LUNA GOCO COLLEGES, INC.

DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

MODULE 12
FUTURE DIRECTIONS AND ENTREPRENEURSHIP IN NURSING
Objectives
After working on this module, you should be able to:
1. Discuss trends in the health care system today;
2. Discuss the implications of these trends for the future of nursing;
3. Discuss entrepreneurship and niche creation in nursing; and
4. Construct an outline of a business plan.
In the previous modules, we covered general trends in health care delivery systems. Now, we will be more
specific by situating our discussion in particular nursing scenarios.
This module is on developing nursing business and niche creation. The next module is about social marketing
and how it can be applied in nursing.
Review of Health Trends and their Effects on Nursing Practice
Trends in the health sector with their consequent effects on the health care market and environment will
continue to impact on nursing practice in general, and nursing practice
In general, and nursing administration in particular. Nursing administrators and managers need to be aware
of these trends if nursing is to have a voice in its own future and assume leadership in the new health care
arrangements.
1. A trend that is affecting health care delivery is the prevalence of lifestyle diseases. Life in the new
millennium, especially in the metropolis, has become exceedingly hectic and fraught with pressure, both
personal and job-related. People have become used to processed, “instant,” “fast” foods, which are not
necessarily healthy foods. Physical inactivity has become the trend as people sit on their desks for eight
hours at a time, and ride motor vehicles instead of walk. More and more people are also smoking cigarettes.
There are increasing problems of substance abuse, sex-related diseases and crimes. Unhealthy diets,
inactivity, and smoking are all established risk factors for cardiovascular diseases, diabetes mellitus, cancer,
chronic obstructive pulmonary diseases, and malignancies, among others. Another significant trend is the
increase in the aging population. The elderly are heavy health care users because of chronic illnesses that
occur as longevity increases.
2. This is the age of hi-technology, cyber-information, and automation. Computers are used increasingly in
practically every area of health care, including diagnosis, treatment, communication, and documentation. We
see the emergence of “information therapies” delivered to health consumers via cable, satellite and video.
Other trends are the biologic replacement of some organs or bionics, genetic engineering, laser surgery
and super or wonder drugs that may eliminate the need for such procedures as kidney stone removal and
coronary artery by-pass surgery.
3. Values are changing. Lack of reverence for life is apparent in increasing reports of abortion, suicide, and
other crimes against humanity. Controversial issues brought about by new technologic capabilities that

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LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

extend and give life have brought with them whole new sets of ethical questions for health workers. All
these may further be complicated by financial issues, economic constraints, and limited resources. The ethics
of lack of access of indigent and street people as well as the ill effects of a polluted environment will need to
be addressed.
4. On the agenda of public policy, national health insurance or Philhealth is presently deemed to be slow
and still evolving. Health care economists predict that national health insurance will succeed in the next
decade yet.
5. In the area of managed care, the most common type is the health maintenance organization (HMO).
Managed care is a coordinated approach to providing necessary health services with an ultimate goal of low-
cost, quality care. In present HMOs, more focus is given to the issues of catastrophic and long-term coverage
as well as required provisions of health insurance for private employees (Tappen, Wise and Whitehead,
1998).
The theory behind managed care is that preventive health care, including annual medical check-ups,
immunizations, and health education, is an effective way to avoid illness and future hospitalizations, thereby
reducing cost. If clients do become ill, the doctors within the plan are often given powerful incentives to control
costs by limiting the number of diagnostic tests done or by avoiding a hospital stay altogether (Richards,
1996).
In the USA and other Western countries, there are sub-acute and community care units which offer
alternative ways of reducing cost by shifting people out of expensive acute care units as quickly as possible.
Sub-acute units offer round-the-clock nursing care to stable clients with a variety of diagnoses. Many sub-
acute providers have developed programs for specific populations, such as people in need of wound care,
oncology treatment, or rehabilitation. Community based care is care in ambulatory settings and in the home.
Many types of surgery can be done on an out-patient basis, and many therapies once considered too complex
to do at home (IV therapy and dialysis, for example) are now being done safely and effectively in clients’
homes.
Locally, although health insurance companies mouth quality of care, this, alas, is overshadowed by very
prohibitive and limited coverage. As a consequence, both government and private hospitals continue to bear
the brunt of uncompensated care.
6. Changes in health care institutions such as reengineering, restructuring and cross training are
responses to pressure to restrain spending for health care. Reengineering involves changing the processes
by which things are accomplished. The use of critical pathways in directing client care is a form of
reengineering. Restructuring alters the architecture of the organization. It is characterized by a smaller
number of managerial levels, decentralization, and allowing first-line caregivers to make more decisions. Job
redesign is focused on who does what and how work can be accomplished more efficiently. To accomplish
this, cross training is used (Curtin, 1994). Cross training involves training health care professionals from
other disciplines to perform some nursing functions such as dispensing medications or starting IVs. At the
same time, nurses are being taught the skills of other health care providers, such as doing ECGs or basic
laboratory skills. We can see that cross training is part of a movement away from having many different
specialists and making everyone more of a generalist.

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LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

7. The declining peso value forces many hospitals to focus on cost containment, including downsizing of
nursing service personnel. To safeguard care of hospital patients, health care workers undergo cross training
(including nurses) so that they are capable of performing other duties not normally within their scope of work.
8. Today the health care consumer is cost conscious and more informed. Consumers want to participate
in decisions related to their care and will become more aggressive in seeking that opportunity. Nurse
managers in turn must develop competence technically as well as polish their human relations skills so that
they can be of real assistance to patients and their families and at the same time serve the interest of the
hospital organization. Satisfied patients means patient retention and this is good business for the hospital.
9. The biggest problem of nurse executives and managers in the Philippines today is the migration of
professional nurses to other countries because of economic reasons. They definitely will earn more (8
to 10 times more than if they were to work in the country) and this is a major reason for them to leave
(oftentimes with their families, too) and work abroad.
Entrepreneurship and Niche Creation for Nurse Executives and Managers
Recognizing the many changes, demands and limitations of the health service delivery business, nurse
executives can exploit opportunities for a different business or a different service. Nurses can learn much
from Peter Drucker’s proposal in his book Innovation and Entrepreneurship: Practice and Principles (1985).
According to Drucker, innovation is the special tool of entrepreneurs. Sources of innovative opportunities
include:
1. The unexpected-unexpected success, unexpected failure, an unexpected outside event
2. The incongruity between reality as it actually is and reality as it is assumed to be or as it “ought to be”
3. Innovation based on process need
4. Changes in industry structure or market structure that catch everyone unaware
5. Demographic (population) changes
6. Changes in perception, mood and meaning
7. New knowledge, both scientific and non-scientific
Drucker (1985), Puetz and Thomas (1998) wrote about nurturing and articulating an idea through the process
of developing a business plan prior to starting a new venture. They emphasized focusing on the business
aspects of any new venture. A key idea may come from considering many different solutions to problems
and then pursuing one as a new venture.
Creating a niche means setting a unique selling point or specialization of a business venture. How is this
possible among nurses? The model of modern nursing, Florence Nightingale, is an example of “niche
creation.” In addition to her trademark of hygiene, Nightingale was known for taking health care to the place
where it was needed, including the “frontlines of war and other frontiers.”
Changes in lifestyles and consumer preferences may provide opportunities for business ventures and niche
creation; likewise, telehealth services and innovation in where, how, and who provides nursing care and other
clinical services.

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LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

The use of proven home remedies and DFA-approved herbal medicines, plus innovative nursing visitation
services, may provide opportunities to certain groups of clients in the not-so-urbanized localities.
Post-hospitalization monitoring by nurses may be an area of health ser- vices that is not only reassuring to
patients and their families but also a welcome convenience, especially for housebound clients with chronic
and debilitating diseases.
Dalgic and Leeuw (1994) list niche characteristics in terms of markets that have:
1. Sufficient size to be potentially profitable
2. No real competitors, or markets that have been ignored by others 3. Growth potential
4. Sufficient purchasing ability
5. A need for special treatment
6. Customer goodwill
7. Opportunities for the entrance company to exercise superior competence
It is safe to say that niche markets can start small, sort of piloting the project or venture. This can grow big
when successful. Starting small minimizes the risks in a highly competitive environment. It is also suggested
that a new venture created within a complex health care services system will have a greater chance of
success if the unique selling point or specialized service is limited and narrow.
Characteristics of entrepreneurs
Entrepreneurs are not born; they are “made.” They are “doers”-hard working, adventurous risk takers, with a
“tenacious and unrelenting belief in the value of their ideas.” The work of entrepreneurs may take several
years of long hours, hard work, financial sacrifice, and stress. There- fore, these individuals must have good
health, stamina, and high energy to sustain them.
Entrepreneurs, when inside an organization (called intrapreneurs), mani- fest behaviors characterized by
love of freedom and desire for access to corporate resources. They are usually goal oriented, highly
motivated and “driven” and possess an urgency to meet self-imposed and corporate time- tables.
Often we hear the phrase “entrepreneurial spirit” and this is exactly the temperament that is characteristic of
“trailblazing individuals” who embrace new ideas and changing processes. They have active imaginations,
are creative and are generously endowed with self-confidence. Zoghlin (1991) wrote about corporate
executives who made the transition from the corporate ladder to a different work arrangement, such as:
1. Consulting
2. Spin-offs such as franchises, licensing deals, or distributorships
3. Equity arrangements in which a salary is received along with partial ownership of a venture
4. Buying an existing business
5. Starting from scratch as a corporation, sole proprietorship, or partnership

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LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

It is best that we remind ourselves that in addition to the willingness to work hard, the successful entrepreneur
must also have the ability to define the value of the product, service or business idea in terms of money.
From various experiences of entrepreneurs, we are cautioned that there are new businesses that go under
during the first two years because of the following reasons:
1. Poor choice of venture type
2. Poor location
3. Inadequate knowledge
4. Failure to get professional advice
5. Insufficient planning and research
6. Insufficient capital
7. Inadequate costing and pricing practices
8. Poor management
Entrepreneurial options for nurses
There are several entrepreneurial options open to nurses as enumerated by Flanagan (1993):
1. Health promotion
2. Health risk management
3. Disability management
4. Geriatric case management
5. Home infusion therapy
6. Home care management of special populations
7. Nursing clinics
8. Consulting
9. Diabetes resource center
We can add to the list opportunities in operating supervised day care centers for small children and older
persons.
Developing the business plan
The business plan serves as the framework and is an essential tool in the planning and implementation of
a new venture. It provides information about the venture to the nursing business owner and other concerned
individuals and groups. It is the “road map that allows entrepreneurs to decide where they are going and also
permits them to know when they have arrived at the desired destination.”

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LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

A business plan Is “a document that convincingly demonstrates that your business can sell enough of its
product or services so as to make a satisfactory profit and be attractive to potential backers” Several authors
agree that business plans are very useful particularly in the following areas of business:
1. In a start-up venture to obtain financing
2. When additional financing is needed
3. For new activities within a business
4. Arranging for strategic alliances with other companies
5. Obtaining large contracts
6. Attracting key employees
7. Completing mergers and acquisitions (Gumpert, 1990, Puetz and Thomas, 1998)
Puetz and Shinn (1997) mention the following key points to consider when writing a business plan: conveying
the energy, enthusiasm, and excitement of the business, stressing what makes the business unique, and
being “as honest about negative aspects of the business, as about positive ones.” They also caution against
disparaging others in the field, particularly when describing the competition for the entrepreneur’s products
or services.
The business plan must be concise and as complete as possible, but not too long. For start-up ventures,
perhaps 12 to 15 pages may be adequate to cover all the necessary information. While banks and other
lending institutions may have their proforma requirements, at a minimum, a business plan must contain the
following (Gumpert, 1990):
1. Cover page
2. Table of contents
3. Executive summary
4. Description of the company
5. The target market
6. The product/service
7. Marketing strategies
8. Finances
We will now describe each of these sections in more detail.
1. Cover Page. According to Gumpert (1990), the cover page of the business plan should contain the name
of the company, its business address, telephone number, zip code, area code, and the owner’s name. It must
contain a number prominently displayed if copies of the plan are furnished to several individuals. The return
of the copies of the business plan can be tracked by the number on the cover page.

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LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

2. The Table of Contents is important for the reader’s convenience in turning to pages containing specific
areas of particular interest. All the pages must be numbered, including the appendices. The table of contents
must reflect the pagination.
3. The Executive Summary encapsulates the contents of the business plan and must emphasize its critical
components, including the target market, current and future services, and financing needs. The priorities of
the business must be conveyed, preferably in an enthusiastic and energetic manner.
4. The Description of the Company describes what the business is, how it will be managed, and why the
business will be successful. Important things that must be mentioned are how the business was started, its
current status, and future projections. If it is a start-up business, information about how the idea evolved must
be mentioned. Information about the educational background, experience in the field, accomplishments and
abilities of the owners or managers must be included.
The résumé or curriculum vitae of the principals can be included in the appendices as well as in the job
descriptions for all the individuals involved.
5. The Target Market includes information on the company’s clients, both current and potential, the
competition, and the marketing efforts that have been implemented or are contemplated. The description of
the target market must be detailed to include their characteristics and the estimate of their availing themselves
of the company’s services. There should also be a prediction of the extent to which the target market will be
reached in 1, 3, and 5 years.
The entrepreneur should also describe competitors as to size, services offered, profitability (when possible),
strengths, and weaknesses. Products and services offered by competitors must be described objectively and
compared with what is/are offered by the entrepreneur, without making a value judgment.
6. The Product/Service of the company to be offered to clients should be clearly identified and described.
While it is difficult to describe a service (the description of the service must be reviewed for clarity before
including it in the business plan), the product’s marketing materials can be included in the appendices. The
product’s unique aspects (that set it apart from the rest of the competition) should be described in this section.
7. Marketing Strategies contains a description of how the entrepreneur intends to reach consumers in the
target market and convert them into clients. Plans for marketing should be detailed so that readers know that
the entrepreneur knows the target market, as well as how best to reach it.
8. Finances includes a complete financial picture of the company, including its sources of financing. For “old”
businesses, past results must accompany future projections, including cash flow projections, profit and loss
statements and balance sheets.
Care should be taken in writing the business plan because how the plan is organized and how it looks can
greatly influence the responses to it.
After writing all the sections, it is advised that initial reading be done after a short rest. Then revisions can be
made. After this initial revision, the business plan can be reviewed by individuals who are not involved in the
business and who will have an objective viewpoint about the content. It is said that lawyers and accountants
are better reviewers than family members and close friends.
An easily readable format using a font size of 12 or 14 is recommended. It is best that the plan is edited for
punctuation and grammar. It may be helpful to bind the business plan with the cover letter and the business
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LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

plan appearing on the right side and the appendices of promotional materials (of varying sizes) on the left
side of a two-pocket folder.
Writing the business plan is time-consuming and very often trying. However, without a well-prepared business
plan, most entrepreneurs may not be successful in translating an idea or ideas for a proposed venture into
an enterprise.