Individual Factors and Business Success among Nurse Entrepreneurs in Nursing and Midwifery Clinics

Abstract

Background: Launching and running nursing and midwifery clinics successfully can be challenging. There are multiple contextual factors that impact business success, but individual factors can also have an influence. When nurse entrepreneurs set up new ventures, individual factors are essential considerations that can influence business success. In fact, individual factors influence behavior in complex and significant ways and may be strengths or weaknesses for achieving business success. However, to date, no studies have examined or identified the individual factors influencing business success in nursing entrepreneurship, particularly focusing on nursing-owned clinics.Objective: The objective of this dissertation and the overall focus of the three studies was to explore factors associated with business success in nursing entrepreneurship. The first study aimed to assess and synthesize the literature on nursing entrepreneurship and identify gaps regarding factors influencing nursing entrepreneurship. The second study aimed to determine the association of individual factors through a quantitative survey that included personality traits, transformation leadership, self-efficacy, and social support, that influence business success in nursing and midwifery clinics in Thailand. The third study aimed to elaborate on these individual factors, including personality traits, transformational leadership, self-efficacy, social support, and others, that influence the business experiences of nurse entrepreneurs by triangulating nurse entrepreneurs' qualitative perceptions with the earlier quantitative findings. Research design: The data for this dissertation were drawn from three main methodological approaches: a scoping review (the first study), a cross-sectional correlational design (the second study), and an explanatory mixed-methods design (the third study). Subjects: The sample for the quantitative study included 190 nurse entrepreneurs who owned nursing and midwifery clinics in Thailand for at least 1 year and 20 nurse entrepreneurs selected from among the survey respondents for the in-depth qualitative interviews. Measures: A cross-sectional correlational design (the quantitative study) used the Ten-Item Personality Inventory (TIPI) measuring the Big Five model of personality traits (extraversion, agreeableness, conscientiousness, emotional stability, and openness to experiences), the Global Transformational Leadership Scale (GTL), the General Self-Efficacy Scale (GSE), a social support questionnaire, the Business Performance Measurement, the Nurse Satisfaction with Quality-of-Care Scale (NSQC), and an investigator-developed demographic questionnaire. For the explanatory mixed-methods study, the qualitative interviews were guided by questions about participants' individual factors, including the Big Five personality traits, transformational leadership, self-efficacy, social support, and others, that influence business experiences of nurse entrepreneurs in nursing and midwifery clinics. Findings from those interviews were then analyzed considering results from the quantitative study analyses in order to elaborate on and explain those findings. Results: The scoping review identified 22 articles; 16 were qualitative studies and 6 were quantitative studies. Multiple levels of factors that influence nursing entrepreneurship were identified and categorized using a social-ecological model with following levels: individual (knowledge and skills in entrepreneurship, characteristics of nurse entrepreneurs, entrepreneurial leadership, clinical and management experience, and social support); interpersonal (professional networks), organizational (healthcare organizations, the scope of legal/regulatory practices, and the new role of the professional nurse entrepreneur); community (social entrepreneurship and social capital); and public policy (healthcare policies and small business support). For the quantitative cross-sectional correlational design, the multiple regression analyses were conducted to examine associations, which indicated that self-efficacy, social support, and engaging in clinic ownership as a part-time job collectively explain a substantial proportion of the variance in business performance (F (3, 189) = 16.88, p < 0.001). In addition, self-efficacy, social support, and work experience in nursing together explained a significant portion of the variance in quality of care (F (3, 189) = 27.71, p < 0.001). For the sequential explanatory mixed-methods design, overall findings offered a comprehensive understanding that integrated both the quantitative and qualitative findings, with the triangulation of findings offering seven integrated themes: 1. Enhancing personality traits of conscientiousness and emotional stability (with subthemes careful and accurate in the patient care and safety, effective organized clinic management, and resilience in the face of challenges); 2. Self-efficacy promotes effective transformational leadership; 3. Conscientiousness enhances transformational leadership (idealized Influence, inspirational motivation, intellectual stimulation, and individualized consideration); 4. Self-efficacy for quality of care (confidence in providing quality care and having mission and passion for healthcare); 5. Self-efficacy enhances business performance; 6. Enhancing business performance (role of self-efficacy, role of social support, and time management when clinic ownership is part-time) and 7. Enhancing quality of care (role of self-efficacy, role of social support, and work experience in nursing). Conclusion: These findings are helpful in understanding and identifying gaps in what important factors influence business success, as well as the complex interplay between individual factors, personality traits, transformational leadership, self-efficacy, social support, and business success for nurse entrepreneurs in nursing and midwifery clinics. The findings of these studies can also serve as an evidence base for future research on nursing entrepreneurship, informing concepts and content to address in nursing education and training, guiding nursing practice in healthcare delivery and policy, and fostering interdisciplinary collaboration in healthcare, which can lead to success in nursing and midwifery clinics as well as healthcare businesses in Thailand. Ultimately, these future activities can enhance healthcare for the Thai population and more globally.