|Year : 2018 | Volume
| Issue : 1 | Page : 230-236
The experience of Iranian entrepreneurial nurses on the identification of entrepreneurial opportunities: A qualitative study
Simin Jahani1, Heidarali Abedi2, Masoud Fallahi Khoshknab3, Nasrin Elahi1
1 Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Department of Nursing, Nursing and Midwifery Faculty, Islamic Azad University, Isfahan, Iran
3 Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
|Date of Web Publication||30-Apr-2018|
Dr. Heidarali Abedi
Nursing and Midwifery Faculty, Islamic Azad University, Isfahan (Khorasgan) Branch, Arghavaniyeh, Jey St., Isfahan
Source of Support: None, Conflict of Interest: None
Background: To respond to the growing and emerging needs of the people in the health sector, the nurses need to develop their working domain from the hospitals to the community and be prepared to provide entrepreneurial roles at different care levels. Thus, to discover how to identify entrepreneurial opportunities in the field of nursing entrepreneurship, a study was conducted with the aim of describing the experiences of Iranian entrepreneurs on the identification of proper opportunities in entrepreneurship. Materials and Methods: This study was a qualitative research in which the Graneheim and Lundman's content analysis was used to collect and analyze the data. Thirteen entrepreneurial nurses were purposefully selected, and the data were collected by unstructured interviews. Results: As a result of data analysis, three main themes were obtained including the resources for opportunity identification and opportunity assessment and identification of proper opportunities. Conclusion: The findings indicate how to identify entrepreneurial opportunities in the field of health by entrepreneurial nurses which is the first step in the entrepreneurial process. Therefore, the findings of this study can be used to educate nurses who are interested in entering the field of nursing entrepreneurship.
Keywords: Content analysis, entrepreneurship, identification of opportunities, Iran, nursing
|How to cite this article:|
Jahani S, Abedi H, Khoshknab MF, Elahi N. The experience of Iranian entrepreneurial nurses on the identification of entrepreneurial opportunities: A qualitative study. J Family Med Prim Care 2018;7:230-6
|How to cite this URL:|
Jahani S, Abedi H, Khoshknab MF, Elahi N. The experience of Iranian entrepreneurial nurses on the identification of entrepreneurial opportunities: A qualitative study. J Family Med Prim Care [serial online] 2018 [cited 2021 May 18];7:230-6. Available from: https://www.jfmpc.com/text.asp?2018/7/1/230/231560
| Introduction|| |
Nurses comprise more than 80% of the health workforce  and are known as the front-line employees in the health chain in most countries and health services. The reports released by the Institute of Medicine Robert Wood Johnson Foundation Initiative shows that nurses play a significant role in creating the health-care system to meet the demand for safe, high quality, patient-centered, accessible, and affordable care. To achieve such outcomes, the nurses must in addition to developing their knowledge and self-education alter their care methods by joining other health-care professions  and move on the path of innovation and entrepreneurship.
An entrepreneurial nurse specifies a need and creates a service to meet that need  and is known as the business owner who offers nursing services with the direct care, educational, research, administrative, and consulting identities. In terms of character, they have attitudes that are beyond the existing environmental conditions and actually can step beyond the environment and see situations through other lenses or other dimensions. Thus, nurse entrepreneurs are innovators who own the primary motivations for change, modernization of health systems, and display of leadership. The main feature of entrepreneurs includes the use of creativity to develop a new idea, improvement of services or service delivery methods, development of new products or new ways of using existing products. By combining these features with advanced or specialized knowledge and skills, we can say that entrepreneurial nurses are advanced nurses that produce goods or services and can sell them to foreign sources.
Many researchers believe that identifying opportunities is the first stage of the entrepreneurial process.,, Identifying the entrepreneurial opportunity is defined as understanding the appropriate conditions to achieve potential profitability through the establishment and operation of a new business or improving an existing business  or exploring ideas for creating new businesses  and is the most significant ability of successful entrepreneurs. Opportunity identification is one of the essential elements of the entrepreneurial process  and the individual pursuing these opportunities is an entrepreneur who is the representative of the new changes and placed at the heart of the entrepreneurial process.
Identification of opportunities is the key part for the entrepreneurial research. According to Hansen et al., regardless of the study mechanisms and factors affecting the development of entrepreneurial opportunities, no good and appropriate understanding will be achieved through entrepreneurial process. Therefore, identifying the opportunities must be central in entrepreneurship research center, and the major studies must focus on the fact that how are opportunities exploited to create and provide goods and services and why only some people discover these opportunities.
Fatima et al. believe that opportunity identification is a multidimensional phenomenon that has been less studied. Therefore, investigating why, how, and when to identify opportunities is a significant aspect of it. As no research has been done on how to identify entrepreneurial opportunities in nursing, the researcher decided to use a qualitative approach to describe the experiences of Iranian entrepreneur nurses in this field so that other nurses get aware of the experiences of entrepreneur nurses step in the field of nursing entrepreneurship and respond to the growing and emerging needs of community in the health sector by developing their roles.
| Materials and Methods|| |
In this study, a qualitative method was used to describe Iranian entrepreneur nurses' experience on the identification of proper entrepreneurship. Qualitative research methodology is suitable for obtaining a new perspective on a familiar situation or for describing and illustrating areas that have not been previously investigated and clarifying the relationships between variables that have not already been clarified. This approach emphasizes on the perception of human experience, as it is, through collecting and analyzing qualitative materials which are subjective and narrative.
This study was conducted during 2013–2014. Purposeful sampling was done to choose entrepreneur nurses from several provinces. First, the researcher interviewed with the two entrepreneurial nurses introduced by the colleagues. At the end of each interview, they were asked to introduce their colleagues who work in this field. During a phone call with the introduced entrepreneurs, the purpose of the study was proposed and the place and time of interview were determined. All interviews were conducted in private institutions of the participants. Unstructured and in-person interviews were used to collect data and all interviews were recorded using voice recorder. Each interview lasted between 60 and 120 min. The main question asked from the participants was that how did you identify opportunities to create and develop your business? Exploratory questions such as “what do you mean?” and “Elaborate and exemplify” were used to increase the depth of interviews. Data collection and analysis were simultaneously done, and the interview ended when the themes appeared and the data got saturated.
Content analysis of Graneheim and Lundman's steps  was used for data analysis which involved transcribing interviews and studying them several times to get an overall feeling, splitting the text into semantic summarized units, abstraction of the summarized semantic units and labeling by codes, separation of codes in the subthemes by comparing them based on the their similarities and differences and setting themes as an indicator of hidden text content. In the present study, immediately after each interview, the content was carefully transcribed several times to obtain an overall understanding of the statements of entrepreneurs in line with the purpose of the study. The semantic units were then identified in the transcripts, and the initial codes were extracted. The codes were classified based on their similarities and differences in the subthemes and eventually themes.
The measures recommended by Graneheim and Lundman  were used to examine the integrity of the data. Participants with different experiences with diversity in age and sex were used. Furthermore, in choosing the semantic units, summarizing and abstracting them, choosing subthemes and themes, great efforts are made so that the authors individually analyzed the data and compared the emerging codes and subthemes. When there was disagreement, debate and discussion took place between them until reaching agreement. In addition, the coded interviews were returned to five participants to see if the researchers have seen their views. In addition, two doctoral students reanalyzed the data.
The present study was approved by the Research Council and Ethics Committee of Jundishapur University of Medical Sciences (Ajums.REC.2013, 138). All participants were provided with the informed consent form in which the research objectives, confidentiality, and the willingness to withdraw from the study at any time were mentioned.
| Results|| |
In this study, 4 out of 13 participants were female, and the rest were male with a mean age of 50, the youngest was 37, and the oldest was 65. Participants had 4–30 years of clinical or educational experience in state institutions and had bachelor's degree (4 cases), Masters' degree (6 cases), or doctoral (3 cases). Of the participants, 3 of them were retired, 7 had governmental jobs, and 3 lacked governmental jobs. Participants were entrepreneurial nurses who launched a center for counseling and providing nursing services (3 cases), center for health education to staff of the health sector and the public (2 cases), the center for rehabilitation of mentally disabled people and scientific and practical training to educate the required coaches (1 case), center for ambulance equipment and service provision for private ambulance (1 case), the center for health tourism to facilitate the delivery of health services to Iraqi citizens in Iran (1 case), clinic for caring foot ulcers and marketing medical products produced by knowledge base institutions (1 case) publication of nursing works (1 case), the center for cognitive therapy advice (1 case), and nursing loan funds (2 cases). The above-mentioned private institutions were established since 2–22 years.
As a result of data analysis, three main themes including the identification of opportunities, evaluation of opportunities, and identifying proper opportunities were obtained that will be discussed in the following.
sThe first theme: Sources for opportunity identification
Prior knowledge and experience
Entrepreneurial nurses believed that enjoying the knowledge and experience play a significant role in identifying opportunities and decision-making to launch their business. They stated:
“Once I was thinking about the establishment of a nursing care center at home. But when I rethought, I concluded that I myself am a psychiatric nurse and into the topics individual therapy and family therapy. I have its knowledge. Therefore, I chose the consulting work” (Participant 2).
“If somebody ask me to name one of the secrets of success I would say having the knowledge of work. I could establish geriatric care center or a rehabilitation center for the blind or deaf people. But I did not do so, because I had neither the knowledge nor the literacy” (Participant 6).
“Before starting such a complex, we were working with our colleagues in Tehran University on Mondays in a center called the wound clinic dedicated to diabetic patients. We provided service to the diabetic patients by physician and surgeon friends” (Participant 12).
Another source of opportunity identification in the present study was the social interaction of entrepreneurs which comprised other classes including interaction with entrepreneurs, interacting with customers, and interaction with the associations.
Interaction with entrepreneurs
Some entrepreneurs acknowledged that interaction with other entrepreneurs plays a significant role in identifying opportunities and their orientation toward entrepreneurship in the health field:
“The work began since one of my former students invited me to the opening of nursing care center. The center was one of the first centers. Their work was interesting to me. He suggested that I work with them and admit people with mental health problems. I accepted. I worked for a while and my patients increased and I thought about becoming independent and starting a new career for myself” (Participant 6).
“One of the nurse colleagues helped me a lot. When I was in the hospital, she spoke to me about biological dressing. I said, do we have those kinds of things in Iran. She said yeah, do you want to come once to our company? She gave me the address and I went to their company. I worked there for a while, and I was the director of the wound and ostomy ward. Little by little, I got out of that set and created another setup that all of his staff were nurse. In our company, we not only set up and equip the wound clinics and import of medical equipment but also connected to the knowledge base groups in Iran and are marketing for them” (Participant 12).
Interaction with customers
Another source for opportunity identification was the interaction of entrepreneurs with customers in this study. As a result of interaction with their customers, they directly understand their needs and identify their opportunities. One of the entrepreneurs stated:
“When I was counseling in schools, parents told me that why you don't start counseling center so that we could go there and easily discuss our problems. Here, at school environment, we do not feel safe” (Participant 2).
Interaction with associations
Another resource for entrepreneurial nurses, especially in health education to access to opportunities raising ideas was communication and interaction with the medical and nursing associations, the participants stated in this case:
“Because of the contacts with the nursing scientific association, I was offered to start up the Association Education Unit in the city. I was greatly interested for such kind of works, so agreed. Then, according to our well performance, the Medical Association Education unit was delegated to us and we developed our work” (Participant 3).
“Once I was the only executive in nursing association. That was when we proposed to set up the scientific branch of nursing association for developing the association. I was looking for such an opportunity, so I accepted the responsibility and followed up” (Participant 8).
The second theme: Opportunity evaluation
From the perspective of entrepreneurs, simultaneous with the available opportunities, the opportunities must be evaluated, and their potential must be investigated. This theme consisted of subthemes of potential opportunity efficiency, competition position, legal issues, and position of customers.
Potential opportunity efficiency
One of the cases evaluated by entrepreneurs is the potential opportunity efficiency and profitability of business in the future. One of the participants said:
“When the idea of work occurred in my mind, I thought that does it have any outcomes? Whether the costs spent for the work would be compensated? So before taking any action, I did a field survey and then I followed my job” (Participant 11).
The assessment of the strength and threat of competitors was another subject evaluated by the entrepreneur's nurses. One of the participants said:
“Well, it is natural, when you start a job, you think about your competitors. Who are your competitors, doctors, or anyone else, can you cope with them? As the saying goes, can you keep the wolf from the door?” (Participant 2).
Reviewing the relevant laws and regulations, such as licensing and ownersh ip conditions and so on, is among cases considered by entrepreneur nurses. Entrepreneurs said:
“When I realized that I want to work in the field of rehabilitation of mentally ill people, I thought that what permissions are given to me to have a legal work? Where can I get my license and what conditions must exist for this work?” (Participant 6).
Position of customers
One of the cases evaluated by entrepreneurs was to investigate the position of customers in terms of population, their cultural, and financial conditions. Entrepreneurs stated:
“Who are my customers, their cultural and financial conditions and that do they welcome the service or not were significant questions to me and I had to do some investigations” (Participant 4).
“A lower percent of the exceptional community are blind and deaf, 75% of exceptional community of the country are mentally retarded people. So I thought to enter the job which has more customers” (Participant 6).
The third theme: Identification of proper opportunities
Subthemes of identifying the needs of society for care services, identifying the need to organize the treatment program of foreign citizens, identifying the need of the society for training and consulting, identifying the need of the society for rehabilitation services, identifying the need of the nursing community for welfare services, and identifying the need of nursing community to the facilitation of publication of nursing works comprised the theme for the identification of proper opportunities.
Identification of the need for care services
According to entrepreneur nurses, one of the most significant needs of people in the health-care service is delivering care service at the community level. In Iran, the greatest care is provided during hospitalization, and patients after discharge from the hospital are deprived of these services at home and community. In their view, there are many opportunities to set up private businesses to provide health care services after discharge:
“I saw the diabetic patients who were amputated solely because of necrotic tissue in their finger, and just because of a scalping tissue on their palm of foot, its whole is removed. They don't receive enough training at the hospital, and there's no place to refer to receive proper training and care. So I thought to set up a clinic to provide these services to the diabetic patients” (Participant 12).
“When I worked in the Intensive Care Unit, I saw that families face problems after the discharge of their patient, for example, after being discharged he returned with sepsis. They left with JCS-12 or 9 and returned with JCS 5. No matter how you trained families, they faced problems at home. I realized that regarding the home care, patients and their families have many needs” (Participant 13).
Identification of the need to organize the treatment program of foreign citizens
One of the opportunities identified by an entrepreneur nurse is the identification of the need for Iraqi citizens to health care in Iran. These patients need a coherent plan to receive such services in Iran, through which the physicians and hospitals are identified and amenities and care facilities are received before admission and after discharge in an organized method. The participant stated:
“Given that relations with Iraq have become much better and we have many health presenters, especially in Ahvaz, unfortunately, a series of problems have occurred to them. There are people who are broker and are not into it and do it only because of financial gain. I found that inconvenient events have occurred both for the sick, and for those who are engaged in it. So I thought about a complex to organize this category of patients and efficiently help them” (Participant 11).
Identification of the society to training and consulting services
According to the entrepreneur nurses, different social groups and different professions need health education and counseling to improve their health. So this need lays the groundwork for the nurses to develop their activities. Participants stated:
“Some job positions seem trivial, between, and we think they don't need any special training such as patient carriers, guards, secretaries. But they also need training to protect and promote their health; they need to learn what to do in order not suffer from job burnout. There are jobs which are handling the health of people but have seen no special training. In foreign countries, such kinds of jobs must pass certain courses, but in our country, no planning has been conducted for them which this really needs consideration” (participant 3).
“I used to lecture in high schools. After the speeches, many students referred to me and talked about their problems. Little by little, their families became willing to this work. I saw that the problems of these kids and their family can be solved with counseling sessions. Psychological nurses are skilled in this regard, so why don't we get into it” (Participant 2).
Identifying the need of the society to rehabilitation services
One of the opportunities identified by one of the nurses is identifying the need of the mentally handicapped to rehabilitation services. To provide such a service, this entrepreneur developed its activities and even trained specialists in the field. A participant said:
“In the past, I had a mental disability was born and after several years had passed away. I had close acquaintances with these people and I had seen in mental hospitals that many mental illnesses were initially just one mentally retarded person, but because they had not established proper relationships with them, they experienced behavioral disorders after adolescence and Psychological disorders. I felt that this group of people really needed help and should do something for them.” (Participant 6).
“Following setting up the rehabilitation center, I found that the coaches in this field are so expensive and families who want these services are very poor. Very expensive rehabilitation, very expensive private teachers, this made the families to keep the children at home and refer late to the schools and centers keep many chances away from the children and make many of the diseases more chronic in children, that's why I thought to educate the coaches” (Participant 6).
Identification of the nursing community needs to facilities
From the perspective of the participants, one of the nursing opportunities in the field is the provision of financial and welfare services for nurses, and responding to this need will affect the mental health of nurses and ultimately improve the quality of care services. The entrepreneurs in this regard stated:
“When I had an executive position in the hospital, I saw nurses who did everything and resorted to anyone to get a loan. Well, it's natural that all such financial concerns will affect the quality of the works of nurses. It has always bothered me and I always thought we should do something for the financial difficulties of the nurses” (participant 5).
“We believe that funds are essential for the country and for the vulnerable class. When the loan is 1–5 million and we have so many applicants in turn, what does it mean? It means that the nursing is the vulnerable community of our society. We are concerned about this group. Perhaps in the perspective of the governmental system and the central bank, we have nothing to do with it.” (Participant 7).
Identification of the need of nursing community to facilitate the publication of nursing works
One of the opportunities that nurses can use to expand their activities is the establishment of book publishing centers through which the nurses can more easily obtain for publication of their works. One of the participants said:
“I remember in the year 1984, when I wanted to publish my previous book, I referred to 52 publishers around the university, but none of them accepted to publish my book. All were alien to nursing, and this became an incentive for me to focus my job in nursing so that other nurses who want to publish their book don't have to visit 52 publishers and all disagree with it and treat it as an alien” (participant 10).
| Discussion|| |
In the present study, the entrepreneurs use the opportunity identification resources including the previous knowledge and skills and interaction with entrepreneurs. The associations and customers have attempted to identify needs and opportunities. The studies show that mental repository and skills knowledge of people affect their entrepreneurial alertness level. The previous knowledge of individuals creates a special knowledge corridor allowing him/her to identify specific opportunities. Ardichvili et al. and Shane  believe that work experience, relevant education, and awareness of the hidden need of the client are among the prior knowledge components that affect the entrepreneurial alertness and identification of entrepreneurial opportunities. Cooper in his study found that more than 97% of the new companies activate in the field of advanced technology and have had at least one founder who has already worked in the same industry and almost 85% of the new companies own the basic goods or services where the previous technical experiences of the founders were used. Hence, the majority of new entrepreneurs, whether successful or unsuccessful, has had previous experience in their industry. Furthermore, Shane states that access to the relevant information plays a key role in identifying opportunities and people who have greater access to information to explore opportunities will more likely discover opportunity than people without access to information. Ozgen and Baron argue that social networks or interactions and relationships with others is a source of significant information in the identification of opportunities. They investigated the effect of the coaches, informal social networks, and specialized meetings as social resources of information in identifying the opportunity to review and found it positive. Fudurik states that the previous experience and the size of social networks are two significant factors in the process of identifying opportunities, and the social networks are the most important way for entrepreneurs to receive information. In the study of Fuentes et al. also, it was found that the person's previous knowledge and the power of entrepreneurial social networks have a positive effect on the number of developed and operational opportunities. Furthermore, the results of the study of Klyver and Schott showed that the social networks affect the efficacy and competitiveness of the individual to shape the entrepreneurial intention and increase the individual access to information resources.
In the present study, the entrepreneurs along with the identification of opportunities began evaluating the opportunities including reviewing the potential efficiency of opportunities, market position, legal issues, and the position of their customers. Haynie in evaluating opportunities mentions three notable points including (1) the attractiveness of the opportunity or the potential ability of opportunity to create competitive advantage and entrepreneurial profits, (2) future-oriented opportunity evaluation, and (3) dominance of the first person to the third person during opportunity evaluation meaning that whether this opportunity is attractive to me? Mullins provided a comprehensive model for the evaluation of the opportunities, including seven dimensions of stable profit, industry attractiveness, attractiveness of the market, interest and attractions of the target market, the ability to execute the key success factors by the entrepreneur or entrepreneurial team, risk-taking of individuals or entrepreneur group, and the supply chain. The International Council of Nurses also states that the entrepreneur nurses in the evaluation of opportunities should ask themselves questions and answer them. These questions include Who are the customers? Who are the competitors? What is the demand of customers of this business? How much does it cost to set up? What business structures are needed? When are the products and services needed? What are the advantages of the business compared to the competitors?
Identification of opportunities in entrepreneurial nursing in various sectors of care, education, counseling, rehabilitation, health tourism, welfare publishing, and utilities for nurses were the findings of the study. The Oxford dictionary defines opportunity as the turning point or favorable conditions to reach a purpose or encountering what is effective and desirable. Sarasvathy et al. suggest that an entrepreneurial opportunity includes some of the ideas and beliefs that enable creating goods and services when they are not found in any market. Austin et al. defined opportunity as the future favorable position which is different with the present situation and the belief that it is possible to achieve such a position. Wilson et al. introduced a variety of entrepreneurship opportunities at different levels of care. At the primary level of care, they provided community-centered care including health screening, preventive care, health education, maternal, and child health care services such as family planning and vaccination and providing health-care services to patients with chronic common problems such as high blood pressure, diabetes, asthma, chronic obstructive pulmonary disease, depression and anxiety, back pain, arthritis, and thyroid dysfunction. International Council of Nurses also introduced opportunities such as providing care services to the chronically ill, specialty care such as care for stoma, diabetes, dialysis, and palliative care; consultancy services in the field of health promotion including stress reduction, nutrition, preventive sexual programs, drug abuse, juvenile delinquency, and women's health; management consulting services and human resource planning, professional health consulting services, research consulting, psychotherapy, respiratory treatments, production or marketing of products or care tools, and publishing services to develop nursing entrepreneurship. Wilson et al. expressed a variety of clinical problems and clinical services, educational services and recipients of educational services, types of consulting services and recipients of consulting services, types of research services, and recipients of research services. Badulescu and Badulescu introduced medical tourism and explained that the medical tourism and healthcare include a wide range of activities, from controlling the medical condition and health screening to heart surgery and neurosurgery and treatment of infertility. The industry during 2005–2007, provided revenue of $ 60 billion with growth of around 20%.
Since this study was conducted on Iranian entrepreneur nurses, there might be some limitations in generalizing the findings of this study to other areas and cultures.
| Conclusion|| |
The findings of this study show that how Iranian entrepreneur nurses use resources for opportunity identification and evaluation of the opportunities identified to gain proper entrepreneurial opportunities in the health care. The educational planners and nursing administrators are recommended to use the findings of this research to teach nurses and nursing students to enter the field of health entrepreneurship.
This article was derived from the PhD thesis of the first writer approved by the Jundishapur University of Medical Sciences, Ahvaz with No. U-92122. The author appreciates all the participants who have helped them in this article.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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