In this conversation, Dr. Tiffany Street shares her journey through nursing, leadership, and clinical practice at Vanderbilt Heart and Vascular Institute. She currently serves as the Associate Nursing Officer and continues to practice as an acute care nurse practitioner in vascular surgery, a specialty she has loved since 2005. She oversees clinical operations across 23 clinics in Tennessee, with additional locations in Kentucky, Indiana, and Alabama, making her service line the first at Vanderbilt to operate in four states. Dr. Street talks about her unconventional path into nursing. She originally studied biology and chemistry with plans for medical school but discovered the nursing model through a nurse practitioner she worked with after graduation. She completed a bridge program at Vanderbilt, moved into cardiac surgery at the VA, and eventually shifted into vascular surgery, where she has spent most of her career. She later pursued leadership, which eventually led her back to Vanderbilt in a director role and then into executive nursing leadership. Her motivation for earning both her MSN and DNP grew out of wanting to serve, lead, and better understand the systems guiding patient care. A major theme she returns to is balance. With over 400 FTEs under her leadership, she emphasizes the importance of motivation, communication, and purpose. She believes strongly in starting with the “why” when leading change and in staying connected to frontline staff and patients. Continuing her own weekly clinical practice keeps her grounded and gives her credibility with the teams she leads. She notes the importance of reflection, feedback, and the role of informal leaders in shaping culture. Dr. Street also speaks passionately about advocacy and professional governance. Her involvement in organizations like the Society for Vascular Nursing and the Tennessee Nurses Association grew from realizing how deeply public policy affects nursing practice. She encourages nurses to get involved at any level—through professional organizations, unit councils, or grassroots advocacy—because their voices directly impact patient care and the future of the profession.