Allergic to Enterprise - Stacy Johnson

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  • Example from the feminist perspective She writes of how women's work is unpaid or underpaid and results in the transfer of energies to please and comfort men
  • Opportunity deprivation Wages of nurses might be falling in real terms (wage rises etc)
  • Annual % change in wages 5.4% Inflation RPI Primary School teachers 27,519 Paramedics 31,295 Radiographers 28,641
  • The presurre form the different imperatives change over time. We have gained our indpendence for mdical practiec and oare no longer handmanidens. But the imperatives of the mangerial cutlure of the NHS has taken over. Need to cut waiting tiem and contacuin costs mane that we tytake on roles not always by choice but by force,. Etc Agenda fpr change
  • Insurance and professional regulation:Baraniak example Insuracne reimbursement : USA and Germany, legislation ahs changed to allow Medicaid to reimburse nurses for servces.
  • Example device development, dcootors sharing profits with Universoties, able to work privately e.g. endoscopy opportunity deprivation Insurance and professional regulation:Baraniak example Insuracne reimbursement
  • Written and led by a Doctor not logical, situation as coordinator for care???
  • Paradoxically, one is both made invisible and presented in a stereotypical fashion.   Nursing representation by the mass media not of being entrepreneurial, immage and acceptibity by the public because of theornimage of what a nurse is and what they shoud do and earn
  • Oppressed group's own experience and interpretation of social life finds little expression that touches the dominant culture, while that same culture imposes on the oppressed group its experience and interpretation of social life. Nurses’ expression of their interpretation of their own identity is less obvious
  • McKenna et al describe it as a significant problems other authors describe it as endemic in Nursing workplace. Horizontal violence is non physical inter group conflict and is manifested in overt and covert behaviours of hostility (Freire 1972; Duffy 1995). It is behaviour associated with oppressed groups and can occur in any arena where there are unequal power relations, and one group's self expression and autonomy is controlled by forces with greater prestige, power and status than themselves (Harcombe 1999). It is one arm of the submissive/aggressive syndrome that results from an internalised self-hatred and low self esteem as a result of being part of an oppressed group (Glass 1997; Roberts 1996; MCCall 1995). It is the inappropriate way oppressed people release built up tension when they are unable to address and solve issues with the oppressor.
  • Retention control over terms and condistion Educaition The IMA is constantly receiving enquiries from nurses leaving the NHS frustrated by being unable to practise the full role of an autonomous practitioner and provide holistic care. Figures s
  • Critical theory: deconstruction, challenge Challenging of the status quo It regards specific belief claims, not primarily as propositions to be assessed for their truth content, but as parts of systems of belief and action that have aggregate effects within the power structures of society. It asks first about these systems of belief and action, who benefits? refers to the role of critical theory as a means through which to affect a critique of the ideological underpinnings of current patterns and perceptions of participation in healthcare market
  • Criticism of CP: opportunity for individual teachers to simply Pedle their views Subjectiveity….. Want to promote emotion Dialogue with experts
  • What is the object of my transformation? nurses; through education The system: activism through economic and reform of market in nursing services, Transformation from what to what?? Oppression to liberation Exploitation to….. Marginalsation to….. Powerlessness to….. Cultural imperialism to…
  • Critical Consciousness In addition to its focus on personal liberation through the development of critical consciousness, critical pedagogy also has a more collective political component, in that critical consciousness is positioned as the necessary first step of a larger collective political struggle to challenge and transform oppressive social conditions and to create a more egalitarian society.
  • |Praxis , ;reflection and doing after reflection: Already embedded in nursing practice and a core competency in nursing education configured as an ongoing, reflective approach to taking action.
  • Allergic to Enterprise - Stacy Johnson

    1. 1. Condition Critical: Overcoming Allergic Reactions to Entrepreneurship and Enterprise in Healthcare Education. Stacy Johnson
    2. 2. Plan <ul><li>Learner’s key questions </li></ul><ul><li>Relevance </li></ul><ul><li>Congruence </li></ul><ul><li>Utility </li></ul><ul><li>Pyramid exercise </li></ul><ul><li>Mapping exercise </li></ul><ul><li>Questions and Discussion </li></ul>
    3. 3. Disclaimers <ul><li>My working definition of entrepreneurship </li></ul><ul><li>Entrepreneurship, enterprise, innovation: well which is it? </li></ul><ul><li>My emphasis on praxis and emancipation </li></ul><ul><li>Emphasis on teaching and learning: reaching the hard to reach </li></ul><ul><li>Holistic entrepreneurship education: the triumvirate of knowledge, attitudes and skills </li></ul>
    4. 4. Entrepreneurship <ul><li>“… .the transformation of an idea into an enterprise that creates value: economic, social, cultural, or intellectual.” (University of Rochester 2008) </li></ul>
    5. 5. Enterprise, innovation and entrepreneurship <ul><li>The enterprise concept : the skills and mindset for making things happen </li></ul><ul><li>The entrepreneurship concept : making it happen, transforming ideas into going concerns </li></ul><ul><li>The innovation concept : entrepreneurship and enterprise are pre conditions for innovation </li></ul><ul><li>(NCGE 2009) </li></ul>
    6. 6. Learner’s key questions <ul><li>Gaining “buy in” is contingent on supplying satisfactory answers to learners’ key questions. </li></ul><ul><li>What does this have to do with me? </li></ul><ul><li>Are these principles compatible with my professional and personal values? </li></ul><ul><li>How does it help me to meet my objectives (individual, professional, organisational)? </li></ul>
    7. 7. Establishing Relevance <ul><li>What does this have to do with me (my job, my degree)? </li></ul><ul><li>Understanding situation and unique challenges </li></ul><ul><li>Understanding context </li></ul><ul><li>Understanding the learner’s objectives </li></ul>
    8. 8. Nurses Oppressed? <ul><li>There is some literature regarding the low status, marginalisation, oppression and subordinate position of nurses </li></ul><ul><li>Sociological perspectives: gender, women’s work, doctor/nurse relationship </li></ul><ul><li>My conceptual analysis approaches the issue from the perspective of economic theory </li></ul><ul><li>Monopsonic labour leads to poor terms and conditions and an element of professional and economic oppression </li></ul>
    9. 9. Monopsony in the UK Nursing Labour Market <ul><li>Monopsony exists when there is a single employer </li></ul><ul><li>of a particular form of labour </li></ul><ul><li>75% of UK nurses work in the NHS </li></ul><ul><li>(ICN 2008) </li></ul><ul><li>The UK nursing labour market operates under monopsonistic conditions </li></ul><ul><li>UK Government/DoH is (currently) a monopsonistic employer </li></ul>
    10. 10. Five faces of oppression (Young 1990) <ul><li>Exploitation </li></ul><ul><li>Marginalisation </li></ul><ul><li>Powerlessness </li></ul><ul><li>Cultural imperialism </li></ul><ul><li>Violence </li></ul>
    11. 11. Exploitation <ul><li>The transfer of the results of the labour of </li></ul><ul><li>one social group to benefit another </li></ul><ul><li>Economic oppression </li></ul><ul><li>Professional oppression </li></ul>
    12. 12. Economic Oppression <ul><li>Limited choice of employer: monopsonistic employers can exploit their position and not employ those who refuse to work for a low wage </li></ul><ul><li>Lower earnings than similar jobs: confronted with a monopsonist employer, workers are forced to accept a lower wage </li></ul><ul><li>With the existence of a monopsony employer wages are likely to fall </li></ul><ul><li>Opportunity deprivation: Less access to entrepreneurship education </li></ul>
    13. 13. Source: UK National Office of Statistics 2008, Annual Survey of Hours and Earnings (ASHE) Occupation Gross Annual Income 2006 2007 Nurses 21,871 23,044 School Teachers 30,428 31,340 Lawyers 49,378 50,649 Police officers 34,988 36,025 Occ. therapists 22,316 23,778 Physiotherapists 21,894 23,153 Social workers 25,259 26,306
    14. 14. Professional Oppression <ul><li>Nursing practice and education forced to change to meet the needs of </li></ul><ul><ul><li>The medical profession </li></ul></ul><ul><ul><li>The NHS: managerialism, costs containment </li></ul></ul><ul><ul><li>The political needs of the government of the time: the replacement agenda, </li></ul></ul><ul><li>Main employer, NHS </li></ul><ul><ul><li>pays to educate: pre-reg-deaneries, post-reg-hospitals managers </li></ul></ul><ul><ul><li>determines numbers trained </li></ul></ul><ul><ul><li>Influences courses developed and provided </li></ul></ul>
    15. 15. Marginalisation <ul><li>Marginalization is the process by which </li></ul><ul><li>categories of people are sidelined from full </li></ul><ul><li>participation aspects of social life </li></ul><ul><li>Within the healthcare sector, organisational conditions offer less opportunity for participation in the knowledge economy e.g. </li></ul><ul><ul><li>Insurance: indemnity </li></ul></ul><ul><ul><li>Insurance: reimbursement </li></ul></ul>
    16. 16. <ul><li>the styles of discourse, systems of power-knowledge, institutional structures and practices- all combine to marginalize nurses </li></ul><ul><li>Nurses are prevented from fully benefiting from the commercial gains of innovation, entrepreneurship and enterprise in the way that other professions do </li></ul><ul><li>Not exposed to or presented with the same access to entrepreneurship and enterprise education as other students in HEIs </li></ul>
    17. 17. Powerlessness <ul><li>The powerless are those who lack authority or power... </li></ul><ul><li>those over whom power is exercised without their </li></ul><ul><li>exercising it; the powerless are situated so that they must </li></ul><ul><li>take orders and rarely have the right to give them </li></ul><ul><li>The current health service model disempowers nurses </li></ul><ul><ul><li>Nursing influence in the UK health sector </li></ul></ul><ul><ul><li>Education: funding </li></ul></ul><ul><ul><li>Monopsony power: employer has considerable power over wage rates employee has lower relative bargaining power under monopsonic conditions </li></ul></ul>
    18. 18. Cultural Imperialism <ul><li>How the dominant meanings of a society render </li></ul><ul><li>the particular perspective of one's own group </li></ul><ul><li>invisible at the same time as they stereotype one's </li></ul><ul><li>group and mark it as the other </li></ul><ul><ul><li>Clinical </li></ul></ul><ul><ul><li>Angels, poorly paid </li></ul></ul><ul><ul><li>Sexualised </li></ul></ul><ul><li>This form of oppression is particularly evident in mass media representations of oppressed groups, </li></ul>
    19. 19. The Public Image of the Modern Nurse?
    20. 20. The Public Image of the Modern Nurse?
    21. 21. (Horizontal) Violence <ul><li>Horizontal violence is hostile and aggressive behaviour by </li></ul><ul><li>individual or group members towards another member or </li></ul><ul><li>groups of members of the larger group. (Duffy1995) </li></ul><ul><li>inter-group conflict </li></ul><ul><li>‘ bullying’ </li></ul><ul><li>associated with oppressed groups </li></ul><ul><li>results from an internalised negative self perception and low self esteem arising form being part of the oppressed group </li></ul>
    22. 22. A solution in nursing entrepreneurship? <ul><li>Multiple firms: address monopsonic conditions </li></ul><ul><li>Increase wage rate: competition for labour </li></ul><ul><li>Increase professional influence: greater choice of employer and self employment </li></ul><ul><li>Increase power: bargaining power </li></ul><ul><li>Professional Autonomy </li></ul><ul><li>And…. </li></ul><ul><li>Innovation </li></ul><ul><li>Enterprise </li></ul>
    23. 23. Establishing Congruence <ul><li>Are these principles compatible with my professional and personal values? </li></ul><ul><li>Exploring attitudes and beliefs </li></ul><ul><li>Challenging attitudes and beliefs </li></ul><ul><li>Identifying core values and how entrep allows them to maintain these: the best for the patient through increased professional power, innovating our way out of trouble </li></ul>
    24. 24. Entrepreneurship <ul><li>“ the transformation of an idea into an enterprise that creates value: economic, social, cultural, or intellectual.” </li></ul><ul><li>(University of Rochester 2008) </li></ul>
    25. 25. Critical Pedagogy <ul><li>“ illuminates the relationship among knowledge, authority, and power” (Giroux, 1994: 30) </li></ul><ul><li>Roots in the critical theory of the Frankfurt School, whose influence is evident in the emancipatory works of Paulo Friere, the most renowned critical educator </li></ul><ul><li>The power to care </li></ul>
    26. 26. Rejection of the banking model of teaching and learning <ul><li>Dialogue with nursing experts </li></ul><ul><li>Dialogue with nursing neophytes </li></ul><ul><li>We don’t have to answer pesky questions like “Are entrepreneurs born or taught” and “Can you teach entrepreneurship?” </li></ul>
    27. 27. Reflections of a Critical Pedagogue <ul><li>The role of the educator in critical pedagogy </li></ul><ul><ul><li>Educational Arsonist </li></ul></ul><ul><ul><li>Educational Activist </li></ul></ul>
    28. 28. Transformation <ul><li>The primary preoccupation of Critical Pedagogy is with social injustice and educating people to be agents who transform inequitable, undemocratic, or oppressive institutions and social relations. </li></ul><ul><li>To transform individuals from being objects of educational processes to subjects of their own autonomy and emancipation </li></ul>
    29. 29. Power <ul><li>power in the teaching and learning context </li></ul><ul><li>how and in whose interests knowledge is produced and 'passed on' and view the ideal aims of education as emancipatory </li></ul><ul><li>examination of what knowledge is the way in which one comes to know and who provides knowledge (Habermas, 1971). </li></ul>
    30. 30. <ul><ul><li>“ As a profession, we need to move beyond simply selling nursing labour to commercialising nursing knowledge” </li></ul></ul>
    31. 31. Conscientization <ul><li>Liberatory education focuses on the development of critical consciousness </li></ul><ul><li>Seeks to enable learners to recognize connections between their individual problems and experiences and the social contexts in which they are embedded. </li></ul><ul><li>Coming to consciousness: “conscientization” is the necessary first step of praxis. </li></ul>
    32. 32. Praxis <ul><li>The engagement in the cycle of theory, application, </li></ul><ul><li>evaluation, reflection and then back to theory </li></ul><ul><li>Social transformation is the product of praxis at the collective level </li></ul><ul><li>Adopting an orientation towards critical praxis (synchronised reflection and action) will facilitate the examination of what knowledge is, the way in which one comes to know and who provides knowledge (Habermas, 1971). </li></ul>
    33. 33. Establishing utiltiy <ul><li>How does it help me to meet my objectives? (individual, professional, organisational)? </li></ul><ul><li>What personal objectives are there </li></ul><ul><li>What are the individual professional objectives? </li></ul><ul><li>What might be the current organisational objectives? </li></ul><ul><li>How can entrep help them to meet those </li></ul><ul><li>What’s in it for them? </li></ul>
    34. 34. The Healthcare Entrepreneurship Pyramid Roles of staff Proportion of staff involved in activity Talent Management Education and Training Innovators: ideas Entrepreneurs: new ventures <ul><li>Managers; </li></ul><ul><li>stewards </li></ul><ul><li>infrastructure </li></ul><ul><li>Frontline staff </li></ul><ul><li>pose clinical problems </li></ul><ul><li>Apply solutions </li></ul><ul><li>Engage in knowledge translation </li></ul><ul><li>Senior clinicians: </li></ul><ul><li>lead/manage change </li></ul><ul><li>provide problems </li></ul>Knowledge mobilisation infrastructure Creators of the environment in which entrepreneurship and innovation flourish: enterprising
    35. 35. The Healthcare Entrepreneurship Pyramid Roles of staff Proportion of staff involved in activity Talent Management Education and Training Innovators Entrepreneurs Managers Junior practitioners Support staff Senior practitioners Knowledge mobilisation infrastructure Creators of the environment in which entrepreneurship and innovation flourish: enterprising
    36. 36. What is your pyramid? <ul><li>Unit of Analysis </li></ul><ul><li>Sector/Economy </li></ul><ul><li>Organisation </li></ul><ul><li>Team </li></ul><ul><li>Context </li></ul><ul><li>Policy landscape </li></ul>
    37. 37. Locate your learners in the pyramid <ul><li>Who are the creators of the environment in which entrepreneurship and innovation flourish? </li></ul><ul><li>What activities do your innovators engage in in your pyramid? </li></ul><ul><li>What activities do your entrepreneurs engage in in your pyramid? </li></ul>
    38. 38. Creators of the Environment <ul><li>What knowledge do they need </li></ul><ul><li>What skills do they need? </li></ul><ul><li>What attitudes need to be challenged/fostered? </li></ul>
    39. 39. Innovators <ul><li>What knowledge do they need </li></ul><ul><li>What skills do they need? </li></ul><ul><li>What attitudes need to be challenged/fostered? </li></ul>
    40. 40. Entrepreneurs <ul><li>What knowledge do they need </li></ul><ul><li>What skills do they need? </li></ul><ul><li>What attitudes need to be challenged/fostered? </li></ul>
    41. 41. Concept mapping and translation Level of Practice Level of Practice Professional Objectives Organisational Objectives Entrepreneurship concepts, skills and attitudes Junior Clinicians Plan and deliver best patient care Research utilisation Evidence based practice Enterprising, Resourcefulness Entrepreneurial orientation Senior Clinicians Improve patient care and outcomes Change practice Service Innovative Service improvement Sustained regeneration Incremental innovation Entrepreneurial Leadership (Clinical) Managers Cost effective service delivery Service redesign New ways of working Commissioning Income generation Renewal activity Strategic Entrep Corporate venturing Entrepreneurial Leadership
    42. 42. Concept mapping and translation Level of Practice Level of Practice Professional Objectives Organisational Objectives Entrepreneurship concepts, skills and attitudes Junior Practitioners Senior Practitioners Managers
    43. 43. Concept mapping and translation: Level of study Level of Study Individual objectives Educational/Professional objectives Entrepreneurship concepts, skills attitudes Undergraduate Get a good job Finish my course Get a good degree Employability Enterprise Resourcefulness Proactiveness Masters Finish my Masters degree Move up band Change practice Service Innovation Service improvement Radical innovation Renewal activity Corporate entrepreneurship Sustained regeneration/incremental innovation Doctoral Get my PhD Get lectureship Generate new knowledge Commercialisation of knowledge Product development Business plans
    44. 44. Concept mapping and translation Level of study Level of Study Individual objectives Educational /Professional objectives Entrepreneurship concepts, skills attitudes Undergraduate Masters Doctoral
    45. 45. Concept mapping and translation Organisational Level Level Objectives (micro) Objectives (macro) Entrepreneurship concepts, skills and attitudes
    46. 46. References <ul><li>Duffy, E. (1995, April), Horizontal violence: a conundrum for nursing. Collegian. Journal of the Royal College of nursing Australia. 2(2), 5-17. </li></ul><ul><li>Freire, P. (1972) Pedagogy of the Oppressed. Harmondsworth: Penguin. </li></ul><ul><li>Giroux, H. A. (1994). Disturbing pleasures: Learning popular culture. New York: Routledge. </li></ul><ul><li>Young, Iris. 1988. &quot;The Five Faces Of Oppression.&quot; Philosophical Forum 19:270-90 </li></ul>

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