The terms "intrapreneur" and "entrepreneur" have long been associated with innovation. Characteristically, these persons have insights that extend beyond present circumstances. They are able to apply new paradigms to old situations that no one else is seeing. They can be a part of the milieu but can step out of the milieu, seeing situations with another lens or from another facet. The fresh examination yields insights heretofore hidden. These insights then allow for more creative problem solving. "Thinking outside the box" is the phrase commonly used to characterize these thought patterns.

The terms "intrapreneur" and "entrepreneur" are used universally to describe the differences in the position from which innovative change is being proposed. The pivotal points are as follows: (1) the base for the change, that is, inside or outside an organization, and (2) the source of funding for the development of the change. Intrapreneurs reside within an organization and do not use personal resources, for instance, their own money, to make their proposed change happen. Instead, they negotiate within the current system and its budget to forge the acceptance of new ideas that better meet the goals of their organization. Entrepreneurs, however, see the need for change and are willing to proceed to effect the change outside of a supportive structure. The capital used for their projects represents personal funds or monies solicited from external resources, for example, angel donors (wealthy person who wish to invest in private enterprises for a share of the resulting profits), bank loans, and federal grants. The term "nurse intra/entrepreneur" is used to connote a registered nurse (RN) who seeks to make changes within or without an organization. (Note that "nurse" does not necessarily imply a degree beyond the RN, although, in practice, the nurse frequently has advanced training.) The change being proposed by a nurse intra/entrepreneur does not necessarily have to be within health care, but most often the term refers to RNs who are seeking new avenues for the effective delivery of health care.

As mentioned in the January/February issue of this journal, within the innovation feature, the term intra/entrepreneur has connotations of being "avant-garde and 'sexy,' like having a distinctive or preferred status over the general populous."1 So why is it that one even considers these presumably distinguished persons as being "nursing misfits"? "Misfit" is a most unfortunate name to call anyone. The term is certainly loaded with all kinds of negative connotations, none of which anyone would want to be associated! But seriously, have you ever looked around and watched how the "out-of-the-box" thinker is regarded in the workplace? Are they welcomed? Or, are these person shunned? Or, are they kept somewhere between the two extremes, frequently negatively confined? What should be the response to nurse intra/entrepreneurs? Do any of these responses even matter? Think about holistic nursing. Does holistic nursing have "out-of-the-box" thinkers? Should holistic nursing have "out-of-the-box" thinkers? What difference would it make to the practice of nursing if holistic nursing had "out-of-the-box" thinkers? Or, is holistic nursing really "out-of-the-box" thinking?

The previous questions are meant to pause your thinking and to encourage you to ask more questions. The concept of innovation is like a diamond with many facets. Depending on the way the diamond has been cut and the perspective from which its facets are viewed, the array of its beauty is perceived differently by each person. The same thinking can be applied to a study of innovation. Depending on the way one perceives innovation and studies its facets, the resulting "views" reveal a multitude of complex component parts. Each facet can be studied as an entity unto itself. But it is usually the final product that is valued the most, the overall result. In nursing, to successfully introduce more innovation in its practice, that is, overall results, it would be imperative to understand some of challenges and many facets of the change process.

"Out-of-the-box" thinking is usually a term associated with innovators. The ability to think in this manner has many positive results. Why, therefore, would anyone ever consider such a person as being a "misfit"? Part of the answer to the perception of a "misfit" lies in an understanding of change theory. (Refer to Kurt Lewin's change theory of "unfreezing, change, refreezing" at http://currentnursing.com/nursing_theory/change_theory.html.) What is the first reaction to a new idea? Is it immediate acceptance? As with so many other situations, acceptance depends on the position from which a person is viewing the change. For the most part, though, change is usually met with resistance and the literature is replete with multiple examples of this behavior. The degree of resistance and hence the length to which one carries the resistance is situation dependent. What does not change is human nature. If pushed into a corner by an aggressive handler, a normally placid dog may bite. It is a defensive action. If a person is faced with changes that impact his or her normal routine and considered a nuisance or challenging to his or her well-being, he or she too will "bite." Hopefully, there is no physical "bite," but a common response tactic is to marginalize the intruder, not separating the message from the person of the intruder. It is logically, then, that an inventor can be considered a "misfit" if his or her intrusive ideas invade the "personal space" of another person. It is a defensive position. These innovators do not conform to the present organizational thinking. "Misfit" has a maligning tone and easily accommodates many deprecatory remarks that are frequently emotionally based rather than factual. The term socially isolates the inventor, insulating the status quo. The strategy of negatively categorizing and then isolating an innovator has been very successfully used throughout history, especially if the attacked person has a strong need for social acceptance in his or her working group. But who would not like acceptance with one's coworkers?

Why is it that there is any consideration that nursing might call its intra/entrepreneurs "misfits"? What are "edge runners"? If you have never heard of the term "edge runner," it is a term that is first coined by the American Academy of Nursing to exemplify persons in nursing who have made extraordinary contributions to nursing that represent a step change in nursing practice. They are "practical innovators who have led the way in bringing new thinking and new methods to a wide range of health care challenges. Edge runners have developed care models and interventions that demonstrate significant clinical and financial outcomes. Many of the stories underscore the courage and fighting spirit of nurse leaders who have persevered despite institutional inertia or resistance."2 A list of these persons can be found at http://www.aannet.org/edgerunners. From the explanation of the American Academy of Nursing regarding "edge runners," can you not see why nursing can be charged with calling its intra/entrepreneurs "misfits." Look at the words, "Many of the stories underscore the courage and fighting spirit of nurse leaders who have persevered despite institutional inertia or resistance."2 The statement is a powerful indicator of nursing unwillingness to change! Indeed, it takes a strong personality to withstand the poisonous arrows of those who want to maintain the status quo. Nurses with avant-garde ideas are often considered "misfits" despite the positive literature that supports their ideas and the efforts of professional nursing societies to celebrate the substantial accomplishments of its members through special recognition and awards. Many nurses on the local level have so many responsibilities, aside from their jobs, that to" fight the system" is an impossible task. They either have to move to an organization with more forward thinking or have to keep quiet. But is this the track record we want for holistic nursing?

Have you ever challenged your practice of holistic nursing and asked, "Am I supportive of new ideas or do I squash them?" In the privacy of your own thinking, you can answer this question. The immediate changes within health care legislation makes it imperative for holistic nurses, any nurse for that matter, to be a part of the solution instead the recipient of another's decision. If we silo our "misfits" and never entertain their ideas, the resulting effect will stifle growth and destroy opportunities for nursing to experiment with new avenues of care.

Has holistic nursing ever considered some of its proponents "misfits"? Without a doubt, many of you could site instances where this has happened. Can this pattern change? Indeed, it not only can change but also holistic nursing can grow to greater heights. Progress, however, begins with you. What is it that you are doing in your work environment that fosters new ideas and experiments with new paradigms? Have you established a mechanism that supports the generation of new ideas and celebrates intra/entrepreneurs? The challenge is incumbent on each individual RN to carefully appraise his or her performance and to take action. Your rank in nursing does not make the difference, but your attitude does. "Think wildly" but act responsibly. The resulting effect of this attitude is a sense of accomplishment and enormous fulfillment. And it becomes a reservoir of encouragement to spawn more ideas. The final questions is, therefore, "What are you doing to foster creative, imaginative thinking in holistic nursing so that the chancrous "misfit" label can be dispelled and a new cap of creative energy can be dunned?

REFERENCES

1. MacFadyen JS. Holistic nursing: innovatively addressing health care needs? Holist Nurs Pract. 2013;27(1):4-5. doi:10.1097/HNO.0b013e31827938c7. [Context Link]

2. American Academy of Nursing. Raise the voice. Edge runners. http://www.aannet.org/raisethevoice. Accessed January 30, 2013. [Context Link]