The 4 Steps to Unapologetic Nursing

In Honor of Dr. Janelle Smith

By Dr. Rachel Hill

Some nurses change practice.

Some change policy.

Some nurses change people’s hearts and minds. 

And some nurses manage to do it all and change the world- simply by standing fully in who they are.

This reflection is offered in honor of Dr. Janelle Smith, a certified nurse-midwife whose life and work embodied unapologetic nursing in its truest form.

She practiced with courage, clarity, and deep reverence for life while advocating fiercely for women, families, and communities across the world. Her impact extended far beyond borders, credentials, or titles.

Dr. Smith nursed unapologetically.  She owned her knowledge without shrinking.
She named unsafe systems without silence. She practiced with boundaries rooted in integrity.  She advocated for others with unwavering devotion.

Her death during childbirth is a heartbreaking reminder that even the most skilled healers are not immune to the vulnerabilities of the systems they serve within. Yet her legacy does not end in tragedy, but lives on in the nurses she inspired, the lives she touched, and the standard she set.

I am inspired by humans in the nursing profession every single day, because of the compassion, desire, and willingness to show up for people who need support.  There are so many Dr. Janelle’s in the world that we will never know, because they work their magic in silence.  When I saw the flooding of social media posts and recognition of Dr. Janelle, it gave me much to think about regarding my role as a nurse, nurse practitioner, and leader in healthcare.  

Unapologetic nursing is not about ego or defiance...

It is about nursing from the heart. 

Nursing from the heart is rooted in our purpose that first called us into this profession. And with that calling comes responsibility, along with the clarity required to carry it forward with integrity.

I remember when I first came out into the world as a new nurse. It didn’t take long before I wanted to crawl back into my cave. It was scary to have this dream in your mind, through school, about all the things you want to do to make a difference and be met with resistance (inside and out).  The beautiful dreams I carried suddenly felt too big, too idealistic, too incompatible with the reality I was facing.  I did what many nurses did. I kept my head down, did my job, and focused on surviving both the world and the profession.

But I’ve come to believe this:

Dreams don’t die.

We just stop believing in ourselves, in relation to the obstacles we are perceiving. 

However, those dreams? They wait- quietly, patiently, lurking in the background. 

And then one day, something happens. You witness a moment where you know you made a difference. You feel it in your body. In your heart. In your spirit. And suddenly, those dreams come back out and poke you. They ask: Are you ready now?

Unapologetic nursing is the moment you stop disappearing inside a role and start remembering who you are within it.  Here is where you start the steps to answer the call.

It’s the refusal to shrink your vision to fit someone else’s limitations.

It’s the courage to ask yourself what you will do with the career—and the responsibility—this profession has entrusted to you.

Here is where you begin to reflect the readiness to make all those changes you dream of or dreamt of, in the past.

So I ask you:

What have you done and what will you do with your nursing career?

What have you built and what are you building, protecting, challenging, or transforming?

Come out, come out, wherever you are, because "The Call" is still there.

That call never truly stops. What changes is our relationship to our call. Over time, it can get buried beneath expectations, exhaustion, and the pressure to conform. But it remains—waiting for a way to be carried forward from deep within our being. 

“How do we bring it forth?” you might ask.  Not long ago, I asked myself the same question.  What I realized is that my career needed a visional guide rooted in my values and beliefs that allowed me to work within a framework I had intentionally created.

Once I had that clarity, everything shifted. It became easier to recognize when I was operating in alignment—and just as important, when I wasn’t.  When systems felt like they were pushing me outside of that framework, I could take responsibility and stand for the structure I had built rather than shrinking to meet expectations that conflicted with my integrity.

This is how unapologetic nursing begins—not with defiance, but with clarity. Not by becoming louder, but by becoming rooted.

What I did, I now offer to you.

Create a vision statement to live and work by. See what you want to do and work toward that vision (aka dream).

Be clear in your knowledge.
Be clear in your boundaries.
Be clear in your advocacy.
Be clear in your self-worth.

For too long, nurses have been conditioned to shrink, soften, and silence themselves in the name of professionalism. What’s emerging now is something far more sustainable—and far more powerful.  We do not have to default playing small.  We are much bigger than that.

This reflection is not about asking you to become someone else.  That call is to be who we are, authentically.  It is not about telling you to practice like Dr. Janelle Smith or to follow any single model of nursing. Each nurse carries a unique light, a distinct way of serving, and a voice shaped by lived experience.

Unapologetic nursing honors that uniqueness.

It is in our individuality that we find our rightful place—not hidden in the shadows but standing fully in the sun.

Here are 4 practical steps we can use to nurse unapologetically:

1. Own Our Knowledge without Shrinking

Nurses are highly educated clinicians, yet many were taught—explicitly or subtly—to downplay what they know.  I always get teased about all the letters behind my name and I don’t get offended.  The certifications that I have keep me well versed and informed in evidence-based practice.  Knowledge is power and is something that can’t be taken away.

Owning your knowledge means speaking with confidence instead of disclaimers, offering insight without apology, and trusting your assessment and experience.

This does not require arrogance. It requires self-trust.

When nurses stop shrinking, conversations change, collaboration improves, and patient safety strengthens.

You do not need to prove your worth—your training and lived wisdom already have.

2. Name Unsafe Systems without Guilt

Unsafe systems depend on silence to survive.  Identifying risk is not negativity, it is responsibility. Don’t let people steer you otherwise. 

Naming unsafe systems includes calling out unrealistic ratios, documenting patterns rather than isolated incidents, and speaking up about policies that compromise care.

Most nurses have faced moments like these—times when doing the right thing felt uncomfortable, risky, or uncertain.

The outcomes may not always bring immediate change or the results we hope for. But at the end of the day, our conscience remains. Knowing that we spoke up for the right reasons carries a long-term reward: integrity.  Accountability is not betrayal.  It is advocacy.

When nurses name harm, they interrupt cycles that normalize burnout, moral distress, and preventable errors. They plant markers of truth within systems that too often depend on silence to continue operating as they are. 

This is not about winning. It is about standing in alignment with the values that brought us into nursing in the first place.

3. Set Boundaries without Justification

Boundaries are not explanations. They are decisions. 

Unapologetic nurses understand they do not owe excessive availability, emotional labor beyond capacity, or personal sacrifice to uphold broken systems. 

Setting boundaries preserves longevity, clarity, and respect.

You do not need permission. You do not need justification. You are allowed to be human.

4. Advocate for Yourself as Fiercely as You Advocate for Others

Nurses are exceptional advocates for patients and communities.
Unapologetic nursing asks what happens when that same advocacy is turned inward.

Self-advocacy includes requesting accommodations, leaving harmful environments, seeking support early, and choosing roles aligned with values.
This is not selfishness. This is leadership.  Treat yourself, like the patient you care for!

The Collective Impact of Unapologetic Nursing

Each step creates ripple effects.

When one nurse stops shrinking, others notice.
When one names harm, silence loosens.
When one sets a boundary, culture shifts.
Unapologetic nursing is not rebellion—it is evolution.

Unapologetic nursing does not ask nurses to become less compassionate.
It asks them to become more whole.

You were never meant to be quiet about your knowledge.
You were never meant to tolerate unsafe conditions.
You were never meant to earn rest through exhaustion.
You were never meant to abandon yourself in service of others.

This is the work of reclaiming nursing—clearly, courageously, and without apology.

The life and legacy of Dr. Janelle Smith remind us that unapologetic nursing does not require a stage, a title, or global recognition. It requires presence, integrity, and the willingness to stand fully in one’s values—right where you are. 

Dr. Janelle made a difference because she practiced from the heart, honored her knowledge, and advocated fiercely for others while remaining rooted in her calling.

Her impact did not come from trying to be extraordinary, it came from being deeply aligned. And that alignment continues to ripple outward through the lives she touched and the nurses she inspired. 

Her legacy invites us forward—not to imitate her path, but to honor our own. To nurse with clarity. To protect life, dignity, and safety. Speaking when silence would cause harm. And to trust that meaningful change begins wherever we stand.

That is how nursing moves forward.
That is how lives are changed.
That is how legacy lives on.

That is how your legacy will live on.

--Dr. Rachel