Nurse practitioners as entrepreneurs: constrained or liberated?

May 6 2008

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).

The Barriers

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, 2007).

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 harm.

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 (Galanti, 1991).

Conclusions

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). 

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