By: Ashley Oates, Yev Ostrovskiy, and Dan Nguyen
Long before they were leading organizations, many healthcare executives were caring for patients and learning lessons that continue to guide how they lead today. This article features conversations with two healthcare leaders whose careers reflect that evolution, offering insight into how early clinical experiences shape leadership philosophy, decision making, and organizational impact.
Juana Gonzalez, MSN, RN, serves as Associate Chief Administrative Officer and Director of Nursing and Clinical Practice at GSAA Kaiser Permanente. With more than 16 years of experience across inpatient and outpatient settings, Juana is known for her hands-on, integrity-driven leadership style and deep commitment to clinical excellence. Her career reflects a progression from bedside nursing to executive leadership, with a continued focus on workforce development, advancing health equity, and collaborating across regions to improve access, quality, and patient outcomes.
Tamara (Tammy) Powers, BSN, MBA-HCM, FACHE is the Chief Executive Officer of Sutter Roseville Medical Center, a tertiary acute care hospital serving Sutter Health’s Greater Sacramento Division in Northern California. With more than two decades of leadership experience in women’s and children’s services and hospital operations, Tammy brings a collaborative, mission-driven approach to her role. Her career reflects a transition from clinical nursing practice to executive leadership, grounded in operational excellence, physician education, service line development, and a strong commitment to community impact.
1) What experiences in your clinical practice motivated you to pursue leadership, and what were the most significant adjustments you encountered during that transition? Looking back, what do you wish you had known earlier?
Juana Gonzalez, MSN, RN:
My decision to move into leadership was driven by what I saw every day at the unit level. I experienced operational challenges firsthand and wanted to improve the working environment for clinical staff. I often felt that certain processes could be improved and that stronger partnerships between staff and physicians would ultimately lead to better patient care. Early in my career, I struggled with limited support and training, and that experience stayed with me. I wanted to make sure future nurses and nursing assistants were better prepared than I had been. The biggest adjustment was shifting my mindset from focusing on individual patient care to thinking at the system level, where the goal is long-term improvement rather than immediate fixes.
I wish I had understood sooner how complex leadership truly is. From the bedside, leadership can appear straightforward, but it is far more nuanced in practice. As clinicians, we are trained to solve problems quickly, but I learned that quick solutions may address the moment without solving the underlying issue. Sustainable leadership requires deeper analysis and meaningful stakeholder engagement. I also learned not to take challenges personally and to step back so I could see issues through a broader organizational lens. Finding trusted mentors and peers was essential, especially when I became the most senior manager in a high-turnover environment just six months into my first Senior Manager role.
Tammy Powers BSN, MBA, FACHE:
I started my career as a bedside nurse in the neonatal intensive care unit. One of the things I loved about that environment was the variety of roles I could take on, from bedside nurse to charge nurse to what we called a “life support nurse,” where I led resuscitations and stabilization until a physician arrived. In those moments, I realized how much I enjoyed taking the lead, making sure everyone knew their role, and trusting the team to come together for the baby. A leader I worked with later told me I had reached the ceiling of roles at the bedside and encouraged me to consider leadership. That conversation made me reflect on the next step in my career and whether to pursue as a neonatal nurse or step into a role focused on leading people and operations.
The biggest adjustment was letting go of being the expert. Clinical work followed clear algorithms, while leadership was far less defined and required comfort with ambiguity. I wish I had known sooner that leadership is not about becoming the expert again. My first leadership role was outside of neonatology, which made that lesson even more apparent. Early on, I felt pressure to prove myself by having all the answers. Over time, I learned that effective leadership is about recognizing who the experts are, building trust, and creating space for others to lead. Humility and curiosity mattered far more than technical mastery.
2) Which leadership skills did you need to develop beyond your clinical training, and what formal or informal learning has been most valuable? How do you continue building these skills while managing day-to-day demands?
Juana Gonzalez, MSN, RN:
One of the most important skills I had to develop was adaptive communication. Moving from peer to manager required redefining relationships and establishing professional boundaries, particularly in a unionized environment. Staff sometimes challenged my authority, not out of resistance, but because trust dynamics had changed. The most valuable learning did not come from formal training programs. It came from experience, consistency, and follow-through. Being consistent and transparent was critical to building credibility and maintaining trust during that transition.
Confidence and humility are equally important. In new environments, I encountered skepticism related to my age and experience, including being asked how long I had been a nurse or a manager. Instead of allowing that doubt to undermine me, I focused on clearly expressing confidence in my leadership while staying open to learning. I remind myself that frontline teams are the experts. My role is to support them, remove barriers, and create the conditions they need to succeed.
Tammy Powers BSN, MBA, FACHE:
Formally, earning my MBA was very intentional. My first leadership role was as a nurse leader, and I did not grow up on the operations or business side of healthcare, so I knew I needed to close that gap. I chose an MBA rather than a master’s in nursing because I wanted exposure to strategy, operations, and economics while still being able to apply those concepts in a healthcare setting. The hybrid program I selected helped me learn how to see the big picture and translate it into action within a clinical environment.
Informally, one of the most important skills I had to develop was listening with confidence. Early on, I often listened more than I spoke, which at times may have been perceived as a lack of confidence. What I learned is that listening only adds value if you can synthesize what you hear, identify themes, and turn it into action. That skill became essential as I grew into leadership without a traditional operations background.
3)How do you foster trust and collaboration between clinical and administrative teams, and how do you address common misunderstandings that arise between them?
Juana Gonzalez, MSN, RN:
Trust is built through consistent actions, not titles or intentions. I am very intentional about making sure my actions align with my words. Proactive communication and transparency are central to my approach, especially during high-stakes situations such as regulatory surveys. When multiple stakeholders ask for the same information, it usually signals a communication gap. You can be doing excellent work, but if people do not know what you are doing, it does not matter. Providing regular updates and setting clear expectations helps reduce uncertainty and strengthens collaboration.
Tammy Powers BSN, MBA, FACHE:
I work very intentionally to remember what clinicians experience every day. They go into healthcare because they want to do good work, and my role is to support that by removing barriers and providing the right tools. I lead with appreciation and respect, and I try to be clear that my goal is partnership. When you keep the patient at the center and take care of the people providing the care, trust and collaboration tend to follow.
4) Can you describe a time you disagreed with a leadership decision and how you approached that situation?
Juana Gonzalez, MSN, RN:
I have encountered many situations where I did not agree with a leadership decision. I believe it is important to voice concerns respectfully and clearly explain the reasoning behind them. When I disagree, I make sure to communicate why. At the same time, once a decision is made, alignment is essential. Initiatives cannot move forward without collective support. Over time, I learned to move away from rigid thinking and toward a more flexible approach, one that emphasizes exploration and compromise. This was especially important during a complex accreditation process involving two hospitals and a new physician partner, where open communication helped transform early tension into a strong and effective partnership.
Tammy Powers BSN, MBA, FACHE:
There are times in leadership when decisions are made that you may not fully agree with. What matters is having the opportunity to share your perspective and then understanding what needs to be true for you to support the final decision. I experienced this when a pediatric unit had to close due to changing volumes. While the decision itself did not change, I strongly advocated to be the one to deliver the message to the team. They had built something they were incredibly proud of, and I felt it was important to show compassion and be present with them during that moment.
5) How do you see the relationship between clinical leaders and health administrators evolving in the next decade?
Juana Gonzalez, MSN, RN:
I see the future of healthcare leadership as increasingly interdependent. Clinical insight and administrative expertise must be integrated for organizations to succeed. Healthcare is becoming more complex, and neither role can function effectively in isolation. At the core, we are caring for patients, but healthcare is also a business. The next decade will require stronger collaboration, greater adaptability, and shared accountability as organizations navigate rising expectations and increasing complexity.
Tammy Powers BSN, MBA, FACHE:
I hope clinicians become even more engaged with administrative leaders in driving innovation. We cannot continue approaching challenges the same way and expect different results. Clinicians bring clinical expertise, and administrators understand the sustainability challenges facing healthcare. When those perspectives come together and we are transparent about the why behind decisions, we can create meaningful and lasting change.
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