Joni: 

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders brought to you by Works, healthcare's flexible staffing platform. I'm thrilled to introduce our distinguished episode guest, Dr. Terry McDonnell. Dr. McDonnell is the System Chief Nursing Executive and Senior Vice President for the Duke University Health System, as well as the Vice Dean for Clinical Affairs at the Duke University School of Nursing. In her current role, Dr. McDonnell works closely with chief nursing officers and system leaders to foster a culture of belonging and purpose among frontline clinical teams, ensuring that patients and their families receive world-class healthcare and a truly remarkable experience. Before her tenure at Duke, Dr. McDonnell served as Vice President of Clinical Operations and Chief Nursing Officer at the Fred Hutchinson Cancer Center in Seattle, where she was instrumental in overseeing clinical operations and staff to deliver exceptional patient-centric care.

A doctoral level nurse practitioner certified in acute care, Dr. McDonnell specializes in treating patients with gastrointestinal cancers and has served in numerous prestigious academic and clinical roles, including as a clinical associate of medicine at the University of Washington's School of Medicine, a recognized leader in healthcare. Dr. McDonnell is celebrated for her ability to empower her teams, foster collaboration, and enhance patient care through compassionate leadership, she has been honored with awards such as the National Pancreas Foundation Compassionate Caregiver Award for her dedication to patients and their families. Dr. McDonnell's educational journey includes undergraduate degrees in English and economics from Boston College, a master's in acute care nursing, and a doctorate of nursing practice and administration from the MGH Institute of Health Professions. Today, she joins us to discuss the language of leadership, the importance of supporting individualized career pathways for nurses and the growing presence of second and third career nurses in the workforce. Please welcome Dr. Terry McDonnell. Terry, welcome to The Handoff.

Terry:

Thank you so much, Joni. It's wonderful to be here with you.

Joni: 

Excellent. Well, I'm really looking forward to our time today, and Terry, you have a unique perspective and certainly as we are all coming out of the COVID-19 pandemic, we have a lot of work going on in nursing today, particularly, there's a lot of conversation around how we talk about nursing as a profession, which has been a thread ongoing throughout the nursing profession, but it seems like this is really coming into the limelight these days. And so I'm curious from your perspective as a chief nurse executive, how has the messaging around nursing changed since the pandemic and what is the nurse leader's role in transforming communication?

Terry: 

It's been a fascinating rollercoaster. We've always been a highly respected profession, and the pandemic intensified a lot of attention around nursing. We became, very early on, the face of the pandemic and care and urgency, and then there was this narrative that was created around heroism, and that narrative almost shifted into one that had a hint of victimization, I'll say.

And coming out of the pandemic now, we all have to acknowledge nurses work very hard, but it's also a privilege and an honor to be part of the nursing profession. We get to meet patients at their most vulnerable times. We get to be part of that journey with them, and the work is hard, but it's also incredibly gratifying. And I think now we're at a juncture where we kind of need to emerge, spread our wings, take on a position of positivity, and really focus on the things that brought us to the profession in the first place. We've got a whole new generation of nurses that, quite frankly, I'm seeing a lot of excitement coming out of. They're excited about the work, they're excited about being at the bedside, and they want to be valued for that. They want to be acknowledged for providing excellent clinical care. So I think we've got a great opportunity as nursing leaders to really take that energy and move it forward.

Joni:

Yeah, I totally agree with you. It was really interesting to see what happened during the pandemic because it just so happened that the World Health Organization had named it “The Year of the Nurse” right? And so you're right. There was this interesting shift in communication and how we spoke about the profession, but I think you make a good point. This is our profession, and we get the opportunity to really shape the way that we work and speak about our profession. We own it. So Terry, you have quite the nursing history, career background. I loved learning about your background, and I wonder if you could maybe give our listeners just a little snippet of how you came into nursing first.

Terry: 

Well, nursing is, by some counts, maybe my third career, but I love this. I entered the nursing journey about 25 years ago, after a couple of fairly significant life experiences and illness with my 8-year-old son, and then unfortunately, another illness with my dad right after 9/11, and we lost him. My son, however, is alive and well, if anyone is worried. 

But it was really interesting when you're at those points when you're on the other side of the bed and you get to experience really complicated acute healthcare. I mean, no parent ever wants to be told that their kid's the sickest one in the hospital at an academic medical center, but these are the things that build who we become. And it was an ICU nurse, a pediatric ICU nurse who looked across the bed at me during his ICU stay and said, “What do you do? Because you're very curious. You ask a lot of questions.” And I was just being a mom, I was being an advocate, a mom, but also I wanted to understand what was happening. At the time I was running a Montessori school. And she said, have you ever thought of nursing? I really hadn't considered it at that point. A year and a half later, we ended up with my dad in the medical ICU, same hospital, and he had interstitial pneumonitis, a similar situation.

This time, I'm the daughter, I'm the advocate. I'm trying to understand. And again, the questions come, “What do you do?” And I had kept in touch with that pediatric intensive care nurse who had cared for my son, and she had introduced me to a direct entry program, Massachusetts General Hospital Institute for Health Professions. And it was an opportunity that she had taken. She had transitioned from biomedical sales to being an ICU nurse and nurse practitioner. And I had started to look into it and there was something in me that was clearly pulling me towards it. And my father passed away on October 27th, 2001. By January 15th, 2002, I was taking my prerequisites. By September, I was fully matriculated, and I never looked back and I've never regretted it.

Nursing has opened incredible doors. And when I have the opportunity to speak to people who are considering the transition or who are in nursing school, I mean, I could not have imagined 25 years ago that I would be sitting here at Duke University as part of the health system, having the honor of serving all of these nurses and patient care services staff and being able to really be part of what the future of healthcare looks like. Only nursing gives you those chances.

Joni: 

Oh my goodness, Terry. I mean, just to hear your story, the sense of pride that is sort of welling up in me. I mean, first of all, kudos to those acute care nurses who were recruiting you in the midst of that and for spurring your curiosity. I love that, and I love that about nurses as well. But the reason I just appreciate your story and career so much is because as I've grown as a leader, I have just been enthralled and enamored with second and third career or fourth career, whatever, career nurses. They bring such unique perspectives, truly diverse perspectives to patient care. And so from your perspective, what do you think about the backgrounds of second and third career nurses enriching the community and elevating our care provided? I mean, clearly I'm biased and you are too likely, but I'm curious from your perspective. We don't hear too much talk about this group of nurses, honestly.

Terry:

Well, I think the thing that I love the most about, I'll call them, “second career nurses,” is that it's that wealth of diversity. And the thing that makes us better is when we bring diverse opinions, different ways of thinking about things, innovation, all of that coming together as part of a care team helps us move forward faster because it pushes us to think differently. Because people do come with different perspectives, maybe finance, maybe manufacturing, who knows? But it's that diversity that really enriches the profession. 

Joni: 

And so you talk so beautifully about this enrichment, and I mean, you previously said things like “only nursing, the profession of nursing can give someone that opportunity.” From your perspective, what are some of the rewarding aspects of nursing that we might need to remind ourselves and the public about, especially in today's challenging environment?

Terry: 

It's really interesting. It's the why, right? We always have to reground ourselves in what led us here, what ignited the passion. For some, it's the science, it's the innovation, it's being part of being able to improve the human condition. I think for many of us, it's really funny. When I started, I thought I wanted to be only in the ICU, really wasn't interested in longitudinal care, any of that yet. My very first job was an aide in oncology, inpatient oncology at Mass General. And I fell in love with the patient population and I never left.

And as a nurse practitioner today, I continue to care for GI oncology patients. And what I loved about it is you meet people, they've been given this life-changing news, and I think nursing is all about those junctures in our lives. And sometimes it's the highest of the high, the birth of a child, someone being cured of a disease, a great outcome from a surgery, but also sometimes it's the lowest of the low. Someone's been handed a terminal diagnosis or they're in an ICU battling a disease that they're likely not going to be able to recover from. And where nurses really have a unique, and I believe honored place in all of this is that we get to be part of it, and we get to help people through those transitions no matter what they are.

Joni: 

Yeah. I wholeheartedly agree. Terry, I forgot for a moment that your background was oncology. That's my clinical background too. And very similar to you, I wanted to do labor and delivery because I thought I wanted those very small interactions, but through some series of events ended up in oncology early in my career. And I agree it was a subspecialty or a specialty that I didn't realize that I would love it until I stepped into it. And it's interesting because as I've stepped into other areas of nursing through leaders growing me stepping into cardiovascular care or orthopedics or trauma, I have found that I like those two. I love those two because it's the people in those environments that are just absolutely incredible. So yeah, I wholeheartedly agree with you. And it's easy to forget your why in the middle of all of the mess at times. And so regrounding in “the why” is key. I think that's gold. Terry.

I'm going to shift over and start talking about Gen Z nurses because for some reason, and I feel like this happens every time a new generation enters into nursing, is that we always have these conversations about how the next generation is so different, and every generation is different, albeit we all I think want a lot of the same things. And Gen Z has their own unique whys in the midst of why they're doing nursing. And so with Gen Z nurses having distinct needs and expectations, just like every generation of nurses before them has had those unique needs and expectations. How is your organization redesigning career programs to support their profession, professional and career growth and development?

Terry:

That is a great question. And we are building the plane as we're flying it. So we are in the midst of some organizational transformation. And one of the things that we're focused on is redesign of the career ladder, ensuring that we've got equity and professional practice built in. I would say one of the things that's happened is there's been a shift a little bit away from professional practice towards a more transactional culture, and we need to swing back and find that happy medium. People expect to be paid fairly and equitably. We can build that into a career ladder framework without creating a whole lot of extra administrative burden. And that's the work we're trying to do. And we're also trying to build out clearly distinct pathways for people to grow and develop informatics, education, regulatory quality improvement administration. And it was really interesting when we were talking to a whole group of nurses about this getting feedback, they pointed out, well, what about those of us who really just want to be excellent clinicians. We should have had clinical excellence baked in. But it's so very interesting because generations ahead have been very keenly focused on that advancement. What's my next step? Am I going to be an administrator? Am I going to be a nurse informaticist? Am I going to go and get an MBA? What's my next step? And this generation, they want to be valued for being excellent clinicians. And how awesome is that? 

Joni: 

Yes, absolutely. Absolutely. I think it's interesting that you say that, Terry, because I'm an older millennial nurse, and so I feel like especially with the millennial generation, that was a big part of our thought process. “What's my next step? What's my growth?” And then we had this large concern of nurses totally leaving the bedside. And so I do have a sense that that is shifting as well, that because we're finally, I feel like putting our money where our mouth is and our feet step together to say, you are a nurse leader where you are in direct care. So I love that, Terry, that you're making sure that nurses who want to provide exceptional clinical care over the course of their career have continued growth and are valued where they are. Sounds really easy. I'm sure there's a lot to it. So TBD, we will all be watching you and definitely want to see and hear more as you work through that. So recruitment and retention strategies, they too vary across generations, and I love that that nurse recruited you straight across the bedside in the midst of life. What are some of the key differences that you're seeing and experiencing and how are you addressing them at Duke Health?

Terry: 

Again, interesting times because we have this, we are getting back to where we started. We were talking about the narrative coming out of the pandemic. There is this intense narrative around shortage. And so how do we respond to that? And when I think about recruitment, I'm recruiting everywhere, but where we're really doubling down is actually getting kids in elementary school and high school interested and engaged in STEM. We are in a very fortunate, unique place at Duke because we are participating in this Bloomberg grant together with the Durham Public Schools and Durham Tech, and we're creating an early college around health professions, nursing, surgical techs, other disciplines, and we're thinking really longitudinally. It's not just about putting a person in a seat, it's about recruiting an individual who's part of your community and how are you going to work with that person and not just get them onboarded and competent in their job, but how are you going to support them throughout their career? The one place where I think just about every health system is focused is that zero to three year tenured staff, and a lot of it is they come on board, they've had a bad onboarding, they don't feel confident. Well, we need to address that with better education and onboarding, which by the way, we're doing with all of this redesign work. But the other piece of it is, okay, once I'm clinically competent, confident, what's my next skill?

They don't necessarily want to move upward, but they want to branch out. So then how do we work with our workforce and develop them so that they don't have to go on Google or LinkedIn and be looking for jobs that are interesting outside the system. We want to meet with people, career counsel them, and work with them around opportunities to really broaden and deepen their skillset. So we launched an internal center for career and professional development so that staff have a place to go to talk to some senior staff who know the different roles and can help guide them.

Joni: 

Yeah. Wow, that's incredible. I have long thought about career ladders and I have shifted my thinking to thinking about, and you just spoke to it as my growth as a lattice. Rather than thinking I have to continue to climb up and up and up and up and up, and that's the only way to grow that my growth can be lattice like. And that's thanks to other nurses in my profession, in my career who have said, “Hey, there's more than one way to grow, lady.”

I love that you're developing the systems and the processes to help nurses see that as they're pulled to grow in those directions. That's really beautiful. Well, Terry, we have certainly talked about quite a few things already today. I love your perspective on second career nurses on owning the way we talk about and shape our profession and driving to support nurses across all generations. And so I'm always curious what curious leaders like yourself are reading or doing to sharpen your skills, and so what are you reading, doing, learning about these days to spur your thinking or nourish your soul? Do you have any recommendations for us?

Terry:

I've been keenly focused in two areas, which are very different because of my background in GI oncology. I'm fascinated with all of the emerging research that's coming out around the microbiome and the importance of nutrition and food as medicine. So I love learning about that. The other piece is technology and AI, and I don't think any nurse leader can avoid it. We have to embrace it. We have to learn about it. There's one very interesting book that I read recently, The AI Revolution in Medicine by Peter Lee. It's available by audio. It's a great overview because as I came into this role, we've got this incredible relationship with Microsoft, and we're working on the ambient voice recognition and all of that work, and it was just a great overview. So I'm trying to learn as much as I can in that technology space.

Joni: 

Yes, this is what I'm talking about. I mean to see how diverse your learning is as you're studying AI foundation principles plus the microbiome of our bodies. I mean, again, this kind of leads me back to what we've talked about with second and third career nurses is that we all just kind of pull in the things that we're passionate about and we love to the benefit of patient care. So I love that. Terry, thank you for those recommendations. So again, we talked about a lot today, Terry. Ultimately, what would you like to hand off to nurse leaders at all levels and in every setting today?

Terry: 

Optimism. We have an incredible opportunity for all of the narratives that are swirling right now over the finances and staffing shortages. Wow, there's an incredible amount of good going on. There's shifting paradigms around moving patients from the acute setting more into the home setting. There are incredible opportunities for growth and development. Healthcare is a team sport, and nurses are right there in the thick of it helping coordinate and interweave and really bring that team together around the patient, and there's incredible opportunity. We need to own that narrative, and we need to be optimistic and hopeful for a bright future. It's going to look very different than it's looked historically. Care is changing, but we are here to help architect it. 

Joni: 

That is beautiful. Terry, thank you. I'm going to have to replay this because I feel like I can do anything after talking to you, honestly. Well, Terry, I know that people are going to want to connect with you after listening to this podcast. So where can people follow or connect with you to continue learning from you and find more of your work?

Terry:

Well, thank you for offering that up. I can always be reached on LinkedIn. So I'm at linkedin.com/in/terrymcdonnell/. I can also be reached here at Duke University Health System. Please feel free to email me again, it's terrymcfonnell@duke.edu. I always love to take opportunities to speak to people like you and talk to the upcoming generation. So if I can be of help or service to anyone who's even considering a transition, please feel free to reach out to me.

Joni:

Excellent. Everyone, be sure to find Dr. Terry McDonnell on LinkedIn or via email. Terry, thank you for sharing your time, your energy, your expertise, your passion with us today so that we can architect a bright and optimistic future for nursing. Thank you so much for that.

Terry: 

Thank you so much, Joni. It's been such a pleasure.