Laporan Institute of Medicine tahun 2010 menegaskan bahwa dunia Keperawatan saat ini sedang mengalami perubahan. Keadaan perubahan ini seiring dengan pergeseran yang terjadi dalam dunia Kesehatan secara global. Inovasi dalam pelayanan kesehatan saat ini semakin mengarah kepada harapan untuk mencapai tahap kesehatan yang paling tinggi, aneka pilihan dalam diagnostik dan perawatan, begitu juga keefektifan dan keterjangkauan sistem pelayanan kesehatan imbas dari semakin pesatnya perkembangan teknologi informasi yang saat ini mulai menyisihkan sistem pelayanan kesehatan yang konvensional.
Oleh karena itu, dunia Keperawatan saat ini perlu untuk mengidentifikasi peran baru yang unik yang memiliki jangkauan yang luas guna mempersempit ketertinggalan profesi ini dalam sistem pelayanan kesehatan. Sehingga penyediaan layanan kesehatan yang inovatif dan kreatif melalui upaya entrepreneurship dan intrapreneurship dalam Keperawatan bagi semua tatanan pelayanan yang ada adalah suatu keniscayaan. Berikut ini adalah peluang yang bisa peraih raih dalam era inovasi dewasa ini.
Entrepreneurship dalam Nursing
Nursing entrepreneurship provides nurses with self-employment opportunities which allow them to pursue their personal vision and passion to improve health outcomes using innovative approaches. Similar to other entrepreneurs, a nurse entrepreneur is considered to be a “proprietor of a business that offers nursing services of a direct care, educational, research, administrative or consultative nature” (International Council of Nurses, 2004, p.4). As such, the nurse is self-employed and is directly accountable to the client (e.g., individual, private, or public organisation) for whom they provide services (Liu & D’Aunno, 2011). Such nurses may conduct an independent clinical practice; own a business (e.g., nursing home or pharmaceutical company); or run a consultancy business in, for example, education or research. Thus, nurse entrepreneurs are innovators who initiate incentives that lead to change, the modernisation of health systems, and demonstration of leadership (Raine, 2003). Use of creativity to develop a new idea, improve service or delivery methods, or develop new products or new ways to use existing products is a fundamental characteristic of entrepreneurship. Combining these characteristics with advanced or specialist skills and knowledge, at the very least, entrepreneurial nurses are advanced practice nurses who create products or services which they can market to external sources.
Intrapreneurship dalam Keperawatan
In contrast to an entrepreneur, a nurse intrapreneur is a salaried employee, often of a government run health service, who develops, promotes, and delivers an innovative health or nursing service within a health care setting, such as hospital or nurse-led clinic (Hewison & Badger, 2006). Nurses have been developing intrapreneurial ventures since the time of Florence Nightingale; however, it is only now with increasing demand for safe, high-quality, and effective health care services that more resources are dedicated to nurses assuming a wider variety of roles with more responsibility.
Nurse intrapreneurs develop innovative health practices from within the organisational framework in which they work, and consequently share the risks and benefits associated with this innovative practice with their employer (Dayhoff & Moore, 2005). The type of innovations developed by intrapreneurs often involve efforts to transform workplace climate or culture, improve processes, or develop new products or services (Drucker, 1985). Intrapreneurs are often motivated by the needs of their patients to identify gaps in service that can be addressed through the determined work of a health care team that may or may not include themselves.
Persamaan Entrepreneurship dan Intrapreneurship
Although defined by the context of how they practice, rather than the position they hold, entre/intrapreneurial nurses will generally operate at an advanced level due to the application of a highly developed set of knowledge and skills. There are several personality characteristics shared by both entre- and intrapreneurial nurses. These include self-confidence, courage, integrity, self-discipline, and the ability to take risks, deal with failure, and articulate their goals (Cooper, 2005; Wilson & Averis, 2002). A conceptual model depicting the salient characteristics of the nurse entrepreneur (Wilson & Averis, 2002), including internal and external influences, advantages, and challenges, may be similarly applied to the nurse intrapreneur within the employed setting. It is essential to both entre and intrapreneurial ventures that the nurses are able to seize opportunities to address gaps in service provision; are provided the infrastructure support to do so; and are able to explain what they are doing, why they are doing it, and how service should be provided in the future (Cooper, 2005).
Perbedaan Entrepreneurship dengan Intrapreneurship
Due to a variety of factors, it is difficult to determine how many nurses are working in entre and intrapreneurial roles throughout the world. For instance, entre- and intrapreneurship is defined differently across professions and countries. Thus the concept of nurses as entrepreneurial may not be widely understood or realised in some areas/cultures.
Nurse entrepreneurs may work as independent contractors and it is often difficult to systematically record the number of nurses outside of the public and private systems by role and skill mix. In some regions, demographics may not exist. In addition, some countries may not recognise independent nurses, who own and run their own primary health practices, to be nurses at all (Manion, 1991).
Figures gathered by the International Council of Nurses estimated that 0.5-1% of registered nurses worldwide work in entrepreneurial roles. Actual numbers within individual countries may be lower or higher as estimates of nurses or midwives who are self-employed or own professionally related businesses are as low as approximately 0.1% in New Zealand (Drennan et al., 2007) and 0.18% in the United States (Cheater, 2010) and as high as 18% in the United Kingdom. However, it appears more common for midwives to be self-employed with estimates of 50% self-employed in New Zealand and 64% in the Netherlands. In Australia, numbers are unknown as the most recent Australian Institute of Health Workforce Nursing and Midwifery Labour Force Survey (2009) does not mention self-employed nurses, although numbers are generally thought to be low. Better data collection and information infrastructure is required for targeted health workforce planning and this need is evident worldwide (Institute of Medicine, 2010).