Édition 19.1.2
Stretching Across Boundaries : A Leadership Journey into Global Nursing, Education, and Policy
From the beginning, my career in nursing has been guided by a fundamental belief: that access to quality healthcare is a human right—and that nurses, when empowered, are catalysts for global transformation. My path has not been a straight one, but it has always been intentional. Through strategic personal planning, I have continuously sought to align my beliefs and strengths with regional, national, and global needs, asking not only, What can I do? but Where can I make the greatest impact?
Like many nurses, I initially went into nursing knowing that I wanted to have a career that was flexible, and most important needed it to be meaningful. I came to Quebec as a second-degree nursing student at McGill University, intent on making a difference after traveling the world and seeing the eye-opening extreme poverty, disability, and the critical lack of basic healthcare for countless vulnerable individuals across various regions around the world. Subsequently, I worked in Canada a bit, then moved to the USA later becoming a Nurse Practitioner (NP) and NP business owner, an Advanced Practice Nursing (APN) educator and researcher, and ultimately a Global Nurse Consultant.
While much of my professional identity is now tied to international work in nursing education, advocacy, and policy, my early leadership roots are regional and deeply personal. Serving as the NP Government Affairs Chair for Eastern Virginia and later as the elected Representative for the State of Virginia to the American Association of Nurse Practitioners (AANP), I helped lead successful legislative efforts that expanded scope of practice for over 8,000 nurse practitioners and access to health care throughout Virginia. It was during this time that I began to fully appreciate how policy is not an abstract system—it’s a tool that, when wielded strategically, can expand access, reduce suffering, and elevate entire professions.
This commitment to strategic leadership expanded as I took on national and global roles. I was invited to join a United Nations Foundation team as an expert advisor, where we developed a Global Health Policy Fellowship that has since been completed by students from 53 universities across nursing and allied health disciplines. The goal was simple: to create future leaders who can think critically about global health policy, grounded in equity and informed by real-world experience.
At the intersection of education, innovation, and global health I saw an opportunity to make a lasting contribution. Over a decade ago, I created one of the first graduate level nursing entrepreneurship university courses in the U.S., designed to help advanced practice nurses (APNs) develop business models that would improve healthcare access in underserved areas. We integrated telehealth early on—not as a trend, but as a necessity. Since its inception, this course has empowered over 800 APNs and contributed to nurse-led clinics that now serve over 10,000 patients across rural Appalachia and inner-city communities in several states. With this success, I took the nurse entrepreneurship course concept global, presenting and publishing on it internationally. For this work, I was honored to be the first nurse inducted as an Entsminger Entrepreneurial Fellow, however, I am most proud that all of these nurses are not just providers—they are change agents, business owners, and leaders in their communities.
My commitment to global health deepened through a Fulbright Scholar Award (2018–2019) in Sub-Saharan Africa. At the University of Botswana (UB), I worked with the World Health Organization Collaborating Centre (WHOCC) to expand access to nursing education and care through telehealth and distance learning. We transitioned nursing and health sciences courses from in-person to online, increasing access across the continent. When the COVID-19 pandemic disrupted education worldwide, this model enabled nurses and APNs to continue their studies—making UB the only institution in the country to maintain educational continuity.
In addition to building this digital infrastructure, I led a WHOCC telehealth hypertension control initiative for primary care nurses around the country, and also collaborated with the UB Center for eHealth to integrate telehealth into hospitals and clinics, extending care to patients throughout Botswana. These models inspired similar initiatives at the University of Ghana, and I continue to present and publish on these outcomes, advocating for scalable innovations in global nursing education.
Beyond institutional work, I have contributed to shaping the global policy landscape. As Chair of Research for the International Council of Nurses (ICN) NP/APN Network, I coordinated with an international team to map competencies for advanced practice nursing—a foundational project for countries developing APN roles. That research informed the ICN Guidelines for Global Nurse Prescribing (2021), in which I co-authored the nurse prescriber education section. These guidelines are now shaping nursing practice and legislation around the world.
In 2020, I stepped into a new role as Deputy Director of the ICN NP/APNN Global Academy of Research and Enterprise. This position allowed me to expand my focus further, leading policy collaboration with WHO, Jhpiego, and health care leaders across Africa to implement the APN role on a national and regional scale. These partnerships are not only reshaping health systems—they are rewriting what’s possible for nurses in policy leadership.
Currently, I am living in Southern Africa once again on a second Fulbright Scholar Award, serving as a Visiting Professor at the University of Eswatini and working with the Ministry of Health’s Nursing Leadership Initiative. I am teaching in the Advanced Practice Master’s programs and supporting the development of the Family Nurse Practitioner role—a model that holds promise for reshaping primary care delivery across the region.
Across each chapter of my journey—whether advocating for policy reform in Virginia, launching educational programs in Sub-Saharan Africa, or mentoring nurse entrepreneurs—I have remained anchored by a core question: How do we stretch ourselves beyond borders, disciplines, and roles to meet the evolving needs of the world?
For my initiatives, I am humbled to have been inducted as a Fellow of both the American Academy of Nursing and the American Association of Nurse Practitioners, and to have received the Distinguished Nurse Practitioner Award for the State of Virginia. But the greatest reward lies not in the accolades—it is in the students who launch new clinics, the patients who now receive care, and the communities who see what is possible when nurses lead.
This work has taught me that purpose is not found—it is built. And building it requires strategic reflection, courage to step into unfamiliar spaces, and a relentless commitment to equity and innovation. For me, that is the essence of nursing leadership.
References
Stewart, D., Schober, M., Nissen, L., Ladd, E., Gray, D. C., Lemarche, K., Bornival, M., Sevilla, S., Kroezen, M., & Wong, F. (2021). ICN Guidelines on Prescriptive Authority for Nurses 2021. Geneva: International Council of Nurses. https://www.icn.ch/system/files/2022-08/ICN_Nurse_prescribing_guidelines_EN.pdf
Author
Deborah C. Gray, DNP, MSc, FNP-C, ANP-BC, CGNC, FAANP, FAAN
Fulbright Scholar, Visiting Professor, University of Eswatini School of Nursing
Emerita Clinical Associate Professor, Old Dominion University Ellmer School of Nursing
Quote (APA)
Gray, D. (2025). Stretching Across Boundaries: A Leadership Journey into Global Nursing, Education, and Policy. Revue de l’infirmière praticienne spécialisée du Québec, 19(1), 46–48. Association des infirmières praticiennes spécialisées du Québec (AIPSQ).