University innovation and start‐ups: Barriers and facilitators experienced by nursing faculties – A content analysis study

Abstract

Aim

University start‐ups have gained significant popularity as a means of translating knowledge and research into practical applications. However, there is a lack of understanding regarding the experiences and perspectives of nursing faculties engaged in start‐up ventures. The objective of this study was to explore valuable insights into the barriers and facilitators within this context for promoting success, generating entrepreneurial attitudes, as well as enhancing the sustainability of nursing faculty‐led start‐ups.

Design

We employed a content analysis methodology to capture the real‐life experiences of nursing faculties involved in university start‐ups. This approach is an effective way to gain a comprehensive understanding of the subject.

Methods

Data were collected using semi‐structured interviews. Graneheim and Lundman's step was used for analysis and to identify recurring patterns and themes within the collected data. Sampling was done purposefully, with convenience and snowball techniques until data saturation. The MAXQDA version 10 software was utilised to easily analyse, code and present data.

Results

The analysis revealed four major themes encompassed: motivational factors, personal attributes, limited entry support and barriers to scaling. These themes shed light on factors, support systems, challenges faced during growth as well as personal characteristics highlighted by the participants. Our study highlighted the factors influencing entrepreneurship in nursing faculties. Addressing the challenges of this study requires enhancing support systems and fostering personal development for entrepreneurial success in healthcare innovation. Policymakers can promote university education to expand the entrepreneurship process using more facilities and make more services accessible.

1. INTRODUCTION

Start‐ups emerged in the 1970s as small, innovative firms that disrupted traditional markets and organisational models (Chesbrough, 2003). Originally, the term referred to high‐tech micro businesses operating in electronics and computer technology. A startup can be seen as an agent of innovation, driven by the latest scientific and technological advancements. Additionally, it represents a business philosophy (Skala & Skala, 2019). Today, start‐ups are vital for economic and social development, especially in post‐pandemic scenarios (Andreessen, 2011; Skawińska & Zalewski, 2020). The global healthcare market is expanding rapidly and entrepreneurship in the nursing profession is expected to grow (Lee, 2022). Along with changes in healthcare needs, nurses as healthcare professionals should be able to provide new forms of health business services at the intersection of healthcare and information technology (Lim et al., 2021b).

Technological advancements, intellectual property exchange and business innovations greatly impact the growth and prevalence of start‐ups (Andreessen, 2011; Skawińska & Zalewski, 2020). Universities have evolved their roles over time, with a growing focus on their contribution to society, known as the ‘third mission’ (Compagnucci & Spigarelli, 2020; Trencher et al., 2014). This shift began in the 19th century when higher education institutions expanded their activities to include research alongside teaching. The second academic revolution in the 20th century further integrated research, teaching and collaboration with industry to drive economic development (Etzkowitz, 2003). The term ‘Entrepreneurial University’ was coined to describe this new role, emphasising its contribution to fostering an innovation‐driven economy (Etzkowitz, 1983). Consequently, universities are transitioning from traditional teaching and research to embracing a multifaceted role that promotes the quality of entrepreneurship education (Urbano & Guerrero, 2013) and plays a vital role in driving entrepreneurship and innovation (Guerrero et al., 2016). They act as catalysts for local economic growth (Urbano & Guerrero, 2013) and the concept of entrepreneurial universities is closely linked to the practical application of academic entrepreneurship (Mascarenhas et al., 2017). Entrepreneurship is widely recognised as a key driver of the market economy (Van Burg & Romme, 2014), which involves the creation of new economic, social, institutional or cultural environments through individuals or groups (Rindova et al., 2009). Today, entrepreneurship research and the emergence of entrepreneurship in the context of universities are receiving the attention of researchers (Rindova et al., 2009), However, they argue that entrepreneurship research is still largely paradigmatically fragmented (Van Burg & Romme, 2014).

University entrepreneurship can take various forms, including research collaborations with businesses, patent filings, consulting services, the creation of start‐ups or spin‐offs, entrepreneurship training and offering business incubator services (Secundo et al., 2020).

Nurses who are entrepreneurs establish new business ventures to create new value (Ippoliti et al., 2018). Nursing entrepreneurship, although understudied, has a rich history with notable figures like Florence Nightingale (Boore & Porter, 2011; Nielsen et al., 2014). Other examples of entrepreneurial figures in nursing include: Anna Nery, who worked in the care for the wounded in the Paraguayan War and Wanda de Aguiar Horta, the first Brazilian theorist of the profession (Backes, 2008). Entrepreneurship education in universities has a positive effect on increasing the level of entrepreneurial intention (Maresch et al., 2016). Therefore, various universities in the nursing sector also offered courses in the field of business technology to improve the entrepreneurial skills of nursing students (LaMar, 2016).

In contrast, only a small percentage of nurses currently identify as entrepreneurs (Denmark, 2018). Yet, nurse entrepreneurship is crucial for reshaping perceptions of the profession and addressing healthcare challenges (Tan et al., 2020). Nurses are well‐positioned to contribute to innovation and entrepreneurship in healthcare (Wilson et al., 2012). Encouraging more nurse entrepreneurship can drive innovation in solutions, technologies, care models and nurse‐owned businesses (Colichi et al., 2019). Conversely, significant limitations still exist, including a lack of entrepreneurial education, risk aversion within nursing culture and limited support from employers.

Nursing faculties play a vital role in fostering entrepreneurship among nursing students and future nurses. Survey findings from South Korea revealed a strong interest among nurses in healthcare start‐ups, influenced by various internal and external factors such as heavy workloads, shift challenges, low levels of empowerment, changes in the clinical environment and an ageing population (Huston, 2021; Lee et al., 2003). These results indicate that the nursing field is likely to experience a diversification of start‐ups in the coming years, emphasising the growing importance of entrepreneurial skills for nurses (Colichi et al., 2019; Lim et al., 2021b).

In several countries, including Iran, there is a lack of entrepreneurial programs aimed at assisting nurses in launching start‐ups. An examination of nursing programs revealed that a mere 28.8% of undergraduate nursing programs (55 out of 191) and only 7.84% of graduate nursing programs (4 out of 51) included business courses that could aid in the establishment of start‐ups (Lim et al., 2020). Several support initiatives are available to nurses in different countries, such as the Nurses in Business Association in the United States (Shirey, 2007). These organisations can serve as valuable models for other countries to establish similar support networks for nurse entrepreneurs.

Experts' evaluation of entrepreneurship about the existing weaknesses in the context of medical universities showed that education and research barriers are one category. With over 19,000 faculty members in more than 60 medical universities in the country, researchers and faculty members of the medical universities of Iran produce about one‐third of Iran's scientific articles every year. Therefore, in the current situation, the country needs creative and innovative students who can use their theoretical understanding of a subject to generate knowledge and create wealth and social welfare (Alhosseini et al., 2021).

Indeed, the existing literature on nursing start‐ups is limited, primarily focusing on incentives and obstacles (Barr et al., 2021; Colichi et al., 2019; Copelli et al., 2019; Lim et al., 2021a). Although a study in Iran explored perceived barriers to entrepreneurship among Iranian nurses, it did not specifically address nursing faculty members (Jahani et al., 2016). To address this gap, this study aims to explore the barriers and facilitators to nursing faculty entrepreneurship in Iran and provide insights for future strategies. We help students using nursing faculties experience to develop their entrepreneurship programs. The study adopts a content analysis approach using interview data from nursing faculty members to identify key factors influencing entrepreneurship in Iran. The objective of this research is to examine the factors that hinder or enhance the triumph and entrepreneurial mindset of start‐ups founded by nursing faculty. The primary focus will be on nursing products that utilise artificial intelligence technology to coordinate well‐being and amalgamate diverse health data for the creation of healthcare strategies. The purpose is to gather significant knowledge that can assist aspiring nursing students in utilising their faculty experience to cultivate entrepreneurial skills and bolster the growth of nursing start‐ups. Using the content analysis method can help us gain a deeper understanding of the subject matter by unlocking layers of insight. It can also contribute to broader knowledge and reveal trends and themes, making it particularly useful when analysing multiple texts (Drisko & Maschi, 2016).

2. METHOD

2.1. Study design

Qualitative research aims to comprehend phenomena by exploring meanings, perceptions, concepts, thoughts, experiences, or feelings (Seers, 2012) and explores the how and why behind a phenomenon by gathering data through interviews, observations, photographs, texts, or document analysis (Barrett & Twycross, 2018). This qualitative content analysis was conducted to explore the perceived barriers and facilitators of nursing faculties regarding start‐ups between April 2023 and July 2023. The utilisation of qualitative methodology offers several advantages, including the ability to provide a fresh perspective on a familiar situation, shed light on neglected areas and reveal previously ambiguous relationships between variables (Grove et al., 2012). By utilising this method, we can enhance our comprehension of the subject matter by uncovering multiple layers of insights (Drisko & Maschi, 2016).

This methodology prioritises the collection and analysis of qualitative materials that are narrative and subjective, with a specific focus on examining human experiences and perceptions (Polit & Beck, 2020). The reporting of this study was guided by the Consolidated Criteria for Reporting Qualitative Studies (COREQ), which is a set of guidelines designed to enhance the transparency and quality of reporting in qualitative research (Tong et al., 2007).

2.2. Participants

The participants were recruited through purposeful sampling, convenience sampling and snowball sampling techniques. Once we established the aim of our study and identified a group of experts to participate, we selected the most accessible individuals or units to be part of the research. During the interview phase, we used snowball sampling to select the study populations. This involved using their social networks to refer us to additional people who could potentially participate in or contribute to the study (Shorten & Moorley, 2014). Criteria for inclusion include being a nursing faculty member, having at least 2 years of entrepreneurial experience, participating in entrepreneurial activities, receiving high‐quality formal entrepreneurial training and also, ethnic diversity. In our research, we ensured diversity by including various dimensions such as age, gender, university and location. After conducting each interview, we thoroughly analysed the data and insights collected from participants to see how they reflected our expectations and study goals.

At the outset, the researcher conducted interviews with two entrepreneur faculty members in the nursing field referred by a co‐worker. Participant Recruitment: To minimise bias in snowball sampling, we diversified our initial ‘seed’ contacts. Following each interview, the participants were requested to recommend others who were engaged in this field. The study included faculty members in the nursing field who were employed by universities under the supervision of the Minister of Health and had either developed a product or established a company. However, participants who expressed reluctance or declined to continue with the interview were excluded from the study.

2.3. Data collection

After determining the study's objectives, the preferred time and location for the interviews were established through phone calls. Semi‐structured interviews were conducted in in‐person (n = 10) or by video calls (n = 5) with Iran nursing faculties entrepreneurs between June and July 2023. We obtained informed consent from participants and provided information about the study's purpose, procedures, risks and benefits. For the sake of anonymity and confidentiality, we ensured that the subject's responses not be linked to their identity. While using the telephone provides higher confidentiality and anonymity, it gives the perception of more anonymity (Glogowska et al., 2011).

The interviews were carried out by the first and second authors, who were assistant professors in nursing with more than 10 years' experience in qualitative research. Only one interviewer would be present at each interview (Kvale & Brinkmann, 2015) and a senior researcher who continuously supervised the interviewers in the process. A semi‐structured interview form was used to collect data. Data were recorded using a tape recorder. Each interview lasted between 45 to 90 min, with the primary questions focusing on the barriers and facilitators associated with running and developing the business (Table 1). To obtain more in‐depth insights, exploratory questions such as ‘What do you mean?’ and ‘Can you provide examples and elaborate further?’ were also posed during the interviews. The data was analysed simultaneously and once the themes were identified and the data was saturated, the interviews were concluded.

TABLE 1.

Semi‐structured interview questions.

Can you tell me about your experience or involvement with start‐ups within the nursing field? What motivated you to pursue entrepreneurship or engage with start‐ups as a nursing faculty member? In your opinion, what are the main barriers or challenges that nursing faculties face when starting their businesses or ventures? Have you encountered any specific challenges or barriers that are unique to nursing faculties in the context of start‐ups? How do you perceive the level of support and resources provided to nursing faculty members who are interested in pursuing start‐ups or entrepreneurial endeavours? Can you describe any facilitators or resources that have been helpful to you or other nursing faculties in overcoming barriers and establishing successful start‐ups? Have you received any specific training or support related to entrepreneurship as a nursing faculty member? If so, how has this training influenced your entrepreneurial journey? How do you balance your responsibilities as a nursing faculty member with your entrepreneurial pursuits? Can you share any success stories or examples of start‐ups or entrepreneurial initiatives led by nursing faculties that have had a positive impact on the nursing profession or healthcare sector? What advice or recommendations would you give to nursing faculties who are interested in pursuing start‐ups or entrepreneurial ventures?

2.4. Data analysis

Graneheim and Lundman's method (Graneheim & Lundman, 2004) was employed for data analysis in this study. After each interview, the contents were immediately reviewed multiple times to grasp the overall perception of the entrepreneurs. The process involved transcribing the interviews word by word and conducting multiple readings to gain a general understanding. The first author transcribed all the recordings. Then, the first and second authors combined the transcripts into one text. Semantic units were identified within the interview transcriptions and primary codes were extracted. The codes were then classified into sub‐themes based on their similarities and differences, leading to the classification of themes. The first and second authors independently reviewed the coding assignment of the data and commented on the appropriateness of the coding categories and emerging themes and ultimately, themes were identified as indicators of the underlying content of the text.

To ensure data saturation, we conducted interviews with two additional nursing faculties, but no new data was gathered. The MAXQDA version 10 software was utilised to easily analyse, code and present data. (Kuckartz & Rädiker, 2019). This software enabled researchers to save time and gain deeper insights into data and empowering them throughout research and analysis. Two authors coded the data and the final analysis was confirmed by the third author.

2.5. Validity and reliability/rigour

The consolidated criteria for qualitative reporting research (COREQ) was used to guide this study (Tong et al., 2007) (File S1). Further, the data analysis employed measures suggested by Granheim and Lundman. The study included participants with diverse experiences, representing different age groups and genders. Careful attention was given to selecting appropriate semantic units, summarizing and abstracting them and identifying sub‐themes and themes. The authors individually analysed the data and compared the codes and emerging sub‐themes, resolving any disagreements through discussions to reach a consensus. To ensure the accuracy of the findings, the encoded interviews were shared with five participants for member checking, allowing them to verify if their viewpoints were accurately represented by the researcher. Additionally, two PhD candidates independently conducted data analysis as part of the peer‐checking process.

3. RESULTS

3.1. Participants characteristics

The study included 15 participants who were nursing faculty members with experience in entrepreneurship. The participants comprised a diverse group in terms of gender, with 11 male participants and 4 female participants. The age of the participants ranged from 35 to 65 years, with a mean age of 50.6 years. They had varying lengths of experience as nursing faculty members, with an average of 18.9 years. Regarding their experience as entrepreneurs, they had been involved in entrepreneurial activities for different durations, ranging from 2 to 16 years. All of the participants had received high‐quality formal entrepreneurial training or education. The majority of participants in this study were actively employed as full‐time nursing faculty members at universities (Table 2).

TABLE 2.

Characteristics of the study participants.

Participants	Gender	Age (years)	Years as a faculty	Years as an entrepreneur	Received formal entrepreneurial training/education	Working as a full‐time or part‐time	Currently active or retired nursing faculty	Type of start‐ups
P1	Male	40	8	3	Yes	Full‐time	Active	Education
P2	Male	43	9	5	Yes	Full‐time	Active	Education
P3	Female	41	6	4	Yes	Full‐time	Active	Clinical care
P4	Male	65	25	15	Yes	Part‐time	Active	Both education and Clinical care
P5	Male	55	21	9	Yes	Full‐time	Active	General business, health equipment's
P6	Female	48	25	3	Yes	Full‐time	Active	Clinical care
P7	Male	55	26	14	Yes	Full‐time	Retired	Clinical care
P8	Male	52	21	16	Yes	Full‐time	Active	Clinical care
P9	Male	35	3	3	Yes	Full‐time	Active	Clinical care
P10	Female	38	5	2	Yes	Full‐time	Active	Clinical care
P11	Male	61	29	10	Yes	Full‐time	Active	Clinical care and research
P12	Male	55	20	9	Yes	Full‐time	Active	Clinical care
P13	Female	56	23	5	Yes	Full‐time	Active	Clinical care
P14	Male	54	26	9	Yes	Full‐time	Retired	Herbal medicine
P15	Male	52	16	12	Yes	Full‐time	Active	Clinical care

Based on the analysis of the data, four major themes emerged: motivational factors, support, scaling challenges and personal characteristics. These themes will be discussed in detail in the following sections. Table 3 provides a comprehensive overview of the main themes, sub‐themes and corresponding codes.

TABLE 3.

The main themes, sub‐themes and corresponding codes.

Themes	Sub‐themes	Codes
Motivational factors	Intrinsic motivations	Personal fulfilment and passion for entrepreneurship, Desire for autonomy and independence in career choices, Belief in the potential impact and innovation of start‐ups
	Extrinsic motivations	Encompassing competent and motivated teachers, Financial incentives and potential for monetary gains, Recognition and credibility associated with successful Start‐ups, Opportunities for career advancement and growth, Career development and growth, Meeting the needs of the profession
Personal attributes	Low‐personal competency	Lack of entrepreneurial spirit, confidence and professional development opportunities, Fear of failure, Poor risk management, Low motivation, Inadequate leadership skills and critical thinking skills, Importance of personal characteristics
	Work‐Life imbalance	Personal sacrifices, Difficulty in balancing studies and business, High cost of living
	Mental health management	Work‐related stress management techniques, Coping with entrepreneurial pressures, Mindfulness and meditation practices, Self‐care strategies for entrepreneurs, Dealing with uncertainty and managing anxiety, Seeking professional help and therapy, Building resilience and emotional intelligence, Balancing personal and professional relationships, Time management and prioritisation for stress reduction
Limited entry support	Limited funding and resources support	Financial challenges, Limited resources, professional training, quality of education and access to technology, Difficulty in attracting grants and managing finances.
	Limited guidance and mentorship	Lack of entrepreneurial education, business partners and training, mentorship, support from faculty, community support, Requirement to restructure the curriculum, Limited and Insufficient access to mentors, exposure to successful start‐ups, Difficulty in securing partnerships
Barriers to Scaling	Market understanding and competition	Difficulty in customer acquisition, building brand identity, understanding customer needs, developing a pricing strategy and marketing plan, identifying business opportunities and identifying industry trends
	Disconnection with industry	Limited industry collaboration and access to industry resources, Difficulty in translating research into practical applications
	Intellectual property and legal challenges	Poor understanding of intellectual property rights and legal aspects, Difficulty in protecting intellectual property
	Networking and communication	Lack of networking opportunities and interdisciplinary collaboration, Limited access to international markets, Inadequate problem‐solving skills, Poor understanding of marketing strategies and Difficulty in networking skills

3.2. Motivational factors

The first major theme explored in this study was motivational factors. This theme delves into the underlying motivations that drive faculties towards entrepreneurship. It is divided into two sub‐themes: intrinsic motivations and extrinsic motivations.

3.2.1. Intrinsic motivations

Intrinsic Motivation, encompassing personal fulfilment and passion for entrepreneurship, the desire for autonomy and independence in career choices and a belief in the potential impact and innovation of start‐ups, served as a powerful driving force. Nursing faculties expressed their perspective, with one stating, ‘Entrepreneurship lets me pursue my passion, find fulfilment and create innovative solutions for healthcare challenges.’ (Participant = P. 3) One other also shared his viewpoint stating, ‘The desire for autonomy drives me to pursue entrepreneurship, as I value the freedom to make independent decisions and shape my professional path. I believe in the transformative power of start‐ups to make a meaningful impact and drive innovation in the healthcare industry.’ (P. 7) These intrinsic motivations provide the inspiration and determination needed to navigate the challenges of entrepreneurship, propelling individuals towards their entrepreneurial goals.

3.2.2. Extrinsic motivations

Extrinsic Motivation, encompassing competent and motivated teachers, financial incentives and the potential for monetary gains, recognition and credibility associated with successful startups, opportunities for career advancement and growth and meeting the needs of the profession, serves as a driving force in entrepreneurship. Nursing faculties expressed their perspective, with one stating, ‘The financial incentives and potential for monetary gains in entrepreneurship are appealing, providing opportunities for personal and professional growth.’ (P. 14) The other entrepreneurs stated, ‘The recognition and credibility that come with building a successful startup are invaluable, opening doors for career advancement and growth. Additionally, entrepreneurship allows me to address the unmet needs of the profession, making a meaningful impact in the healthcare industry.’ (P.37) Furthermore, additional insights were provided by a faculty member regarding the healthcare work opportunities. They highlighted various challenges and areas for improvement within the field, stating, ‘We observe several critical issues in the healthcare sector, including unmet societal health service needs, a multitude of health concerns, limited hospital bed capacity, a high prevalence of chronic diseases, disparities in healthcare access, the demand for home nursing services, the need for innovative approaches, optimization of healthcare delivery, mandatory in‐service education in hospitals, annual hospital accreditation, the necessity to empower nurses to work independently and the expansion of the nursing domain. Addressing these issues requires innovative problem‐solving tasks.’ (P. 1) These extrinsic motivations play a pivotal role in inspiring nursing faculties to embark on the entrepreneurial journey, providing them with the drive and determination to overcome challenges and achieve success.

3.3. Personal attributes

The personal characteristics shed light on the challenges related to individual attributes and skills faced by nursing faculties in university start‐ups. The theme encompasses the following sub‐themes: personal characteristics and skills, work‐life balance and personal sacrifices and mental health and stress management which were explored below:

3.3.1. Low‐personal competency

This sub‐theme encompasses the challenges faced by nursing faculties in terms of their attributes and skills. One participant mentioned, ‘Lack of entrepreneurial spirit and confidence hinders our ability to take risks and pursue innovative ideas.’ (P. 10) Another participant highlighted the importance of personal characteristics, stating, ‘Inadequate leadership and critical thinking skills affect our ability to navigate the entrepreneurial landscape effectively.’ (P. 14).

3.3.2. Work–life imbalance

This sub‐theme addresses the challenges nursing faculties have faced in achieving a balance between their academic responsibilities, business ventures and personal lives. Participants expressed difficulties in balancing their tasks and business ventures, managing stress, coping with the high cost of living and maintaining a work‐life balance. One participant mentioned, ‘Personal sacrifices are necessary to juggle the demands of the business and academic responsibilities.’ (P. 6) Another participant stated, ‘Difficulty in managing stress and maintaining work‐life balance negatively impacts our overall well‐being.’ (P. 2).

3.3.3. Mental health management

Participants acknowledged the importance of mental health and stress management in the entrepreneurial journey. They discussed various strategies, such as work‐related stress management techniques, mindfulness and meditation practices, self‐care strategies and building resilience and emotional intelligence. Participants also emphasised the significance of seeking professional help and therapy, managing uncertainty and anxiety and balancing personal and professional relationships through effective time management and prioritisation. Two participants highlighted the role of these strategies in their own experiences:

I've realized the crucial role of self‐care and stress management techniques in maintaining my mental well‐being as an entrepreneur. Mindfulness practices and seeking therapy have helped me navigate the challenges and uncertainties. (P. 1)

Balancing personal and professional relationships has been essential for my mental health. By prioritising my time effectively and setting boundaries, I've been able to manage stress and maintain a healthier work‐life balance. (P. 7)

3.4. Limited entry support

The headline ‘limited entry suppport’ emphasises the obstacles encountered by nursing faculties in university start‐ups, particularly in terms of limited funding, resources, professional training and difficulties in securing grants. Additionally, there is a lack of guidance, mentorship and access to successful start‐ups, business partners, entrepreneurial education and the need to restructure the curriculum. This theme encompasses two significant subthemes: ‘limited funding and resources support’ and ‘limited guidance and mentorship.’ These barriers pose challenges for nursing faculties seeking to enter the entrepreneurial arena within the university context.

3.4.1. Limited funding and resources support

Under the subtheme of ‘limited funding and resources support,’ the participants identified various challenges. One participant stated, ‘We face financial challenges in securing adequate funding for our start‐ups,’ (P. 3) highlighting the difficulties in obtaining necessary financial resources. Another participant mentioned, ‘Limited access to technology hinders our progress,’ (P. 14) indicating the lack of resources required for technological advancements. Additionally, participants expressed difficulties in attracting grants, managing finances and dealing with limited resources.

3.4.2. Limited guidance and mentorship

Within the subtheme of ‘limited guidance and mentorship,’ the participants described several barriers they encountered. One participant stated, ‘We have limited exposure to successful start‐ups and lack business partners,’ (P. 15) emphasising the lack of networking opportunities and collaborative ventures. Another participant mentioned, ‘Insufficient business education hampers our entrepreneurial skills,’ (P. 9) highlighting the need for better business training. Lack of mentorship, support from faculty and community support were also reported. Participants mentioned the limited access to mentors, a dearth of entrepreneurial education and challenges in securing partnerships.

3.5. Scaling challenges

The theme ‘barriers to scaling’ represents the challenges and obstacles faced by nursing faculty entrepreneurs when attempting to scale their ventures. Scaling refers to the process of expanding and growing a business beyond its initial stage. This theme encompasses various factors that hinder the scaling process in the nursing entrepreneurship context. These challenges encompassed a range of obstacles, including limited market understanding, disconnection from the industry, issues related to intellectual property and legal compliance and difficulties in communication and networking. The present theme encompassed: market understanding and competition, scaling challenges, healthcare industry challenges, intellectual property and legal challenges and communication and networking.

3.5.1. Market understanding and competition

Participants identified challenges related to market understanding and competition, such as poor market understanding, high competition, difficulty in customer acquisition, building brand identity, understanding customer needs, developing pricing and marketing strategies, identifying business opportunities and staying aware of industry trends. In this regard, two participants mentioned:

We face poor market understanding and struggle with customer acquisition and developing a pricing strategy. (P. 5)

Understanding customer needs and identifying industry trends pose significant challenges for us. (P. 7)

3.5.2. Disconnection with industry

The disconnection between the healthcare and industry sectors poses a significant hindrance to the development of start‐ups in universities. This disconnection hampers the progress of entrepreneurial initiatives by limiting access to industry knowledge, resources and collaboration opportunities. As one potential nursing faculty member expressed, ‘Without strong ties to the industry, it becomes challenging to bridge the gap and translate innovative ideas into viable healthcare solutions’ (P. 13) indicating the need for specialised knowledge and industry connections. Another faculty member specialising in the cardiovascular field expressed, ‘I have been wanting to develop a non‐invasive blood pressure sensor for many years, but I don't have any connections in the industry to help make it a reality.’ (P. 10) Similarly, another individual in the field shared their aspiration to develop an autonomous suction device for ICU patients. However, they faced a common challenge, expressing their frustration, stating, ‘I've had this idea for an autonomous patient suction device, but I don't have any industry contacts to bring it to life.’ (P. 1).

3.5.3. Intellectual property and legal challenges

Based on the participants' experiences, it was observed that intellectual property and legal challenges encompassed various factors, including a lack of understanding of intellectual property rights, challenges in protecting intellectual property and limited comprehension of legal aspects. One participant stated, ‘We struggle with understanding intellectual property rights and protecting our innovative ideas,’ (P. 12) highlighting the need for legal expertise in this area.

3.5.4. Networking and communication

The participants highlighted that networking plays a crucial role in the success of start‐ups, yet it can also present significant challenges. Building a robust network of mentors and potential collaborators is essential for accessing resources, knowledge and opportunities. However, limited networking opportunities can hinder the growth and development of start‐ups, impeding their ability to form valuable partnerships and gain crucial industry insights. One participant highlighted the impact of networking challenges on university start‐ups, stating, ‘We face difficulties in establishing meaningful connections and expanding our network beyond academia’ (P. 11).

4. DISCUSSION

This study analysed the obstacles and opportunities for entrepreneurship in nursing as perceived by faculty members in Iran. In this article, we highlight the barriers and opportunities that universities encounter in promoting entrepreneurship as a specific process that relies on the experience of entrepreneurs. Our study recognised that while facilitators are a desirable path to increase the impact of a startup, they can also create barriers in the entrepreneurial process. Our findings offer important contributions to the literature on university innovation and start‐ups. They also shed light on the challenges faced in establishing nursing start‐ups and provide valuable insights to inform future strategies for promoting nursing entrepreneurship.

4.1. Motivational factors

In the present study, the nursing faculty participants identified ‘motivational factors’ as the first factor influencing nursing start‐ups. According to their perceptions, both intrinsic and extrinsic motivation were considered effective in improving start‐up programs. The participants recognised various motivation factors such as personal fulfilment, autonomy, financial incentives and opportunities for professional growth, which were seen as essential for enhancing nursing motivation and streamlining the start‐up process.

A study has shown that developing professional and personal attributes related to achievement, creativity, motivation and professional autonomy plays a significant role in nurturing nurses' entrepreneurial tendencies (Costa et al., 2013). Another study also indicates that many factors play a key role in shaping the intention to create start‐ups. University teachers may effectively contribute intentions of students to develop their entrepreneurship programs as well (Bouarar et al., 2022). Our research indicates that previous studies have placed greater emphasis on motivating and shaping students' intentions, which can be achieved by faculty through their university education. These findings align with a study by Marques and colleagues, which explored how motivation mediates the relationship between entrepreneurial traits and nurses' entrepreneurial intentions. The results indicated that nurses who exhibit higher levels of determination to become entrepreneurs also display slightly higher levels of motivation (Marques et al., 2019).

Another study emphasised that nurses' inclination towards self‐improvement can strengthen their entrepreneurial motivation (Costa et al., 2013). In our study, participants believe that faculty members need to be highly competent in adapting to technological developments to foster better learning in the field of entrepreneurship. They pointed out that having competent and motivated teachers is crucial when it comes to promoting students' entrepreneurial skills learning. Similarly, studies have highlighted the importance of internal and external stimuli in encouraging nursing professors with an entrepreneurial mindset to overcome obstacles and actively engage in entrepreneurial activities (Hosseinzadeh et al., 2023; Neergård, 2021), our study also emphasised these stimuli and showed that the development of enterprising motivation has been characterised as one of the primary stimuli to the widening of entrepreneurship.

In the face of entrepreneurship, stimuli factors and adequate capital among other factors affect the startup's motivation and development of entrepreneurship. Hence, this study aims to identify the barriers and facilitators of university innovation and start‐ups and motivate such entrepreneurs to start up businesses despite the above challenges. For this reason, universities and other empowerment institutions should take note of these factors if entrepreneurship is to be fostered. It is also important to highlight that by recognising and harnessing the power of motivational factors, nursing faculties can effectively address barriers to nursing entrepreneurship and facilitate the implementation of entrepreneurial initiatives. Fostering a supportive environment that nurtures both intrinsic and extrinsic motivation can empower nurses to embrace entrepreneurship and contribute to innovation and advancements in healthcare delivery.

4.2. Personal attributes

We discovered that ‘personal attributes’ played a significant role in the success or failure of entrepreneurship. The participants emphasised that personal attributes, skills, work–life balance and the ability to manage personal sacrifices, mental health and stress were vital for enhancing entrepreneurship. They reported that faculties' heavy workload hindered their ability to maintain a work‐life balance, which, in turn, influenced their inclination to pursue entrepreneurship.

Previous studies have indicated that personal characteristics influence individuals' attitudes towards entrepreneurship, whether positive or negative (Yıldız & Alpkan, 2015). Consistent with our findings, other studies have highlighted the importance of possessing expertise, skills, self‐confidence, risk‐taking abilities and the ability to overcome fears as key personality traits of successful entrepreneurs (Heinonen & Poikkijoki, 2006; Mahbobkhah & Beigzadeh, 2018). Faculties believe that personal attributes can be considered as a reflection of the state of mind of an individual which prompts them towards taking up self‐employment. Our study also revealed that effective management of work‐related stress can drive individuals towards entrepreneurship and contribute to the development of essential entrepreneurial characteristics. Eminoglu and Gungormus (2019) further supported this notion, suggesting that proper stress management can address entrepreneurial deficiencies. Our participants emphasised that personal attributes like innovativeness and risk‐taking can be profoundly conducive to entrepreneurial intention. Participants also believed that to start a new business, personal attributes are to be remembered as an individual dimension that directs entrepreneurial aim.

4.3. Limited entry support

In this study, the third identified theme regarding the barriers to nursing entrepreneurship was ‘limited entry support.’ Analysing the relevant resources that impact nursing start‐ups is crucial for effective promotion. The findings of this study revealed that nursing faculty perceived the need to address barriers related to the requirement of restructuring the curriculum, limited funding, resource support, guidance and mentorship to fulfil the support requirements of the entrepreneurial process and goals. Numerous studies have examined the resources influencing nursing faculty start‐ups and have demonstrated the positive and significant effects of variables such as internal resources, external resources and technology transfer on entrepreneurial outcomes (Jesemann, 2020; Lee & Lee, 2020; Sudiana et al., 2020). Business leaders in health systems recognise that nurses have the greatest opportunity to use innovation to improve care for patients and incorporating innovation into nursing curricula is necessary (Leary et al., 2022). Among the resources influencing start‐ups, funding support has been found to have a positive and significant impact on initiating start‐up programs (Alves et al., 2019). This is likely because funding enables the creation of business plans, facilitates market research and supports production.

Researchers have emphasised the importance of proper planning and highlighted that entrepreneurship cannot thrive without support and assistance (Nabijonovna & Ulugbekovna, 2022). The participation of nursing faculty in start‐up interviews underscores the need for access to appropriate technology, which plays a critical role in the early stages of start‐ups and the entrepreneurial process. These results align with a study conducted by Lee and colleagues, further supporting the significance of technology in nursing entrepreneurship (Lee & Lee, 2020). The results presented in this section about limited funding confirm the general barriers picture emerged in our study. There is a clear correlation between resources and success in entrepreneurship. The interviews highlighted the many barriers faced – especially by young faculties – in accessing and securing funding. Not surprisingly, then, they suggest that more funding and resources support be given to them in sourcing start‐up funding.

The participants in this study identified other factors that influence the growth of this process. Nursing faculties expressed that the maintenance and scaling of start‐ups in the nursing education sector is also challenging. Current nursing education needs major changes in its educational model. To attain higher levels of knowledge, technique and skill in startups, nursing education needs to innovate and leverage expert guidance.

Discover the limited guidance and mentorship in this study suggests a pressing need to gain a deeper understanding of the underlying processes that foster entrepreneurial growth. These processes are instrumental in increasing access to resources and promoting the expansion of the entrepreneurial ecosystem. These findings underscore the need to comprehend the facilitators of entrepreneurial growth processes and create an enabling environment by alleviating the associated obstacles.

Interestingly, the results of this study align with a previous study (Wright & Stigliani, 2013) that reported similar findings. Furthermore, another study has emphasised the significance of four critical variables in the scaling process of entrepreneurship. These variables encompass financial limitations, capital constraints, inadequate technology and stringent regulatory frameworks. Together, these factors exert a substantial influence on the growth and overall development of entrepreneurial ventures (Nkwabi & Mboya, 2019). Since the financial limitations are also the key variable in our research, policymakers should remove these barriers to facilitate entrepreneurship and startup business growth.

4.4. Scaling challenges

The final theme about barriers to nursing entrepreneurship was ‘Barriers to Scaling’ from the perspective of nursing faculty. Scaling across refers to an approach that focuses on disseminating and sharing the innovation developed by the entrepreneur with others. They believe that, to date, marketing, industry collaboration, intellectual property, legal challenges and networking and communication pose a significant hindrance to the development of start‐ups in universities, however, poor understanding of intellectual property rights, legal aspects and difficulty in protecting intellectual property may lead entrepreneurs to deviate from ethical principles. Participants argue that the intellectual property and legal of entrepreneurs can be challenged when they engage in the process of scaling up their ventures. Since complicated and long processes of legal licensing waste time, therefore, policymakers should facilitate this process and make more services accessible. Entrepreneurs should use their relationships to access legal resources and the existence of obstacles in the mentioned cases is a direct threat to the continuation of their entrepreneurial process. One study found a significant relationship between the effect of access to legal constraints in business activities and reported that legal constraints were one of the challenging factors affecting entrepreneurial activities in entrepreneurial (Khalid et al., 2022). Since the number of nursing school graduates is increasing, there is a strong need to encourage them to start their businesses, which creates opportunities not only for themselves but also for others. In the study. Awasthy et al reported that the management of collaborations plays an important role in the development of the industry‐university relationship (Awasthy et al., 2020).

A contribution of this study was to provide barriers and facilitators of university innovation and start‐ups according to the experience of nursing faculties and building bridges between global and our contexts. In addition, by identifying the barriers and facilitators that contribute to instilling entrepreneurship at a university level, we discussed the conditions under which universities may be fostered.

5. IMPLICATIONS AND RECOMMENDATIONS

Today's nurses can use entrepreneurship for all types of care situations such as palliative and home care and nursing care in hospitals. In this way, they can increase the visibility of the nursing profession. Teaching entrepreneurship skills plays an important role in promoting nursing employment and improvement of people's health. The results showed that entrepreneurship skills, attitudes and support are not receiving enough attention in nursing universities.

Policymakers can promote university education to expand the entrepreneurship process using more facilities and make more services accessible. According to the results, although entrepreneurship in nursing still faces several barriers, it's full of opportunities for nurses to develop their profession and self‐potentials. Nursing education institutions should provide comprehensive entrepreneurship programs that address these challenges with the necessary skills and knowledge to effectively guide diverse groups of nursing students. Nursing educators can incorporate entrepreneurship concepts into nursing programs to assist students who are well‐equipped to handle the demands of nursing entrepreneurship. Moreover, nursing educators can use the findings of this study to emphasise the importance of entrepreneurship to their students.

6. CONCLUSION

Our study provided comprehensive insights into the factors influencing entrepreneurship in the nursing faculties. The findings revealed that addressing these challenges requires fostering personal development, improving support systems and enhancing industry collaboration and access to resources. By addressing these issues, the nursing profession can create an enabling environment for entrepreneurial success and contribute to innovation and growth in healthcare while we need the broader perspectives and experiences to be fully explored.

7. STUDY LIMITATIONS

The study has several limitations that should be considered. Firstly, the study was limited to personal start‐ups initiated by nursing faculties, rather than being aligned with university‐designed start‐up programs. This limitation arose from the absence of explicit programs at the university level for entrepreneurship and innovation in the nursing field. As a result, nursing faculties interested in entrepreneurship and innovation pursued their ventures individually. Despite this limitation, the insights provided by the participating nursing faculties have been invaluable in understanding the experiences and challenges they encounter in their start‐ups. It should be noted that the study only focuses on experience and as such, it did not measure the actual performance of universities and may be subject to bias.

To improve future research, it may be useful to recruit diverse samples from various institutions. Additionally, the study focused specifically on barriers, facilitators and experiences of nursing faculties in university start‐ups. It did not extensively cover other stakeholders such as students, entrepreneurs from other disciplines, or healthcare professionals. These limitations highlight the need for future research to address these gaps and provide a more comprehensive understanding of the barriers, facilitators and experiences of nursing faculties in university start‐ups.

AUTHOR CONTRIBUTIONS

Study concept, design and supervision: Mehdi Jafari‐Oori, Zahra Jamshidi, Mojtaba Aieen; acquisition of data: Mehdi Jafari‐Oori, Zahra Jamshidi, Mojtaba Aieen; analysis and interpretation of data: Mehdi Jafari‐Oori, Zahra Jamshidi; drafting of the manuscript; Mehdi Jafari‐Oori, Zahra Jamshidi, Mojtaba Aieen; critical revision of the manuscript for important intellectual content, statistical analysis and administrative, technical and material support: Mehdi Jafari‐Oori, Zahra Jamshidi.

FUNDING INFORMATION

No funding source.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

EHICS STATEMENT

The research project received approval from Baqiyatallah University of Medical Sciences (BUMS) (ID: IR.BMSU.REC.1401.111). Prior to the interviews, participants were informed that the interviews would be recorded and they were asked for their consent. Participants were also informed that they could withdraw from the study at any time without any penalty. To ensure confidentiality, the participants' names were kept private and they were referred to using codes (e.g. P1, P2, P3, etc.).

Supporting information

File S1.

Jamshidi, Z. , Aieen, M. , & Jafari‐Oori, M. (2024). University innovation and start‐ups: Barriers and facilitators experienced by nursing faculties – A content analysis study. Nursing Open, 11, e2190. 10.1002/nop2.2190

DATA AVAILABILITY STATEMENT

The data that supports the findings of this study are available in the supplementary material of this article.