What determines the career path of leaders? Do leaders always know what they want to do, or do they find direction by mere accident?

We asked three nurse leaders across Canada to retrace their career path and reflect on how they got to their current positions.

Carolyn Hoffman

Carolyn Hoffman is the Principal Nursing Advisor for the Department of Health in Saskatchewan. She advises the Minister, Deputy Minister and Senior Leadership of Saskatchewan Health on the development and implementation of strategies to address nursing issues.

Her background includes quality improvement and risk management responsibilities at both provincial and district level. She was the Quality Improvement / Risk Manager for all programs and Clinical Educator for the Emergency Departments in the former Regina Health District. Carolyn has extensive experience as a Registered Nurse specializing in General Surgery, Cardiovascular Surgery, Critical Care, Home Care and Emergency.

Carolyn has worked provincially and nationally to improve patient safety and was the consultant writer / editor of the September 2002 report, Building a Safer System: A National Integrated Strategy for Improving Patient Safety in Canadian Healthcare, and the co-author of the Canadian Patient Safety Dictionary (2003).

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I decided early in my nursing career to take the path less travelled and to grow professionally by seeking new work experiences. My initial goal was to focus on gaining a variety of clinical skills and expertise. Patients in the coronary care unit held my interest for a few years until emergency nursing became my passion. I experienced first hand how a team of health providers can save lives and sooth sorrows in a truly collaborative environment. Moving into an emergency clinical educator position provided an important opportunity to develop programs and policies.

Ambition, and the urge to discover new ground, motivated me to seek a quality improvement / risk management role after several years of teaching. My understanding of safety and quality grew as I moved from the courtroom to the boardroom and along the way became inspired by Dr. Don Berwick's belief that all decisions should ultimately benefit our patients. While in this role, I collaborated with several other professionals to develop a root cause analysis policy that would help the organization to address patient safety issues.

The high point of my career occurred after I moved to the Provincial Department of Health and began working with the National Steering Committee on Patient Safety. The Chair, Dr. John Wade, led a national group of diverse and committed professionals in a process that ultimately resulted in the release of Building a safer system: A National Integrated Strategy for Improving Patient Safety in Canadian Healthcare. I am grateful that the Steering Committee asked me to work with them as the consultant writer / editor of the report. The experience was a powerful example of how much is accomplished by collaborating across the healthcare sector and with government.

As Principal Nursing Advisor, I am able to indulge my passion for the profession by working with a variety of partners to address relevant nursing issues. From nursing seats to workplace initiatives, there is a great deal of work being done and more to be accomplished. French novelist Jacques Anatole Thibault, writing as Anatole France, wrote "To accomplish great things we must not only act, but also dream; not only plan, but also believe". The quote is a good summary of the advice that I would give to someone wanting my job. I would also suggest taking the career path less travelled.

Sue Matthews

Sue Matthews is the Provincial Chief Nursing Officer for Ontario. An experienced nursing leader, she has held a variety of positions as a staff nurse, nurse educator, manager, director of inpatient programs, Chief of Nursing and Professional Practice.

Sue holds an R.N. Diploma, a Bachelor of Arts in Health Studies, a Masters of Health Science, Nursing, and is currently enrolled in a Doctorate in Public Health at Charles Sturt University. She is also a Fellow of the Wharton School of Business in Philadelphia.

Sue is the recipient of the RNAO Leadership Award in Nursing Administration for 2002, and York Region's In Celebration of Women Award for 2003. Sue has consistently been involved in provincial activities and has held positions as Treasurer of the Association of Nurse Executives of the Greater Toronto Area, and both Treasurer and President Elect for the Nursing Leadership Network of Ontario. She is the founder of the Professional Practice Network of Ontario.

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As a point of care nurse working nights on the mixed surgical unit, it was 8:00 p.m. when the announcement went over the p.a. system, "The time is 8:00 and visiting hours are now over. Would all visitors, please leave." This was my cue to start my evening rounds. By the time it was 8:30, I had arrived in the room of Mrs. 'X', a 38-year old woman who was recovering from a D&C that day. (OK, I'm old, because they no longer stay in overnight.) She was in a four-bed room, and there was a man at her bedside. I politely asked him to leave, stating that visiting hours were over half an hour ago. He stood up, and looked me in the eyes, and said, "My wife and I have just spent seven years, and $35,000 to obtain the dream that we have just lost. And you are telling me I can't grieve with her?"

That was the turning point in my career. I knew then, as I pulled up a geri chair and got him a blanket, that I was going to be different. I was going to make a difference in the lives of the people I cared for, and devote my career to making sure that this could be the case for all nurses. Within months, I had enrolled in my bachelor's program. (I eventually completed a master's degree in Nursing and am still involved in learning, as I pursue my Doctorate in Public Health.) I took a job as a nurse educator, which led me to a career path in education, management and professional practice. At each crossroads along the way, I asked myself if I could continue to make a difference in the lives of the people we care for. As the Provincial Chief Nursing Officer, I believe that I can make a difference on a broad scale - supporting nurses to make a difference in people's lives each and every day. I devote my career to making this a reality, always keeping in mind Mr. And Mrs. 'X'.

Alice Thériault

Alice Thériault is the Chief Nursing Officer and the Nursing Resources Advisor with the New Brunswick Department of Health and Wellness. Involved in Health Human Resource Planning, management and development for the province, with a focus on nursing human resources she provides advice and expertise to the Minister and Deputy Minster on a wide range of provincial health policy and program specific issues related to nursing.

A graduate of the University of Montreal's Master of Science Nursing Program, Alice has 30 years of varied and progressive
nursing experience including leadership positions at the regional and provincial levels as Assistant-Director of a Nursing Services of a Regional Hospital, Senior Hospital Liaison Officer and Regional Director of a Community Mental Health Services. She is also involved at the national level as a member of a variety of national committees, which includes being the Canadian Nurses Association nominee on the Healthcare Advisory Committee and advising the Commissioner of Correctional Services Canada on healthcare issues in federal prisons.

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My first year of nursing practice as a new graduate from the Université de Moncton baccalaureate of nursing program was as a nurse-in-charge with the Victorian Order of Nurses (VON). Not conscious at the time that management would become an integral part of my career life, I moved from VON to hospital nursing administration, to hospital liaison officer at the provincial level, to regional director of community mental health services, current to my position as nursing resource advisor and chief nursing officer with the New Brunswick Department of Health and Wellness.

Part of the second class of graduates from the new French BN program, my career path was not paved ahead of me. The New Brunswick healthcare system was not ready at the time to integrate the baccalaureate graduates as part of the nursing care team. Perseverance and acceptance of being a pioneer, I had the pleasure to be part of the decision to make the BN as entry to practice in NB.

After 10 years of nursing practice, I decided it was time to get a master's degree. I moved to Montreal and obtained a MSc in administration of nursing services. At that time, master's degrees were for university teachers. My desire was not to move to a teaching career but to stay in a health service delivery management role.

The opportunity to gain experience as policy advisor and as manager of direct health service delivery has permitted me to grow as a person, as a nurse and as an open minded leader by witnessing the impact of policy on practice. Without any clearly defined career plan, I fully assumed my responsibilities to the best of my knowledge and abilities, working flexible hours and still maintaining work/leisure equilibrium. Walking to work has become a trademark.

To someone who would like my job, I would advise to nurture an eagerness toward continuous learning to keep up with changes in the profession; move constantly toward new challenges; be honest and fair to yourself and others. Knowledge, skills and sound judgement are the foundation of any rewarding career.Facing challenges as opportunities helps, develop an attitude that nothing happens in a vacuum, and for every problem there is a solution. Collaboration and teamwork bring results that are greater than anticipated.

I am grateful to my mentors and supervisors who believed in me and took the risk in offering the positions I held over the past 34 years.

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