Nurse Entrepreneurs: Diversifying & Innovating

Florence Nightingale is generally acknowledged as the founder of modern nursing. A legend in Victorian society, she was known as the lady with the lamp, an image that remains linked with nursing and conjures up the nurse as a deeply feminine, nurturing, compassionate, and devoted figure. Behind the image however, is the lesser known and extraordinary reality of Florence Nightingale as pioneer, educator, reformer, activist, writer, feminist, and gifted statistician. Her legacy is profound and her list of accomplishments is so long, it would give most Fortune 500 CEOs an inadequacy complex.

Perception vs. Reality

This dichotomy between a traditional, conservative image of nursing and the dynamic and multifaceted reality of who nurses are and what they do every day, is a gap that is being identified and addressed at the University of Rochester's Center for Nursing Entrepreneurship (CNE). The first of its kind, the CNE functions on the premise that nurses have unique patient-centered skills, knowledge, training, and experience that can bring new value and energy to the healthcare system through entrepreneurial ventures, e.g., by diversifying existing services, breaking new ground, or innovating what already functions well.

The CNE believes it has never been a better time to be an RN and highlights the entrepreneurship that has lead nurses into new categories such as the RN first assist, legal nurse consultant, testifying legal expert, forensic nurse examiner, and health promotion specialist. All these fields are open for further innovation and exploration, and necessitate bedside practice. The field of health promotion is a particular area of emphasis in the effort to prevent illness and therefore limit additional demands of illness care.

Skeptics may ask how the altruistic philosophy of nursing is compatible with the more mercenary aspect of capitalism. The answer can be found in a growing trend in universities and businesses: social entrepreneurship, where the mission drives activities that generate the income required to be operate and be self-sustaining. A presentation on the CNE's website cites nurse historian Barbra Mann Wall's studies of the work of Catholic nuns in the late 19th and early 20th centuries, and the social entrepreneurship of Catholic mission hospitals, which contracted services to local businesses and factories to provide healthcare for their workers, providing steady revenue for expenses while fulfilling their mission of providing healthcare to the local population.

So what does the CNE do? It has a three-pronged mission. It helps "nurses start companies through education, experience, support and investment." It "contributes value to the School of Nursing – financial, practical and intellectual," and it aims to solve "health care problems; attract new nurses and retain experienced ones, helping to address chronic shortages." Indeed, there is currently a worldwide shortage of nurses. In the US alone, JAMA predicts that by the year 2020 there will be a 20% shortfall – the equivalent of 800,000 nursing jobs. Factor in the issues of an aging baby-boom population and medical work force and the prospect of an influx of entrepreneurial energy from nurses on the medical frontline, certainly sounds like a good idea. By emphasizing preventive care, alternative methods of delivering services and expanding the career opportunities available to nurses, the hope is to retain and utilize the wealth of knowledge and experience that exists within the current nursing population while offering exciting new career prospects to potential nurse recruits.

Some History

An endowment to support the entrepreneurial spirit is what enabled the existence of the CNE itself. In 2003, the Ewing Marion Kauffman Foundation awarded a $3.5 million grant, one of eight of its kind in the United States, to the University of Rochester's School of Nursing. The grant allowed the university's Community Nursing Center, staffed by faculty, to evolve into the Center for Nursing Entrepreneurship.

The Community Nursing Center, one of the first nurse-managed clinics in the US, began life as a place for faculty to maintain their clinical skills while doing outreach work within the community. The Center was dependent on grant funding, an operations scenario fraught with uncertainty. In order to avoid hitting the point of "no funds, no mission," the Center switched strategies to focus on services that would generate revenue. A crucial player in this transition was co-founder and current CEO of the CNE, Donna Tortoretti, RNC, MS, CMAC.

Tortoretti, who began her career as a neuropsychiatric nurse, explains the transition, saying that the Center reviewed its functions, "identified areas of problems and found niches that nurses do well." She acknowledges that in trying to find strategies that were not dependent on grants, the Center had to focus less on working with the poor and indigent community to find more of a balance in its work with local businesses. The Center's strategy worked so well, it soon became a revenue generator instead of an overhead expense for the School of Nursing. This transition from being an institution dependent on grants to a profitable community health model, shed light on a huge area of opportunity for nurses Dean Patricia Chiverton, EdD, RN, FNAP, is a co-founder of the CNE and believes that "nurses are in a unique position to contribute significantly, but we must empower them with the education, tools, and resources they need to become more entrepreneurial."

The Bottom Line and What Surrounds It

The CNE is largely designed to turn "ideas into businesses and nurses into entrepreneurs" and it has a message for the nursing population that "entrepreneurs are made, not born." Along with providing start-up support for businesses, the Center also operates as an incubator and maintains an open door policy for the development of new ideas or opportunities.

As a hybrid of business and education, the Center also currently operates eight business initiatives, many of which have a welcome bias in preventive practices. The businesses also provide the CNE with a healthy bottom line of $600,000 in profits. Examples of the businesses include: Edvantage, a professional service for nurses and health professionals that helps map out and reach goals through coaching, mentoring and continuing education. Entrepreneur Nurse, a membership network and publisher, which enables nurses to connect, share ideas, learn, innovate, and start companies. HEALTH e NOVATION, which provides clinical research and statistical analysis services and also helps the development and deployment of technologies, particularly in the areas of telehealth and remote health monitoring. Health Checkpoint helps to "set goals for improved health and provides knowledge, tools and encouragement to achieve and maintain them." The CNE also operates a franchise of the successful Passport Health, a "provider of customized risk reduction education and immunizations for international travelers." It also holds an equity stake in a new spin-off located in Oklahoma City, called the National Forensic Nursing Institute (NFNI), which was incubated at the CNE with faculty member Rusty Rooms, MSN, RN, a pioneering forensic nurse at the helm. Rooms' take on harnessing the power of nursing's social entrepreneurship can be heard in an online presentation at the CNE's website. In it, he identifies passion as a foundation for nursing, as well as a trigger for all worthwhile leadership, innovation, and enterprise.

With the United States spending $1.4 trillion on healthcare, more than any other country in the world, but being ranked 37th globally by the World Health Organization, the CNE's mission to more fully utilize the wealth of resources in the nursing population, diversify the delivery of health services, stimulate innovation and problem solving and promote the nursing profession itself, offers alternatives to the existing model of medical practice in the United States. Some believe the solution is precisely what the doctor ordered, or more accurately, an idea whose time has come.

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