This document discusses introducing entrepreneurship concepts to healthcare education. It addresses common concerns learners may have by establishing relevance, congruence, and utility. It analyzes how nurses experience oppression through economic, professional, and other means due to their monopsonistic labor market. Introducing entrepreneurial concepts and skills could help address this oppression by increasing wages, professional influence, and bargaining power for nurses.

1. Condition Critical: Overcoming Allergic Reactions to Entrepreneurship and Enterprise in Healthcare Education. Stacy Johnson

2. Plan Learner’s key questions Relevance Congruence Utility Pyramid exercise Mapping exercise Questions and Discussion

3. Disclaimers My working definition of entrepreneurship Entrepreneurship, enterprise, innovation: well which is it? My emphasis on praxis and emancipation Emphasis on teaching and learning: reaching the hard to reach Holistic entrepreneurship education: the triumvirate of knowledge, attitudes and skills

4. Entrepreneurship “… .the transformation of an idea into an enterprise that creates value: economic, social, cultural, or intellectual.” (University of Rochester 2008)

5. Enterprise, innovation and entrepreneurship The enterprise concept : the skills and mindset for making things happen The entrepreneurship concept : making it happen, transforming ideas into going concerns The innovation concept : entrepreneurship and enterprise are pre conditions for innovation (NCGE 2009)

6. Learner’s key questions Gaining “buy in” is contingent on supplying satisfactory answers to learners’ key questions. What does this have to do with me? Are these principles compatible with my professional and personal values? How does it help me to meet my objectives (individual, professional, organisational)?

7. Establishing Relevance What does this have to do with me (my job, my degree)? Understanding situation and unique challenges Understanding context Understanding the learner’s objectives

8. Nurses Oppressed? There is some literature regarding the low status, marginalisation, oppression and subordinate position of nurses Sociological perspectives: gender, women’s work, doctor/nurse relationship My conceptual analysis approaches the issue from the perspective of economic theory Monopsonic labour leads to poor terms and conditions and an element of professional and economic oppression

9. Monopsony in the UK Nursing Labour Market Monopsony exists when there is a single employer of a particular form of labour 75% of UK nurses work in the NHS (ICN 2008) The UK nursing labour market operates under monopsonistic conditions UK Government/DoH is (currently) a monopsonistic employer

10. Five faces of oppression (Young 1990) Exploitation Marginalisation Powerlessness Cultural imperialism Violence

11. Exploitation The transfer of the results of the labour of one social group to benefit another Economic oppression Professional oppression

12. Economic Oppression Limited choice of employer: monopsonistic employers can exploit their position and not employ those who refuse to work for a low wage Lower earnings than similar jobs: confronted with a monopsonist employer, workers are forced to accept a lower wage With the existence of a monopsony employer wages are likely to fall Opportunity deprivation: Less access to entrepreneurship education

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. Professional Oppression Nursing practice and education forced to change to meet the needs of The medical profession The NHS: managerialism, costs containment The political needs of the government of the time: the replacement agenda, Main employer, NHS pays to educate: pre-reg-deaneries, post-reg-hospitals managers determines numbers trained Influences courses developed and provided

15. Marginalisation Marginalization is the process by which categories of people are sidelined from full participation aspects of social life Within the healthcare sector, organisational conditions offer less opportunity for participation in the knowledge economy e.g. Insurance: indemnity Insurance: reimbursement

16. the styles of discourse, systems of power-knowledge, institutional structures and practices- all combine to marginalize nurses Nurses are prevented from fully benefiting from the commercial gains of innovation, entrepreneurship and enterprise in the way that other professions do Not exposed to or presented with the same access to entrepreneurship and enterprise education as other students in HEIs

17. Powerlessness The powerless are those who lack authority or power... those over whom power is exercised without their exercising it; the powerless are situated so that they must take orders and rarely have the right to give them The current health service model disempowers nurses Nursing influence in the UK health sector Education: funding Monopsony power: employer has considerable power over wage rates employee has lower relative bargaining power under monopsonic conditions

18. Cultural Imperialism How the dominant meanings of a society render the particular perspective of one's own group invisible at the same time as they stereotype one's group and mark it as the other Clinical Angels, poorly paid Sexualised This form of oppression is particularly evident in mass media representations of oppressed groups,

19. The Public Image of the Modern Nurse?

20. The Public Image of the Modern Nurse?

21. (Horizontal) Violence Horizontal violence is hostile and aggressive behaviour by individual or group members towards another member or groups of members of the larger group. (Duffy1995) inter-group conflict ‘ bullying’ associated with oppressed groups results from an internalised negative self perception and low self esteem arising form being part of the oppressed group

22. A solution in nursing entrepreneurship? Multiple firms: address monopsonic conditions Increase wage rate: competition for labour Increase professional influence: greater choice of employer and self employment Increase power: bargaining power Professional Autonomy And…. Innovation Enterprise

23. Establishing Congruence Are these principles compatible with my professional and personal values? Exploring attitudes and beliefs Challenging attitudes and beliefs 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

24. Entrepreneurship “ the transformation of an idea into an enterprise that creates value: economic, social, cultural, or intellectual.” (University of Rochester 2008)

25. Critical Pedagogy “ illuminates the relationship among knowledge, authority, and power” (Giroux, 1994: 30) 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 The power to care

26. Rejection of the banking model of teaching and learning Dialogue with nursing experts Dialogue with nursing neophytes We don’t have to answer pesky questions like “Are entrepreneurs born or taught” and “Can you teach entrepreneurship?”

27. Reflections of a Critical Pedagogue The role of the educator in critical pedagogy Educational Arsonist Educational Activist

28. Transformation 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. To transform individuals from being objects of educational processes to subjects of their own autonomy and emancipation

29. Power power in the teaching and learning context how and in whose interests knowledge is produced and 'passed on' and view the ideal aims of education as emancipatory examination of what knowledge is the way in which one comes to know and who provides knowledge (Habermas, 1971).

30. “ As a profession, we need to move beyond simply selling nursing labour to commercialising nursing knowledge”

31. Conscientization Liberatory education focuses on the development of critical consciousness Seeks to enable learners to recognize connections between their individual problems and experiences and the social contexts in which they are embedded. Coming to consciousness: “conscientization” is the necessary first step of praxis.

32. Praxis The engagement in the cycle of theory, application, evaluation, reflection and then back to theory Social transformation is the product of praxis at the collective level 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).

33. Establishing utiltiy How does it help me to meet my objectives? (individual, professional, organisational)? What personal objectives are there What are the individual professional objectives? What might be the current organisational objectives? How can entrep help them to meet those What’s in it for them?

34. The Healthcare Entrepreneurship Pyramid Roles of staff Proportion of staff involved in activity Talent Management Education and Training Innovators: ideas Entrepreneurs: new ventures Managers; stewards infrastructure Frontline staff pose clinical problems Apply solutions Engage in knowledge translation Senior clinicians: lead/manage change provide problems Knowledge mobilisation infrastructure Creators of the environment in which entrepreneurship and innovation flourish: enterprising

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. What is your pyramid? Unit of Analysis Sector/Economy Organisation Team Context Policy landscape

37. Locate your learners in the pyramid Who are the creators of the environment in which entrepreneurship and innovation flourish? What activities do your innovators engage in in your pyramid? What activities do your entrepreneurs engage in in your pyramid?

38. Creators of the Environment What knowledge do they need What skills do they need? What attitudes need to be challenged/fostered?

39. Innovators What knowledge do they need What skills do they need? What attitudes need to be challenged/fostered?

40. Entrepreneurs What knowledge do they need What skills do they need? What attitudes need to be challenged/fostered?

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. 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. 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. Concept mapping and translation Level of study Level of Study Individual objectives Educational /Professional objectives Entrepreneurship concepts, skills attitudes Undergraduate Masters Doctoral

45. Concept mapping and translation Organisational Level Level Objectives (micro) Objectives (macro) Entrepreneurship concepts, skills and attitudes

46. References Duffy, E. (1995, April), Horizontal violence: a conundrum for nursing. Collegian. Journal of the Royal College of nursing Australia. 2(2), 5-17. Freire, P. (1972) Pedagogy of the Oppressed. Harmondsworth: Penguin. Giroux, H. A. (1994). Disturbing pleasures: Learning popular culture. New York: Routledge. Young, Iris. 1988. "The Five Faces Of Oppression." Philosophical Forum 19:270-90