- Email: [email protected]
Education for entrepreneurship in nursing
Nurse Education Today 31 (2011) 184–191
Contents lists available at ScienceDirect
Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Education for entrepreneurship in nursing Jennifer Boore a,⁎, Sharon Porter b a b
School of Nursing, University of Ulster, Coleraine, Co. Londonderry, BT52 1SA, United Kingdom University of Ulster, United Kingdom
a r t i c l e
i n f o
Article history: Accepted 28 May 2010 Keywords: Entrepreneurship Nursing education Pre-registration nursing education
s u m m a r y The different types of entrepreneurship, including social entrepreneurship and intrapreneurship, and the importance of social entrepreneurship skills in the changing world of health care are discussed. The term social intrapreneurship is introduced to characterise the many nurses introducing change and enhancing care working within the NHS. The strategy for development of entrepreneurship education within one region of the UK is presented and its integration into a pre-registration nursing programme is the main focus of this paper. The process of integration of skills in the changing world of health care is discussed. The strategy for development of entrepreneurship is presented under the headings of the NICENT (Northern Ireland Centre for Entrepreneurship) @ Ulster Integration Model: Awareness and Understanding; Interpretation; Contextualisation; Integration (Theoretical Content); Integration (Assessment); Validation/Revalidation; Implementation; and Review and Reflection. The most important stages were the first two in which nursing academic staff came to realise the relevance of the topic to nursing and the interpretation and translation into ‘nurse-speak’ of the business terminology to alleviate the initial rejection of entrepreneurship as of no relevance to nursing. © 2010 Elsevier Ltd. All rights reserved.
Introduction In 1985 Drucker stated that ‘what we need is an entrepreneurial society in which innovation and entrepreneurship are normal, steady and continual’ (cited in a Report of the Global Education Initiative, 2009, p. 12) for which education is the key. The focus of this paper is the integration of entrepreneurship education within pre-registration education in the School of Nursing at the University of Ulster.
Entrepreneurship: what is it? Entrepreneurship is an important aspect of economic life today as indicated by the European Union (EU) in the Lisbon Strategy in 2000 when it declared its objective of transforming the EU into the most competitive and dynamic knowledge-based economy in the world by 2010. It considered entrepreneurship to be one of the ‘new basic skills’ (European Commission, 2006). Entrepreneurship has usually been considered as an aspect of business and commerce with an entrepreneur being defined by the Oxford English Dictionary as ‘a person who sets up a business or businesses, taking on financial risks in the hope of profit’ (Soanes and Stevenson, 2006). While this is appropriate within the context of
⁎ Corresponding author. Tel.: + 44 28 7083 3665. E-mail address: [email protected] (J. Boore). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.05.016
commercial activity for the economic development of a country, the European Union has interpreted the term much more widely as: ‘Entrepreneurship refers to an individual's ability to turn ideas into action. It includes creativity, innovation and risk taking, as well as the ability to plan and manage projects in order to achieve objectives. This supports everyone in day-to-day life at home and in society, makes employees more aware of the context of their work and better able to seize opportunities, and provides a foundation for entrepreneurs establishing a social or commercial activity’ (European Commission, 2006, p. 4). However, Bridge et al. (2009) trace the evolution of the meaning of the word and argue that ‘the term entrepreneurship has become ambiguous and has no single commonly accepted definition’ (p. 9). Nevertheless, in the context of this paper, the EU definition above is relevant to the more recent concepts of social entrepreneurship and intrapreneurship both of which exemplify the description of entrepreneurship as: ‘the unique process that, by fusing innovation and implementation, allows individuals to bring new ideas into being for the benefit of themselves and others. It is sui generis, an irreducible form of freedom’ (Kauffman Foundation, 2007, p. 6). Social entrepreneurship (social enterprise) and intrapreneurship are important concepts with wider implications than commercial entrepreneurship. The term social entrepreneurship implies the use of entrepreneurial skills to meet social needs or lead social change within private, public or not-for-profit organisations (CCSE, 2001). Dees (2001) described social entrepreneurs as people who:
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
‘… play the role of change agents in the social sector, by: • Adopting a mission to create and sustain social value (not just private value), • Recognizing and relentlessly pursuing new opportunities to serve that mission, • Engaging in a process of continuous innovation, adaptation, and learning, • Acting boldly without being limited by resources currently in hand, • Exhibiting heightened accountability to the constituencies served and for the outcomes created’ (p. 4). CASE (2008) discusses what they call the ‘ecosystem of social entrepreneurship’ (p. 2) summarised in Fig. 1 which can be used to help prospective entrepreneurs to identify the conditions necessary for their enterprise. This figure suggests that key issues to facilitate social entrepreneurship include education, training and support to provide the striving entrepreneur with the knowledge to access the resources necessary for success. In the context of the health service, entrepreneurial people may be considered as those health and social care professionals who take innovative action, that challenge the status quo and change culture. They are often change-masters that seek to add value to the organisations that they work in and the communities where they live. Florence Nightingale has been identified as a successful social entrepreneur (CASE, 2008). Such television programmes as the recent BBC's ‘Can Gerry Robinson change the NHS’ illustrated many of the current challenges facing health and social care and the need for ’entrepreneurial thinking/leadership’ to help drive change to reduce waiting lists and enhance care. Commenting on the programme Dr. Tom Heller, of the Open University and academic advisor for the series said, referring to the hospital featured, ‘.....there are people prepared to use their personal energy to advocate change, and who have developed ideas for improving the system. Gerry seems to sniff them out and let them have their say. These ‘champions’ need encouragement and rewards for bringing about change.’ (BBC/OU, 2007). Intrapreneurship is when an organisation encourages and develops the entrepreneurial talents of staff in order to establish an innovative and effective organisation … (NICENT, 2004). As long ago as 1990 Hisrich identified that an intrapreneur has similar characteristics to the entrepreneur but can only be fully effective when working within an organisation which provides a culture supportive of the intrapreneur. In the context of nursing, it is probable that, in the UK with the majority of nurses working in the NHS, the majority of entrepreneur-
185
ial staff could be characterised as social intrapreneurs. They will function most effectively where management is supportive of innovation and creativity. However, nurses are also functioning as social entrepreneurs within the private sector. Much of the nursing literature uses the term entrepreneur to signify all these individuals. Education for entrepreneurship Within the UK each country has developed its own response to the Lisbon Agenda (although with similarities between the four countries) with the Northern Ireland Programme for Government 2001–04 accepting the EU definition of entrepreneurship. In addition it recognised ‘the vital role of education and training in supporting economic development and prosperity and the need to equip young people in particular with the skills, confidence and values to live their lives to the full’ (Northern Ireland Executive, 2002). The Entrepreneurship and Education Action Plan (DETL et al., 2003) emphasises the commitment to ensure that all learners should have the opportunity and support to develop the skills and attributes to be able to be ‘unique, innovative and creative’ (p. 4) in their work. The Skills Strategy (DEL, 2004) builds on this Action Plan and indicates that the core concepts of enterprise and entrepreneurship should be included early in the experience of young people and that the curricula in second and third level education should reflect enterprise and entrepreneurship. These policies, and comparable ones throughout the UK, have required higher education to incorporate entrepreneurship within educational programmes at undergraduate and post-graduate level. Thus Schools of Nursing within participating Universities in the UK now need to consider the relevance of this concept to nursing and the preparation of nurses. Within Northern Ireland entrepreneurship education has been implemented through NICENT (the Northern Ireland Centre for Entrepreneurship) established in 2000 as a joint enterprise between the two main Universities in the region, the University of Ulster and Queens University Belfast. Initial funding from the Science Enterprise Challenge (SEC) focused on integrating entrepreneurship education within the Faculties of science, engineering and technology (SET). This was followed by funding from Northern Ireland's Industrial Research and Technology Unit (IRTU), which, in 2002, was subsumed into a new organisation, Invest Northern Ireland (Invest NI). This enabled broadening activity into all Faculties within the universities of the NICENT Partnership. To help achieve its objectives NICENT at Ulster developed a number of learning outcomes for entrepreneurship education at undergraduate and post-graduate levels, endorsed by the Teaching and Learning Committee of the University. Course teams were free to decide how best
Fig. 1. Ecosystem of social entrepreneurship (summary) (From CASE, 2008).
186
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
to incorporate the learning outcomes into their programmes over the duration of the student's learning cycle, for example as part of a discrete module or modules or integrated into the content of the programme. NICENT developed its strategy based upon the ‘enterprise for life’ approach to entrepreneurship education utilising a broad understanding of entrepreneurship focusing not only on new venture creation but also social entrepreneurship and the ability to apply entrepreneurial thinking within one's employment (intrapreneurship). The aim was to establish a foundation of enterprise skills and attributes upon which students can later base a variety of entrepreneurship applications rather than just business creation. As a result NICENT has been successful in introducing entrepreneurship education to all Faculties within the University, including those disciplines initially resistant to entrepreneurship due to the traditional business orientation of entrepreneurship (Bridge et al., 2009). The School for Social Entrepreneurs (SSE) was set up in 1997 with its headquarters in London and bases throughout the UK, including Belfast. While the activities discussed above function primarily within formal education, the SSE uses an action learning approach ‘to provide training and opportunities to enable people to use their creative and entrepreneurial abilities more fully for social benefit’ (SSE, 2010). Individuals, who may be nurses, can be helped to establish new charities or entities which function as social enterprises within communities. Entrepreneurship in nursing Entrepreneurship is a concept becoming increasingly important within the health and social care sector although until fairly recently the scope of its potential in nursing has not been widely recognised in the UK. For example, the RCN (2007) publication for budding entrepreneurs primarily focuses on providing guidance for nurses wishing to become self-employed and provides a range of examples of business opportunities including setting up a private care home, acting as an expert witness, undertaking consultancy, starting an agency etc., exemplifying the types of activities one usually thinks of under the term ‘entrepreneurship’: the social entrepreneur receives little attention and the intrapreneur none. However, in the US entrepreneurship among nurses is a more mainstream activity as indicated by the journal, Clinical Nurse Specialist, which has recognised the needs of their readers by starting a column on Entrepreneurial Dimensions of CNS Practice (Dayhoff and Moore, 2002). Policies which have promoted enterprise and entrepreneurship only began to be introduced in 1997 when Government published The New NHS: Modern, Dependable (DoH, 1997) and in later DoH publications (1999 and 2000, cited by Traynor et al., 2008) nursing was ‘put at the heart of the modernisation agenda’ (p. 14). More recently entrepreneurship, or the attributes of the entrepreneur, is being encouraged by Government and in 2003 the then Secretary of State for Health said that ‘I want to encourage a new generation of entrepreneurial nurses … (who) take the initiative, creating and implementing new ideas’ (cited in Faugier, 2005, p. 49). Traynor et al. (2008) implies that promotion of entrepreneurial activities and the development of nursing into more advanced roles has been used to reduce the authority of medicine in negotiation with Government. Whatever the underpinning rationale, the situation offers opportunities for nurses to exploit, particularly within the current economic climate. Indeed, the Minister of Health in the Republic of Ireland emphasised the importance of entrepreneurial skills in facing the challenges for health care and said that ‘if we are all flexible and innovative and open-minded and work together’, we can continue to provide the services patients expect for the money invested (IrishTimes.com, 2009). White and Begun (1998) emphasise the importance of being able to adapt to the ‘myriad forces of change’, which they described as ‘chaotic (apparently irregular and unpredictable) and complex (difficult to analyse) (p. 43). Many nurses would recognise this description. Nursing practice is continually changing with develop-
ments in medical science, policy directives and movements in priorities in health care, and advances emanating from nursing and medical research. Thus, there is a need for entrepreneurial nurses, and other staff, within the Health Service to maintain and enhance the quality of care. However, staff have to be given the freedom and encouragement to develop ideas, without a fear of failure and with the encouragement of senior staff. Drennan et al. (2007) have identified three groups of nurse/midwife/ health visitor entrepreneurs in the UK: the nurse intrapreneurs working within the Health Service; employers or self-employed providing services indirectly related to healthcare; employers or self-employed providing direct care. Some posts in nursing are innately entrepreneurial, for example in Public Health nursing, in order to bring health benefits to deprived populations, and many of the early entrepreneurial nurses were working as district nurses, health visitors or midwives to improve the health of the community (Faugier, 2005). Advanced Practice Nurses (Ireland) and Clinical Nurse Specialists (UK) are described as using the entrepreneurial skills of ‘creativity and innovation in the delivery of client-centred care’ (Furlong and Smith, 2005, p. 1064) and as displaying ‘entrepreneurial characteristics’ (Austin et al., 2006, p. 1541). McCray and Ward (2009) discuss the possible increase in social enterprise to provide the services commissioned for patients in the community, with nurses working in collaboration with other professionals and organisations. These individuals will need the enterprise skills of the entrepreneur as well as clinical knowledge and competence. However, the authors also argue that all UK nurses will need similar skills. All the various positions discussed above are important in developing services to meet changing needs. However, examples which are embedded within general nursing practice and initiated by staff at different levels can be identified; just two examples within one Health and Social Care Trust in Northern Ireland are: • Preparation, introduction and evaluation of a story book to prepare children being admitted for tonsillectomy with or without adenoidectomy (Tunney, 2009) which is now being developed for use with a wider range of conditions. • A Health Care Assistant in acute care has developed her skills in working with people with dementia and has prepared an information sheet for all staff to enhance their abilities in working with these patients. This has now been disseminated across the whole Trust (RCN, 2009). All nurses need to understand the process of the introduction and management of change in order to recognise and fulfil their position in the change process and participate effectively. However, we also need nurses who have acquired the set of skills needed to initiate and lead the introduction of change. Thus education about entrepreneurship is becoming an important issue for nursing education. However, to date there has been little emphasis on the inclusion of entrepreneurship within nursing education and the provision of education for entrepreneurship specifically for nurses is a recent development. Shirey (2007) described two master's level programmes starting in the USA in 2006 specifically focusing on development of entrepreneurship. However, most courses identified in the UK are either short courses or on-line courses not leading to a recognised qualification. The developments discussed earlier are leading to some content on entrepreneurship within, at least, some pre-registration programmes to prepare nurses to be innovators in practice. Incorporating entrepreneurship into nursing education For entrepreneurship to be developed seriously in nursing, nursing education must ensure that students are provided with the opportunity to develop the necessary knowledge and skills. Entrepreneurs need to have certain characteristics which are common amongst nurses and are the type of characteristics we look for in selecting students to enter nursing programmes. They need to be: creative and innovative;
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
confident, motivated, realistic; energetic and hard-working; good communicators and people people (NICENT, 2004). In addition, they need a range of generic skills most of which nurse education programmes endeavour to instil and which have been identified as abilities in: opportunity spotting and innovation; planning and decision-making; time-management and self-discipline; and communicating (NICENT, 2004). However, there is additional knowledge and skills which need to be incorporated to meet the entrepreneurship agenda, and a process to be negotiated to embed it successfully in the curriculum. The pre-registration nursing programme was being prepared for revalidation when entrepreneurship education became an issue within the University. The Integration Model developed by NICENT (Fig. 2) illustrates the curriculum development steps for a programme incorporating entrepreneurship followed by the School of Nursing and guides the discussion that follows. Awareness and understanding The University expected entrepreneurship to be included within the undergraduate programme in Nursing, but the School of Nursing needed to accept its relevance: the idea of entrepreneurship was new to the nurses involved and the initial reaction of the course team was ‘what has this to do with nursing?’ This was an important area to address with all academic staff involved. NICENT staff (i.e. experienced entrepreneurs and educators of entrepreneurship) met with the course team to discuss the University requirements and the work by NICENT to facilitate the introduction of entrepreneurship education. Ongoing discussion clarified the meaning of the entrepreneurial terms and identified the skills involved. The enthusiasm and flexible approach of the NICENT staff were contagious and nursing staff rapidly began to see the relevance to nursing and to identify the comparable activities within nursing. Several staff could identify situations within their previous clinical careers which were entrepreneurial in nature and helped others to accept the ideas. Further consideration of the complexities and continuous change in nursing, and discussions between staff of NICENT and the curriculum planning team, resulted in interpretation of entrepreneurship within the nursing context. NICENT's description of social entrepreneurship (NICENT, 2004) clarified the importance of creativity and innovation in the identification
187
of opportunities and in the solving of problems that add value to the lives of people within society. It incorporates the ability to identify the resources needed to progress their ideas, resources such as creative partnerships with others in society, a project plan, (financial) resources, and people. During curriculum development, this description was found to be valid within the context of nursing and one that could guide us in developing content.
Interpretation One of the difficulties encountered by nurses when considering entrepreneurship is the language which is derived from the world of business and includes terms such as ‘venture capital’ or ‘market opportunity analysis’ which are unfamiliar to nurses. To enable the concept of entrepreneurship to be understood and accepted within nursing the language used has to be acceptable to nurses, i.e. it needs to be translated into ‘nurse-speak’. Within this School of Nursing, we defined entrepreneurship through innovative practice as: • the application of creativity in facilitating innovative practice or introducing change. It includes: • assessing the needs of a patient/client group, identifying the skills and resources (including financial) required to meet those needs; • planning, implementing and evaluating changes in clinical care, a new patient/client care initiative or service, or setting up a health or social care related business. Table 1 shows the University learning outcomes related to entrepreneurship, developed by NICENT and used throughout the University. Our interpretation of these within the context of nursing programmes is indicated through the presentation of learning outcomes more suitable for the nursing context. This was a particularly important step in programme development to enable staff to integrate this content into the various modules comprising the programme. All students complete the set of learning outcomes equivalent to those of the module on Entrepreneurship Awareness and most of those within Entrepreneurship Applied.
Fig. 2. Nicent@Ulster integration model (©Sharon Porter).
188
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
Table 1 Entrepreneurship learning outcomes modified for Nursing. University learning outcomes Entrepreneurship awareness (Required) 1 They will be able to define entrepreneurship, the entrepreneur and the entrepreneurial process. 2 They will be able to identify steps required to research the potential for an innovative idea, social or community development or new venture opportunity. 3 They will be able to examine the key resources for new venture creation. 4 They will be able to point out the key steps required for exploiting an innovative idea, progressing a social or community development or setting up a new venture opportunity. 5 They will be able to recognise the central role of creativity and innovation in entrepreneurship and, where appropriate, the core challenges of protecting new ideas. 6 They will be able to discuss the components of a new venture/project and aspects of the planning process. 7 They will be able to manipulate an elearning environment. Entrepreneurship applied (Optional) 8 They will demonstrate and apply creative and innovative thinking. 9 They will practice market opportunity analysis.
10
They will be able to apply new venture/project planning competencies.
11
They will be able to demonstrate an ability to manage key entrepreneurial resources.
12 13
They will be able to operate as a team member. They will be able to communicate new ideas effectively using a variety of media.
Contextualisation It was decided by the course planning team that entrepreneurship, as described by the (translated into nurse-speak) learning outcomes in Table 1, was an integral part of nursing and almost all of the necessary content was incorporated within the materials already completed for the pre-registration nursing programme. Therefore the decision was taken that we would take the second option, integration of entrepreneurial content into the programme, rather than teaching it as a separate module or modules. Content of the programme planned to date for revalidation needed to be reviewed to identify which learning outcomes were already included and what additional content was required. The programme for revalidation was planned within six key themes: • • • • • •
Reflective and Proficient Practice Theoretical and Professional Issues Leadership and Management Communication, Teaching and Learning Health and its Determinants Research and Evidence Informed Practice
The development of each theme was carried out by a team of academic and clinical staff who ensured that the relevant content was included. Each of these themes runs through the programme and is delivered in units of study of 5, 10 or 15 credit points which are grouped into modules with specified credit point values. This structure facilitates revisiting of topics and the incremental building of knowledge and skills related to entrepreneurship consistent with the students' stage of development as a nurse. Integration: theoretical content Issues related to entrepreneurship are considered within units in the theoretical components of the course within all the themes above but mainly within the themes on Leadership and Management and
Modified learning outcomes They will understand the role of the entrepreneur and potential for the application of entrepreneurial skills in health and social care. They will be able to identify the steps required to research the need/potential for an innovative idea, or patient care development in nursing practice. They will be able to identify the resources required for introduction of change. They will be able to identify the steps required for the introduction of change.
They will recognise the importance of creativity and innovation in planning individualised patient care. They will be able to discuss the component parts and the planning process for introduction of change. They will be able to manipulate an elearning environment.
They will demonstrate and apply creative and innovative thinking. They will be able to carry out a needs assessment for individual patients and for groups of patients. They will be able to research the demand for a proposed health care innovation. Demonstrate appropriate skills in developing a care delivery plan from identification to delivery. Demonstrate appropriate skills in introducing change in practice. They will display the ability to manage the resources needed for the provision of patient care. They will be able to demonstrate an understanding of the identification and management of resources for the introduction of change. They will be able to operate as a team member. They will be able to communicate new ideas effectively using a variety of media.
Research and Evidence Informed Practice, as shown in Table 2, and within placement. The student group is divided into several groups and small groups of academic staff (3–5 in number) work with each group of students through the programme. Students build up their understanding of entrepreneurship through completion of the learning materials and groupwork for the relevant units of study throughout the programme. Learning about entrepreneurship occurs in each year of the course within the themes of the programme. Table 2 summarises how the individual entrepreneurship learning outcomes are achieved through the programme. The first year of the programme aims to provide students with a solid foundation about nursing and the sciences on which it is based. A number of the topics fundamental to nursing considered in this year also form the foundation for understanding and developing skills in entrepreneurship: the importance of creativity and innovation; assessment of need of individuals; planning and delivering care for individuals including necessary resources; and the use of elearning. Year 2 builds on the previous work. The unit on Decision-Making in Multidisciplinary Practice at the beginning of year 2 incorporates an introduction to the role and characteristics of the entrepreneur and examines the characteristics of teams and how they function. Later in this year knowledge and skills in needs assessment of groups is studied in relation to Public Health. While students have been introduced to the importance of evidence and research in nursing in year 1, in the later part of year 2 they undertake a substantial unit on Understanding Research which helps to develop the knowledge and understanding necessary to ‘research the need/potential for an innovative idea, or patient care development in nursing practice’. However, it is the unit on Management of Change in year 3 which contains the bulk of content on the skills and processes for introducing innovation into practice. This unit focuses mainly on entrepreneurship knowledge with students developing their skills through groupwork. It examines: models and strategies for change and for entrepreneurship; the scope of entrepreneurship and the characteristics required; identifying entrepreneurial opportunities and the importance of market research; planning change including
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
189
Table 2 Entrepreneurship within pre-registration nursing programmes. Learning outcomes
Integration in course
Theme of study
Entrepreneurship awareness (Required) 1 Characteristics of entrepreneur covered in year 2, in unit on Decision-making in Multidisciplinary Practice. Year 3 unit on Management of Change considers potential in Nursing for application of skills. 2 Knowledge and skills about research developed in several units in years 1, 2 and 3. 3 Achieved within unit on Management of Change in year 3. 4 Achieved within unit on Management of Change in year 3. 5 Unit on Study Skills and Use of Evidence (year 1) emphasises importance of creativity in nursing. Unit on Care Planning and Reflection emphasises individualised care. Innovation and creativity is emphasised throughout the course. 6 Considered within unit on Management of Change in year 3. 7 Theoretical content of programme is provided by elearning. All students will become competent. Entrepreneurship applied (Optional) 8 Innovation and creativity are expected throughout the programme. 9 Students are taught individual and group needs assessment in years 1 and 2 respectively. They apply these skills in clinical placement. Students learn necessary research skills in units on Understanding Research and Research Skills. 10 Students learn these skills in year 1 units and develop and apply them in practice throughout the course. Students practice these skills in groupwork in unit on Management of Change. 11 Students learn about the resources needed to implement patient care plans in practice focused units. Identification of resources dealt with in unit on Management of Change in year 3. 12 All students function as team members in groupwork and clinical placement throughout the course. They develop communication skills in units through course. 13 Students are introduced to and use a variety of media within groupwork activities.
identifying the necessary resources; entrepreneurial teams; and financial management. They also build on their earlier work on research and develop the research skills necessary to ‘research the demand for a proposed health care innovation’. The theme on Research and Evidence Informed Practice runs throughout the programme and is considered essential for a graduate nurse, but is of equal importance in relation to entrepreneurship.
Leadership and Management Communication, Teaching and Learning Research and Evidence Informed Practice Leadership and Management Leadership and Management Research and Evidence Informed Practice Reflective and Proficient Practice Leadership and Management All themes
Theoretical and Professional Issues Reflective and Proficient Practice Health and its Determinants Research and Evidence Informed Practice Reflective and Proficient Practice Leadership and Management Reflective and Proficient Practice Leadership and Management Communication, Teaching and Learning Communication, Teaching and Learning
Integration: assessment Assessment in relation to the entrepreneurship learning outcomes occurs through a range of methods for summative and formative assessment in both academic and clinical placements through the programme as shown in Table 3. Clinical Assessment in the majority of placements assesses competencies around assessment and management
Table 3 Assessment of entrepreneurship learning outcomes.
1 2 3 4 5 6 7
8 9
10
11
12 13
Entrepreneurship awareness (Required)
Assessment approaches
They will understand the role of the entrepreneur and potential for the application of entrepreneurial skills in health and social care. They will be able to identify the steps required to research the need/potential for an innovative idea, or patient care development in nursing practice. They will be able to identify the resources required for introduction of change.
Formative assessment in groupwork.
They will be able to identify the steps required for the introduction of change. They will recognise the importance of creativity and innovation in planning individualised patient care. They will be able to discuss the component parts and the planning process for introduction of change. They will be able to manipulate an elearning environment.
Entrepreneurship applied (Optional) They will demonstrate and apply creative and innovative thinking. They will be able to carry out a needs assessment for individual patients and for groups of patients. They will be able to research the demand for a proposed health care innovation. Demonstrate appropriate skills in developing a care delivery plan from identification to delivery. Demonstrate appropriate skills in introducing change in practice. They will display the ability to manage the resources needed for the provision of patient care. They will be able to demonstrate an understanding of the identification and management of resources for the introduction of change. They will be able to operate as a team member. They will be able to communicate new ideas effectively using a variety of media.
Formative assessment in groupwork and summative assessment in final year through Research Proposal Dissertation. Formative assessment through contribution to debate and summatively assessed in written examination in year 3. As above. The Undergraduate Assignment Feedback sheet specifically assesses creativity within theoretical work. Formative assessment through contribution to debate and summatively assessed in written examination in year 3. Not formally assessed, elearning used for knowledge acquisition throughout course and competence assured in first semester.
The School of Nursing Assignment Feedback sheet assesses the demonstration of creativity. Individual patient assessment assessed in Clinical Assessment in placements. Research skills demonstrated through the final year Research Proposal Dissertation. Competence in developing and implementing care plans is assessed in Clinical Assessment. Module examination will enable students to demonstrate understanding of necessaryskills. Management of resources for patient care are assessed in Clinical Assessment in placement. Module examination will enable students to demonstrate understanding of resources for implementation of change. Assessed within Clinical Assessment in placement (section on management of care). Students use a variety of media in presenting groupwork activities used in formative assessment.
190
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
which are inherently entrepreneurial in nature; in particular, the management placement in the final year offers the opportunity to demonstrate such skills. Teaching and learning activities, especially those carried out within groupwork, involve students working in small groups to develop their entrepreneurial skills, with immediate feedback on their achievement. Demonstration of creativity has been incorporated into the School of Nursing Assignment Feedback Sheet for many years and thus some of the key attributes of the entrepreneur are assessed within every piece of academic work submitted. In particular, completion of the final year dissertation, while focusing on research also enables students to demonstrate abilities relevant to entrepreneurship.
following groupwork session. Placements draw upon all learning up to that point in the programme. Review and reflection Throughout the programme individual modules of study are evaluated by students and reflected upon by staff who modify them as appropriate. However, completion of the first intake of students on this replanned curriculum coincides with the need to begin preparing for a full review of the course for the next five-yearly revalidation. At this time, the cycle shown in Fig. 2 recommences with a review of the Awareness and Understanding of entrepreneurship within the nursing context. Discussion
Validation/revalidation In preparation for validation or revalidation of a new or revised programme, the course document (and when relevant, as in this programme, the on-line learning materials) is reviewed for incorporation and assessment of the entrepreneurship learning outcomes within the programme by the staff of NICENT. If all outcomes of Entrepreneurship Awareness (i.e. the first seven learning outcomes) are completed and assessed within the programme, it is agreed at validation that, in addition to their Degree parchment, graduating students will be awarded a Certificate in Entrepreneurship. Students completing this programme, therefore, are awarded this Certificate.
Implementation In replanning this programme, our own entrepreneurial skills were applied in dealing with specific issues which had arisen in the previous version of the programme after student numbers were dramatically increased and spread over two (instead of one) campuses, at very short notice. The key difficulties arose in relation to teaching very large classes and in monitoring students' attendance and development. Following considerable debate involving all academic staff involved in the programme, it was agreed that a complete change in delivery of the University parts of the programme would be introduced in which elearning would be the major method of transmission of knowledge. This is blended with groupwork for facilitating application and integration of knowledge, and for development of a range of skills — academic, clinical, communication, and problem-solving. All learning is then integrated and applied within placement. Fig. 3 demonstrates the relationship between the different modes of learning using the example of entrepreneurship. In relation to any aspect of learning, students first complete the elearning and undertake the specified preparatory work before attending the
Creativity and innovation will be essential to maintain and enhance healthcare within a period of economic restraint and increasing health care needs as demographic change leads to a larger elderly population. Entrepreneurial skills are becoming more important in nursing as the services provided must constantly adapt to maintain the high quality care which patients deserve in the continually changing contexts in which nursing takes place, described as an ‘era of chaos and complexity’ (White and Begun, 1998, p. 40). Nurses may initiate businesses using entrepreneurship or social entrepreneurship skills or find themselves in positions within the health service which can be described as intrapreneurial. In addition, all nursing posts offer the opportunity to apply the skills and knowledge of entrepreneurship. At this time of economic uncertainty, they become particularly important, as professional staff have to find new ways of doing more with less. Integration of entrepreneurship into the pre-registration nursing programme produces graduates who have had the opportunity to develop the necessary skills and attributes to contribute to this endeavour within hospital and community settings, and within the NHS, private and non-profit making organisations who contribute to the health and welfare of the population. Over the coming years, as this new breed of ‘entrepreneured’ nurses and health care professionals graduate and seek employment, their impact will contribute to the development of a strong and vibrant health and social care sector. Ulster's innovative approach to the integration of entrepreneurship into the curriculum requires each discipline area to consider the meaning and relevance of entrepreneurship within that area. Within Nursing this education compliments and adds value to the programme. A number of learning points can be taken from the experience of integration within the School of Nursing at Ulster and are summarised as follows: • achieving relevancy and context: academic staff must achieve a clear understanding and an awareness of what entrepreneurship
Fig. 3. Implementation of entrepreneurship education.
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
means within the context of their own discipline. Within nursing it was interpreted, developed and delivered by nursing academic staff in a manner that ensured relevancy. • achieving commitment and championing: selling the concept of entrepreneurship education to all relevant stake-holders to obtain commitment and support for integration efforts. The use of champions within academic faculties is valuable for achieving entrepreneurship education; at Ulster each faculty has a member of academic staff with a remit to champion entrepreneurship education. In addition, staff were able to use examples from their own careers to illustrate entrepreneurship in action helped to bring to life the concept of entrepreneurship within nursing. • recognizing, celebrating and rewarding success in entrepreneurship education: students who have achieved the specified outcomes are awarded a Certificate in Entrepreneurship. • actualization of entrepreneurial thinking and behaviour: this needs to be within a secure environment where students (and staff) can ‘tryout’ entrepreneurship. NICENT recommended action based or experiential learning in pedagogy development for entrepreneurship education focusing on the enterprise for life approach with ‘education for doing’. The blended learning approach with substantial elearning and groupwork within this programme and clinical placement provide opportunities for students to develop their entrepreneurial skills. Conclusion In summary, nurses in any area of practice and at any level will be able to make a valuable contribution to health care if they demonstrate the characteristics and skills of the entrepreneur. Gibb (2000) describes entrepreneurship in a way applicable to nurses in any context and which emphasises competencies important to nurses in any context: ‘Entrepreneurship relates to ways in which people, in all kinds of organisations behave in order to cope with and take advantage of uncertainty and complexity and how in turn this becomes embodied in: ways of doing things; ways of seeing things; ways of feeling things; ways of communicating things; and ways of learning things’ (p. 16). In many areas of nursing, uncertainty and complexity are standard conditions of work and many nurses find ‘ways of doing, seeing, feeling, communicating and learning’ that enhance the quality of care either directly with patients or indirectly through working in management, education, research or policy. Thus, it is necessary that nurse educationalists take on the challenge of preparing nurses with the appropriate knowledge and skills to meet the demands of an ever-changing and increasingly demanding professional practice. In this paper the approach used in one university has been presented which, it is hoped, may be of value to other nurse educators. References Austin, L., Lucker, K., Ronald, M., 2006. Clinical nurse specialists as entrepreneurs: constrained or liberated. Journal of Clinical Nursing 15, 1540–1549.
191
BBC/OU, 2007. Challenges to the NHS Accessed 3/2/10 http://www.open2.net/ healtheducation/health_socialcare/challenges_to_the_NHS.html2007. Bridge, S., Hegarty, C., Porter, S., 2009. Re-establishing enterprise: identifying and applying appropriate entrepreneurship for undergraduates. Conference paper presented at ICSB Conference, S Korea. CASE, 2008. Developing the field of social entrepreneurship: a report from the Center for Advancement of Social Entrepreneurship (CASE) Alberta, Canada: Canadian Centre for Social Entrepreneurship, Duke University: The Fuqua School of Business. CCSE, 2001. Social entrepreneurship discussion paper no. 1. Alberta, Canada: Canadian Centre for Social Entrepreneurship, Duke University: The Fuqua School of Business. Dayhoff, N.E., Moore, P.S., 2002. Entrepreneurial clinical nurse specialists — innovators of patient care. Clinical Nurse Specialist 16 (5), 274–276. Dees, J.D., 2001. —revised. The meaning of ‘social entrepreneurship’. Alberta, Canada: Canadian Centre for Social Entrepreneurship, Duke University: The Fuqua School of Business. DEL, 2004. Skills strategy for Northern Ireland. Department for Employment and Learning, Belfast. DETL, et al., 2003. Entrepreneurship and education action plan. Belfast: Departments of Enterprise, Trade and Investment, Education, and Employment and Learning. http://www.detini.gov.uk/enterprising_education-2.pdf2003. DoH, 1997. The new NHS: modern dependable. Department of Health, London. Cm 3807. Drennan, V., Davis, K., Goodman, C., Humphrey, C., Locke, R., Mark, A., Murray, S.F., Traynor, M., 2007. Entrepreneurial nurses and midwives in the United Kingdom: an integrative review. Journal of Advanced Nursing 60 (5), 459–469. Drucker, P., 1985. Innovation and Entrepreneurship. HarperCollins, New York. European Commission, 2006. Implementing the Community Lisbon Programme: fostering entrepreneurial mindsets through education and learning. COM 33 final. Commission of the European Communities, Brussels. Faugier, J., 2005. Developing a new generation of nurse entrepreneurs. Nursing Standard 19 (30), 49–53. Furlong, E., Smith, R., 2005. Advanced nursing practice: policy, education and role development. Journal of Clinical Nursing 14, 1059–1066. Gibb, A.A., 2000. SME policy, academic research and the growth of ignorance: mythical concepts, myths, assumptions, rituals and confusions. International Small Business Journal 18 (3), 13–29. Hisrich, R.D., 1990. Entrepreneurship/intrapreneurship. American Psychologist 45 (2), 209–222. IrishTimes.com, 2009. http://www.irishtimes.com/newspaper/ireland/2009/0509/ 1224246190508.html2009Saturday, May 9. Kauffman Foundation, 2007. Entrepreneurship in American Higher Education: a report from the Kauffman Panel on Entrepreneurship Curriculum in Higher Education. Ewing Marion Kauffman Foundation, Kansas City, Missouri. McCray, J., Ward, C., 2009. Social enterprise — a new challenge for nursing practice and collaborative partnerships. International Journal of Nursing Studies 46, 151–153. NICENT, 2004. Entrepreneurship awareness — an elearning module. University of Ulster, NICENT. Northern Ireland Executive, 2002. Northern Ireland Programme for Government — Making a Difference 2002–2005. Belfast: Northern Ireland Executive. http://www. pfgni.gov.uk/pfgdocs.htm2002. RCN, 2007. reviewed 2009. Nurse entrepreneurs: turning initiative into independence. Royal College of Nursing, London. RCN, 2009. Nurse of the Year Awards programme. Belfast, RCN (NI). Report of the Global Education Initiative, 2009. Educating the next wave of entrepreneurs; Unlocking entrepreneurial capabilities to meet the global challenges of the 21st Century. World Economic Forum. www.weforum.org, Geneva. Shirey, M.R., 2007. Innovation and entrepreneurship — shaping your professional horizon. Clinical Nurse Specialist 21 (1), 16–21. Soanes, C., Stevenson, A., 2006. Concise Oxford English Dictionary, 11th Edition. Oxford University Press, Oxford. (Revised). SSE, 2010. School for Social Entrepreneurs web-site accessed 2/2/10 http://www.sse. org.uk/index.php2010. Traynor, M., Drennan, V., Goodman, C., Mark, A., Kavis, K., Peacock, R., Banning, M., 2008. ‘Nurse entrepreneurs’ a case of government rhetoric? Journal of Health Service Research and Policy 13 (1), 13–18. Tunney, A.M., 2009. An evaluation of the use of a story book on pre-operative coping mechanisms and post-operative recovery in children undergoing tonsillectomy and adenoidectomy. Unpublished MPhil Thesis, University of Ulster. White, K.R., Begun, J.W., 1998. Nursing entrepreneurship in an era of chaos and complexity. Nursing Administration Quarterly 22 (2), 40–47.
Contents lists available at ScienceDirect
Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Education for entrepreneurship in nursing Jennifer Boore a,⁎, Sharon Porter b a b
School of Nursing, University of Ulster, Coleraine, Co. Londonderry, BT52 1SA, United Kingdom University of Ulster, United Kingdom
a r t i c l e
i n f o
Article history: Accepted 28 May 2010 Keywords: Entrepreneurship Nursing education Pre-registration nursing education
s u m m a r y The different types of entrepreneurship, including social entrepreneurship and intrapreneurship, and the importance of social entrepreneurship skills in the changing world of health care are discussed. The term social intrapreneurship is introduced to characterise the many nurses introducing change and enhancing care working within the NHS. The strategy for development of entrepreneurship education within one region of the UK is presented and its integration into a pre-registration nursing programme is the main focus of this paper. The process of integration of skills in the changing world of health care is discussed. The strategy for development of entrepreneurship is presented under the headings of the NICENT (Northern Ireland Centre for Entrepreneurship) @ Ulster Integration Model: Awareness and Understanding; Interpretation; Contextualisation; Integration (Theoretical Content); Integration (Assessment); Validation/Revalidation; Implementation; and Review and Reflection. The most important stages were the first two in which nursing academic staff came to realise the relevance of the topic to nursing and the interpretation and translation into ‘nurse-speak’ of the business terminology to alleviate the initial rejection of entrepreneurship as of no relevance to nursing. © 2010 Elsevier Ltd. All rights reserved.
Introduction In 1985 Drucker stated that ‘what we need is an entrepreneurial society in which innovation and entrepreneurship are normal, steady and continual’ (cited in a Report of the Global Education Initiative, 2009, p. 12) for which education is the key. The focus of this paper is the integration of entrepreneurship education within pre-registration education in the School of Nursing at the University of Ulster.
Entrepreneurship: what is it? Entrepreneurship is an important aspect of economic life today as indicated by the European Union (EU) in the Lisbon Strategy in 2000 when it declared its objective of transforming the EU into the most competitive and dynamic knowledge-based economy in the world by 2010. It considered entrepreneurship to be one of the ‘new basic skills’ (European Commission, 2006). Entrepreneurship has usually been considered as an aspect of business and commerce with an entrepreneur being defined by the Oxford English Dictionary as ‘a person who sets up a business or businesses, taking on financial risks in the hope of profit’ (Soanes and Stevenson, 2006). While this is appropriate within the context of
⁎ Corresponding author. Tel.: + 44 28 7083 3665. E-mail address: [email protected] (J. Boore). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.05.016
commercial activity for the economic development of a country, the European Union has interpreted the term much more widely as: ‘Entrepreneurship refers to an individual's ability to turn ideas into action. It includes creativity, innovation and risk taking, as well as the ability to plan and manage projects in order to achieve objectives. This supports everyone in day-to-day life at home and in society, makes employees more aware of the context of their work and better able to seize opportunities, and provides a foundation for entrepreneurs establishing a social or commercial activity’ (European Commission, 2006, p. 4). However, Bridge et al. (2009) trace the evolution of the meaning of the word and argue that ‘the term entrepreneurship has become ambiguous and has no single commonly accepted definition’ (p. 9). Nevertheless, in the context of this paper, the EU definition above is relevant to the more recent concepts of social entrepreneurship and intrapreneurship both of which exemplify the description of entrepreneurship as: ‘the unique process that, by fusing innovation and implementation, allows individuals to bring new ideas into being for the benefit of themselves and others. It is sui generis, an irreducible form of freedom’ (Kauffman Foundation, 2007, p. 6). Social entrepreneurship (social enterprise) and intrapreneurship are important concepts with wider implications than commercial entrepreneurship. The term social entrepreneurship implies the use of entrepreneurial skills to meet social needs or lead social change within private, public or not-for-profit organisations (CCSE, 2001). Dees (2001) described social entrepreneurs as people who:
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
‘… play the role of change agents in the social sector, by: • Adopting a mission to create and sustain social value (not just private value), • Recognizing and relentlessly pursuing new opportunities to serve that mission, • Engaging in a process of continuous innovation, adaptation, and learning, • Acting boldly without being limited by resources currently in hand, • Exhibiting heightened accountability to the constituencies served and for the outcomes created’ (p. 4). CASE (2008) discusses what they call the ‘ecosystem of social entrepreneurship’ (p. 2) summarised in Fig. 1 which can be used to help prospective entrepreneurs to identify the conditions necessary for their enterprise. This figure suggests that key issues to facilitate social entrepreneurship include education, training and support to provide the striving entrepreneur with the knowledge to access the resources necessary for success. In the context of the health service, entrepreneurial people may be considered as those health and social care professionals who take innovative action, that challenge the status quo and change culture. They are often change-masters that seek to add value to the organisations that they work in and the communities where they live. Florence Nightingale has been identified as a successful social entrepreneur (CASE, 2008). Such television programmes as the recent BBC's ‘Can Gerry Robinson change the NHS’ illustrated many of the current challenges facing health and social care and the need for ’entrepreneurial thinking/leadership’ to help drive change to reduce waiting lists and enhance care. Commenting on the programme Dr. Tom Heller, of the Open University and academic advisor for the series said, referring to the hospital featured, ‘.....there are people prepared to use their personal energy to advocate change, and who have developed ideas for improving the system. Gerry seems to sniff them out and let them have their say. These ‘champions’ need encouragement and rewards for bringing about change.’ (BBC/OU, 2007). Intrapreneurship is when an organisation encourages and develops the entrepreneurial talents of staff in order to establish an innovative and effective organisation … (NICENT, 2004). As long ago as 1990 Hisrich identified that an intrapreneur has similar characteristics to the entrepreneur but can only be fully effective when working within an organisation which provides a culture supportive of the intrapreneur. In the context of nursing, it is probable that, in the UK with the majority of nurses working in the NHS, the majority of entrepreneur-
185
ial staff could be characterised as social intrapreneurs. They will function most effectively where management is supportive of innovation and creativity. However, nurses are also functioning as social entrepreneurs within the private sector. Much of the nursing literature uses the term entrepreneur to signify all these individuals. Education for entrepreneurship Within the UK each country has developed its own response to the Lisbon Agenda (although with similarities between the four countries) with the Northern Ireland Programme for Government 2001–04 accepting the EU definition of entrepreneurship. In addition it recognised ‘the vital role of education and training in supporting economic development and prosperity and the need to equip young people in particular with the skills, confidence and values to live their lives to the full’ (Northern Ireland Executive, 2002). The Entrepreneurship and Education Action Plan (DETL et al., 2003) emphasises the commitment to ensure that all learners should have the opportunity and support to develop the skills and attributes to be able to be ‘unique, innovative and creative’ (p. 4) in their work. The Skills Strategy (DEL, 2004) builds on this Action Plan and indicates that the core concepts of enterprise and entrepreneurship should be included early in the experience of young people and that the curricula in second and third level education should reflect enterprise and entrepreneurship. These policies, and comparable ones throughout the UK, have required higher education to incorporate entrepreneurship within educational programmes at undergraduate and post-graduate level. Thus Schools of Nursing within participating Universities in the UK now need to consider the relevance of this concept to nursing and the preparation of nurses. Within Northern Ireland entrepreneurship education has been implemented through NICENT (the Northern Ireland Centre for Entrepreneurship) established in 2000 as a joint enterprise between the two main Universities in the region, the University of Ulster and Queens University Belfast. Initial funding from the Science Enterprise Challenge (SEC) focused on integrating entrepreneurship education within the Faculties of science, engineering and technology (SET). This was followed by funding from Northern Ireland's Industrial Research and Technology Unit (IRTU), which, in 2002, was subsumed into a new organisation, Invest Northern Ireland (Invest NI). This enabled broadening activity into all Faculties within the universities of the NICENT Partnership. To help achieve its objectives NICENT at Ulster developed a number of learning outcomes for entrepreneurship education at undergraduate and post-graduate levels, endorsed by the Teaching and Learning Committee of the University. Course teams were free to decide how best
Fig. 1. Ecosystem of social entrepreneurship (summary) (From CASE, 2008).
186
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
to incorporate the learning outcomes into their programmes over the duration of the student's learning cycle, for example as part of a discrete module or modules or integrated into the content of the programme. NICENT developed its strategy based upon the ‘enterprise for life’ approach to entrepreneurship education utilising a broad understanding of entrepreneurship focusing not only on new venture creation but also social entrepreneurship and the ability to apply entrepreneurial thinking within one's employment (intrapreneurship). The aim was to establish a foundation of enterprise skills and attributes upon which students can later base a variety of entrepreneurship applications rather than just business creation. As a result NICENT has been successful in introducing entrepreneurship education to all Faculties within the University, including those disciplines initially resistant to entrepreneurship due to the traditional business orientation of entrepreneurship (Bridge et al., 2009). The School for Social Entrepreneurs (SSE) was set up in 1997 with its headquarters in London and bases throughout the UK, including Belfast. While the activities discussed above function primarily within formal education, the SSE uses an action learning approach ‘to provide training and opportunities to enable people to use their creative and entrepreneurial abilities more fully for social benefit’ (SSE, 2010). Individuals, who may be nurses, can be helped to establish new charities or entities which function as social enterprises within communities. Entrepreneurship in nursing Entrepreneurship is a concept becoming increasingly important within the health and social care sector although until fairly recently the scope of its potential in nursing has not been widely recognised in the UK. For example, the RCN (2007) publication for budding entrepreneurs primarily focuses on providing guidance for nurses wishing to become self-employed and provides a range of examples of business opportunities including setting up a private care home, acting as an expert witness, undertaking consultancy, starting an agency etc., exemplifying the types of activities one usually thinks of under the term ‘entrepreneurship’: the social entrepreneur receives little attention and the intrapreneur none. However, in the US entrepreneurship among nurses is a more mainstream activity as indicated by the journal, Clinical Nurse Specialist, which has recognised the needs of their readers by starting a column on Entrepreneurial Dimensions of CNS Practice (Dayhoff and Moore, 2002). Policies which have promoted enterprise and entrepreneurship only began to be introduced in 1997 when Government published The New NHS: Modern, Dependable (DoH, 1997) and in later DoH publications (1999 and 2000, cited by Traynor et al., 2008) nursing was ‘put at the heart of the modernisation agenda’ (p. 14). More recently entrepreneurship, or the attributes of the entrepreneur, is being encouraged by Government and in 2003 the then Secretary of State for Health said that ‘I want to encourage a new generation of entrepreneurial nurses … (who) take the initiative, creating and implementing new ideas’ (cited in Faugier, 2005, p. 49). Traynor et al. (2008) implies that promotion of entrepreneurial activities and the development of nursing into more advanced roles has been used to reduce the authority of medicine in negotiation with Government. Whatever the underpinning rationale, the situation offers opportunities for nurses to exploit, particularly within the current economic climate. Indeed, the Minister of Health in the Republic of Ireland emphasised the importance of entrepreneurial skills in facing the challenges for health care and said that ‘if we are all flexible and innovative and open-minded and work together’, we can continue to provide the services patients expect for the money invested (IrishTimes.com, 2009). White and Begun (1998) emphasise the importance of being able to adapt to the ‘myriad forces of change’, which they described as ‘chaotic (apparently irregular and unpredictable) and complex (difficult to analyse) (p. 43). Many nurses would recognise this description. Nursing practice is continually changing with develop-
ments in medical science, policy directives and movements in priorities in health care, and advances emanating from nursing and medical research. Thus, there is a need for entrepreneurial nurses, and other staff, within the Health Service to maintain and enhance the quality of care. However, staff have to be given the freedom and encouragement to develop ideas, without a fear of failure and with the encouragement of senior staff. Drennan et al. (2007) have identified three groups of nurse/midwife/ health visitor entrepreneurs in the UK: the nurse intrapreneurs working within the Health Service; employers or self-employed providing services indirectly related to healthcare; employers or self-employed providing direct care. Some posts in nursing are innately entrepreneurial, for example in Public Health nursing, in order to bring health benefits to deprived populations, and many of the early entrepreneurial nurses were working as district nurses, health visitors or midwives to improve the health of the community (Faugier, 2005). Advanced Practice Nurses (Ireland) and Clinical Nurse Specialists (UK) are described as using the entrepreneurial skills of ‘creativity and innovation in the delivery of client-centred care’ (Furlong and Smith, 2005, p. 1064) and as displaying ‘entrepreneurial characteristics’ (Austin et al., 2006, p. 1541). McCray and Ward (2009) discuss the possible increase in social enterprise to provide the services commissioned for patients in the community, with nurses working in collaboration with other professionals and organisations. These individuals will need the enterprise skills of the entrepreneur as well as clinical knowledge and competence. However, the authors also argue that all UK nurses will need similar skills. All the various positions discussed above are important in developing services to meet changing needs. However, examples which are embedded within general nursing practice and initiated by staff at different levels can be identified; just two examples within one Health and Social Care Trust in Northern Ireland are: • Preparation, introduction and evaluation of a story book to prepare children being admitted for tonsillectomy with or without adenoidectomy (Tunney, 2009) which is now being developed for use with a wider range of conditions. • A Health Care Assistant in acute care has developed her skills in working with people with dementia and has prepared an information sheet for all staff to enhance their abilities in working with these patients. This has now been disseminated across the whole Trust (RCN, 2009). All nurses need to understand the process of the introduction and management of change in order to recognise and fulfil their position in the change process and participate effectively. However, we also need nurses who have acquired the set of skills needed to initiate and lead the introduction of change. Thus education about entrepreneurship is becoming an important issue for nursing education. However, to date there has been little emphasis on the inclusion of entrepreneurship within nursing education and the provision of education for entrepreneurship specifically for nurses is a recent development. Shirey (2007) described two master's level programmes starting in the USA in 2006 specifically focusing on development of entrepreneurship. However, most courses identified in the UK are either short courses or on-line courses not leading to a recognised qualification. The developments discussed earlier are leading to some content on entrepreneurship within, at least, some pre-registration programmes to prepare nurses to be innovators in practice. Incorporating entrepreneurship into nursing education For entrepreneurship to be developed seriously in nursing, nursing education must ensure that students are provided with the opportunity to develop the necessary knowledge and skills. Entrepreneurs need to have certain characteristics which are common amongst nurses and are the type of characteristics we look for in selecting students to enter nursing programmes. They need to be: creative and innovative;
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
confident, motivated, realistic; energetic and hard-working; good communicators and people people (NICENT, 2004). In addition, they need a range of generic skills most of which nurse education programmes endeavour to instil and which have been identified as abilities in: opportunity spotting and innovation; planning and decision-making; time-management and self-discipline; and communicating (NICENT, 2004). However, there is additional knowledge and skills which need to be incorporated to meet the entrepreneurship agenda, and a process to be negotiated to embed it successfully in the curriculum. The pre-registration nursing programme was being prepared for revalidation when entrepreneurship education became an issue within the University. The Integration Model developed by NICENT (Fig. 2) illustrates the curriculum development steps for a programme incorporating entrepreneurship followed by the School of Nursing and guides the discussion that follows. Awareness and understanding The University expected entrepreneurship to be included within the undergraduate programme in Nursing, but the School of Nursing needed to accept its relevance: the idea of entrepreneurship was new to the nurses involved and the initial reaction of the course team was ‘what has this to do with nursing?’ This was an important area to address with all academic staff involved. NICENT staff (i.e. experienced entrepreneurs and educators of entrepreneurship) met with the course team to discuss the University requirements and the work by NICENT to facilitate the introduction of entrepreneurship education. Ongoing discussion clarified the meaning of the entrepreneurial terms and identified the skills involved. The enthusiasm and flexible approach of the NICENT staff were contagious and nursing staff rapidly began to see the relevance to nursing and to identify the comparable activities within nursing. Several staff could identify situations within their previous clinical careers which were entrepreneurial in nature and helped others to accept the ideas. Further consideration of the complexities and continuous change in nursing, and discussions between staff of NICENT and the curriculum planning team, resulted in interpretation of entrepreneurship within the nursing context. NICENT's description of social entrepreneurship (NICENT, 2004) clarified the importance of creativity and innovation in the identification
187
of opportunities and in the solving of problems that add value to the lives of people within society. It incorporates the ability to identify the resources needed to progress their ideas, resources such as creative partnerships with others in society, a project plan, (financial) resources, and people. During curriculum development, this description was found to be valid within the context of nursing and one that could guide us in developing content.
Interpretation One of the difficulties encountered by nurses when considering entrepreneurship is the language which is derived from the world of business and includes terms such as ‘venture capital’ or ‘market opportunity analysis’ which are unfamiliar to nurses. To enable the concept of entrepreneurship to be understood and accepted within nursing the language used has to be acceptable to nurses, i.e. it needs to be translated into ‘nurse-speak’. Within this School of Nursing, we defined entrepreneurship through innovative practice as: • the application of creativity in facilitating innovative practice or introducing change. It includes: • assessing the needs of a patient/client group, identifying the skills and resources (including financial) required to meet those needs; • planning, implementing and evaluating changes in clinical care, a new patient/client care initiative or service, or setting up a health or social care related business. Table 1 shows the University learning outcomes related to entrepreneurship, developed by NICENT and used throughout the University. Our interpretation of these within the context of nursing programmes is indicated through the presentation of learning outcomes more suitable for the nursing context. This was a particularly important step in programme development to enable staff to integrate this content into the various modules comprising the programme. All students complete the set of learning outcomes equivalent to those of the module on Entrepreneurship Awareness and most of those within Entrepreneurship Applied.
Fig. 2. Nicent@Ulster integration model (©Sharon Porter).
188
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
Table 1 Entrepreneurship learning outcomes modified for Nursing. University learning outcomes Entrepreneurship awareness (Required) 1 They will be able to define entrepreneurship, the entrepreneur and the entrepreneurial process. 2 They will be able to identify steps required to research the potential for an innovative idea, social or community development or new venture opportunity. 3 They will be able to examine the key resources for new venture creation. 4 They will be able to point out the key steps required for exploiting an innovative idea, progressing a social or community development or setting up a new venture opportunity. 5 They will be able to recognise the central role of creativity and innovation in entrepreneurship and, where appropriate, the core challenges of protecting new ideas. 6 They will be able to discuss the components of a new venture/project and aspects of the planning process. 7 They will be able to manipulate an elearning environment. Entrepreneurship applied (Optional) 8 They will demonstrate and apply creative and innovative thinking. 9 They will practice market opportunity analysis.
10
They will be able to apply new venture/project planning competencies.
11
They will be able to demonstrate an ability to manage key entrepreneurial resources.
12 13
They will be able to operate as a team member. They will be able to communicate new ideas effectively using a variety of media.
Contextualisation It was decided by the course planning team that entrepreneurship, as described by the (translated into nurse-speak) learning outcomes in Table 1, was an integral part of nursing and almost all of the necessary content was incorporated within the materials already completed for the pre-registration nursing programme. Therefore the decision was taken that we would take the second option, integration of entrepreneurial content into the programme, rather than teaching it as a separate module or modules. Content of the programme planned to date for revalidation needed to be reviewed to identify which learning outcomes were already included and what additional content was required. The programme for revalidation was planned within six key themes: • • • • • •
Reflective and Proficient Practice Theoretical and Professional Issues Leadership and Management Communication, Teaching and Learning Health and its Determinants Research and Evidence Informed Practice
The development of each theme was carried out by a team of academic and clinical staff who ensured that the relevant content was included. Each of these themes runs through the programme and is delivered in units of study of 5, 10 or 15 credit points which are grouped into modules with specified credit point values. This structure facilitates revisiting of topics and the incremental building of knowledge and skills related to entrepreneurship consistent with the students' stage of development as a nurse. Integration: theoretical content Issues related to entrepreneurship are considered within units in the theoretical components of the course within all the themes above but mainly within the themes on Leadership and Management and
Modified learning outcomes They will understand the role of the entrepreneur and potential for the application of entrepreneurial skills in health and social care. They will be able to identify the steps required to research the need/potential for an innovative idea, or patient care development in nursing practice. They will be able to identify the resources required for introduction of change. They will be able to identify the steps required for the introduction of change.
They will recognise the importance of creativity and innovation in planning individualised patient care. They will be able to discuss the component parts and the planning process for introduction of change. They will be able to manipulate an elearning environment.
They will demonstrate and apply creative and innovative thinking. They will be able to carry out a needs assessment for individual patients and for groups of patients. They will be able to research the demand for a proposed health care innovation. Demonstrate appropriate skills in developing a care delivery plan from identification to delivery. Demonstrate appropriate skills in introducing change in practice. They will display the ability to manage the resources needed for the provision of patient care. They will be able to demonstrate an understanding of the identification and management of resources for the introduction of change. They will be able to operate as a team member. They will be able to communicate new ideas effectively using a variety of media.
Research and Evidence Informed Practice, as shown in Table 2, and within placement. The student group is divided into several groups and small groups of academic staff (3–5 in number) work with each group of students through the programme. Students build up their understanding of entrepreneurship through completion of the learning materials and groupwork for the relevant units of study throughout the programme. Learning about entrepreneurship occurs in each year of the course within the themes of the programme. Table 2 summarises how the individual entrepreneurship learning outcomes are achieved through the programme. The first year of the programme aims to provide students with a solid foundation about nursing and the sciences on which it is based. A number of the topics fundamental to nursing considered in this year also form the foundation for understanding and developing skills in entrepreneurship: the importance of creativity and innovation; assessment of need of individuals; planning and delivering care for individuals including necessary resources; and the use of elearning. Year 2 builds on the previous work. The unit on Decision-Making in Multidisciplinary Practice at the beginning of year 2 incorporates an introduction to the role and characteristics of the entrepreneur and examines the characteristics of teams and how they function. Later in this year knowledge and skills in needs assessment of groups is studied in relation to Public Health. While students have been introduced to the importance of evidence and research in nursing in year 1, in the later part of year 2 they undertake a substantial unit on Understanding Research which helps to develop the knowledge and understanding necessary to ‘research the need/potential for an innovative idea, or patient care development in nursing practice’. However, it is the unit on Management of Change in year 3 which contains the bulk of content on the skills and processes for introducing innovation into practice. This unit focuses mainly on entrepreneurship knowledge with students developing their skills through groupwork. It examines: models and strategies for change and for entrepreneurship; the scope of entrepreneurship and the characteristics required; identifying entrepreneurial opportunities and the importance of market research; planning change including
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
189
Table 2 Entrepreneurship within pre-registration nursing programmes. Learning outcomes
Integration in course
Theme of study
Entrepreneurship awareness (Required) 1 Characteristics of entrepreneur covered in year 2, in unit on Decision-making in Multidisciplinary Practice. Year 3 unit on Management of Change considers potential in Nursing for application of skills. 2 Knowledge and skills about research developed in several units in years 1, 2 and 3. 3 Achieved within unit on Management of Change in year 3. 4 Achieved within unit on Management of Change in year 3. 5 Unit on Study Skills and Use of Evidence (year 1) emphasises importance of creativity in nursing. Unit on Care Planning and Reflection emphasises individualised care. Innovation and creativity is emphasised throughout the course. 6 Considered within unit on Management of Change in year 3. 7 Theoretical content of programme is provided by elearning. All students will become competent. Entrepreneurship applied (Optional) 8 Innovation and creativity are expected throughout the programme. 9 Students are taught individual and group needs assessment in years 1 and 2 respectively. They apply these skills in clinical placement. Students learn necessary research skills in units on Understanding Research and Research Skills. 10 Students learn these skills in year 1 units and develop and apply them in practice throughout the course. Students practice these skills in groupwork in unit on Management of Change. 11 Students learn about the resources needed to implement patient care plans in practice focused units. Identification of resources dealt with in unit on Management of Change in year 3. 12 All students function as team members in groupwork and clinical placement throughout the course. They develop communication skills in units through course. 13 Students are introduced to and use a variety of media within groupwork activities.
identifying the necessary resources; entrepreneurial teams; and financial management. They also build on their earlier work on research and develop the research skills necessary to ‘research the demand for a proposed health care innovation’. The theme on Research and Evidence Informed Practice runs throughout the programme and is considered essential for a graduate nurse, but is of equal importance in relation to entrepreneurship.
Leadership and Management Communication, Teaching and Learning Research and Evidence Informed Practice Leadership and Management Leadership and Management Research and Evidence Informed Practice Reflective and Proficient Practice Leadership and Management All themes
Theoretical and Professional Issues Reflective and Proficient Practice Health and its Determinants Research and Evidence Informed Practice Reflective and Proficient Practice Leadership and Management Reflective and Proficient Practice Leadership and Management Communication, Teaching and Learning Communication, Teaching and Learning
Integration: assessment Assessment in relation to the entrepreneurship learning outcomes occurs through a range of methods for summative and formative assessment in both academic and clinical placements through the programme as shown in Table 3. Clinical Assessment in the majority of placements assesses competencies around assessment and management
Table 3 Assessment of entrepreneurship learning outcomes.
1 2 3 4 5 6 7
8 9
10
11
12 13
Entrepreneurship awareness (Required)
Assessment approaches
They will understand the role of the entrepreneur and potential for the application of entrepreneurial skills in health and social care. They will be able to identify the steps required to research the need/potential for an innovative idea, or patient care development in nursing practice. They will be able to identify the resources required for introduction of change.
Formative assessment in groupwork.
They will be able to identify the steps required for the introduction of change. They will recognise the importance of creativity and innovation in planning individualised patient care. They will be able to discuss the component parts and the planning process for introduction of change. They will be able to manipulate an elearning environment.
Entrepreneurship applied (Optional) They will demonstrate and apply creative and innovative thinking. They will be able to carry out a needs assessment for individual patients and for groups of patients. They will be able to research the demand for a proposed health care innovation. Demonstrate appropriate skills in developing a care delivery plan from identification to delivery. Demonstrate appropriate skills in introducing change in practice. They will display the ability to manage the resources needed for the provision of patient care. They will be able to demonstrate an understanding of the identification and management of resources for the introduction of change. They will be able to operate as a team member. They will be able to communicate new ideas effectively using a variety of media.
Formative assessment in groupwork and summative assessment in final year through Research Proposal Dissertation. Formative assessment through contribution to debate and summatively assessed in written examination in year 3. As above. The Undergraduate Assignment Feedback sheet specifically assesses creativity within theoretical work. Formative assessment through contribution to debate and summatively assessed in written examination in year 3. Not formally assessed, elearning used for knowledge acquisition throughout course and competence assured in first semester.
The School of Nursing Assignment Feedback sheet assesses the demonstration of creativity. Individual patient assessment assessed in Clinical Assessment in placements. Research skills demonstrated through the final year Research Proposal Dissertation. Competence in developing and implementing care plans is assessed in Clinical Assessment. Module examination will enable students to demonstrate understanding of necessaryskills. Management of resources for patient care are assessed in Clinical Assessment in placement. Module examination will enable students to demonstrate understanding of resources for implementation of change. Assessed within Clinical Assessment in placement (section on management of care). Students use a variety of media in presenting groupwork activities used in formative assessment.
190
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
which are inherently entrepreneurial in nature; in particular, the management placement in the final year offers the opportunity to demonstrate such skills. Teaching and learning activities, especially those carried out within groupwork, involve students working in small groups to develop their entrepreneurial skills, with immediate feedback on their achievement. Demonstration of creativity has been incorporated into the School of Nursing Assignment Feedback Sheet for many years and thus some of the key attributes of the entrepreneur are assessed within every piece of academic work submitted. In particular, completion of the final year dissertation, while focusing on research also enables students to demonstrate abilities relevant to entrepreneurship.
following groupwork session. Placements draw upon all learning up to that point in the programme. Review and reflection Throughout the programme individual modules of study are evaluated by students and reflected upon by staff who modify them as appropriate. However, completion of the first intake of students on this replanned curriculum coincides with the need to begin preparing for a full review of the course for the next five-yearly revalidation. At this time, the cycle shown in Fig. 2 recommences with a review of the Awareness and Understanding of entrepreneurship within the nursing context. Discussion
Validation/revalidation In preparation for validation or revalidation of a new or revised programme, the course document (and when relevant, as in this programme, the on-line learning materials) is reviewed for incorporation and assessment of the entrepreneurship learning outcomes within the programme by the staff of NICENT. If all outcomes of Entrepreneurship Awareness (i.e. the first seven learning outcomes) are completed and assessed within the programme, it is agreed at validation that, in addition to their Degree parchment, graduating students will be awarded a Certificate in Entrepreneurship. Students completing this programme, therefore, are awarded this Certificate.
Implementation In replanning this programme, our own entrepreneurial skills were applied in dealing with specific issues which had arisen in the previous version of the programme after student numbers were dramatically increased and spread over two (instead of one) campuses, at very short notice. The key difficulties arose in relation to teaching very large classes and in monitoring students' attendance and development. Following considerable debate involving all academic staff involved in the programme, it was agreed that a complete change in delivery of the University parts of the programme would be introduced in which elearning would be the major method of transmission of knowledge. This is blended with groupwork for facilitating application and integration of knowledge, and for development of a range of skills — academic, clinical, communication, and problem-solving. All learning is then integrated and applied within placement. Fig. 3 demonstrates the relationship between the different modes of learning using the example of entrepreneurship. In relation to any aspect of learning, students first complete the elearning and undertake the specified preparatory work before attending the
Creativity and innovation will be essential to maintain and enhance healthcare within a period of economic restraint and increasing health care needs as demographic change leads to a larger elderly population. Entrepreneurial skills are becoming more important in nursing as the services provided must constantly adapt to maintain the high quality care which patients deserve in the continually changing contexts in which nursing takes place, described as an ‘era of chaos and complexity’ (White and Begun, 1998, p. 40). Nurses may initiate businesses using entrepreneurship or social entrepreneurship skills or find themselves in positions within the health service which can be described as intrapreneurial. In addition, all nursing posts offer the opportunity to apply the skills and knowledge of entrepreneurship. At this time of economic uncertainty, they become particularly important, as professional staff have to find new ways of doing more with less. Integration of entrepreneurship into the pre-registration nursing programme produces graduates who have had the opportunity to develop the necessary skills and attributes to contribute to this endeavour within hospital and community settings, and within the NHS, private and non-profit making organisations who contribute to the health and welfare of the population. Over the coming years, as this new breed of ‘entrepreneured’ nurses and health care professionals graduate and seek employment, their impact will contribute to the development of a strong and vibrant health and social care sector. Ulster's innovative approach to the integration of entrepreneurship into the curriculum requires each discipline area to consider the meaning and relevance of entrepreneurship within that area. Within Nursing this education compliments and adds value to the programme. A number of learning points can be taken from the experience of integration within the School of Nursing at Ulster and are summarised as follows: • achieving relevancy and context: academic staff must achieve a clear understanding and an awareness of what entrepreneurship
Fig. 3. Implementation of entrepreneurship education.
J. Boore, S. Porter / Nurse Education Today 31 (2011) 184–191
means within the context of their own discipline. Within nursing it was interpreted, developed and delivered by nursing academic staff in a manner that ensured relevancy. • achieving commitment and championing: selling the concept of entrepreneurship education to all relevant stake-holders to obtain commitment and support for integration efforts. The use of champions within academic faculties is valuable for achieving entrepreneurship education; at Ulster each faculty has a member of academic staff with a remit to champion entrepreneurship education. In addition, staff were able to use examples from their own careers to illustrate entrepreneurship in action helped to bring to life the concept of entrepreneurship within nursing. • recognizing, celebrating and rewarding success in entrepreneurship education: students who have achieved the specified outcomes are awarded a Certificate in Entrepreneurship. • actualization of entrepreneurial thinking and behaviour: this needs to be within a secure environment where students (and staff) can ‘tryout’ entrepreneurship. NICENT recommended action based or experiential learning in pedagogy development for entrepreneurship education focusing on the enterprise for life approach with ‘education for doing’. The blended learning approach with substantial elearning and groupwork within this programme and clinical placement provide opportunities for students to develop their entrepreneurial skills. Conclusion In summary, nurses in any area of practice and at any level will be able to make a valuable contribution to health care if they demonstrate the characteristics and skills of the entrepreneur. Gibb (2000) describes entrepreneurship in a way applicable to nurses in any context and which emphasises competencies important to nurses in any context: ‘Entrepreneurship relates to ways in which people, in all kinds of organisations behave in order to cope with and take advantage of uncertainty and complexity and how in turn this becomes embodied in: ways of doing things; ways of seeing things; ways of feeling things; ways of communicating things; and ways of learning things’ (p. 16). In many areas of nursing, uncertainty and complexity are standard conditions of work and many nurses find ‘ways of doing, seeing, feeling, communicating and learning’ that enhance the quality of care either directly with patients or indirectly through working in management, education, research or policy. Thus, it is necessary that nurse educationalists take on the challenge of preparing nurses with the appropriate knowledge and skills to meet the demands of an ever-changing and increasingly demanding professional practice. In this paper the approach used in one university has been presented which, it is hoped, may be of value to other nurse educators. References Austin, L., Lucker, K., Ronald, M., 2006. Clinical nurse specialists as entrepreneurs: constrained or liberated. Journal of Clinical Nursing 15, 1540–1549.
191
BBC/OU, 2007. Challenges to the NHS Accessed 3/2/10 http://www.open2.net/ healtheducation/health_socialcare/challenges_to_the_NHS.html2007. Bridge, S., Hegarty, C., Porter, S., 2009. Re-establishing enterprise: identifying and applying appropriate entrepreneurship for undergraduates. Conference paper presented at ICSB Conference, S Korea. CASE, 2008. Developing the field of social entrepreneurship: a report from the Center for Advancement of Social Entrepreneurship (CASE) Alberta, Canada: Canadian Centre for Social Entrepreneurship, Duke University: The Fuqua School of Business. CCSE, 2001. Social entrepreneurship discussion paper no. 1. Alberta, Canada: Canadian Centre for Social Entrepreneurship, Duke University: The Fuqua School of Business. Dayhoff, N.E., Moore, P.S., 2002. Entrepreneurial clinical nurse specialists — innovators of patient care. Clinical Nurse Specialist 16 (5), 274–276. Dees, J.D., 2001. —revised. The meaning of ‘social entrepreneurship’. Alberta, Canada: Canadian Centre for Social Entrepreneurship, Duke University: The Fuqua School of Business. DEL, 2004. Skills strategy for Northern Ireland. Department for Employment and Learning, Belfast. DETL, et al., 2003. Entrepreneurship and education action plan. Belfast: Departments of Enterprise, Trade and Investment, Education, and Employment and Learning. http://www.detini.gov.uk/enterprising_education-2.pdf2003. DoH, 1997. The new NHS: modern dependable. Department of Health, London. Cm 3807. Drennan, V., Davis, K., Goodman, C., Humphrey, C., Locke, R., Mark, A., Murray, S.F., Traynor, M., 2007. Entrepreneurial nurses and midwives in the United Kingdom: an integrative review. Journal of Advanced Nursing 60 (5), 459–469. Drucker, P., 1985. Innovation and Entrepreneurship. HarperCollins, New York. European Commission, 2006. Implementing the Community Lisbon Programme: fostering entrepreneurial mindsets through education and learning. COM 33 final. Commission of the European Communities, Brussels. Faugier, J., 2005. Developing a new generation of nurse entrepreneurs. Nursing Standard 19 (30), 49–53. Furlong, E., Smith, R., 2005. Advanced nursing practice: policy, education and role development. Journal of Clinical Nursing 14, 1059–1066. Gibb, A.A., 2000. SME policy, academic research and the growth of ignorance: mythical concepts, myths, assumptions, rituals and confusions. International Small Business Journal 18 (3), 13–29. Hisrich, R.D., 1990. Entrepreneurship/intrapreneurship. American Psychologist 45 (2), 209–222. IrishTimes.com, 2009. http://www.irishtimes.com/newspaper/ireland/2009/0509/ 1224246190508.html2009Saturday, May 9. Kauffman Foundation, 2007. Entrepreneurship in American Higher Education: a report from the Kauffman Panel on Entrepreneurship Curriculum in Higher Education. Ewing Marion Kauffman Foundation, Kansas City, Missouri. McCray, J., Ward, C., 2009. Social enterprise — a new challenge for nursing practice and collaborative partnerships. International Journal of Nursing Studies 46, 151–153. NICENT, 2004. Entrepreneurship awareness — an elearning module. University of Ulster, NICENT. Northern Ireland Executive, 2002. Northern Ireland Programme for Government — Making a Difference 2002–2005. Belfast: Northern Ireland Executive. http://www. pfgni.gov.uk/pfgdocs.htm2002. RCN, 2007. reviewed 2009. Nurse entrepreneurs: turning initiative into independence. Royal College of Nursing, London. RCN, 2009. Nurse of the Year Awards programme. Belfast, RCN (NI). Report of the Global Education Initiative, 2009. Educating the next wave of entrepreneurs; Unlocking entrepreneurial capabilities to meet the global challenges of the 21st Century. World Economic Forum. www.weforum.org, Geneva. Shirey, M.R., 2007. Innovation and entrepreneurship — shaping your professional horizon. Clinical Nurse Specialist 21 (1), 16–21. Soanes, C., Stevenson, A., 2006. Concise Oxford English Dictionary, 11th Edition. Oxford University Press, Oxford. (Revised). SSE, 2010. School for Social Entrepreneurs web-site accessed 2/2/10 http://www.sse. org.uk/index.php2010. Traynor, M., Drennan, V., Goodman, C., Mark, A., Kavis, K., Peacock, R., Banning, M., 2008. ‘Nurse entrepreneurs’ a case of government rhetoric? Journal of Health Service Research and Policy 13 (1), 13–18. Tunney, A.M., 2009. An evaluation of the use of a story book on pre-operative coping mechanisms and post-operative recovery in children undergoing tonsillectomy and adenoidectomy. Unpublished MPhil Thesis, University of Ulster. White, K.R., Begun, J.W., 1998. Nursing entrepreneurship in an era of chaos and complexity. Nursing Administration Quarterly 22 (2), 40–47.