Entrepreneurship and entrepreneurial education in the context of postgraduate nursing

Emprendimiento y educación emprendedora en el contexto de posgrado en enfermería

ABSTRACT

Objective

To understand entrepreneurship and entrepreneurial education in the context of postgraduate nursing.

Method

Qualitative study based on Grounded Theory. The theoretical sample consisted of 15 master’s and doctoral students and seven professors from a postgraduate nursing program at a university in southern Brazil. Individual interviews were conducted between August/2018 and February/2019 in a location defined by the participants, in general the University. The data were collected and analyzed simultaneously by initial and focused coding.

Results

Three categories and 11 subcategories emerged that, interrelated, represented the phenomenon “Glimpsing entrepreneurship and entrepreneurial education in postgraduate nursing”.

Conclusion

Entrepreneurship and entrepreneurial education, in the context of postgraduate nursing, were understood as incipient and promising processes. In this sense, it is necessary to intensify studies to demonstrate the entrepreneurial possibilities of the area.

Keywords
Entrepreneurship; Nursing; Education nursing; Education nursing graduate; Innovation and development policy

RESUMEN

Objetivo

Comprender el emprendimiento y la educación emprendedora en el contexto del posgrado de enfermería.

Método

Estudio cualitativo basado en la Teoría Fundamentada. La muestra teórica estuvo compuesta por 15 estudiantes de maestría y doctorado y siete profesores de un programa de posgrado en enfermería de una Universidad del sur de Brasil. Las entrevistas individuales se realizaron entre agosto/2018 y febrero/2019 en un lugar definido por los participantes, en general la Universidad. Los datos se recopilaron y analizaron simultáneamente mediante codificación inicial y enfocada.

Resultados

Surgieron tres categorías y 11 subcategorías que, interrelacionadas, representaron el fenómeno “Vislumbrando el emprendimiento y la educación emprendedora en los posgrados de enfermería”.

Conclusión

El emprendimiento y la educación emprendedora, en el contexto del posgrado de enfermería, fueron entendidos como procesos incipientes y prometedores. En este sentido, es necesario intensificar los estudios para demostrar las posibilidades emprendedoras de la zona.

Palabras clave
Emprendimiento; Enfermería; Educación en enfermería; Educación de postgrado en enfermería; Política de innovación y desarrollo.

RESUMO

Objetivo

Compreender o empreendedorismo e a educação empreendedora no contexto da pós-graduação em enfermagem.

Método

Estudo qualitativo, do tipo Teoria Fundamentada nos Dados. A amostragem teórica foi composta por 15 estudantes de mestrado e doutorado e sete docentes de um programa de pós-graduação em enfermagem de uma Universidade do sul do Brasil. Realizaram-se entrevistas individuais entre agosto/2018 e fevereiro/2019 em local definido pelos participantes, em geral a Universidade. Os dados foram coletados e analisados simultaneamente por codificação inicial e focalizada.

Resultados

Emergiram três categorias e 11 subcategorias que, interrelacionadas, representaram o fenômeno “Vislumbrando o empreendedorismo e a educação empreendedora na pós-graduação em enfermagem”.

Conclusão

O empreendedorismo e a educação empreendedora, no contexto da pós-graduação em enfermagem, foram compreendidos como processos incipientes e promissores. Nesse sentido, é preciso que se intensifiquem estudos para demostrar as possibilidades empreendedoras da área.

Palavras-chave
Empreendedorismo; Enfermagem; Educação em enfermagem; Educação de pós-graduação em enfermagem; Política de inovação e desenvolvimento

INTRODUCTION

There are several changes in the nursing labor market in Brazil and worldwide. Unemployment and underemployment have increasingly haunted the profession, showing professionals that it is necessary to reinvent themselves1. For many years, Nursing has been portrayed by its peers, health colleagues and society in general as a socially devalued profession, which earns little and gives a lot. Nursing, however, occupies a relevant space and function in society, but to make it visible as such, it is necessary to (re)think the way in which it is taught and learned, in the sense of fostering a new culture, through education that transform2. Entrepreneurial education has, therefore, a prominent role in the deconstruction of the current paradigm of the nursing labor market and in the reconstruction of a new culture, the culture of entrepreneurship.

In addition to these findings, entrepreneurial education is important for the development of a nation, as an income generating factor. With regard to Brazil, entrepreneurial education may increase the number of young innovators with new and transformative ideas3. Entrepreneurial education is not only related to education for the creation of a company or for autonomous activity, but it is also related to education for personal and social development4.

Entrepreneurial education does not consist only in stimulating the opening of new businesses, but also in teaching human and solidary attitudes, capable of exercising entrepreneurial behavior, transforming their reality and that of those around them. Thus, in this conception, entrepreneurship also encompasses attitudes of transformation at work, in interpersonal relationships, in the articulation of knowledge, in the search for autonomy and freedom, which can have repercussions on the opening of a business, in social protagonism, or in a proactive attitude towards life5.

Entrepreneurial education can also be analyzed through the look of pedagogy. From this perspective, movements are emerging that aim to break with the traditional training of educational institutions, focusing only on the formal labor market. Thus, entrepreneurial education emphasizes the process of learning to learn, the appropriation of learning by the student, the professor as a mediator of learning, based on non-linear prospective strategies6^-7.

Entrepreneurial education can be stimulated from the beginning of learning, therefore, it can be developed from school8. Thus, the importance of higher education institutions to improve and/or develop gaps is reaffirmed, based on teaching that values ​​human, social and business development. It is believed, therefore, that the university has a fundamental and essential role in promoting entrepreneurial education at the undergraduate level and, above all, at the postgraduate level4^,6^,9. It is highlighted the commitment of postgraduate nursing programs to the development of investigations that contribute to innovations for the transformation of professional practice10.

However, two recent literature reviews on entrepreneurship in Nursing11, which included international databases, such as Publisher Medline (PUBMED), SciVerse Scopus (SCOPUS), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Education Resource Information Center (ERIC), evidenced the lack of studies on entrepreneurial education in Nursing, especially in the context of postgraduate education. Thus, there is a gap in the knowledge production about the issue at hand, which makes this study relevant to broaden the discussions on the theme among the scientific community and contribute to fostering an entrepreneurial culture and education in Nursing. Thus, the question is: how does entrepreneurship and entrepreneurial education occur in a postgraduate nursing program?

This study aimed to understand entrepreneurship and entrepreneurial education in the context of postgraduate nursing.

METHOD

Qualitative study guided by Grounded Theory (GT12. The GT was chosen for this study due to the possibility of analytical reflection on the data set12.

Data were collected through semi-structured interviews with a theoretical sample divided into two sample groups, between the months of August 2018 and February 2019. The first sample group (SG1) was formed by 15 master’s and doctoral students from a postgraduate nursing program. This group included students from the first to the fourth year of postgraduate studies. The second sample group (SG2) was composed of seven professors from the same program.

The SG1 was intentionally determined, based on the hypothesis that these would be the key participants to answer the objective of the study. The following inclusion criteria were defined: being regularly enrolled in the postgraduate nursing program and being available to participate in the study. Master’s and inter-institutional doctoral students were excluded, due to the difficulty of accessing these participants and post-doctoral students due to the reduced number of students. The SG2 was constituted from the data analysis from the first sample group, which pointed out the professors as the main responsible for the diffusion of the entrepreneurial culture of the program. The sample size culminated in the theoretical saturation of the data, reached with 22 participants12. No participant quitted or withdrew from the research.

The interviews were in-person, with an average duration of 20 minutes each and conducted from questions about the meaning of entrepreneurship and entrepreneurial education. The interviews were conducted by a single interviewer, co-author of this study, on the premises of the University where the Postgraduate Nursing Program in question is located. This location was chosen because it is a Program of excellence and reference in the country. The interviews were digitally recorded, transcribed, and inserted into the NVIVO 10 software for coding and data organization. The transcripts were returned and validated by the participants for inclusions or exclusions. Data collection and analysis were performed simultaneously.

For data analysis, two steps were adopted: initial coding and focused coding. In the initial coding, the transcribed text was transformed into data segments that generated provisional, comparative and data-based codes. In focused coding, the most significant and frequent codes were grouped by conceptual similarities forming categories, memos and diagrams were used as a strategy to help the process of constant-comparative analysis12. In the end, the theoretical construction obtained was validated by study participants and researchers with experience in the method.

Ethical aspects were respected, as recommended by Resolution number 466/12, of the National Health Council. The study was approved by the Research Ethics Committee under opinion number 2.620.227 and CAAE 81636017.9.0000.012. The confidentiality of the participants’ identity was preserved through the adoption of the code “ME” for master’s students, “DO” for doctoral students and “PRO” for professors, followed by an ordinal number to identify their statements (e.g., ME1, DO2, PRO3).

RESULTS

The results will be described from the design of the three categories and 11 subcategories that, interrelated, represented the phenomenon “Glimpsing entrepreneurship and entrepreneurial education in postgraduate nursing” (Figure 1). Next, each of the categories and their respective subcategories are presented.

Figure 1 -
Representative model of the phenomenon, categories, and subcategories.

Demystifying the entrepreneurial profile in postgraduate nursing

When asked about entrepreneurship, the participants mentioned some postgraduate situations that referred to three main behaviors, which, interrelated, comprise the entrepreneurial profile in postgraduate nursing. These are managerial and business behaviors, personal behaviors and social behaviors.

Managerial and business behaviors: economic entrepreneurship

Managerial and business behavior was the most cited, mainly in relation to the ability to manage. In this topic, entrepreneurship was associated with capitalism, the creation of a company, leadership, and motivation in front of a team or work group. Finally, examples of entrepreneurial situations regarding the development of a business were cited, such as the practice of advising and consulting, home care, among others.

Entrepreneurship confuses a lot with the issue of management (DO6).

When talking about entrepreneurship, the first thing that crosses my mind is capitalism, business, administration, companies not focused on health (ME3).

[...] the entrepreneur usually likes to be a leader, he/she needs to be a leader, this is a characteristic (PRO3).

Entrepreneurship in nursing I think of situations such as consulting on breastfeeding, dressings, providing home care, integrative and complementary therapies [...] (ME4).

Personal behaviors: innate entrepreneurship

The behaviors of this block are those that represent the personality of entrepreneurial people, based on a set of natural, unique, individual, and innate characteristics of the individual. The expression “thinking outside the box”, the restlessness of “looking at what is routine and questioning yourself”, the search for opportunities to “transform not very good situations into possibilities”, creativity and innovation were elements brought as synonyms of the entrepreneurship in the postgraduate nursing scenario. These behaviors, associated with the self-confidence of “believing in your potential” and the personal interest in dedicating themselves to something you are aiming for, they relate to the feeling of dissatisfaction, desire for change and evolution that are typical of entrepreneurs.

Creativity is fundamental for the entrepreneur [...] creativity is thinking outside the box, looking at what is routine and questioning yourself (DO5).

I think [entrepreneurship] is a matter of really believing in your potential and in what is possible to develop (PRO7).

I think entrepreneurship is the dedication that we apply to something we are aiming for (ME5).

Social Behaviors: social entrepreneurship

Social behaviors are those allusive to human relationships and collectivities. In this regard, communication, solidarity, and partnership formation can be considered entrepreneurial skills in the context of the postgraduate nursing program. In addition, the concept of social entrepreneurship and the importance of generating value for society was raised, as a way to benefit communities, reinforcing the concern to give feedback to the community.

Entrepreneurs perceive people's potential and convince them that the enterprise is possible, create partnerships [...] (PRO5).

To be an entrepreneur from the point of view of human relations, is thinking about what makes a difference to the collective, what brings collective and social benefits, it is adding value to society [...] (PRO1).

As I remember, I read that there is social entrepreneurship, which is more focused on the collective, so I think that in health we have this entrepreneurship more focused on the social (ME3).

Pointing out the challenges for entrepreneurship in postgraduate nursing

The challenges of entrepreneurship in postgraduate nursing are focused on two lines. The first is linked to the difficulty in understanding the relationship between entrepreneurship and nursing; and the second, by the history of the profession, marked by abnegation, charity and giving to others.

Mis(understanding) the relationship between entrepreneurship and nursing

This subcategory expresses the paradoxical relationship of misunderstanding and understanding of entrepreneurship in the context of the postgraduate nursing program. The lack of knowledge regarding the theme and the non-identification of entrepreneurial strategies and actions were mentioned several times. However, despite this misunderstanding initially expressed, through the examples mentioned in the previous category, behaviors and attitudes that made up the entrepreneurial profile in postgraduate nursing were presented. This may have happened because students and professors are not yet sensitized to these concepts. In addition, this misunderstanding versus understanding was general among the participants, with no difference between master’s, doctoral students, or professors.

I know very little about entrepreneurship. It's because everyone hears about entrepreneurship, but sometimes we don't understand much about it (ME6).

I think that in nursing we are a little late in this sense [being an entrepreneur] (PRO3).

Here in the postgraduate program [in nursing], from the contact network I have, I can't think of anything that was entrepreneurial (DO8).

Analyzing nursing from the historical and social perspective

The reflection on the previous social history of Nursing was carried out in an attempt to justify the current absence of entrepreneurship in the profession. In this sense, the charity performed in the beginning was mentioned as an explanation of the configuration of the profession, today, in the labor market, including characteristics of devotion, “nursing for love” and donation. In addition, nursing work options were mentioned, criticizing that nurse, in the majority, occupy vacancies of employees in health institutions.

Nursing doesn't have that much [entrepreneurship], you graduate and go to work in a clinic, a hospital, in primary care or you teach. Now, create your own thing, of course there is, but this entrepreneurship within nursing is still missing (PRO3).

Entrepreneurship seems to be something far away for us [nurses], we do not have this vision of financial entrepreneurship [...] (ME1).

We [nurses] were never entrepreneurial, this comes from the history of our profession [...] nursing started by providing charity, there was no financial issue involved and until today “nursing is for love”, nursing should not be just for love, nursing is also a science, it is a profession, it is knowledge (ME4).

“Learnpreneurship” learning to become an entrepreneur in postgraduate nursing, initial possibilities

Entrepreneurship education for nursing was highlighted as a starting point for reaching new professional levels. In this sense, reflections were made on changes that could be made in the postgraduate program in which the study was developed, so that in the future entrepreneurship could be installed as a content, a method or a strategy employed. In addition, they started from the assumption that entrepreneurship is a relevant and necessary theme for Nursing, especially in the face of changes in the labor market. Thus, in this regard, the use of active methodologies and the importance of research in nursing and entrepreneurship were listed as initial possibilities for the emergence of entrepreneurship in this scenario.

Using active methodologies as an entrepreneurial education strategy

Entrepreneurship was strongly associated with active methodologies. In this sense, the use of teaching strategies that transcend the traditional and banking model represented one of the ways of entrepreneurship in the postgraduate program in nursing. In addition, it was commented that the postgraduate courses have an appropriate and enlightening syllabus, but they could be more attractive, innovative, and dynamic, in the sense of modifying didactics and developing other didactic strategies, such as active methodologies. It was also reported the need to update some professors, who end up using the same teaching-learning strategies in undergraduate and postgraduate classes for years, without considering the specificities of each group. It was shown that, for many times, the only strategy used is the presentation of seminars, revealing the lack of other teaching strategies.

The subjects are enlightening, but I don't know if the didactics should be maintained, I think there should be another strategy, because we spend a lot of time just doing seminars and don't listen well to the professor's experience in that (DO4).

I see that some professors can develop methodologies and work with methodologies that are more didactic, so that the student can better understand that content. It is very common that professors end up working in the same way throughout the entire course, including undergraduate, master's and doctoral degrees (DO8).

Researching in nursing and entrepreneurship

Research and scientific production were understood as ways of entrepreneurship together with the postgraduate nursing program. Thus, it was concluded that to strengthen entrepreneurship in nursing it is necessary to invest in research. Therefore, research in entrepreneurship has been placed in two directions: one related to research that has already been developed and that has been adding value to Nursing, and the other, related to the need to research entrepreneurship to apply in nursing practice and make it a more entrepreneurial profession.

I think the program [postgraduate nursing] is very entrepreneurial, so from the moment that each professor publishes an article, which is something innovative or something to change the practice, it is already a type of entrepreneurship (PRO6).

I think that a lot of research that we develop in the research group is entrepreneurial. I understand that research stimulates entrepreneurship (DO2).

The aspects that could facilitate would be to have more contact with entrepreneurship, because we have little contact, scientific production, which is related to this contact, because I think we have a scarce production on the theme (ME2).

DISCUSSION

Despite not having emerged a single concept for entrepreneurship in postgraduate nursing, the results of this study signaled an entrepreneurial profile. The first behavior that comprises this profile is managerial or business behavior. Given this result, two lines of thought can be established. The first line is related to the association that participating nurses make from entrepreneurship to the management/administration/company. To justify such finding, it is enough to look at the history of entrepreneurship, which emerged from the science of administration many decades ago13. Added to this, it is attributed to the fact that entrepreneurship is mainly related to an individual who starts and/or manages their own business, assuming risks and responsibilities, contributing to the entrepreneur being seen as a businessman and vice versa14.

The second line of thought, on the other hand, may be associated with the rise of entrepreneurship in nursing, in recent years, in view of professional autonomy in the face of new scenarios of action occupied by nurses. In this logic, similar to health professionals from other areas, nursing discovered that it can have economic representation, acting as the owner of a company, offering nursing services, directly or indirectly, in the care, educational, research or management areas15.

The second behavior reported by the participants was personal behavior. In this scope, creativity, determination, self-confidence, leadership, knowledge, and innovation were mentioned as innate behaviors, that is, inherent and natural to each individual. For a long time, it was considered that these characteristics were innate to entrepreneur individuals, that is, impossible to be learned. However, the advancement of knowledge production has shown that these and other skills, called “soft skills”, can be learned and taught from specific approaches that direct the theoretical knowledge necessary to replace and/or enhance what is not innate16. From this perspective, it can be considered that the entrepreneurial profile is both in people who have innate skills, as well as in people who developed skills from the search and improvement of theoretical-practical knowledge about entrepreneurship.

The social attitudes mentioned by the participants are, in part, in line with the widely spread concept of social entrepreneurship. Although most of the participants did not appropriate the concept, they ended up associating the idea of ​​collectivity with (social) entrepreneurship in nursing. This may have occurred because nursing is historically considered a charitable profession, concerned with people and, therefore, with society. Furthermore, it is possible that the participants connected teamwork, which is characteristic in nursing, to collective thinking and the formation of partnerships.

In view of what has been listed, as social attitudes and social entrepreneurship, regarding interpersonal relationships, communication, and others, it is considered that there is a bias between what is described in the literature as social entrepreneurship in nursing and what the participants understood for social entrepreneurship in nursing. Thus, it is believed that there is a relative disagreement between the results of this study and the scientific literature regarding social entrepreneurship in nursing, which presents it as an attitude to promote healthy living for individuals, families and communities17.

In this sense, it is understood that the concept of social entrepreneurship in nursing can be expanded, in order to contemplate all the nuances that involve the social, the collective, the group and the team. Despite this and the diversity in the classification and typification on the entrepreneurial profile in the context of postgraduate nursing, the results of the study allow us to consider the presence of a positive view of entrepreneurship in nursing, whether from a managerial, personal, or social perspective. However, there are still challenges to be overcome.

The first challenge to entrepreneurship in nursing was the relative to misunderstanding/understanding of the relationship between entrepreneurship and nursing in the postgraduate program. Thus, it is worth noting that entrepreneurship is old in the history of Nursing, despite having obtained greater evidence in recent years. Nursing is the main health workforce and naturally generates new ideas and contributes to the development of new technologies9.

Therefore, it reinforces the idea that both students and professors are not sensitized to entrepreneurship. This assumption strengthens the importance, already identified by the participants themselves, of new possibilities for entrepreneurship in nursing from entrepreneurial education in the postgraduate program.

The lack of knowledge of the relationship between entrepreneurship and nursing also comes from the history of the profession, marked by the characteristics of charity, giving to others and vocation. The impact of this, together with the training model that still forms for employability, reverberates in the current scenario of Brazilian Nursing, of unemployment, sub-salaries, low working conditions and professional and social devaluation. At the same time, nurses have a reductive view of economically entrepreneurship, perhaps because of the concept that is disseminated in health training courses for work in the public sector, not presenting, at least in nursing, self-employment1.

Regarding teaching, the participants reported not seeing, in the postgraduate nursing, educational strategies that would help to improve the idea they had of entrepreneurship. However, when asked about entrepreneurial examples in teaching, they identified active methodologies as part of entrepreneurial education. In the literature18, there is a consensus that the use of active methodologies constitutes a strategy for teaching entrepreneurship. Thus, it is up to nursing to overcome reductionism and welfarism to encourage the use of active methodologies in the construction of knowledge. In this sense, professional training that encompasses the concepts of entrepreneurship must necessarily be guided by spaces that encourage creativity, initiative and self-reflection19.

A suggestion from the participants regarding the awakening of postgraduate studies to entrepreneurship was the encouragement of scientific production on the theme. In this direction, the increase in scientific production in the area stands out, especially from 2009 onwards, but still with the need for expansion, in order to evolve together with the global demands of the labor market and with the nursing profession20. In addition, it is believed that entrepreneurship in nursing has a promising path for the coming years. Despite being an expanding field, it is necessary to invest in more studies, initiatives, and experiences to consolidate entrepreneurship in the work of nurses. After all, investing in entrepreneurship also means investing in professional fulfillment and satisfaction in nursing20.

As a limitation of the study, it is pointed out the temporal and contextual cut, after all this is a research that represents a specific context and time, which can compromise its applicability in other scenarios. Therefore, it is suggested that new studies be conducted in other contexts to demonstrate the opportunities and entrepreneurial possibilities in the area. Not only regarding knowledge on the theme, but also for the (re)cognition of the profession by both peers and others.

FINAL CONSIDERATIONS

Entrepreneurship and entrepreneurial education in the context of postgraduate nursing were understood as incipient and promising processes. Regarding the entrepreneurial profile, managerial or business behavior was the central category for entrepreneurship in nursing, since the administrative and business origin of entrepreneurship was the most cited by the participants. In this sense, it was understood that personal and social behaviors are a sub-aspect of core behavior. On the other hand, this shows that nursing is taking on new areas of action, innovating and reinventing itself, based on a new way of thinking about the labor market and the economy. Thus, one can look with optimism to entrepreneurship in nursing.

Regarding the challenges, it was found that the main challenge is the lack of contact with the theme. This can be solved with a series of possibilities that the participants themselves listed for entrepreneurship and entrepreneurial education in the postgraduate program in nursing. In addition to the previous aspect, it was understood that it is also necessary to overcome the charitable characteristic of the profession, which will only be possible from a change in the nursing work process, construction of an entrepreneurial mindset (entrepreneurial culture) among peers and entrepreneurial education in nursing.

In view of this and the phenomenon “Glimpsing possibilities for entrepreneurship and entrepreneurial education in postgraduate nursing”, it was listed an initial path for the construction of this entrepreneurial education in the postgraduate program. As a strategy, we highlight the use of active methodologies and the search for innovation in the production of scientific knowledge to positively contribute to professional practice as initial possibilities for entrepreneurial education in the postgraduate nursing program. Thus, it is believed that this study has provided an initial overview of entrepreneurship education in nursing, in order to show what can be done to modify the current paradigm of the profession in the labor market.

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Publication Dates

• Publication in this collection
  01 Aug 2022
• Date of issue
  2022

History

• Received
  14 Nov 2020
• Accepted
  10 Aug 2021