Kay began her NHS career in Nottingham, training as a nurse at Nottingham School of Nursing, and held a number of nursing, then senior management positions at Queens Medical Centre, and Nottingham City Hospital over a period of 15 years. Kay then moved to the Isle of Wight Healthcare NHS Trust initially as Deputy Director of Nursing, and then Acting Director of Nursing.

In 2003, Kay moved to Southampton University Hospitals Trust initially as Associate Director of Nursing with a lead for modernisation, and then as Acting Director of Nursing, before taking up the post of Director of Nursing at Winchester & Eastleigh Healthcare Trust for three years.

Kay joined Barts and the London as Chief Nurse in October 2006 and also holds an Honorary Visiting Professorship with City University, London

Kay's clinical background was initially in vascular surgery and then specialising in neuro-rehabilitation. Kay's particular interests are in quality and patient safety, developing clinical leadership, promoting inter-professional working and compassionate care.