Rising to the Challenge of Health Care Reform With Entrepreneurial and Intrapreneurial Nursing Initiatives

Anne Wilson, PhD, MN, BN, FRCNA; Nancy Whitaker, BPsych (Hon); Deirdre Whitford, PhD


Online J Issues Nurs. 2012;17(2) 

In This Article

Abstract and Introduction


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 intrapreneurial 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.


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.1). 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 Poz, 2002). It is due to this acknowledgement that in the past two decades nurses' scope of practice has broadened considerably with the development and implementation of advanced and specialist nursing roles, such as that of the nurse practitioner and the advanced practice nurse, implemented through new models of practice. These expanded roles have been implemented in multiple care settings across the continuum of care from community or public health services and primary care, to acute care, and supportive or long-term care.

In this article, we will discuss how emerging and evolving entrepreneurial and intrapreneurial roles in nursing are rising to meet the challenge of health care reforms throughout the globe, across the continuum of health care. A historical overview of entrepreneurship and intrapreneurship is offered. We offer social entrepreneurship as a sustainable model of enterprising nurse-directed health care and describe brief examples of settings for nurse entre/intrapreneurship, and implications for research and practice.