Historical antecedents in the emergency of entrepreneurship in nursing

A nurse entrepreneur is defined by the International Council of Nurses as “a proprietor of a

business that offers nursing services of a direct care, educational, research, administrative, or
consultative nature” (Sanders & Kingma, 2012)

Florence Nightingale

 The first secular nursing training was started by Florence Nightingale (1820-1910) in
England in 1854. Despite chronic brucellosis, which left her severely disabled, she made
a worldwide change in health care.
 Her statistical data collections regarding disease, death, and sanitary conditions
contributed to hospital reform and standards.
 The knowledge-based Nightingale School of Nursing was not associated with a church,
focused on patient care, and initiated a system to monitor nurses’ performance.
 Unfortunately, little regard was given to the importance of a nurse’s work and they were
considered secular servant nurses and paid the same wages as the servants of the day

Mary Grant Seacole

Mary Grant Seacole (1805-1881) a freeborn black Jamaican born in Kingston, Jamaica,

Mary Seacole began life in Kingston, Jamaica in 1805. Her father was a Scottish soldier and
Mary's mother specialised in Jamaican medicine so she grew up watching her mother caring for
the sick in a boarding house where she cared for unacceptable soldiers and their wives. She
learned folk medicine from her mother and volunteered her services in the Crimean war effort.
Unheard of for a women, especially a black women of her time she opened a hotel. Soon Mary
had saved her first cholera patient, and gained a profound understanding of the pathology of this
disease – which she herself contracted and recovered from.

Widely praised for her work in treating cholera, Mary returned to Jamaica in 1853, where there
was a yellow fever epidemic. The medical authorities came to her to provide nurses to care for
the sick soldiers. She travelled again to London, where she heard about the Crimean war and
how the nursing system there had collapsed. She made applications to the War Office, the army
medical department, and the secretary of war to be allowed to go to the Crimea and tend to the
sick and wounded. She pointed out that she had extensive experience, excellent references and
knew many of the soldiers and regiments, having nursed them while they were stationed in
Jamaica.
But she was turned away by everybody, including one of Florence Nightingale’s assistants. Was
it possible, she asked herself, ‘that American prejudices against colour had taken root here? In
her disappointment, Mary cried in the street.

A distant relative of hers, called Day, was going to Balaclava on business, and they agreed to
launch a firm called Seacole and Day, which would be a general store and hotel near the British
camp in the Crimea. So, at the age of 50, with her large stock of medicines, Mary followed the
army and sells provisions to the troops. The moment she arrived in Balaclava there were sick and
wounded to attend to. She opened her British Hotel in the summer of 1855, near the besieged
city of Sevastopol. Soon the entire British army knew of ‘Mother Seacole’s’. The soldiers were
her 'sons' and she was their 'mother'.

MARY GRANT SEACOLE (1805-1881)

⮚ Freeborn black Jamaican born in Kingstone Jamaica
⮚ Learned folk medicine from her mother
⮚ Volunteered her services in the Crimean War effort
⮚ Rejected by the Nightingale School of Nursing and the
governing military forces because she was black
⮚ Started a hotel where the wounded soldiers on both
sides of the conflict could recover
⮚ Nightingale’s accomplishment overshadow Seacole
and her medical knowledge as a healer raised fear that
she wouldn’t be subservient
MARY GRANT SEACOLE (1805-1881)
⮚ Freeborn black Jamaican born in Kingstone Jamaica
⮚ Learned folk medicine from her mother
⮚ Volunteered her services in the Crimean War effort
⮚ Rejected by the Nightingale School of Nursing and the
governing military forces because she was black
⮚ Started a hotel where the wounded soldiers on both
sides of the conflict could recover
⮚ Nightingale’s accomplishment overshadow Seacole
and her medical knowledge as a healer raised fear that
she wouldn’t be subservient
Clara Barton Clara

 Clara Barton Clara (Clarissa Harlow) Barton (1821-1912) began her career during the
Civil War and she was soon nicknamed the Angle of the Battlefield.
 She established the Bureau of Records of Missing Army Men at her own expense to help
families find their loved ones.
  She was a hospital nurse in the American Civil War, a teacher, and a patent clerk. Since
nursing education was not then very formalized and she did not attend nursing school,
she provided self-taught nursing care.
 In 1881, she founded the American National Red Cross. She retired in 1904 at the age of
83.
 Barton said of the Red Cross, “It is a peculiar institution, without nationality, race, creed
or sect, embracing the entire world in its humanizing bond of brotherhood, without
arbitrary laws or rules, and yet stronger than armies and higher than thrones.”

Evolution Nursing continued to evolve and during times of peace, many nurses turned to private
duty nursing. They were self-employed and provided nursing services to patients either in the
hospital or in the patient’s home. Eventually, independence and self-employment gained them
respect as professionals.

After the depression in 1929, nurses were forced back to their alma maters, the hospital, to find
work. Patients and families could no longer afford to pay the private duty nurses. At times of
military conflict, the nurse enjoyed increased popularity as a hard worker dedicated to her
profession, but the public image of the independent professional never returned.

A few self-employed, private duty nurses lasted well up into the 1950s. As payment for
healthcare became the responsibility of the insurance companies, the selfemployed nurse all but
disappeared. In the 1970s, nurses began to alter their nursing career paths by developing
businesses and consulting services that stepped out of the traditional mold.

Karon Gibson, RN, started a nursing agency, American Nurse, in Chicago, a first of its kind.

Laura Gasparis Vonfrolio, RN, developed her company, Education Enterprises, in New York.
She provided CPR training to businesses. By 1980, Clarissa Russo, RN, from Southern
California, started presenting seminars nationally addressing career options and business
opportunities for nurses. Russo, by her example, proved that nurse entrepreneurship was possible
and financially feasible.

During the 1970s and early 1980s, corporate America found it increasingly difficult to make a
profit and looked for ways to cut expenses. Businesses began to lay off employees, cut benefit
packages, and do whatever was necessary to increase profits. Healthcare facilities, as part of
corporate America, were also trying to make a profit and followed the lead of other companies
and cut payroll. As a result, many positions were deleted and whole departments removed from
the healthcare corporate structure. Many nurses were innovators of change and as the hospitals
cut services, new areas of consulting arose. At the same time, insurance companies were looking
for ways to help their adjustors understand the medical problems, obtain the appropriate medical
care, and decrease the disability.
The decreased disability was worth less money for maintaining the claimant or when settling the
claim based on the severity of the disability. In the early 1970s, the insurance companies looked
to nurses to fill this much-needed role for rehabilitation and states also looked to nurses to work
with worker’s compensation cases. These nurses were called rehabilitation nurses or workers’
compensation nurses and their work included what is now called legal nurse consulting, case
management, care management, and aspects of life care planning. At the same time, nurses and
nurse attorneys were pioneering the field of bringing nursing expertise to attorneys and insurance
companies when judging the merits of a case based on the adherence of the medical care to the
standards-of-care in the U.S. The role of the legal nurse consultant grew rapidly. The education
department of healthcare facilities suffered the greatest losses. However, education was still
needed on an intermittent basis and consultants filled this need. Paying a consultant to do the
same service as a full-time employee made good sense since paying the consultant cost less than
the full time employee wages. This was a cost effective way of doing business. Laid-off nurses
and healthcare workers set up consulting services. They often found themselves working for the
same hospital that forced them out. Outsourcing (sending work to an outside provider in order to
cut costs) is considered one of the best methods to decrease expenses and increase profits. By the
mid 1980s, nurse consultants were practicing in many areas. Individual nurses were developing
fields of consulting that never existed in the past. They were selling their services to healthcare
facilities, attorneys, and insurance companies. In 1985, it became evident that nurse
entrepreneurs needed a support and networking system.

David Norris, a male critical-care nurse in Petaluma, California, foresaw the need to support
nurses in business. He started a newsletter to promote and support nurses in business and the
National Nurses in Business Association was begun. By 1989, the association was serving nurses
across the country as it continues to do today. The National Nurses in Business Association, Inc.
(NNBA) is the pioneer association dedicated to promoting and supporting nurses in business. It
provides nurses information on business startup that gives them the confidence to continue when
they thought there was no way to succeed. The NNBA makes available to nurse entrepreneurs
the collective wisdom and practical suggestions of many successful nurses. Gross income for
some NNBA members exceeds 35-million dollars annually.

Currently, nurse entrepreneurs are often hired to: use their nursing knowledge to increase
proficiency of staff nurses; identity and resolve problems; supplement staff; act as a mechanism
for change, do pre-survey assessments; train; make recommendations that the facility does not
want to take accountability for; bring new life to a facility or department; create a new
department; influence employees; review patient care; analyze patient care and plan patient
care.

SOME NURSES ENTRPRENUERS IN NIGERIA

Nancy Umeh
A certified registered nurse and a professional international chef. She has helped hundreds of
families reverse picky eating, prevent and cure illnesses by sharing tips on healthy and safe
cooking. Her focus is mainly on exploring the public health benefits of our locally grown fruits,
vegetables and produce. She also teaches on reducing harmful toxic substances in our
environment and raising well rounded wholesome children.

Joseph Ezekwem
Joseph Ezekwem is a Nigerian entrepreneur, business owner, and nurse who graduated from the
College of Nursing (Our Lady of Mercy Hospital) in 2009. Also a 2018 graduate of Western
Governors University, he is the founder and CEO of fintech startup Ruubby.

Ruubby, launched on February 1, 2023, in Nigeria, was set up to encourage citizens to actively
submit their financial data when making purchases. It is a financial marketplace that allows users
to build or improve their credit score, allowing them to access better financial products and
improve their creditworthiness. The startup also provides a business management tool that allows
business owners to set up online stores and deliver customer services.
The nurse-turned-entrepreneur is also the founder and CEO of Roland Health, an online
homecare marketplace founded in October 2022. His marketplace allows caregivers to reach a
wider audience and users to easily hire them.

Ekezie Ralueke Oluchukwu

Founder of Blue Torch Home Care Limited situated at No 2 Chike-Egwuonwu Crescent,

Trans-Ekulu Enugu, Enugu 400123, NG