Enterprising tendencies of nurses in a university hospital

Abstracts

Estudo quantitativo que objetivou identificar tendências empreendedoras dos enfermeiros de um hospital universitário e relacioná-las com idade, tempo de trabalho e conclusão do curso de enfermagem. Estudo quantitativo, transversal contemporâneo realizado em 2010. Todos os 60 enfermeiros responderam ao questionário "Tendência Empreendedora Geral", com cinco categorias. Na categoria "criatividade", um enfermeiro obteve dois pontos, em "necessidade de realização", um enfermeiro somou 12 pontos; em "impulso e determinação", quatro enfermeiros alcançaram maior pontuação; em "riscos calculados/moderados", a maior pontuação foi 10 pontos; em "autonomia/independência", nove enfermeiras obtiveram um ponto. Idades entre 27 e 33 anos mostraram maior tendência empreendedora. Existe decréscimo da tendência empreendedora dos enfermeiros com idades superiores a 43 até 56 anos, com mais de 17 anos de conclusão de curso e com maior tempo de trabalho. São necessárias ações que estimulem enfermeiros na faixa etária em declínio da tendência empreendedora e aqueles com maior tempo de formação e trabalho.

Enfermagem; Recursos humanos de enfermagem no hospital; Inovação organizacional

ORIGINAL ARTICLE

Enterprising tendencies of nurses in a university hospital

Tendencias de actitudes emprendedoras de los enfermeros en un hospital universitario

Fabiana Gallo Costa^I; Helena Heidtmann Vaghetti^II; Daniela Faustino Gonçalves Martinello^III; Daniel Pinho Mendes^IV; Alessandra Chaves Terra^V; Simone Quadros Alvarez^VI; Luiz Augusto Pinto Lemos^VII

^IR.N. graduated at the Federal University of Rio Grande (FURG). Rio Grande, Rio Grande do Sul, Brazil

^IIPh.D. in Nursing. Professor at the Nursing School, FURG. Rio Grande, Rio Grande do Sul, Brazil

^IIIMaster's degree in Nursing by FURG. Rio Grande, Rio Grande do Sul, Brazil

^IVMaster's student at the Nursing Graduate Program of FURG. Rio Grande, Rio Grande do Sul, Brazil

^VMaster's degree in Nursing by the Nursing Graduate Program of FURG. Rio Grande, Rio Grande do Sul, Brazil

^VIMaster's degree in Nursing by the Nursing Graduate Program of FURG. Rio Grande, Rio Grande do Sul, Brazil

^VIIMaster's degree in Engineering. Professor at the Institute of Mathmatics, Statistics and Physics, FURG. Rio Grande, Rio Grande do Sul, Brazil

Author's address

ABSTRACT

Quantitative study aimed to identify the enterprising tendency of nurses at a university hospital and to relate them with age, length of work in the hospital and conclusion of the nursing course. This cross-sectional quantitative study was developed in 2010. All 60 nurses from the hospital answered the questionnaire General measure of Enterprising Tendency, which contains five categories. In the creativity category one nurse obtained two points; in need for achievement one nurse totaled 12 points; one nurse obtained two points; in motivation four nurses achieved higher scores; in taking calculated risks, the highest score was 10 points; in autonomy, nine nurses obtained one point each. Individuals aged between 27 and 33 years showed higher enterprising tendencies. Reduced enterprising tendencies were found for nurses aged between 43 and 56 years, graduated more than 17 years ago and with a greater length of work. Actions are necessary to encourage nurses in the age range of enterprising tendency decline and those who graduated longer ago and who have worked for a longer period of time in the hospital.

Descriptors: Nursing. Nursing staff, hospital. Organizational innovation.

RESUMEN

Estudio cuantitativo que buscó identificar las tendencias emprendedoras de enfermeros de un hospital universitario y relacionarlas con la edad, tiempo de trabajo en el hospital y tiempo de la finalización del curso de enfermería. Estudio cuantitativo, transversal contemporáneo realizado en 2010. Todos los 60 enfermeros del hospital respondieron al cuestionario de Tendencia Emprendedora General con cinco categorías. En la categoría de creatividad, un enfermero obtiene dos puntos, en la necesidad de realización un enfermero totalizó 12 puntos; en el impulso y la determinación cuatro enfermeros lograron mayor puntuación; en los riesgos calculados/moderados la mayor puntuación fue de 10 puntos y la más baja un punto; en la autonomía/independencia nueve enfermeros obtuvieron un punto. Edades entre 27 y 33 mostraron las tendencias más emprendedoras. Hay disminución de esas tendencias en de los enfermeros mayores de 43 y ate 56 años, para aquellos que se graduaron hace más de 17 años y aquellos con más tiempo de trabajo en el hospital. Son importantes actividades que estimulen a los enfermeros que se encuentran en el intervalo de edad de disminución de la tendencia emprendedora, así como los que tienen más tiempo de formación e trabajo en el hospital.

Descriptores: Enfermería. Personal de enfermería en hospital. Innovación organizacional.

INTRODUCTION

The term "entrepreneur" originated from the French verb entreprende or entrepreneur, which means the one who is in the midst or in the center of an action. Similarly, the English word "entrepreneurship" indicates position, degree, relation, state, quality, ability, whereas in German it expresses the person who owns or runs a business, the unternehmer, which, in English, expresses that someone is the "managing owner"⁽¹⁾.

Hence, entrepreneur is the person who has the idea of a product or service and establishes an action so that it becomes an opportunity of profitable business, assuming the legal and financial risks involved⁽²⁾.

The ability to cope with possible setbacks is a vital requisite for the development of the enterprising practice⁽³⁾, since the enterprising worker is able to create innovative solutions and to generate potentially profitable and modifying actions⁽⁴⁾.

Entrepreneurship in nursing has been evident since the 19^th century, when Florence Nightingale served as a nurse in the Crimean War and founded the Nursing School of Saint Thomas Hospital, transforming the care based on the religious model into a professional activity⁽⁵⁾. Other examples of enterprising figures in nursing are Anna Nery, who delivered care to those wounded in the Paraguayan War and Wanda de Aguiar Horta, the first Brazilian nursing theorist⁽⁶⁾.

Enterprising practices in nursing may currently be found in several settings, such as in the third sector (organizations, associations and foundations that generate public services and assets to society), in consulting and advisory services, organizational activities and in teaching and research activities, for instance providing the nurse with autonomy and professional acknowledgement⁽⁷⁾.

The enterprising culture must be encouraged back from the nursing undergraduate course, assisting in the construction of an innovative thought, taking distance from the mechanic action, in the form of a broad care/health concept, in which new fields of activity may be explored and created, providing new forms of social intervention⁽⁸⁾.

Entrepreneurship is, thus, characterized as a catalyst of initiatives and changes, assisting nurses to deal with the common setbacks in their profession, as well as to plan, organize and develop new working methods to improve their daily performance, enabling them to achieve long-lasting success in their careers.

In the light of the exposed, this study aimed to identify enterprising tendencies of nurses in a university hospital and to relate them with the variables age, length of work in the hospital and conclusion of the undergraduate nursing course.

The development of this study is justified by the lack of studies contemplating entrepreneurship in the nursing work settings, having the nurses in their context as study subjects, as entrepreneurship must be promoted in the nursing undergraduate program so as to qualify enterprising professionals. This study is important in order to recognize potentially enterprising nurses and to encourage the others to develop enterprising characteristics that will make them stand out from the simple and ordinary in the profession.

METHODOLOGY

This contemporary quantitative cross-sectional study was developed in a university hospital in the south of Brazil, between August and October of 2010.

The study sample consisted of 60 nurses from several care and administrative units of the aforementioned hospital, who agreed to participate and signed the Free and Informed Consent Form. The decision to develop the study in a university hospital was based on the fact that this is a productive setting for researching, allowing results to be the theme of discussions, and for promoting reflections, especially regarding entrepreneurship and the importance of incorporating it to the nursing working process.

Data were collected using the General measure of Enterprising Tendency (GET) questionnaire, which was developed in the Business and Industrial Qualification Unit of Durham University Business School – Durham, England, by C. Johnson and Sally Caird in 1988 and has been validated by Brazilian researchers⁽⁹⁾. This questionnaire aims to evaluate enterprising characteristics using five categories as parameter: (1) need for achievement; (2) need for autonomy; (3) creative tendency; (4) ability to take calculated risks; (5) motivation, each one with a maximum score of 12 points, with exception to the need for autonomy, which has the maximum score of 6 points.

The GET questionnaire consists of 54 questions, and in each one the participant must check A (I agree) or D (I disagree), according to his/her understanding regarding the assumptions. The scores are calculated as follows: for each "even" question in which the participant checks A (I agree) one point is added, and for each "odd" question in which the participant checks D (I disagree) one point is also added.

The data obtained with the application of the questionnaire were organized in an Excel spreadsheet and analyzed in the light of the descriptive statistics. Dispersion diagrams were used to analyze the results of the relationship of the GET value with the variables age, length of work in the university hospital, length of work in the same unit or sector of the hospital and time of conclusion of the nursing course.

The study proposal complied with ethical guidelines and was approved by the Ethics Committee to which the university hospital is associated, under the protocol no. 88/2010.

RESULTS

The sample of nurses was made up of 98.33% women, aged between 27 and 56 years, of which 50% varied between 32.5 and 49.5 years. Regarding the time of conclusion of the nursing course, the range was 29 years (between 1 and 30 years), and 50% varied between 10 and 22.5 years. The variable length of work in the university hospital ranged from 1 month to 24 years, and the mean of the length of work in the same unit/sector was 7 years, with a variation between 1 and 16 years.

It was observed that nurses aged between 32.5 and 34.5 years presented greater enterprising tendency. On the other hand, subjects over 43 years of age demonstrated a decreased enterprising tendency, recovering and keeping it until the age range of 56 years, when a new decrease in the score restarts. Figure 1 illustrates the results exposed.

The nurses with a greater length of work in the hospital showed a lower enterprising tendency, whereas high scores of GET were found in nurses with 4 to 5 years of work in the hospital. Although it was not the purpose of this study to define a cutoff point, there is strong evidence that after 12 years of work in the university hospital there is a decline in the enterprising tendency, as it may be observed in Figure 2.

It was verified that the nurses who obtained between 42 and 44 points were those who had been graduated for 5 and 11 years, as demonstrated in Figure 3.

The data obtained indicate that the nurse who achieved the highest score in need for achievement, 12 points, was 33 years old, concluded the nursing course in 1999 and had been working in the hospital for 21 months. On the other hand, the nurse with the lowest score, obtaining 5 points, was 52 years old, graduated in 1985 and had been working in the university hospital for 22 years.

The nurse who obtained the highest score in the category need for autonomy, 6 points, was 32 years old, concluded the nursing course in 2002 and had been working in the university hospital for four years. In this category, nine nurses achieved the lowest score, one point, and their ages varied between 28 and 53 years, the time of conclusion of the course dated back to 1982 to 2007 and the length of work in the university hospital varied between 20 months and 16 years.

In creative tendency, the highest score, 12 points, was obtained by a 29-year-old nurse, who graduated in 2004 and had been working in the hospital for two years. The lowest score, 2 points, was achieved by a 29-year-old nurse, who graduated in 2008 and had been working in the hospital for a month.

In calculated risks, the nurse with the highest score, 10 points, was 34 years old, graduated in 1998 and had been working in the hospital for 21 months. The nurse with the lowest score, 1 point, was 55 years old, graduated in 1980 and had been working in the hospital for 22 years.

In motivation, four nurses obtained 12 points. Age varied between 41 and 55 years, the conclusion of nursing course took place between 1980 and 1995, and the length of work in the hospital varied between 16 and 22 years. The lowest score, totaling 6 points, was obtained by a 28-year-old nurse who graduated in 2008 and had been working in the hospital for a month.

DISCUSSION

The relationship between age, time of conclusion of the undergraduate nursing course and the results obtained by means of the questionnaire show two aspects: there is a decrease in the enterprising tendency of nurses aged between 43 and 56 years and as well as for those who have been graduated nurses for more than 17 years.

The combination of a long period of time since graduation and low enterprising tendency may be associated with residues of the educational nursing system that occurred until the 80's, in the 20^th century, which aimed at the vocational aspects of care and the compliance with organizational rules, in detriment of more enterprising actions⁽¹⁰⁾.

Similarly, the age advance associated with the decrease in GET may be related to the weariness generated by the nursing work, which is often exhausting and complex, with the long working hours and the stress being determinant to decreasing the enterprising tendency of the nurses.

Aimed at dimensioning the nursing staff, the legislation of the Federal Nursing Council seems to reinforce the decrease in productivity of nurses aged over 50 years, as recommended in the Art. 9^th - "If made of 60% or more people aged over (fifty) years, the nursing staff of the hospitalization unit must add 10% to the index of technical safety"⁽¹¹⁾.

In the same direction, the correlation between the length of work in the university hospital and the total score obtained in the GET questionnaire identify that the nurses who have been working for a longer time show lower enterprising tendency, whereas the highest values were obtained by nurses with 4 to 5 years of work. This may be justified by the same allegations aforementioned and which may also be found in the study of Wandemberg⁽¹²⁾, titled "Enterprising in the age of the end of employment", in which the author reiterates that, developing the same function for a long period of time, in the same institution, constitutes a harmful factor towards entrepreneurship.

Regarding the dimension "need for achievement", it was verified that the subject with the highest score had not been working in the hospital for a long time, whereas the nurse with the lowest score had been working in the institution for 22 years, a period of time that was also proportional to their time of graduation. "Need for achievement" is associated with personal satisfaction and represents the need an entrepreneur must meet in order to obtain success in his/her entrepreneurship⁽¹³⁾. The nurse who scored 12 points, which is considered a high score, may present the following characteristics: perspective aimed at the future, self-sufficiency, optimism, orientation towards tasks and results, energy, self-confidence, determination and dedication to conclude his/her functions⁽¹⁴⁾, and essential conditions for the satisfactory performance of the nursing work. This need is fundamental so that nurses find sense in the profession and undertake actions at work to achieve both their personal goals as well as those required by the organization where they work.

The nurse who obtained 12 points in the category "creative tendency" may demonstrate qualities such as imagination and innovation, versatility and curiosity, production of ideas, intuition, taste for new challenges, news and changes⁽¹⁵⁾, strategies and tactics necessary to cope with the difficulties and obstacles resulting from the hospital work. Another study reiterates the importance for nursing workers to use creativity, since this may assist in the development of adaptations and improvisations so that the care delivered is effective and tasks are carried out⁽¹⁶⁾.

In the item "motivation", four nurses obtained the maximum score (12 points). High scores in this section means that the person tends to seize opportunities, reject predestination, make their own luck, control their fate, be self-confident, balance results with effort and show considerable determination⁽¹⁴⁾_.

It is important to highlight that one of the nurses with 12 points was a relief worker, that is, someone who develops activities in the most varied settings of the university hospital in the night shift, which makes this person face adversities and unpredicted situations at each shift, since he/she does not have a reference work team nor an identity with a unit or sector. Similarly, another nurse who achieved the highest score develops his functions in the administrative area, dealing with all sorts of problems regarding the nursing staff daily. These two situations indicate that the need for self-improvement may lead nurses to strengthen their enterprising "motivation" feature.

The attribute "need for autonomy" presented the lowest score among all nurses, indicating that, perhaps, the nurses from the university hospital are still bonded to the idea that physicians and administrators are the ones responsible for controlling these settings, determining organizational purposes and policies⁽¹⁷⁾.

In this perspective, nursing professionals are found in a situation in which the limits of their autonomy are outlined by the autonomy of the medical work, since despite being fundamental, their work is still auxiliary in many places⁽¹⁸⁾

This statement, however, may be contradicted since the hospital is in fact coordinated by the nursing, even though there is a paradoxical relationship there, since the nucleus that coordinates is the one affected in this relationship of domination⁽¹⁹⁾. Studies like "The professional autonomy of the nurse" also assure the exposed and argue that nurses have broad spaces for exercising autonomy and decisive power, both in their working process and in the administration of health organizations⁽²⁰⁾.

The dimension "calculated risks", of which results varied between 1 and 10 points, defines that the entrepreneur must seek challenges presenting calculated risks, as well as constantly evaluate the risks involved in their entrepreneurship, since rewards are associated with these risks⁽¹³⁾. Low scores in this item may be related with the question of safety, since most of the nurses are associated with the Brazilian public sector pension system, which offers them stability in the job.

Hence, this category originated questions: 'Could stability be causing a decrease in the enterprising tendency of nurses from the hospital?' and 'Could different results be found in this item if the study was performed with nurses from private hospitals, which do not offer them stability?

Still in the discussion regarding "calculated risks", there is, once again, the high score obtained by the relief nurse, which possibly relates the function to this characteristic, since each shift inevitably presents a new and challenging reality, which is often unexpected.

CONCLUSION

The purpose of this study was to identify the enterprising tendencies of nurses from a university hospital and to relate them with the variables age, length of work in the hospital and time of conclusion of the course.

These evidences and discussions allowed to understand the phenomenon of entrepreneurship in the reality of the nurses in this hospital, even though the study shows a specific moment of the setting and subjects. It is clear that other studies involving, concomitantly, subjectivities of the organizational environment and culture are also pertinent and complementary for a greater immersion in this universe.

Nevertheless, for the present, the university hospital must promote actions aimed to encourage nurses in the age range detected in this study as suffering a decline in the enterprising tendency, as well as those with a greater length of time in the profession and work in the hospital, as a means to invigorate their work and, consequently, directly and indirectly promote nursing care quality. It is also fundamental to develop professional and personal attributes aimed at the enterprising development of the nurses towards achievement, creativity, motivation and professional autonomy. Internal discussions regarding the question of calculated risks and their role for a better use of the enterprising work must also be encouraged and promoted.

It is important for the nurses who were detected as potentially enterprising to participate in these initiatives, so that they act as multipliers, encouraging others to broaden their enterprising characteristics to promote and qualify the nursing work.

Finally, it is necessary to encourage entrepreneurship in nurses at all moments of their professional journey, so that they become singular in the midst of what is simple and ordinary in the profession and develop persistency, tenacity and determination to remain open to what is new, acting with autonomy and seeking their achievement both at work and in their personal lives.

REFERENCES

• 1 Drucker PF. As novas realidades. 4Ş ed. São Paulo: Cengage Learning; 2003.
• 2 Oliveira M. Valeu: passos na trajetória de um empreendedor. São Paulo: Nobel; 1995.
• 3 Roncon PF, Munhoz S. Estudantes de enfermagem têm perfil empreendedor? Rev Bras Enferm. 2009;62(5):695-700.
• 4 Drucker PF. Inovação e espírito empreendedor: prática e princípios. São Paulo: Cengage Learning; 2008.
• 5 Padilha MICS, Borenstein MS, Santos I. Enfermagem: história de uma profissão. São Caetano do Sul: Difusão; 2011.
• 6 Conselho Regional de Enfermagem (COREN-SP). História da enfermagem: as práticas de saúde ao longo da historia e o desenvolvimento das práticas de enfermagem [Internet]. [2000] [citado 2010 Nov 19]. Disponível em: http://inter.coren-sp.gov.br/node/3821
• 7 Erdmann AL, Backes SD, Alves A, Albino AT, Farias F, Guerini IC, et al. Formando empreendedores na enfermagem: promovendo competências e aptidões sócio-políticas. Enferm Glob. 2009;16:1-10.
• 8 Backes DS, Erdmann AL. Formação do enfermeiro pelo olhar do empreendedorismo social. Rev Gaúcha Enferm. 2009;30(2):242-8.
• 9 Gaião BFDS, Silva TA, Queiroz CTAP. Diagnóstico da tendência empreendedora através do modelo de Durham: um estudo de caso no setor educacional. Qu@litas Rev Eletr. 2009; 8(3).
• 10 Lunardi Filho WD. O mito da subalternidade do trabalho da enfermagem à medicina. Pelotas: Universitária/UFPel; 2000.
• 11 Conselho Federal de Enfermagem (COFEN). Resolução n. 293/2004: fixa e estabelece parâmetros para dimensionamento do quadro de profissionais de enfermagem nas instituições de saúde [Internet]. Rio de Janeiro; 2004 [citado 2010 Nov 20]. Disponível: http://corensp.org.br/072005/legislacoes/legislacoes_busca.php?leg_id=10105&text
• 12 Wandemberg A. Empreender na era do fim do emprego [Internet]. 2008 [citado 2010 Nov 20]. Disponível em: http://artigos.netsaber.com.br/resumo_artigo_6591/artigo_sobre_empreender_na_era_do_fim_do_emprego Acesso em: 19 Nov. 2010. Acessado em: 20 nov 2010.
• 13 Uriarte LR. Tendência empreendedora das profissões. In: Anais do 1ş Encontro Nacional de Empreendedorismo; 1999; Florianópolis, Brasil. Florianópolis: UFSC; 1999.
• 14 Andujar AM. Modelo de qualidade de vida dentro dos domínios bio-psicosocial para aposentados [tese]. Florianópolis (SC): Universidade Federal de Santa Catarina; 2006.
• 15 Bernardi LA. Manual de empreendedorismo e gestão. 2Ş ed. São Paulo: Atlas; 2007.
• 16 Souza NVDO, Santos DM, Anunciação CT, Thiengo PCS. O trabalho da Enfermagem e a criatividade: adaptações e improvisações hospitalares. Rev Enferm UERJ. 2009;17(3):356-61.
• 17 Carapinheiro G. Saberes e poderes no hospital: uma sociologia dos serviços hospitalares. Porto: Afrontamento; 2005.
• 18 Marques GQ, Lima MADS. Organização tecnológica do trabalho em um pronto atendimento e a autonomia do trabalhador de enfermagem. Rev Esc Enferm USP [Internet]. 2008. [citado 2013 Mai 09];42(1):41-7. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342008000100006&lng=en http://dx.doi.org/10.1590/S0080-62342008000100006
• 19 Merhy EE, Cecílio LCO. Algumas reflexões sobre o singular processo de coordenação dos hospitais. Saúde Debate. 2003;22(64):110-12.
• 20 Lunardi Filho WD. A autonomia profissional do enfermeiro. Enferm Brasil 2008;6(3):1.

Publication Dates

• Publication in this collection
  02 Dec 2013
• Date of issue
  Sept 2013

History

• Received
  28 May 2012
• Accepted
  27 May 2013