Theresa (Terry) McDonnell, DNP, ACNP-BC is Chief Nurse Executive and Senior Vice President at Duke University Health System and Vice Dean for Clinical Affairs at Duke University School of Nursing. She holds both roles simultaneously, a structure she has used to architect a first-of-its-kind academic-practice partnership accelerating evidence-based innovation across the enterprise.
At Duke, she leads transformational initiatives, including the Duke Co-Care Model redesigning inpatient nursing care using AI and virtual nursing technology, and a landmark workforce equity program consolidating 1,700 advanced practice providers into a physician-aligned employment structure.
A Gold Stevie Award winner for Most Resilient Female Leader and a Modern Healthcare Most Influential Clinical Executive, she is a Forbes contributor and global keynote speaker on AI in healthcare, workforce transformation, and advanced practice leadership.
How did your career in healthcare start?
My career plan did not include healthcare. In 1996, I got the call that my 50-year-old mother had a massive stroke, and she was in critical condition and may not make it through the night. After a prolonged hospitalization and the amputation of her left leg, lingering traumatic brain injury, and loss of her dominant hand, we brought her home. The healthcare system wasn’t equipped to care for her the way she needed, so my husband, my father, and I brought her home to our two-bedroom apartment with a newborn and a 4-year-old and taught ourselves how to care for her wounds and rehabilitate her.
Years later, my eight-year-old son spent twenty-eight days hospitalized with a rare complication from strep throat. That’s when something clicked, and I made the decision to go back to school with a young family and no clinical background, not knowing exactly where it would lead, only that I was called to this work.
You partner with Duke’s School of Nursing, School of Medicine, School of Engineering, and School of Business to create groundbreaking healthcare solutions. Can you share a few of the innovative outcomes that have come from this work?
The most exciting work happens when we stop working in silos and start solving problems together. One of the clearest examples is our Co-Care Model, which brings computer vision and virtual nursing technology to the bedside, allowing experienced nurses to extend their presence across multiple patient rooms simultaneously. We have been live for approximately 2 months and have seen a reduction in harms and improved staff and patient satisfaction.
Our internally developed tools, like Sepsis Watch and the Deterioration Index, provide early signals to clinical staff to intervene, decreasing ICU transfers for sepsis and ensuring that patients receive the right care in the right setting based on clinical complexity and risk. None of these initiatives would be possible without the cross-disciplinary thinking that Duke uniquely enables.
What is the most important leadership skill you’ve built, or are continuing to build?
The skill I return to constantly is the ability to hold strategic clarity and operational reality in the same frame at the same time. In a system the scale of Duke, it is easy for leaders to drift toward one or the other: all vision with no traction, or all execution with no direction. What I have learned, and am still learning, is how to transition fluidly between those registers. To sit in a conversation about the future of AI in healthcare and then walk into a unit and understand exactly what that means for the nurse at the bedside. That translation work is where leadership either earns trust or loses it. The key to all of it is staying genuinely curious and always learning.
What might the WBL network be surprised to know about you?
My first job out of college was as a high-yield bond trader at a fund management firm in Boston. Not exactly a typical origin story for a health system executive. From there, I worked as a pastry chef in the family restaurant and later ran a Montessori school.
What I didn’t realize at the time was that every chapter before it was building something. The bond desk taught me to read risk and move fast. The kitchen taught me precision and how to lead under pressure. The classroom taught me that the best outcomes happen when you design for the person in front of you, not the system around them. I still practice clinically as a GI Oncology Nurse Practitioner. I understand the P&L, the patient, and the people in between.
