Many clinical nurses are struggling with very tough challenges as they work to treat patients with COVID-19: shortages of masks, personal protective equipment (PPE) and ventilators, shortages of staff, shortages even of hospital rooms and, literally, hospital beds. More upsetting, shortage of space to store the dead. And hardest of all: shortage of assurances that they will not become COVID-19 patients, or casualties, themselves (*see note below).

Nurses have taken to social and mainstream media to protest these challenges, becoming incidental activists in the cause of saving their own and patients’ lives, and also the lives of physicians and other hospital workers. Never has what I’m calling New Nursing been more important since nurses’ voices have never been more needed, and yet, many nurses are having gag orders imposed on them by hospital systems more worried about protecting their image than their nurses’ lives.

The silencing of nurses is unfortunately an old story, as old as the history of nursing itself, at least in the United States. I recently became very aware of this history when I read Ordered to Care: The dilemma of American nursing, 1850-1945, by Susan Reverby, emeritus Professor at Wellesley College. Reverby shows that the history of American nursing began with the idea that although nurses were seen as essential to health care, they need not be paid well for the job because caring was “women’s work,” and at that time at least, all nurses were women. Administrative mandates for nurses to be overworked and underpaid were accompanied by the expectation that nurses would be obedient and never complain.

This history is so important for other nurses to understand that I wrote about Ordered to Care in my quarterly column, “What I’m Reading,” for the April issue of the American Journal of Nursing. There’s a link to the column at the end of this one, and I suggest that nurses read it to understand how old the idea of “subordinate” nurses is, and to grasp the importance of nurses valuing ourselves and our work. I quote myself, and Reverby, on this topic: “We nurses must bring nursing into the 21st century. To do so, Reverby says, it’s crucial that nurses ‘create the vision of autonomy and altruism as linked qualities, and achieve the power to forge this unity.’ That is, we need to coalesce the values of professional independence and deep caring for patients, and refuse to accept being overworked and underpaid.”

I acknowledge that speaking up as a nurse is not simple when it can be an easy way to find oneself out of a job. Part of New Nursing hopes that nurses get better at speaking together, so that our jobs and our lives are not bought with our silence. COVID-19 is not leaving anytime soon, unfortunately, and the value of hearing nurses’ voices will also not diminish.

To read the entire column in AJN, click here.

* Note: In China, once they instituted full protective gear for all health care workers, not one additional worker contracted the virus—assurances of safety are possible, at least according to

The Handbook of COVID-19 Prevention and Treatment, from The First Affiliated Hospital, Zhejiang University School of Medicine.

Theresa Brown, BSN, RN, FAAN, is Clinical Faculty at the University of Pittsburgh School of Nursing. Her most recent book, The Shift: One Nurse, Twelve Hours, Four Patients’ Lives, was a New York Times bestseller.

She is a frequent contributor to the New York Times and also for CNN.com. She has been interviewed on the NPR program “Fresh Air,” and has appeared on “Hardball,” and MSNBC live.

Brown writes and speaks about nursing, health care and end of life care. She has a PhD in English from the University of Chicago. Her kids inspired her to leave academia and pursue nursing. It is a career change she has never regretted.

Please visit Theresa’s website, TheresaBrownRN.com, and on Twitter at @TheresaBrown.