857 HINDERING AND SUPPORTING FACTORS OF ENTREPRENEURSHIP IMPLEMENTATION FOR NURSES: A NARRATIVE REVIEW Volume: 4 Number: 3 Page: 857 - 864 Christantie EFFENDY1, Maryadi MARYADI2, Nurdina Wahyu HIDAYATI3, Ruby SUSMAWATI4 1Department of Medical-Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia 2,3,4Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia Corresponding author: Christantie EFFENDY E-mail: christantie@ugm.ac.id Article History: Received: 2023-03-09 Revised: 2023-04-21 Accepted: 2023-05-17 Abstract: Entrepreneurship in the nursing field is still rising, giving greater opportunities for these nursing entrepreneurs. However, nurses need to identify the obstacles and the support so that their businesses will run well and succeed. To identify the hindering and supporting factors for nurses in entrepreneurship. This study was a narrative review with literature research using electronic databases, which included Science Direct and PubMed between 2011-2021. The framework from the European Medical Writers Association developed by Ferrari was used to guide the study from the total of 11 identified and analyzed literature; there were seven hindering factors (fear, knowledge and skill; prior working culture experience; decision-making policy and regulations; health insurance, colleague jealousy; and unprofessional attitudes) and two supporting factors (knowledge and skills; ability to seek opportunities). Conducting entrepreneurship in nursing still faces several obstacles but also has some support, and therefore can be done by developing nurses' self-potentials and professional attitudes. Keywords: Entrepreneur, Nursing, Obstacle, Support. Cite this as: EFFENDY, C., MARYADI, HIDAYATI, N. W., & SUSMAWATI, R. (2023). “Hindering And Supporting Factors of Entrepreneurship Implementation for Nurses: A Narrative Review.” International Journal of Environmental, Sustainability, and Social Sciences, 4 (3), 857 - 864. INTRODUCTION An entrepreneur is an individual who establishes or manages their own business with the principles of profit and growth. Entrepreneurship is the practice of starting a new organization or revitalizing old ones by developing new opportunities to gain added value for ourselves or others (Andrade, Dal Ben, & Sanna, 2015; Deniz, Boz, & Ertosun, 2011). When entrepreneurship is associated with the nursing profession, entrepreneurship can be implemented in the business environment and personal life to develop nurses' skills and to give better quality medical treatment (Andrade et al., 2015). Nursing has its own reasons and chances to establish business. First, nursing understands that people must be seen as a whole and cared for holistically (Chowdhury & Chakraborty, 2017). Second, independent nursing by nurses has increasing potential and opportunities to explore new social spaces without maintaining the traditional nursing approach or focusing on diseases. Doing entrepreneurship enables nurses to create new fields that can improve the economic growth of the country (Backes, Gomes, Pereira, Teles, & Backes, 2017). This potential is due to the numeric representative of nursing professionals as the largest group of health workers with multiple workplaces in numerous health fields (Backes et al., 2018). In Indonesia, entrepreneur nurses are mailto:christantie@ugm.ac.id 858 stipulated in Health Ministry Decree No 26 year 2016 about the stipulation of the Constitution no 38 years 2014 about nursing (Kemenkes RI, 2019). The Board of Directors of the Indonesian National Nurse Association (2017) has stipulated the Independent Nursing Practices Guideline as the basis for nurses to conduct independent practices. In other countries, for example, in Brazil, entrepreneurial nurses are stipulated in the Constitution of Professional Nursing Practices No 7498 year 1986 and Health Ministry Decree in Sistema Único de Saúde chapter 16 article XIV act 8080/90 (Bellaguarda, Nelson, Padilha, & Caravaca-Morera, 2015). Nurses have great opportunities to conduct entrepreneurship by using innovative approaches. Nurses can use their creativity to develop new ideas, improve service and treatment methods, and develop new products or new ways to use existing products (Wilson, Whitaker, & Whitford, 2012). The high rate of non-communicable diseases in Indonesia can be seen as one of these opportunities (P2PTM, 2017). Like other entrepreneurs, nursing professionals can also become business owners and offer the clinical practice of nursing services directly responsible for the clients through individual, private, or public organizations (Jahani, Abedi, Elahi, & Fallahi- khoshknab, 2016). Currently, entrepreneurship in nursing is still in an ongoing developmental process, especially in developing countries of low and middle-income countries (Lokman & Chahine, 2021). Based on the International Council of Nurses (ICN) census, only 0.5-1% of nurses globally conduct businesses as entrepreneurs (International Council of Nurse, 2004). In the developed country, the United States of America, only 1.8% of entrepreneurs in the nursing field (Cheater, 2010). Numerous obstacles and limitations cause problems in the entrepreneurship process, such as some nurses are not well-trained and are seen as poorly developed workers. As a result, they face some challenges and obstacles to assume an entrepreneurial role (World Health Organization, 2010). Elango, Hunter, and Winchell (2007) reported that nurses and other health professionals admit the potential of nursing entrepreneurship. However, some obstacles avert nurses from taking the opportunity for entrepreneurship (Elango et al., 2007). Therefore, this narrative review presents numerous factors that hinder and support nursing entrepreneurship. The findings are expected to serve as a reference and aid in the business considerations of nurses who want to develop and establish entrepreneurship. METHODS This research was a narrative review study using the framework from EMWA (European Medical Writers Association) developed by Ferrari (2015). It started by determining the problem, gathering information, and determining the scope of the problem. The second step was conducting a literature search by determining the database, keywords, and inclusion and exclusion criteria, verifying literature, and quoting references. Data search was conducted using the electronic databases of Science Direct and PubMed in the last 10 years (2011-2021) with the keywords of “entrepreneur OR entrepreneur OR entrepreneurship OR entrepreneurial OR entrepreneurialism AND nursing OR nurses OR nurse." Based on the literature search results in Science Direct and PubMed, three evaluators read and carefully analyzed to determine and summarize the latest information about the hindering and supporting factors. After searching, some literature was chosen based on inclusion criteria such as using English, full text and discussing hindering and/or supporting factors for nurses in entrepreneurship. Meanwhile, the exclusion criterion was entrepreneurship outside the nursing field. The selected literature is categorized and analyzed individually. The next step was to quote some references from the selected literature. 859 RESULT AND DISCUSSION There were 1,411 articles found, and their titles and abstracts screened 279. Furthermore, full- text evaluation was conducted for 46 kinds of literature, and finally, it was concluded that there were 11 articles to be reviewed. Based on the results, there were 9 from PubMed and 2 from Science Direct. Of the 11 kinds of literature, 6 were published between 2011-2016, and 5 were published between 2017-2021. The selected articles involve 3 (27%) qualitative studies, 3 (27 %) review studies, 3 (27 %) cross-sectional, and 2 (19%) theoretical model studies. From the 11 deeply analyzed, it can be concluded that 7 factors were identified as the hindering factors and 2 as the supporting factors for the nurses to conduct entrepreneurship. Source: Author, 2023 Figure 1. PRISMA Flowchart for Study Selection (Higgins & Cochrane Collaboration, 2020). The hindering factors are Fear, Nurses' Knowledge and Skills, Prior Working Culture Experience; Decision-Making Policy and Regulation; Health Insurance; Colleague Jealousy; and Unprofessional Attitude. Meanwhile, the supporting factors are knowledge and skills about entrepreneurship and the ability to see the current opportunities. Fear. Deniz, Boz, and Ertosun (2011) stated that fear greatly influences entrepreneurship. If fear influences attitude in the workplace and plays a vital role in performance in the workplace, then entrepreneurs must understand how fear can limit the success of their business. PubMed: 790 Science Direct: 621 Total: 1.411 Analyzing the title and abstract of 279 literatures Eliminating 1,132 kinds of literature based on criteria Re-evaluation of 14 kinds of literature by researchers 11 articles for review Full-text evaluation for 46 kinds of literature Eliminating 233 kinds of literature based on the analysis of title and abstract Id e n ti fi ca ti o n S cr e e n in g E li g ib il it y In cl u d e d Eliminating 32 kinds of literature based on inclusion and exclusion criteria Eliminating 3 literature without a discussion about hindering and supporting factors 860 Emotion is a factor associated with explaining failure. Fear is a strong emotion and usually contributes to the disability to grow to reach dreams. When fear or emotion appears, it can influence cognitive processes, for example, decision-making, even when emotion is not derived from the actual object, people, or events being evaluated (Deniz et al., 2011). Nurses’ Knowledge and Skills. Intellectual property sourced from knowledge can be transferred to innovations that improve performance. Shortly, a business can reach high performance by directing knowledge and innovative work attitude in harmony. Effective knowledge management can greatly ensure competitive excellence in nursing entrepreneurship (Örnek & Ayas, 2015). However, nurses still view their workplaces as just hospitals, so they do not see the opportunities to become entrepreneurs in the nursing field. After graduating with a nursing education, nurses primarily aim to work in hospitals because they think the risk is negligible than working as higher-risk entrepreneurs (Jahani et al., 2016). This misconception is due to the lack of knowledge about entrepreneurship, so they cannot identify and take risks to conduct entrepreneurship (Jahani, Abedi, Khoshknab, & Elahi, 2018). Prior Working Culture Experience. Nurses still consider that their primary duty is to obey the orders of other professions, and therefore this work culture makes the nurses disregard their competence and potential (Jahani et al., 2016). Decision-making policy and regulation. Getting a license to establish a clinical business seems complicated, and the tax is not based on the actual condition of the business, which is still new. Therefore, the government must formulate a policy to reduce taxes for small and new businesses (Jahani et al., 2016). Most private businesses are regulated within limited-liability nursing practice filing. In some cases, they still depend on the authority of other professions as the policy and decision-makers; for example, private obstetric clinics require oversight from a medical doctor (Nikbakht-Nasrabadi & Shabany-Hamedan, 2016). Health Insurance. Health insurance factors are considered one of the obstacles by nurses in conducting entrepreneurship in the nursing field because the current scope of coverage still needs to include claims for all health services, such as health counseling, which is not covered by insurance. Therefore, the insurance factor needs special attention from the government and the insurance providers to handle that problem (Jahani et al., 2016). Colleague Jealousy. The jealousy of colleagues in hospital institutions can harm the psychology of entrepreneurial nurses (Jahani et al., 2016). As a result, the work environment and the relationship among nurses can become not harmonious. Therefore, there is a need to build good communication among nurses to create supportive conditions inter-professionally. (Mohebifar et al., 2020). Unprofessional attitude. Unprofessional attitudes like incompetence and illegal practices are still found in many places. Those practices offer treatment with lower costs from the legal institutions with proper licensing, so it can lead other nurses' businesses to go bankrupt. That phenomenon occurs due to the lack of supervision from the institutions involved in health system supervision and the lack of knowledge from society in differentiating professional nurses from those who are not professionals (Jahani et al., 2016). Supporting Factors for Nursing Entrepreneurship. Factors supporting nursing entrepreneurship are knowledge, skills, and the ability to see current opportunities. Knowledge and Skills about Entrepreneurship. Universities should teach about entrepreneurship in nursing education so that nurses will know and skills and are interested in entrepreneurship (Jahani et al., 2016). Training and development in entrepreneurship need to be considered because they can positively impact the developing nurses' knowledge and skills in entrepreneurship (Jahani et al., 2018; Wall, 2013). Education about entrepreneurship can also be 861 conducted at the early stages of education because several studies mention that entrepreneurial training can improve the knowledge and the interests of the nurses to establish their businesses (Lim, Kim, & Kim, 2021; Trotte et al., 2021; Wall, 2013). Developing entrepreneurship in nursing education is greatly recommended to facilitate the development of nurses’ entrepreneurship (Mohebifar et al., 2020). Including entrepreneurship education in the learning, curriculum can create new professional nurses to be entrepreneurs and create learning groups to help new entrepreneurial nurses (Bowles & Heil, 2014). Entrepreneurship experiences in education should prepare professional entrepreneurs for the future. Ability to see current opportunities. Knowledge and skills are some factors for nurses in identifying opportunities. Having particular skills in certain aspects and the ability to see market targets (patient groups that become the target) will lead the nurses to take those opportunities and eventually try to establish their businesses. Besides, nurses must also develop the ability for social interactions with anyone (Jahani et al., 2018). In nursing entrepreneurship, nurses must identify and master their competence while building and maintaining their professional dreams. Having a cohesive strategic plan can have positive impacts on the development and continuity in developing entrepreneurial attitudes among nursing organization members (Borseková, Vaňová, & Vitálišová, 2017). Strong determination, hard work, and willingness are needed to succeed in establishing and running entrepreneurship (Yosep & Mardhiyah, 2010). Rotter (1966) states that when individuals believe they can make changes by doing specific actions, they might be more willing to think about their future and act proactively (Rotter, 1966). Of course, in conducting entrepreneurship, nurses must obey the prevailing regulations and follow the rules of conduct designated in the organization where they work. Nurses must think about the various possible obstacles that they might face. In most hospitals, some of the injustice in deciding on a restrictive policy is because only a few nurses are involved in decision-making in the governance process (Currie, Chiarella, & Buckley, 2013). Nurses need to be encouraged to develop themselves related to the professional skills they need to improve to get the exact workplace position and develop policy (Liu & D’Aunno, 2012). Nurses can promote their alternative ideas about health, and through their position, they can be actively involved in policy and decision-making (Wall, 2014). Additionally and of equal importance, economic factors significantly influence the available opportunities for entrepreneurship in the health field, especially capital and revenue (Roy, 2013). In Indonesia, the government has provided capital grants for young entrepreneurs. However, those are addressed only for young entrepreneurs in the industrial, tourism, education, and creative industries. There still needs to be more attention given to the health industry. Therefore, the government needs to give support opportunities for entrepreneurs in the health field to help nurses in their entrepreneurship (KOMINFO RI, 2020). One of the most significant factors in entrepreneurship is the ability to apply a successful marketing strategy and have connections to other entrepreneurs to support the condition of the business economy. In this way, the nurses who establish entrepreneurship can get guidance by relying on their connection to other entrepreneurs (Vannucci & Weinstein, 2017). Many hindering factors are found, but some can be modified as fear, knowledge and skills, and previous work experience. If those factors are handled well, they can become supporting factors through intrinsic motivation and self-determination that can benefit the nurses in their launching efforts in entrepreneurship. Furthermore, some supporting factors can be improved to achieve better results. 862 CONCLUSION Entrepreneurship in nursing could be beneficial for nurses in practice. The current pandemic is an excellent opportunity for nurses to conduct entrepreneurship. Nurses must develop their self- potentials and identify the obstacles and the supports so that their businesses run competently. Some obstacles can be modified, and some supporting factors must be improved. The entrepreneur world is full of challenges and opportunities, so nurses must face them professionally. Only a few studies discuss the obstacles and supporting factors in nursing entrepreneurship. Therefore, there is a need for further study concerning this critical topic to identify the hindering factors and the factors that support nursing entrepreneurship. REFERENCES Andrade, A. de C., Dal Ben, L. W., & Sanna, M. C. (2015). Entrepreneurship in nursing: overview of companies in the State of São Paulo. Revista Brasileira de Enfermagem, 68(1), 35–39. https://doi.org/10.1590/0034-7167.2015680106p Backes, D. S., Gomes, C. A., Pereira, S. B., Teles, N. F., & Backes, M. T. S. (2017). Portable bathtub: technology for bed bath in bedridden patients. Rev Bras Enferm, 70(2). https://doi.org/10.1590/0034-7167-2016-0178 Backes, D. S., Zamberlan, C., de Siqueira, H. C. H., Backes, M. T. S., de Sousa, F. G. M., & Lomba, M. de L. L. de F. (2018). Quality nursing education: a complex and multidimensional phenomenon. Texto e Contexto Enfermagem, 27(3), 4580016. https://doi.org/10.1590/0104- 070720180004580016 Bellaguarda, M. L. dos R., Nelson, S., Padilha, M. I., & Caravaca-Morera, J. A. (2015). Prescriptive authority and nursing: a comparative analysis of Brazil and Canada. Revista Latino- Americana de Enfermagem, 23(6), 1073. https://doi.org/10.1590/0104-1169.0418.2650 Borseková, K., Vaňová, A., & Vitálišová, K. (2017). Smart specialization for Smart spatial development: innovative strategies for building competitive advantages in tourism in Slovakia. Socio-Economic Planning Sciences, 58, 39–50. https://doi.org/10.1016/j.seps.2016.10.004 Bowles, K. H., & Heil, E. (2014). From the unmet clinical need to entrepreneurship: Taking your informatics solution to market. Studies in Health Technology and Informatics, 201, 315–320. https://doi.org/10.3233/978-1-61499-415-2-315 Cheater, F. M. (2010). Improving primary and community health services through nurse-led social enterprise. Quality in Primary Care, 18, 5–7. https://doi.org/10.1002/14651858.CD001271.pub2 Chowdhury, S., & Chakraborty, P. pratim. (2017). Universal health coverage: there is more to it than meets the eye. Journal of Family Medicine and Primary Care, 6(2), 169–170. https://doi.org/10.4103/jfmpc.jfmpc Colichi, R. M. B., Gómez-Urrutia, V., Jimenez-Figueroa, A. E., Nunes, H. R. de C., & Lima, S. A. M. (2020). Profile and entrepreneurial intention of nursing students: a comparison between Brazil and Chile. Revista Brasileira de Enfermagem, 73(6), 1–9. https://doi.org/10.1590/0034-7167-2019-0890 Currie, J., Chiarella, M., & Buckley, T. (2013). An investigation of the international literature on nurse practitioner private practice models. International Nursing Review, 60(4), 435–447. https://doi.org/10.1111/inr.12060 https://doi.org/10.1590/0034-7167.2015680106p https://doi.org/10.1590/0034-7167-2016-0178 https://doi.org/10.1590/0104-070720180004580016 https://doi.org/10.1590/0104-070720180004580016 https://doi.org/10.1590/0104-1169.0418.2650 https://doi.org/10.1016/j.seps.2016.10.004 https://doi.org/10.3233/978-1-61499-415-2-315 https://doi.org/10.1002/14651858.CD001271.pub2 https://doi.org/10.4103/jfmpc.jfmpc https://doi.org/10.1590/0034-7167-2019-0890 https://doi.org/10.1111/inr.12060 863 Deniz, N., Boz, I. T., & Ertosun, Ö. G. (2011). The relationship between entrepreneur’s level of perceived business-related fear and business performance. Procedia - Social and Behavioral Sciences, 24, 579–600. Elsevier. https://doi.org/10.1016/j.sbspro.2011.09.038 Elango, B., Hunter, G. L., & Winchell, M. (2007). Barriers to nurse entrepreneurship: a study of the process model of entrepreneurship. Journal of the American Academy of Nurse Practitioners, 19(4), 198–204. https://doi.org/10.1111/j.1745-7599.2007.00215.x Ferrari, R. (2015). Writing Narrative Style Literature Reviews. The European Medical Writers Association, 24(4), 230–235. https://doi.org/10.1179/2047480615Z.000000000329 International Council of Nurse. (2004). Guidelines on the Nurse Entre/ Intrapreneur Providing Nursing Service. In ICN. Geneva, Switzerland. Retrieved from http://www.crnns.ca/documents/SelfEmpPractice/GuidelinesforNurseEntrepreneurs(ICN ).pdf Jahani, S., Abedi, H., Elahi, N., & Fallahi-khoshknab, M. (2016). Iranian entrepreneur nurses’ perceived barriers to entrepreneurship: a qualitative study. Iranian Journal of Nursing and Midwifery Research, 21(1), 45–53. https://doi.org/10.4103/1735-9066.174749 Jahani, S., Abedi, H., Khoshknab, M. F., & Elahi, N. (2018). The experience of Iranian entrepreneurial nurses on the identification of entrepreneurial opportunities: a qualitative study. Journal of Family Medicine and Primary Care, 230–236. https://doi.org/10.4103/jfmpc.jfmpc Kemenkes RI. (2019). Peraturan Menteri Kesehatan Republik Indonesia Nomor 43 Tahun 2019. KOMINFO RI. (2020, September 12). Bantuan Modal bagi Wirausaha Muda. Retrieved June 23, 2021, from Portal Informasi Indonesia website: https://indonesia.go.id/kategori/keuangan/2050/bantuan-modal-bagi-wirausaha-muda Lim, J. Y., Kim, G. M., & Kim, E. J. (2021). Predictors of entrepreneurial intention of nursing students based on theory of planned behavior. Journal of Multidisciplinary Healthcare, 14, 533–543. https://doi.org/10.2147/JMDH.S288532 Liu, N., & D’Aunno, T. (2012). The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queueing analysis. Health Services Research, 47(2), 594–613. https://doi.org/10.1111/j.1475-6773.2011.01343.x Lokman, L., & Chahine, T. (2021). Business models for primary health care delivery in low- and middle-income countries: a scoping study of nine social entrepreneurs. BMC Health Services Research, 21(211), 1–13. https://doi.org/10.1186/s12913-021-06225-6 Mohebifar, R., Shokri, A., Rafiei, S., Mohammadi, N., Mohammadi, M., & Moghadam, S. M. (2020). Affecting structural factors on the entrepreneurship behavior of the academic members of healthcare. Iranian Journal of Public Health, 49(9), 1750–1757. https://doi.org/10.18502/ijph.v49i9.4095 Nikbakht-Nasrabadi, A., & Shabany-Hamedan, M. (2016). Providing healthcare services at home-a necessity in Iran: a narrative review article. Iranian Journal of Public Health, 45(7), 867–874. Retrieved from http://ijph.tums.ac.ir Örnek, A. Ş., & Ayas, S. (2015). The Relationship between Intellectual Capital, Innovative Work Behavior and Business Performance Reflection. Procedia - Social and Behavioral Sciences, 195, 1387–1395. https://doi.org/10.1016/j.sbspro.2015.06.433 P2PTM. (2017). Rencana Aksi Kegiatan Pengendalian Penyakit Tidak Menular. Kemenkes RI. Pittman, P., & Salmon, M. E. (2016). Advancing nursing enterprises: a cross-country comparison. Nursing Outlook, 64(1), 24–32. https://doi.org/10.1016/j.outlook.2015.09.002 Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs, 80(1), 1–28. https://doi.org/10.1037/h0092976 https://doi.org/10.1016/j.sbspro.2011.09.038 https://doi.org/10.1111/j.1745-7599.2007.00215.x https://doi.org/10.1179/2047480615Z.000000000329 http://www.crnns.ca/documents/SelfEmpPractice/GuidelinesforNurseEntrepreneurs(ICN).pdf http://www.crnns.ca/documents/SelfEmpPractice/GuidelinesforNurseEntrepreneurs(ICN).pdf https://doi.org/10.4103/1735-9066.174749 https://doi.org/10.4103/jfmpc.jfmpc https://indonesia.go.id/kategori/keuangan/2050/bantuan-modal-bagi-wirausaha-muda https://doi.org/10.2147/JMDH.S288532 https://doi.org/10.1111/j.1475-6773.2011.01343.x https://doi.org/10.1186/s12913-021-06225-6 https://doi.org/10.18502/ijph.v49i9.4095 http://ijph.tums.ac.ir/ https://doi.org/10.1016/j.sbspro.2015.06.433 https://doi.org/10.1016/j.outlook.2015.09.002 https://doi.org/10.1037/h0092976 864 Roy, D. R. (2013). Consulting in occupational health nursing: an overview. Workplace Health & Safety, 61(1), 43–49. https://doi.org/10.1177/216507991306100106 Trotte, L. A. C., Santos, J. L. G. dos, Sarat, C. F. N., Mesquita, M. G. da R., Stipp, M. A. C., Souza, P. de, … Lima, C. F. da M. (2021). Entrepreneurial tendency of Nursing students : a comparison between graduating beginners and undergraduate students. Rev. Latino-Am. Enfermagem, 29(e3402). https://doi.org/10.1590/1518-8345.4397.3402 Vannucci, M. J., & Weinstein, S. M. (2017). The nurse entrepreneur: empowerment needs, challenges, and self-care practices. Nursing: Research and Reviews, Volume 7, 57–66. https://doi.org/10.2147/nrr.s98407 Wall, S. (2013). Nursing entrepreneurship: motivators, strategies and possibilities for professional advancement and health system change. Nursing Leadership (Toronto, Ont.), 26(2), 29–40. https://doi.org/10.12927/cjnl.2013.23450 Wall, S. (2014). Self-employed nurses as change agents in healthcare: Strategies, consequences, and possibilities. Journal of Health, Organisation and Management, 28(4), 511–531. https://doi.org/10.1108/JHOM-03-2013-0049 Wilson, A., Whitaker, N., & Whitford, D. (2012). Rising to the challenge of health care reform with entrepreneurial and intrapreneurial nursing initiatives. Online Journal of Issues in Nursing, 17(2). https://doi.org/10.3912/OJIN.Vol17No02Man05 World Health Organization. (2010). Global strategic directions for strengthening nursing and midwifery 2016-2020. Retrieved from https://www.who.int/hrh/nursing_midwifery/global-strategic-midwifery2016-2020.pdf Yosep, I., & Mardhiyah, A. (2010). Sprirt and Softskills of Nursing Entrepreneur. Bandung: Rafika Aditama. https://doi.org/10.1177/216507991306100106 https://doi.org/10.1590/1518-8345.4397.3402 https://doi.org/10.2147/nrr.s98407 https://doi.org/10.12927/cjnl.2013.23450 https://doi.org/10.1108/JHOM-03-2013-0049 https://doi.org/10.3912/OJIN.Vol17No02Man05 https://www.who.int/hrh/nursing_midwifery/global-strategic-midwifery2016-2020.pdf