Health reform worldwide is required due to the largely aging population, increase in chronic diseases, and rising costs. To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. This can involve entrepreneurial or lntrapreneurial roles. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost effective way, but to do so, they must be seen as equal partners in health service provision. This article provides a global perspective on evolving nursing roles for innovation in health care. A historical overview of entrepreneurship and intrapreneurship is offered. Included also is discussion of a social entrepreneurship approach for nursing, settings for nurse entre/intrapreneurship, and implications for research and practice.
Citation: Wilson, A., Whitaker, N., Whitford, D. (May 31, 2012) "Rising to the Challenge of Health Care Reform with Entrepreneurial and Intrapreneurial Nursing Initiatives" OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 2, Manuscript 5.
Key words: nursing, nursing role, entrepreneurial, intrapreneurial, social entrepreneurship, Future of Nursing, health reform
Pressure continues to mount as health systems worldwide endeavour to meet the needs of the population efficiently, economically, and effectively. There are widespread concerns about inappropriate skill mixes in the health workforce, difficulty recruiting and retaining staff, as well as the underutilisation of some health professionals (of which nursing is one). Needs-based, patient-centred approaches to care that employ mixed workforce teams are widely advocated as essential for health care systems to provide seamless, affordable, and quality care that is accessible to all. This approach to health care, specifically the utilization of evidence based interventions, has demonstrated improved health outcomes (McDermott, Tulip, & Schmidt, 2004; Rittenhouse et al., 2010). Interdisciplinary healthcare teams have the potential to improve outcomes, subsequently reduce costs and increase timely access to care (Willens, Cripps, Wilson, Wolff, & Rothman, 2011). A health infrastructure that is adequately funded delivers relevant care and is supported by a workforce suited to the population's health care needs is, therefore, essential to the delivery of high quality care.
Nurses comprise the largest proportion, up to 80% (Hughes, 2006), of the health workforce and are considered to be the front line staff across the health continuum in most health services and countries. In spite of the immense and significant role that nurses play in the health care system, they are seldom considered equal partners in multidisciplinary health care teams. As a result, the unique skills held by generalist and specialist nurses are often underutilised across the health continuum. However, the long-awaited and recently released report from the Institute of Medicine (IOM) (2010) Robert Wood Johnson Foundation Initiative entitled, The Future of Nursing: Leading Change, Advancing Health (FON), indicated that nurses have an important contribution to make in "...building a health care system that will meet the demand for safe, quality,
patient-centred, accessible, and affordable care" (Institute of Medicine, 2010, p.l) . However, in order to deliver these outcomes, it is essential for nurses to practice to the full extent of their knowledge and training while transforming the way in which health care is provided by entering into full partnerships with other health care professionals.
Indeed, research has recognised that there is unrealized scope for extended practice for nurses working in multidisciplinary teams with doctors and allied health professionals (Buchan & Dal ? …