Far horizons
Caitlin Crawshaw - 8 December 2023
Carmel Montgomery, ’07 MNur, ’20 PhD (photo by John Ulan)
Many of us take a circuitous route on our career paths. Others, like Dr. Carmel Montgomery, find their way with few, if any, wrong turns.
For Montgomery, who grew up in rural Saskatchewan, nursing was an obvious career choice.
“It offers opportunities for flexibility,” she says. “Not only where you live, but what type of job you have, because you don’t have to do the same thing for your whole career.”
Since earning her undergrad nursing degree almost 30 years ago, Montgomery’s career has taken her from rural Prairie hospitals to Wellington, New Zealand, and through a wide array of nursing roles.
She credits nursing with enabling her to evolve in unexpected ways to adapt to the dynamic reality of health care in the 21st century — ways she wouldn’t have imagined when she first set out to be a nurse.
Finding Opportunity in Adversity
Early on, Montgomery learned that although nursing offers a vast scope of work, geographical portability and flexible scheduling, the health-care system could quickly derail any well-laid plans. Her graduation in 1996 with a nursing degree coincided with hospital closures and nurse layoffs across Saskatchewan. After a short time working in a hospital in Saskatoon, Montgomery found a more stable opportunity at a hospital in the northern Alberta town of Peace River.
“It ended up being fantastic because I got to do everything — medicine, surgery, pediatrics, obstetrics, ICU and emergency,” she says. She particularly enjoyed intensive care nursing and decided to pursue extra training in ICU nursing. But after a couple of years, the health-care system across the country was still in flux. “All I could get in Canada were offers for casual work,” she says. She decided to look further afield and snagged a full-time job at an ICU in Wellington, New Zealand.
She and her husband moved to New Zealand in 1999, and Montgomery found herself working with nurses from 13 different countries. She learned about health-care systems and nursing around the world. When her husband was recruited to a job opportunity in Australia, the couple relocated to a rural community. In Melbourne, Montgomery found job placements through an agency and ultimately worked at 10 different hospitals. After that, she found a full-time job in Canberra, a small city in eastern Australia.
“It was fantastic and I would have stayed there forever,” says Montgomery, who felt that her ICU training and nursing education were greatly valued. But when her husband’s project came to a conclusion, the couple came back to Canada in 2003.
“We picked Edmonton because I wanted to do my master’s at the U of A,” she says. She started her master’s and began a new job as an cardiovascular ICU nurse at what would become the Mazankowski Alberta Heart Institute. In her mind, graduate school was an opportunity to hone her clinical skills, not a stepping stone to academic work.
“I was never going to do my PhD, I can tell you that,” she says, laughing now at the irony. “No nurses who work clinically are ever planning to do their PhD.”
An Accidental Academic
Montgomery pursued a master of nursing degree with the goal of becoming a clinical nurse specialist (CNS), which is similar to a nurse practitioner in terms of advanced clinical skills but focuses less on clinical cases and more on research, leadership and education.
As a master’s student, she focused her studies on critical care and cardiology nursing. Her thesis examined Patient Safety Indicators (PSI) — factors that put patients at risk of negative outcomes from health interventions, such as hypertension or diabetes — with a method to measure the unplanned outcomes associated with heart surgery. Although she loved the deep analytical work of graduate studies, Montgomery was happy to return to full-time nursing after earning her degree in 2007.
Over the next few years she worked in the cardiovascular ICU and as a part-time clinical quality consultant with Alberta Health Services, then moved to a job with Edmonton palliative home care as a clinical nurse specialist. But then she began thinking about how she wanted her career to evolve from there.
“It was a great job, but I was at a point in my career where I thought I should consider what I wanted to leave behind,” she says. “Like, what's my legacy of having worked all these years?”
Assessing how the system served palliative patients was part of her job at the time — and something she loved — but she wanted to go deeper and develop her skills further. “One thing I wanted to get better at was evaluating the services we are providing and how effective they are.”
Some of her colleagues recommended she do a doctorate to learn more about biostatistics, epidemiology and health economics. In 2016, she began a doctoral program in the Department of Critical Care Medicine in the U of A Faculty of Medicine & Dentistry.
Again, she didn’t begin her studies with the intention of being an academic. “I just love evaluating stuff,” she laughs. She ultimately completed a dissertation on how frailty — a patient’s vulnerability to poor health outcomes as a result of aging — impacts the cost of adult cardiac surgery in Alberta. Montgomery went on to do postdoctoral studies at the Institute of Health Economics, a research centre affiliated with the U of A that explores how we can best allocate health-care resources to maximize benefits for patients.
As time wore on, her fascination with research continued to deepen and she felt compelled to continue her nursing career in academia. She now works as an assistant professor in the U of A Faculty of Nursing and runs a multifaceted research program. She continues to study outcomes associated with frailty in the ICU population, including evaluating an ICU survivorship clinic that helps former ICU patients manage ongoing health issues.
As a nurse scholar, Montgomery seeks to help vulnerable patients by producing research that allows policymakers to fine-tune the health-care system to improve outcomes. However, she also hopes to benefit the nursing profession itself: “There’s a piece of me that says, ‘Well, what do I give back to nursing specifically.’ ” To that end, her research also examines how aspects of the health-care system — like the high turnover rate in ICU nursing — impacts nurses and how nurse practitioners can provide valuable specialized care in outpatient settings
“I’m able to work on projects I choose to work on rather than someone else’s priorities,” she says. “That’s a really unique situation to be in.”
Although her academic life is very full, Montgomery continues to work the occasional ICU shift. “Because that’s real life,” she says. “And it keeps me connected to what’s happening in the real world.”