEO’s effect on intrapreneurial intentions can be
mediated by motivation. This led to the next hypothesis:

H4: Self-motivation partially mediates the effect of IEO on nurses’ intrapreneurial

intentions.

Entrepreneurial skills

Capacity is quality performance that does not depend fundamentally on individuals

themselves (i.e. innate ability), but needs to be developed through training, practice and
experience. Entrepreneurial skills are basic capacities needed to enable individuals to
738 Int Entrep Manag J (2019) 15:733–748

start and develop a business successfully (Adeyemo 2009). Arowomole (2000) iden-
tified the lack of entrepreneurial skills as a strong inhibitor of intention, while Liñán
(2008) established a positive relationship between these two variables. According to the
latter cited author, people who believe they have more entrepreneurial skills also score
higher in self-confidence and self-efficacy (i.e. perceived behavioral control) regarding
entrepreneurship. In addition, these individuals tend to have more positive attitudes (i.e.
feel more attracted) toward entrepreneurship. These two effects combine to favor
entrepreneurial intentions. In addition, Watchravesringkan et al. (2013) found that
perceived skills positively mediate the relationship between traits (i.e. values) and
intentions regarding an entrepreneurial career.
Intrapreneurship in healthcare has been linked to some of the entrepreneurial skills
identified by Liñán (2008), such as leadership and communication (Manion 1990) or
creativity (Hewison & Badger, 2006). We thus formulated the following hypothesis:

H5: Perceived entrepreneurial skills positively affect nurses’ intrapreneurial

intentions.

According to Rauch and Frese (2007), knowledge and skills relevant to entrepre-
neurship can be affected by personality traits. With even greater statistical significance,
traits related to openness to new experiences and, more specifically, connected with
innovativeness are good predictors of subjective knowledge (Flynn and Goldsmith
1999). Furthermore, autonomy, proactivity and involvement increase individuals’
positive perceptions of their skills (Csíkszentmihályi 1990). This led to the next
research hypothesis:

H6: IEO positively affects nurses’ perceptions of their entrepreneurial skills.

Since IEO positively influences entrepreneurial skills, and these also positively
influence intrapreneurial intentions, we could further formulate the following
hypothesis:

H7: Nurses’ positive perception of their entrepreneurial skills partially mediates

the effect of IEO on these nurses’ intrapreneurial intentions.

Management training

Several studies mention the importance of education and training for entrepreneurial
intent and behavior (Liñán and Fayolle 2015). For example, Liñán et al. (2011)
consider education to be one of the main determinants of entrepreneurial intention. A
recent meta-analysis (Bae et al. 2014) provided support for a positive link between
entrepreneurship education and entrepreneurial intent. Bjornali and Støren (2012) argue
that entrepreneurship education promotes not only entrepreneurial behavior, but also
intrapreneurial behavior. Education for entrepreneurship is currently a component
included in the curricula of programs in various scientific areas, although it is more
present in management training courses, especially postgraduate courses in health
services management. This training has been identified by various researchers as
Int Entrep Manag J (2019) 15:733–748 739

encouraging individual entrepreneurial skills and competences, with positive implica-

tions for the performance of organizations and economies (e.g. Farashah 2013; Díaz-
García et al. 2015; Lindh and Thorgren 2016).
Although formal education is not needed to create a business or develop innovation,
management training is positively related to the success of these activities (Colombo
and Grilli 2005). In the field of nursing intrapreneurship, Hewison and Badger (2006)
argue that nursing education should prepare nurses to be more risk-taking and more
confident in their skills. Thus, we formulated the following hypothesis:

H8: Management training positively affects nurses’ intrapreneurial intentions.

Management education, particularly education for entrepreneurship, can be said to

be not just about knowing how to start a business, but also going through a process that
helps to develop skills and entrepreneurial attitudes (Fayolle and Klandt 2006; Fayolle
and Gailly 2015; Piperopoulos and Dimov 2016). Management training also contrib-
utes to improving trainees’ perceptions of their entrepreneurial abilities (Chen et al.
1998; Wilson et al. 2007; Sánchez 2013; Watchravesringkan et al. 2013). Based on
these findings, we developed the next research hypothesis:

H9: Management training positively affects nurses’ perceptions of their entrepre-

neurial skills.

If training in management positively affects nurses’ perception of their entrepre-

neurial skills, and these in turn also positively influence intrapreneurial intentions, we
also needed to formulate the following hypothesis:

H10: Nurses’ perception of their entrepreneurial skills partially mediates the effect
of management training on these nurses’ intrapreneurial intentions.

Conceptual research model

Based on the study’s aims and the research hypotheses developed from the literature,
the conceptual research model shown in Fig. 1 was developed.

Methodology

In order to evaluate the model in Fig. 1 empirically, a questionnaire was admin-

istered to nurses from seven public hospitals in the north of Portugal. The
variables were operationalized through scales already validated in previous stud-
ies, although not all had been applied to the health sector. We used Bolton and
Lane’s (2012) scale to measure IEO and adapted Liñán and Chen’s (2009) scale
for intrapreneurial intention. Self-motivation was measured based on previous
studies of health services (Marques et al. 2013; Lages et al. 2017; Marques
et al. 2018). The entrepreneurial skills scale was originally developed by Liñán
(2008) and translated and retranslated for this study.
740 Int Entrep Manag J (2019) 15:733–748

IEO

Risk-taking
Self-motivation H4
H2
H3
Intrapreneurial
H1
Intention
Innovativeness H6 H5
H7
Entrepreneurial H10
Skills

H8
Proactivity
H9 Training

Fig. 1 Conceptual research model

All items were measured on five-point Likert-type scales, including frequency for
intrapreneurial intention (1 = ‘Never’; 5 = ‘Always’); aptitude for entrepreneurial skills
(1 = ‘No aptitude at all’; 5 = ‘Full aptitude’); and ranging from disagreement (1 =
‘Completely disagree’) to agreement (5 = ‘Completely agree’) for IEO and self-
motivation. Before using structural equation modelling to evaluate the model in Fig.
1, confirmatory factor analysis of all latent variables was performed in order to assess
the validity and reliability of their respective measures. In doing so, we followed the
guidelines provided by Fornell and Larcker (1981) and Mackenzie et al. (2011).
In the first half of 2016, 1,384 questionnaires were distributed to nurses in seven
public hospitals located in the north of Portugal, and 638 completed questionnaires
(46%) were collected. Only the 536 questionnaires (38.7%) containing responses to all
latent variable items were considered in this study. Table 1 summarizes the key
characteristics of the respondents. In most cases, they were women (78%) over 35
(70%) with nursing licenses (85%) and permanent employment contracts (87%). Less
than one-fifth (18%) said they had management training.

Results

Measurement model

Following Mackenzie et al. (2011), we eliminated the problematic indicators for the six latent
variables presented in Fig. 1 by using confirmatory factor analysis. This eliminated an item
from the innovation dimension (i.e. BI usually like to try new and unusual activities but not
necessarily risky ones^), because it presented a modification index that suggested a mea-
surement error term correlated with items of the risk dimension. In addition, one item of
entrepreneurial skills (i.e. Brecognition of opportunities^) had to be taken out because it had a
communality of less than 50%. The six latent variables were thus measured by 23 indicators.
This measurement model has acceptable indexes of goodness of fit: χ2/d.f. = 2.74;
comparative fit index = 0.963; goodness of fit index = 0.917; and root mean square
error of approximation = 0.057. As can be seen in Table 2, all variables have excellent
Int Entrep Manag J (2019) 15:733–748 741

Table 1 Sample characterization

Absolute frequencies (n) Relative frequencies (%)

Gender
Man 108 20.1
Woman 419 78.2
Missing 9 1.7
Age
< 25 years 9 1.7
Between 26 and 35 years 153 28.5
> 35 years 373 69.6
Missing 1 0.2
Education
Less than a bachelor’s degree 6 1.1
Bachelor’s degree 455 84.9
Master’s degree 70 13.1
Doctorate 1 0.2
Missing 4 0.7
Management training
Yes 98 18.3
No 438 81.7
Employment status
Permanent contract 465 86.8
Fixed-term contract 61 11.4
Provision of services 3 0.6
Missing 7 1.3

reliability indexes equal to or greater than 0.8. According to Fornell and Larcker
(1981), a measure has convergent validity when the average of communalities is greater
than 50%. This index, also known as the average extracted variance, varies between a
minimum of 57% and a maximum of 86% (see Table 2), meaning that all measures
have convergent validity. The cited authors also suggest that the latent variables of a
model have discriminant validity when the average of the factor loadings of each
variable (see the diagonal of the correlation matrix in Table 2) is higher than any
correlation with other variables. Therefore, not only the one-dimensional concepts of
the model, but also the three dimensions of IEO, are distinguishable from each other.
In summary, after taking out two items, the measurements of the latent variables
present good indications of validity and reliability. This is true both when considering
the items and when considering the dimensions they measure (Mackenzie et al. 2011)

Structural model

Once the validity of the measures of the six latent variables was established, the
empirical evaluation of the conceptual model could continue with the addition of the
dichotomous variable representing management training (see Fig. 2). The conceptual
model can be considered a mediation model, since we were interested in verifying
742 Int Entrep Manag J (2019) 15:733–748

Table 2 Scale reliability and validity

Correlation matrix

Variable No of items CR AVE Risk Innov. Proact. Self. Skills Intra.Int.

Risk 3 0.796 0.566 0.752
Innovation 3 0.809 0.585 0.681 0.765
Proactivity 3 0.797 0.567 0.547 0.673 0.753
Self-motivation 4 0.902 0.699 0.357 0.360 0.355 0.836
Skills 5 0.906 0.658 0.558 0.493 0.519 0.300 0.811
Intrapreneurial intention 5 0.968 0.859 0.555 0.353 0.368 0.320 0.475 0.927

N, number; CR, composite reliability (Fornell and Larcker 1981); AVE, average variance extracted; Innov.,
innovation; Proact., proactivity; Intra.Int., intrapreneurial intention; values in the diagonal of correlation
matrix are average factor loadings

whether the four exogenous variables (i.e. three dimensions of IEO and management
training) have a direct effect on the dependent variable (i.e. intrapreneurial intention)
and/or if the respective effects are mediated by self-motivation and entrepreneurial
skills. This mediation model was evaluated following Shrout and Bolger’s (2002)
guidelines.
Thus, in addition to the relationships between the mediator and dependent variables
and between the mediator and exogenous variables, the direct relationships between the
exogenous and independent variables were estimated. We used bootstrapping with 2,000
samples to estimate the significance of direct and indirect effects and to verify to what
extent the effect of IEO on intrapreneurial intentions can be mediated by motivation and
skills, as well as degree to which the latter are dependent on management training.
The results are presented in Table 3. Of the three IEO dimensions, innovation has no
significant effect, proactivity has a positive effect on skills and a tenuous indirect effect

Risk-taking .173 .454 .104

.183
Self-motivation .122
.362
.355 Intrapreneurial
Intention

Entrepreneurial .230

Proactivity .267 Skills .394

.027 .083

.118 Training

Direct effect Indirect effect

Fig. 2 Structural results with standardised coefficients
Int Entrep Manag J (2019) 15:733–748 743

Table 3 Direct and indirect effects

Variables Dependent Mediator Dependent

Independent Effect Self-motivation Skills Intrapreneurial intention

Exogenous
Risk Direct 0.183 (0.013) 0.355 (0.001) 0.454 (0.001)
Risk Indirect – – 0.104 (0.000)
Innovativeness Direct 0.120 (n.s.) 0.065 (n.s.) -0.163 (n.s.)
Innovativeness Indirect – – 0.030 (n.s.)
Proactivity Direct 0.176 (n.s.) 0.267 (0.005) 0.068 (n.s.)
Proactivity Indirect – – 0.083 (0.001)
Training Direct – 0.118 (0.001) -0.017 (n.s.)
Training Indirect – – 0.027 (0.001)
Mediator
Self-motivation Direct 0.122 (0.005)
Skills Direct 0.230 (0.001)
R2 0.173 (0.004) 0.394 (0.003) 0.362 (0.004)

Numbers are standardised coefficients (and respective bootstrap p-values)

n.s., non-significant

on intention, and risk-taking has positive and significant effects not only on the mediator
variables but also on intrapreneurial intention. Management training, in turn, has a small
positive effect on entrepreneurial skills, resulting in a negligible indirect effect on
intrapreneurial intention. An analysis of the mediator variables verified that self-
motivation depends only on risk-taking, while entrepreneurial skills benefit from all the
exogenous variables, with the exception of innovation. As self-motivation also has a
relatively weak relationship with intrapreneurial intentions, it turns out to be a weak
mediator variable. Finally, entrepreneurial skills contribute to the significant but weak
indirect effects of risk-taking, proactivity and management training on intrapreneurial
intentions.
Figure 2 above summarizes the results of the mediation model, presenting only the
standardized coefficients and facilitating the visualization of the limited mediating
effects. This figure highlights the great importance of risk-taking as the antecedent of
intrapreneurial intentions, as risk-taking has a substantial direct effect that cannot be
explained by mediator variables. Risk-taking is, however, the only facet of IEO with
this property, since innovation has no effect on any of the endogenous variables, and
proactivity only affects entrepreneurial skills in a limited way, resulting in a very small
indirect effect on intrapreneurial intentions. The impact of management training is even
more reduced, showing an extremely weak contribution to entrepreneurial skills.
In summary, nurses who are more likely to engage in intrapreneurship behavior in
public hospitals are more likely to take risks. These individuals have a stronger belief in
their entrepreneurial skills and, although less clearly, they are more self-motivated.
These results are consistent with the findings of Manion (1990) and Hewison and
Badger (2006) on the characteristics of nurse intrapreneurs, namely their traits and
perceived management and entrepreneurial skills.
744 Int Entrep Manag J (2019) 15:733–748

Conclusion and managerial implications

As a quasi-market perspective is becoming increasingly important in public healthcare

services, intrapreneurial attitudes and behaviors are increasingly required of nurses. To
this end, they need to be convinced that they have entrepreneurial skills and to be
motivated to engage in entrepreneurial behaviors. Given that entrepreneurship research
on nursing careers remains limited and is thus insufficient to help prepare nurses for
intrapreneurship more fully (Wilson et al. 2012; Darbyshire 2014), the present study
sought to demonstrate the need for management training for nurses. In addition, this
research examined the ways that nurses’ tendency toward risk-taking, innovation and
proactivity can enhance their motivation and belief in their entrepreneurial skills.
Although nurse intrapreneurship has been promoted, especially in English-speaking
countries, ever since the concept of intrapreneurship became popular, empirical studies on
healthcare intrapreneurship in general – and nursing intrapreneurship in particular – are still
infrequent. In the present study, we evaluated the relationship between IEO and intrapre-
neurial intentions mediated by entrepreneurial motivations and skills, so this research can be
seen as innovative and will hopefully foster greater interest among scholars in future studies.
The results suggest three things with respect to the subdimensions of IEO. First,
innovation has no effect either on intrapreneurial intentions or on mediator variables
(i.e. skills and motivation). Second, risk-taking has a quite important direct effect on
intrapreneurial intentions, but a more modest indirect effect mediated by skills and
motivation. Finally, proactivity has a rather weak indirect effect on intrapreneurial
intentions, which results from its influence on entrepreneurial skills. The results also
suggest that management training has a relatively weak effect on entrepreneurial skills,
resulting in a negligible indirect effect on intrapreneurial intentions.
However, individuals’ positive perceptions of their entrepreneurial skills play an
important mediating role as a proximal antecedent of intrapreneurial intentions, as
opposed to self-motivation. The results support the conclusion that factors contributing
to the increase of self-confidence in entrepreneurial skills could be indirect facilitators
of intrapreneurial intention, and these facilitators may lead some nurses to find ways to
learn, use, see, feel and communicate these skills to increase the quality of health care,
either directly with patients or indirectly through work in the areas of management,
education, research or policy (Boore and Porter 2011). Dynamic capabilities, opportu-
nities to learn and to share knowledge are relevant organizational factors to increase
nurses’ expertise and self-confidence.
Regarding nursing education, authors such as Hewison and Badger (2006) and
Boore and Porter (2011) have indicated that nursing programmes should promote
entrepreneurship in their courses, as well as the skills needed to be an intra or
entrepreneurial nurse. The results of the present study show that nurses with some type
of management training have an only slightly more positive perception of their
entrepreneurial skills than nurses without this training. Perhaps this is because man-
agement training is not intended to promote self-efficacy, or perhaps this training fails
to develop soft skills that facilitate leadership, communication and networking behav-
iors. However, the most significant finding regarding training is that less than one-fifth
of nurses have had some training in management, a proportion that will need to increase
in order for hospitals to be able to better respond to the inevitable challenges of change
and innovation. In line with Chan et al. (2017), we suggest that organizational
Int Entrep Manag J (2019) 15:733–748 745

innovation and proactivity depend on self-directed individuals, and that specific train-
ing in issues such as leadership and creativity can enhance motivation, attitudes,
desires, and intentions to be an intrapreneur.
A study of this nature always entails some limitations which, when properly identified,
can be converted into suggestions that can improve future research and reduce obstacles in
further studies. One limitation observed is that the data collection included only seven
public hospitals in a region in the north of Portugal. Researchers could extend this study to
include other regions of Portugal and/or carry out comparative studies with other types of
institutions, including private, non-profit and public-private partnership hospitals. A second
limitation arises from the weak mediating role of self-motivation in the proposed model.
Future research could include other motivational factors that may be more strongly related
to entrepreneurship within organizations.

Funding This work is partially funded by the FEDER component of European Structural and
Investment Funds, through the Operational Competitiveness and Internationalisation Programme’s
(COMPETE 2020) Project No. 006971 (UID/SOC/04011); as well as national funds through the
FCT – Portuguese Foundation for Science and Technology under Project UID/SOC/04011/2013 and
Project UID/GES/04630/2013.

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