NURSE EMPOWERMENT THROUGH ENTREPRENEURIAL INNOVATION AND ORGANIZATIONAL CHANGE: A SYSTEMATIC REVIEW OF LEADERSHIP STRATEGIES IN NURSING ROLE EXPANSION
Main Article Content
Tasnidar Tasnidar
Yunia Wardi
Susi Evanita
Hendrik Heri Sandi
Syamsul Amar
Vidyarini Dwita
Nurse empowerment is an important strategy in facing the challenges of an increasingly complex and competitive health care system. This study aims to systematically review how entrepreneurial innovation and organizational change supported by transformational leadership can expand the role of nurses and enhance their strategic contribution to the health system. A literature search was conducted on the Scopus database for studies published in the last ten years, namely from January 1, 2015 to December 31, 2024. Eight articles that met the inclusion criteria were analyzed thematically and narratively. The results of the review indicate that the integration of entrepreneurship into nursing practice encourages the formation of new service models such as independent practice, home care and telenursing that are more responsive to patient needs. Flexible organizational structures, collaborative work cultures and performance-based incentive systems strengthen the role of nurses as agents of change. Participatory leadership has been shown to create a work climate that supports innovation and initiative taking at the clinical level. Challenges such as limited infrastructure, training gaps, and cultural and structural barriers still need to be overcome to optimize nurse empowerment as a whole. This study concludes that empowering nurses through entrepreneurial innovation and organizational change requires a multidimensional approach and sustainable policy support so that nurses can play a strategic role in building a resilient health system that is oriented towards future needs.
Milella F, Minelli EA, Strozzi F, Croce D. Change and Innovation in Healthcare: Findings from Literature. ClinicoEconomics and Outcomes Research. 2021 May;Volume 13:395–408.
Kosiol J, Silvester T, Cooper H, Alford S, Fraser L. Revolutionising health and social care: innovative solutions for a brighter tomorrow – a systematic review of the literature. BMC Health Serv Res. 2024 Jul 12;24(1):809.
Monteagudo NC, Camacho Rodríguez DE, Gonzales Carhuajulca DB, Leyva Moral JM, Martínez ON. Defining nursing entrepreneurship from the point of view of future professionals: A qualitative study. Nurse Educ Today. 2025 Jan;144:106421.
Awad NHA, Zabady HAH, Elbialy GG, Ashour HMA anwer A. Entrepreneurial leadership, nurses’ proactive work behavior, and career adaptability: a structural equation model. BMC Nurs. 2024 Feb 27;23(1):140.
Gottlieb LN, Gottlieb B, Bitzas V. Creating Empowering Conditions for Nurses with Workplace Autonomy and Agency: How Healthcare Leaders Could Be Guided by Strengths-Based Nursing and Healthcare Leadership (SBNH-L). J Healthc Leadersh. 2021 Jul;Volume 13:169–81.
Furunes T. Leadership in Healthcare. In: Integrating the Organization of Health Services, Worker Wellbeing and Quality of Care. Cham: Springer International Publishing; 2020. p. 135–57.
Pedersen KM, Christiansen T, Bech M. The Danish health care system: evolution - not revolution - in a decentralized system. Health Econ. 2005 Sep;14(S1):S41–57.
Mohammad Mosadegh Rad A. The impact of organizational culture on the successful implementation of total quality management. The TQM Magazine. 2006 Nov 1;18(6):606–25.
Allen LK, Hatfield JM, Manyama MJ. Reducing microscopy-based malaria misdiagnosis in a low-resource area of Tanzania. Tanzan J Health Res. 2013 Jan 22;15(1).
Lunt N, Exworthy M, Hanefeld J, Smith RD. International patients within the NHS: A case of public sector entrepreneurialism. Soc Sci Med. 2015 Jan;124:338–45.
Mathole T, Lembani M, Jackson D, Zarowsky C, Bijlmakers L, Sanders D. Leadership and the functioning of maternal health services in two rural district hospitals in South Africa. Health Policy Plan. 2018 Jul 1;33(suppl_2):ii5–15.
Mæhle PM, Hajdarevic S, Håland E, Aarhus R, Smeland S, Mørk BE. Exploring the triggering process of a cancer care reform in three Scandinavian countries. Int J Health Plann Manage. 2021 Nov 21;36(6):2231–47.
Adebanke Yekeen I, Adejumo P, Oluwafunke Kolawole I. Patient-Centered Care as an Optimal Solution for Enhancing the Quality of Healthcare Delivery. International Journal of Innovative Science and Research Technology (IJISRT). 2024 Sep 17;2606–12.
Vrangbaek K. Regionalization Lessons from Denmark. Healthc Pap. 2016 Jul 29;16(1):21–6.
Sousa S. Organizational Culture and Quality Management Practices in the Hospital Sector. Journal of Reviews on Global Economics. 2019 Feb 14;8:196–205.
Šprajc P, Lukhanin O. Impact of Organizational Culture on Work Environment and Quality. In: 41 st International Conference on Organizational Science Development. University of Maribor Press; 2022. p. 957–74.
Ashton RA, Worges M, Zeh Meka A, Yikpotey P, Domkam Kammogne I, Chanda-Kapata P, et al. Can Outreach Training and Supportive Supervision Improve Competency in Malaria Service Delivery? An Evaluation in Cameroon, Ghana, Niger, and Zambia. Am J Trop Med Hyg. 2024 Mar 5;110(3_Suppl):10–9.
Exworthy M, Lunt N, Tuck P, Mistry R. From commodification to entrepreneurialism: how commercial income is transforming the English NHS. Public Money & Management. 2024 May 18;44(4):308–16.
F H, R I, A.M C, H A, Gh R, R HS. Entrepreneurship in Nursing: a literature review. Journal of Medical Education and Development. 2023 May 22;
Ferreira TDM, Mesquita GR, Melo GC, Oliveira MS, Bucci AF, Porcari TA, et al. The influence of nursing leadership styles on the outcomes of patients, professionals and institutions: An integrative review. J Nurs Manag. 2022 May;30(4):936–53.
Vivier E, Robinson B, Jenkins L, Smit A. Institutional logics and relational shifts: permeating hierarchies and silos in the healthcare sector. Public Management Review. 2024 Oct 2;26(10):2943–65.
Michel CL, Meza OD, Cejudo GM. Interacting institutional logics in policy implementation. Governance. 2022 Apr 17;35(2):403–20.
de Oliveira W, Batista J, Novais T, Takashima S, Stange L, Martucci M, et al. OpenCare5G: O-RAN in Private Network for Digital Health Applications. Sensors. 2023 Jan 16;23(2):1047.
Subiyanto P, Gunawan` S, Sulianti A, Suryaningsih C. Community Nursing in the digital age, utilizing Technology to improve health Services. Oshada. 2024 Aug 27;1(4):73–82.
Arbabi Z, Gholampour MH, Zare-Kaseb A, Shahvarooghi S, Ghazanfari MJ. Tele-nursing: A novel opportunity to improve the quality of nursing care. Journal of Nursing Reports in Clinical Practice. 2023 Oct 1;1(3):154–5.
Alanazi NH, Falqi TA. Healthcare Managers’ Perception on Patient Safety Culture. Global Journal on Quality and Safety in Healthcare. 2023 Feb 1;6(1):6–14.
Ünal A, Yıldırım N, Öncel S. Investigation of the Relationship Between Perceived Leadership Behaviours of Nurses and Hospital Safety Culture: A Study With the Structural Equation Model. Int J Nurs Pract. 2025 Feb 26;31(1).
Aloufi OM. Perceptions of patient safety culture and associated factors among clinical managers. Int J Health Sci (Qassim). 2020 Oct 10;4(S1):356–64.
