Blending lessons from baking and the classroom, Terry McDonnell, DNP, RN, senior vice president and chief nursing executive at Durham, N.C.-based Duke University Health System, brings a unique and human-centered approach to executive leadership.
Prior to entering healthcare, Dr. McDonnell worked as a pastry chef and Montessori educator, roles that have helped her to lead with empathy and adaptability, and empowered her to navigate some of healthcare’s toughest challenges without following the traditional script.
Becker’s connected with Dr. McDonnell to further discuss how her unconventional career journey has helped inform her healthcare leadership, the value of outsider perspectives and the lessons she’s learned.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How has your journey from pastry chef and Montessori educator shaped your leadership in healthcare?
Dr. Theresa McDonnell: My early career taught me to lead from the ground up, not from the top. Running a bakery taught me how to multitask under pressure, adapt in real time and stay calm when the stakes are high. All skills that are just as critical in a hospital as they are in a kitchen.
Later, teaching in a Montessori school reinforced the power of empathy, presence and personalized communication. That experience shaped how I approach team dynamics and decision-making today. I trust people not just by their titles, but by their ability to lead from where they are. Both roles instilled in me a deep respect for hands-on work and reinforced my belief that leadership is most effective when it’s human, humble and responsive.
Q: What challenges or advantages have you faced as a nontraditional healthcare leader?
TM: Early on, one of the biggest challenges was credibility. Since I was walking into clinical and executive spaces without the “typical” resume, I had to earn trust through action. But in hindsight, that was also an advantage. Because I didn’t follow the usual path, I wasn’t limited by the usual playbook. I asked different questions than my peers. I saw systems from the outside before I worked within them. That outsider perspective allowed me to spot gaps and bring fresh ideas to the table, from workflow redesigns to team engagement strategies. That perspective was especially useful when I was tasked with opening a new clinical building during the COVID-19 pandemic while also leading an organizational restructuring and system merger. And perhaps most importantly, it helped me lead with humility. I’ve never forgotten what it’s like to be the person still figuring things out.
Q: Can you share a setback that taught you an important leadership lesson?
TM: After opening a family-run bakery, we had to close it just a few years later and declare personal bankruptcy. At the time, it felt like a failure in every way, from a financial standpoint to an emotional one, and especially professionally. But in reality, it was one of the greatest leadership lessons I’ve ever had.
It taught me how to lead through loss, regroup and rebuild. I learned how fragile systems can be and how essential it is to be resourceful, transparent, and calm under pressure. That experience shaped the way I now approach everything from crisis response to supporting my teams through change. I learned to lead with presence over perfection.
Q: What advice would you give to emerging leaders with nontraditional healthcare backgrounds?
TM: Don’t discount the value of what you’ve already done. The skills you’ve built in other industries, whether it’s customer service, teaching, caregiving or entrepreneurship, are not detours. They shape how you lead, approach team dynamics and navigate crises. Healthcare needs creative thinkers, empathetic listeners, and people who can operate without a script. So instead of waiting to feel “ready,” I encourage you to step in, stay curious and bring your whole experience to the table. The field is better for it.
Q: Anything else that you would like to add?
TM: It’s essential that we broaden our definition of leadership, particularly in healthcare. It’s not just about credentials or traditional progression. Some of the most effective leaders I know are the ones who’ve led in kitchens, classrooms and living rooms before ever stepping into an executive suite.
If we want to build an innovative and truly human-centered healthcare system, we have to value the people who bring human experience into every decision they make. I’ve led through times of intense pressure and uncertainty — opening new facilities, managing organizational change and navigating moments when there’s no script to follow. Those are the times that teach you what kind of leader you really are.
