الفهرس 
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Abstract
The challenge for nurse managers is that this strategic role necessitates leadership, dispute resolution, decisive action, and the attainment of desired results, awakening them to the indispensability of being entrepreneurial leaders. EL for nursing is considered a fundamental requirement for effectively addressing the numerous and complex healthcare challenges that are prevalent across the world. Furthermore, the EL serves as a crucial factor in enhancing patient safety and ensuring the attainment of optimal nursing standards.
Aim of the study:
Determine the effect of implementing an entrepreneurial leadership training program for nurse managers on their proactive work behavior and career adaptability.
Research hypotheses:
Nurse managers who attend the entrepreneurial leadership training program exhibit a higher level of proactive work behavior, and career adaptability after the program than before it.
Setting:
This study was conducted in all departments at two private hospitals, namely: Mobaret El Asafra East Hospital (13 units) and Alexandria New Medical Centre (18 units). These hospitals were selected because they provide a wide range of services, are multi-specialty, are planned for GAHAR, and have a bed capacity exceeding 50 beds that require a large number of nurse managers for the study.
Subjects:
The study subjects included all nurse managers (N = 46) who were working in the previously mentioned setting, and they were classified as follows: Mobaret El Asafra East Hospital (N = 23)and Alexandria New Medical Centre (N = 23). They have completed at least six months of experience in the previously mentioned private hospitals.
Tools:
Five tools were used in this study as follow:
Tool (I): Nurse managers’ knowledge about EL questionnaire.
This tool was developed by the researcher based on a review of related literature by Renko et al. (2015), Bagheri & Akbari (2017), Kim et al. (2017), and Bagheri & Harrison (2020) to assess the level of nurse managers’ knowledge about EL. It included 15 closed-ended questions. Each correct answer was given a score of one, and the wrong answer was given a score of zero. The scores of the items were summed up and converted into percentage scores.
Tool (II): Entrepreneurial Leadership Questionnaire (ELQ):
This tool was developed by Bagheri & Harrison (2020) to assess the level of perception of EL practices of nurse managers. It is composed of 40 items, classified into seven dimensions: framing the challenge (5 items), underwriting (5 items), defining gravity (5 items), orientation towards learning (5 items), absorbing uncertainty (4 items), building commitment (6 items), and opportunity identification and exploitation (10 items). The responses were measured on a 5-point Likert scale ranging from (1) strongly disagree to (5) strongly agree.
Tool (III): Proactive Work Behavior Scale (PWBS):
This tool was developed by Parker & Collins (2010) to assess nurse managers’ levels of PWB. It is composed of 13 items and are classified into four dimensions: taking charge (3 items), voice (4 items), individual innovation (3 items), and problem prevention (3 items). The responses were measured on a 5-point Likert scale, ranging from (1) very infrequently to (5) very frequently.
Tool (IV): Career Adaptability Scale (CAS):
This tool was developed by Porfeli and Savickas (2012) to assess nurse managers’ level of perception of CA. It is composed of 24 items and classified into four dimensions: concern (6 items), control (6 items), curiosity (6 items), and confidence (6 items). The responses were measured on a 5-point Likert scale ranging from (1) strongly disagree to (5) strongly agree.
Tool (V): Participant Program Evaluation Questionnaire:
It was developed by the researcher based on a review of related literature to evaluate the effectiveness of program sessions (strengths and weaknesses) from the nurse managers’ point of view. It consists of 16 items such as content, setting, presenter effectiveness, and instructional methods. The responses were measured on a 5-point Likert scale, which ranged from (1) strongly disagree to (5) strongly agree.
In addition, , the socio-demographic structure interview schedule was developed by the researcher; it included questions related to age, gender, marital status, qualification, working unit, job position, and the nursing manager’s experience.
Method:
1. An approval for conducting the study was obtained from the Ethical Research Committee of the Faculty of Nursing, Alexandria University, prior to the start of the study.
2. Permission for conducting the study was obtained from the Dean of the Faculty of Nursing at Alexandria University and the hospital administrators to collect the necessary data.
3. All study tools were translated into Arabic and tested for their face validity by five experts in the field of the study accordingly, the necessary modifications were done.
4. The tools were tested for their reliability using the appropriate statistical tests to measure the internal consistency using Cronbach’s alpha correlation coefficient test.
5. A pilot study was carried out on 10% of nurse managers (n = 5), who were not included in the study subjects, in order to check and ensure the clarity of tools, applicability, and feasibility, identify obstacles and problems that were encountered during data collection, estimate the time needed to fill out each question, and the necessary modifications were done.
6. Ethical considerations were assured.
7. Data collection:
The study was conducted in the following phases for six months:
I. Assessment phase:
This phase was done as follows:
1. The researcher distribute a needs assessment questionnaire for the nurse managers, to collect data related to their previous training and their desires to attend the EL training program.
2. A self-reported questionnaire using tools (II and IV) to assess nurse managers perceptions of EL and CA and returned it back to the researcher, who explained the aim of the study and answered any queries related to the study.
3. Tool (III) was conducted through structured, individualized face-to-face interviews by the researcher to assess the PWB of the nurse managers.
II. Planning and implementation phases of the application of the EL training program:
A: Planning phase
1. Based on the results of the assessment phase, a review of related literature and the EL training program were developed, as were a time schedule, teaching sessions, and teaching planning.
2. Nurse managers were classified into five groups, each group includes 8-9 nurse managers based on their working days.
3. Each session arrangement was approximately two hours, each group was given three consecutive sessions (total time 6 hours/group for 3 weeks) (total of 15 sessions) to cover the content.
4. The program sessions’ content and media were developed based on an EL review of the literature (in the form of a handout and visual materials) and were prepared by the researcher through theoretical knowledge, illustrative pictures, role play, teamwork, brainstorming, and discussion.
B. Implementation phase:
a) A knowledge test (pre-test)using tool (I) was administered to the nurse managers to collect data related to their level of knowledge regarding EL.
b) The training program was implemented for all groups and included general and specific objectives and relevant content, educational methods, and evaluation techniques.
c) The content of the training program was delivered using relevant and interactive teaching strategies according to the information presented.
C. Evaluation phase:
Evaluation of the training program was carried out after the implementation of the EL training program using the following techniques:
a) Evaluation of the program itself through the participant program evaluation questionnairetool (V) was distributed to nurse managers to evaluate their feedback about the program immediately after implementation.
b) Evaluation of the program outcomes, though:
- Posttest, using tool (I) was distributed to nurse managers immediately at the end of the program and after 2 months from program implementation to evaluate the knowledge gained in comparison with the pretest.
- Self-reported questionnaire using tools (II and IV) that were used in the assessment phase of the study, used immediately at the end of the program and after 2 months from program implementation.
- A structured individualized face-to-face interview was conducted by the researcher using tool (III) to assess the PWB of the nurse managers. Immediately after the program and after two months from the implementation of the training program.
The main results of the study showed that:
• The present study revealed that there were statistically significant differences found between the overall mean score of nurse managers’ EL practices and its dimensions except for the building commitment dimension at the three evaluative times (before, immediately after,and after two months).
• Also, it showed that there were statistically significant differences between the overall mean score of nurse managers’ PWB and its dimensions except the individual innovation dimension, at the three evaluative times of the EL training program, where (P= 0.000*).
• Also, it showed that there were statistically significant differences between the overall mean score of nurse managers’ CAand its dimensions at the three evaluative times of the EL training program where (P= 0.000*).
• Finally, this study concluded that implementation of the EL training program had a large effect size on knowledge related to EL where effect size (0.95). However, theEL training program had medium effect sizes on PWB, and CA where effects size (0.76, 0.65) consecutively. The regression weight values indicate that EL (as an independent variable) impacts both dependent variables, PWB and CA, by 86%.
The findings of this study lead to the following recommendations:
In relation to the hospital administrators:
a) Create and coordinate nurses training programs on innovative and effective leadership skills and advanced nursing leadership styles, particularly EL.
b) Encourage the nurse managers to be role model through functioning in a supportive atmosphere with empowerment and mutual trust in order to improve their EL practices.
c) Provide nurse managers with time and tools to carry out creative initiatives, drive innovation as a job requirement, and respond favorably to innovative efforts.
In relation to the faculty administrators:
Recommend faculty leaders and members of the curriculum committee to incorporate EL into the nursing curriculum, which becomes a core aspect and critical feature of nursing education and provides useful outcomes.
Teach the concepts of PWB and CA in theoretical and practical courses for undergraduate and postgraduate nurses, both in terms of knowledge and behavior.
Inform nurse educators to teach students how to develop novel and useful ideas in opportunity recognition, resource utilization, and problem solving.
Analyze and reform nursing courses to remove the drawback and integrate more conditional educational strategies to alter attitudes, enhance understanding, and develop EL, PWB, and CA skills.
In relation to the nurse managers:
• Raise nurses’ awareness toward EL, PWB, and CA and their impact on patients, nurses, and organizations by providing continuous in-service training and education programs and workshops related to this issue.
• Supporting staff nurses’ self-confidence and risk-taking by providing a working environment contributes to the explosion of energies and the generation of ideas that lead to organizational growth and improvement.
• To improve nurses’ career adaptability, nurse managers should facilitate workgroup building, carry out long-term plans, and solve work problems with new creative ideas.
In relation to the nurses:
Nurses should update their knowledge, and frequently update their proactive behavior and adaptability skills, and read more about EL succession in the nursing profession.
Participate intraining programs that focus on EL skills such as proactiveness, risk-taking, innovation, and exploring and exploiting opportunities.
The following are suggestions for further studies in this area should be done:
Qualitative research is recommended to address factors that contribute to EL from the faculty’s perspective and to identify the best educational strategies to teach EL in nursing programs.
A comparative study to identify factors that affect the presence of PWB and CAbetween staff nurses in governmental and private hospitals.