ORIGINAL RESEARCH

Business entrepreneurship among nurses

Sabrina de Cássia Chagas^I; Priscila Néria Milagres^II; Mariana Cristina Rodrigues Silva^III; Ricardo Bezerra Cavalcante^IV; Patrícia Peres de Oliveira^V; Regina Consolação dos Santos^VI

^I Nurse. Federal University of São João del Rei. Minas Gerais, Brazil. E-mail: sabrinachagas1@hotmail.com
^II Nurse. Federal University of São João del Rei. Minas Gerais, Brazil. E-mail: milagresp@hotmail.com
^III Nurse. Federal University of São João del Rei. Minas Gerais, Brazil. E-mail: maryrodrigues235@hotmail.com
^IV Nurse. Adjunct Professor of the Federal University of Juiz de Fora. Minas Gerais, Brazil. E-mail ricardocavalcante@ufsj.edu.br
^V Nurse. Adjunct Professor of the Federal University of São João Del-Rei. Minas Gerais, Brazil. E-mail: pperesoliveira@gmail.com
^VI Nurse. Master of Science. Professor at University of Itaúna. Itaúna, Minas Gerais, Brazil. E-mail: reginasantos72@outlook.com

DOI: http://dx.doi.org/10.12957/reuerj.2018.31469

ABSTRACT

Objective: tto characterize business entrepreneurship among nurses. Method: in this quantitative case study, framed conceptually by Schumpeter, data were collected in 2015, by validated questionnaire and semi-structured interview, from ten business entrepreneur nurses in a municipality in Minas Gerais. The data were analyzed by thematic category content analysis, while data on profile and behavioral characteristics were analyzed using STATA (version 12.0). The study was approved by the research ethics committee. Results: most of the nurses were found to have highly profitable registered businesses providing home care. The following behavioral characteristics need to be leveraged: information search, planning and systematic monitoring, and contact persuasion and network. Conclusion: business entrepreneurship among the nurses studied constituted a professional opportunity envisaged in response to the need for profit and personal satisfaction, which forced them to move away from their traditional professional niches.

Descriptors: Labor market; business practice; nursing; entrepreneurship.

INTRODUCTION

Business entrepreneurship in nursing has provided the provision of services that involve care, education and administration.¹ In this context, the entrepreneur nurse is one who works with ideas and economic opportunities, brings together capital and resources to produce services and goods. This definition parallels the concept developed by Schumpeter, one of the first authors to conceptualize entrepreneurship as one who produces new ideas and manages to program the new.^2,3

International studies show that nurses seek business entrepreneurship to escape the limits imposed by traditional health institutions.^4-6 The nurse, besides being able to comprehend human needs in an integral way, also has the potential to explore new areas, not having to stick to a traditional job where the notion of disease prevails. The nurse, in identifying a need, establishes a service to meet this need, and acts as an entrepreneur in his or her own business.⁷

In Brazil, there are still few studies that address business entrepreneurship in the nursing area and are more focused on social entrepreneurship.⁸ Thus, it is justified the need to broaden the knowledge about entrepreneurship among nurses, seeking to know the characteristics of the entrepreneurial activities and the profile of these nurses in order to understand their entrepreneurial potentialities. Therefore, this study aimed to characterize entrepreneurship among nurses.

THEORETICAL REFERENCE

Currently, economic, technological and social transformations have been discussed because they have an impact on the labor market. It is also observed a transition from the economic model, where the search for stability in work, becomes, in the new model, to achieve professional satisfaction, autonomy and security.⁹

Entrepreneurship can be considered an expression derived from the translation of the word entrepreneurship, referred to the study concerning the entrepreneur from its origin to its performance. ¹⁰ One of the first authors to conceptualize what the entrepreneur is, describes him as one who creates new ones, and/or renews traditional processes. It also complements that the entrepreneur is the one who produces new ideas and can program the new.²

Entrepreneurship establishes an action through the design of new products/processes and/or the exploration of new areas. Thus, being an entrepreneur means acting in front of an opportunity that is worth working on.¹¹

Currently, entrepreneurship emerges in several areas, including health, where it has stood out, as in nursing.¹² The nurse naturally has managerial skills on the health-disease process, including the ability to manage physical, material, human and financial resources.¹³ However, nurses have expanded and innovated their professional performance by creating enterprises based on the needs and opportunities of the labor market.¹⁴

METHODOLOGY

This is a unique case study, which aims to study a specific and little-known phenomenon,¹⁵ with a qualitative approach, due to the need to capture the experiences of participants,¹⁶ supported by the concepts of Schumpeter.² Thus, because business entrepreneurship is new in the context of nursing, a case study can contribute with details and details that have not yet been described in the literature. The research complied with Resolution No. 466/2012 of the National Health Council and was approved by the Ethics Committee on Research with Human Beings of the Federal University of São João Del Rei under opinion/nº76951/20.

The scenario defined for the study was a mining municipality, a health reference for 54 municipalities in its surroundings, in 2015. The definition of the study participants occurred through the identification of nurses who have companies and/or autonomous, within the context of health and/or nursing.

Initially, the first entrepreneur nurse was identified in the media, congresses and at the Regional Council of Nursing of Minas Gerais (COREN-MG), working in the city under study. This nurse was invited to participate in this research and was asked to indicate other entrepreneurial nurses, according to the previously established criteria.

The Snowball technique is used in social research. It is non-probabilistic, i.e. the first participants indicate other new participants and so on until the saturation point.¹⁷ The point of saturation was reached to the total of 10 entrepreneur nurses interviewed.

The data collection was carried out from the application of a semi-structured script, composed of two parts. The first one that characterized the profile of the nurse and his/her enterprise and the second part composed by open questions containing the motivations, facilities and difficulties related to his/her enterprise. The interviews were recorded and later transcribed. Each nurse received a code to ensure anonymity (letter E = Nurse and number 1 to 10 for interviews). The interviews had an average duration of 50 minutes and were performed at a prior defined location by the interviewee. The data collection period occurred from July to September 2015.

The data from the interviews were submitted to content analysis, thematic-categorial modality,¹⁸ by means of pre-analysis or floating reading and exploration and coding of the material which, in the end, were treated in a way to be significant and valid. The entrepreneurial behavioral characteristics of the nurses participating in the study were evaluated as well as their profile. To do so, the questionnaire formulated by McClelland was used.

The objective of this questionnaire is to identify the behavioral characteristics of entrepreneurs (CCE, distributed in ten groups: search for opportunities and initiative, persistence, commitment, quality and efficiency requirements, calculated risks, goal setting, search for information, planning and systematic monitoring, persuasion and network of contacts, independence and self-confidence. The questionnaire proposes a self-assessment, in which the answers with scores from 1 to 5 should be punctuated, which will express the behavior of the interviewee. At the end of the questionnaire, the result of each statement is added, which will indicate the intensity of each of the interviewee's entrepreneurial behaviors. The maximum score is 25 points for each characteristic, being considered an entrepreneur that reaches a minimum score of 15 points. A correction factor was also applied, whose purpose is to correct an eventual tendency of the respondent to present a highly favorable image of himself.¹⁹

The questionnaire data were analyzed using the STATA software version 12.0. The central (mean and median) and dispersion (standard deviation, minimum and maximum) measures of the 10 groups of characteristics evaluated in the questionnaire were calculated.

RESULTS

Regarding the profile of the nurses interviewed, 70% were female, with the age group between 30 and 40 years old. All graduated from a private institution. It was noted that 40% of the nurses have more than one specialization, however these are not always linked to their area of ​​activity in the enterprise. The high monthly profitability of these entrepreneurs stands out, ranging from R $ 1,800 to R$ 85,000, as evidenced in Figure 1.

FIGURE 1: Characterization of the studied nurses. Medium-sized municipality of Minas State Center-West, July to September 2015.

Of the total number of interviewees, 50% currently carry out another activity beyond their enterprise. All have worked in other places before their enterprises and 70% have registered Corporate Taxpayer's ID (CNPJ) and social ratio duly registered in a competent body. Regarding the CCEs of the nurses interviewed, considering the questionnaire proposed by McClelland and his recommended score (15 to 25), it is noted that thecommitment, setting goals and independence and self-confidence were the characteristics that obtained higher averages. Considering the characteristics with lower averages, the most important are persuasion and network of contacts and persistence. However, considering the average, it is noticed that all the characteristics exceeded the recommended minimum value, as shown in Table 1.

TABLE 1: Characterization of Entrepreneurial Behaviors of the nurses studied. Medium-sized municipality of Minas State Center-West, July to September 2015.

It was also verified that the nurses E6, E10 and E7, E9 presented the minimum value in the CCEs information search and persuasion and network of contacts, respectively. In addition, E2 was the only one that did not reach the minimum value recommended by the questionnaire, achieving in CCE Systematic planning and monitoring value of 13 points. However, in general, it is noted that the great majority of entrepreneurs reached the necessary score to be considered an entrepreneur according to McClelland, as shown in Figure 2.

Note: C-1: Search for opportunity and initiative; C-2: Persistence; C-3: Commitment; C-4: Requirement of quality and efficiency; C-5: Take risks; C-6: Setting goals; C-7: Information search; C-8: Systematic planning and monitoring; C-9: persuasion and network of contacts; C-10: Independence and self-confidence.
FIGURE 2: Punctuation of the nurses studied in each entrepreneurial behavioral characteristic. Medium-sized municipality of Minas State Center-West, July to September 2015

The genesis of business entrepreneurship and entrepreneurship: difficulties, satisfaction and goals.

The training and motivations for entrepreneurship were recognized by the nurses interviewed. Firstly, it was emphasized that the graduation period contributed little to the awakening to entrepreneurship:

Another interviewee reports:

Nurses verbalized their motivations for the process of undertaking a business of their own. They are related to the possibility of profitability and independence in the business:

In addition, some interviewees mentioned ease in disclosure as one of the contributing factors to the process of undertaking:

Family support, prior experience and market demand were also referred to as key facilitators in the process of undertaking.

In addition to the facilities to undertake, participants also highlighted the personal characteristics and knowledge required for entrepreneurship , composing the third subcategory. It was recognized that some characteristics are needed to be undertaken: to want to own one's own business, to naturally have the profile of an entrepreneur, to win the trust of the clients and to be cautious in minimizing the risks faced with the challenge of undertaking.

Another recognized feature was the ability to articulate technical/scientific knowledge:

And the identification of a need/opportunity.

The difficulties for entrepreneurship in nursing were highlighted by the participants. The multiplicity of functions in the enterprise was initially recognized as a difficulty to be overcome:

It was also recognized as difficulties the lack of knowledge of the law and the bureaucracy to implement the enterprise:

The lack of supervision and the lack of knowledge of the responsible bodies about the proposed enterprise was also recognized as difficulties faced by the nurses.

The credibility before the clientele for being a nurse was another difficulty experienced:

It was also highlighted the initial unavailability of financial resources to start the venture:

Another difficulty recognized was unfair competition in the market. The complaint is that some services are offered in an amateurish way and with a reduced value. This situation ends up negatively affecting the image of the professional and his devaluation.

In addition to the difficulties recognized by nurses, reports also emerged that highlighted satisfaction about their entrepreneurial activity and future goals. Even with all the difficulties presented by the nurses, personal and professional satisfaction was manifested in relation to their enterprise:

It was found that the nurses already projected their future goals for the enterprise, planned their expansion:

DISCUSSION

Most of the nurses in the study have registered enterprises with a high profitability when compared to nurses who work in the traditional labor market, predominantly home care and care for the elderly in long-term care institutions. These findings point to the innovative possibilities of working in various niches of work provided by business entrepreneurship in the context of nursing. This finding demonstrates the concept of the entrepreneurial being evidenced by Schumpeter, such as the one with the ability to create new and/or renewal of traditional processes.² In addition, it reinforces the importance of nurses to work in an increasingly demanded market, home care and assistance to the elderly population.²⁰

Among the nurses in study, it is noted that there are those who do not have any type of specialization and others with various specializations. However, most of these specializations have no relation to the type of enterprise offered, contributing little to the execution of their entrepreneurial activities. That is, despite the lack of specialization or inadequate specialization to the proposed enterprise, nurses have ventured into businesses that require a certain level of knowledge. It is known that in the business environment, a professional improvement is fundamental for the opening of new ways and alternatives of work, in this way the acquisition of new knowledge directed to the own business favors the achievement of the success.²¹ For the individual to be successful in his enterprise, one must work the intellectual in order to enlarge what the human mind had produced as creative.²

In relation to CCE, it was verified that the information search, systematic planning and monitoring, and persuasion and contact network should be potentiated among the nurses surveyed. Business entrepreneurship requires a systematic planning based on reliable information, being a competitive differential and base for the beginning of the enterprise ²². Regarding persuasion and network of contacts, are CCEs that enhance the venture, based on the conviction of the need and quality of that service, in addition to establishing a network of relationships to disseminate the visibility of the enterprise.²³

Although universities are considered important institutions in the formation of future entrepreneurs²⁴, most of the nurses interviewed did not recognize them as incentives to entrepreneurship, highlighting a gap in nursing graduation when it comes to encouraging entrepreneurship.

Among the initial motivations for opening their enterprises, nurses highlighted the possibility of having their own business and the possibility of profitability and independence. The motivation to entrepreneurship often occurs through the interaction of several factors. For many individuals the motivation to entrepreneurship is given by the identification of an opportunity or need, for others, by the possibility of acquiring autonomy.²⁵

In relation to the factors that facilitated the development of their businesses, the family was recognized as fundamental in the decision to undertake, corroborating the finding that it is important to involve the family in the support network to the entrepreneur.²⁶

Previous experience and knowledge about the market has strengthened the decision to undertake. The individual with previous experience has a greater capacity to maintain the initial motivation and to face the challenges and difficulties, since these individuals have a better knowledge of the demands of the market.²⁷

It was also observed that some characteristics related to the personality of nurses potentiated business entrepreneurship. These findings endorse the fact that the differential of a professional is not exclusively in their skills, curriculum, training or experience, but also in their behavior, perception of the world and in the capacity to innovate, to create and to reinvent itself.²⁸ The entrepreneur's success depends on his intuition, on his ability to see things differently and on perceiving the essentials and leaving aside the superficiality of the business. ²

In relation to the difficulties faced to undertake, the multiplicity of functions was highlighted generating work overload, showing weaknesses in the structuring of the enterprise and potentiating negative influences the survival and competitiveness of the business.

Another difficulty was the lack of knowledge of the legislation needed to regulate the enterprise. Brazil is slowly advancing compared to other countries that seek innovation and the main problem identified is not the lack of resources, but the lack of access to information by the entrepreneurs.²⁹

It has also been pointed out that financial difficulty is a major challenge, something that needs to be considered, as market survival and growth are consequences of properly funded infrastructure, which is therefore essential for high quality care.³⁰

Unfair competition, coupled with the lack of credibility and lack of knowledge of the population about nurses' possibilities of action, was also identified as difficulties, which negatively influence the proposed entrepreneurial activity.³¹

Other difficulties reported (excessive bureaucracy, lack of supervision and lack of knowledge of the competent bodies) show weaknesses in market regulation by the responsible authorities. Who should facilitate the opening of the enterprise and supervise it may not be prepared for such an assignment. This leads to the debate about the need for advances in the opening and inspection sector. Historically, there have been challenges and barriers to entrepreneurship initiatives by nurses.³² However, despite the difficulties presented, the nurses claimed personal and professional satisfaction from their enterprises, as well as already envision possibilities for future expansion and goals.³³

It is possible to generalize because it is a case study, but it is evident its importance as a guide for other studies that deepen the theme of business entrepreneurship in the context of nursing. It is necessary to understand the daily work of these entrepreneurs, as well as studies that elucidate possibilities of insertion of business entrepreneurship in the context of nursing training.

CONCLUSION

Business entrepreneurship in this study was characterized by the articulation between training, personal characteristics, recognition of an opportunity in the market and experiences acquired by the investigated nurses. It was found that nurses need to strengthen some behavioral characteristics such as information search, systematic planning and monitoring, and persuasion and network of contacts.

Among the initial motivations was the possibility of profitability in the market. The participants have registered enterprises, predominantly home care and long-term institutions. In order to undertake, the participants recognized and faced challenges and difficulties to start and maintain their businesses and despite the difficulties they recognize the satisfaction in their ventures and already see future goals.

The limitations found in the present study are related to the lack of national and international research with the same objective and target population. It also relates to the question of many professionals who are not from the municipality under study.

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