COVID-19 brought both struggles and praise for American nurses. Nurses were called heroes and expected to live up to the Nightingale ideal of self-less compassion, all while facing resource shortages, furloughs, and cuts to benefits. Compensation for hospital CEOs, though, continued to grow. This pushed nurses to aspire and cope but also to question the avoidable suffering and deaths they witnessed. Nurses are known for being burnout, not militantly organized. But the largest nursing strike in U.S. history took place in Minnesota in 2022 and the largest healthcare worker strike was in 2023. In the years since the pandemic began, we have seen nurses defy the self-less ideal and demand improvements in pay, staffing, and working conditions. In a healthcare landscape where patients are increasingly conceived of as customers, the nursing profession is refashioning itself beyond the hero’s pedestal—a cracking artifice that overlooks the needs of its own, very human, occupants.

Marci Cottingham's book uncovers the tragic paradox that is American heroization—to be both valorized and dehumanized in a nation with a meager social safety net.

In her research Cottingham turns to confidential diaries collected from nurses from across the country to understand their relationship to the hero ideal. Some nurses work to live up to the ideal as the superhuman nurse, appearing selfless, optimistic, stoic, yet compassionate. They use hero rhetoric to assure the public that they remain committed servants. But others appear wounded. They relay strong feelings of sadness, hopelessness, and guilt. They self-diagnose with burnout or post-traumatic stress disorder. But a notable minority of nurses are defiant against the emotional straightjacket represented by the Nightingale ideal. The dissonance that nurses experience can lead to emotional defiance, not simply defeat.

Emotional defiance is difficult to sustain in isolation. Following nurses’ online discussions of the hero label, strikes, and the emergence of the defiant nurse influencer, Cottingham examines parallels in nurses’ confidential diaries and their public discussions. Nurses are making forceful claims to their own safety and solidarity in shared injustices. While the pandemic is in the rear-view mirror for many who now face fresher crises, the trauma of COVID-19 is still felt in the bodies and psyches of American nurses. When confronted with the choice to stay, go, or organize, many are choosing to organize. The processes of heroization and emotional defiance that this book identifies have parallels in other occupations, as well as ramifications for the entire healthcare industry.