Not All Nurses Wear Scrubs: Taking Risks and Making a Life in Canadian Nursing

There is a kind of story about nursing careers that gets told in recruitment videos and in popular media (I'm looking at you Instagram). In TV and movies it usually looks like this: nursing, bedside story. Fade in: a nurse in scrubs orbits the main character (often a physician), appears in key moments of drama, then dissolves back into the background when the plot moves on. Even when nurses are centered, as with Nurse Jackie (a series about an expert ED nurse whose life is tangled in addiction) the story leans on extremes, as if a nurse can only be a main character by being spectacularly broken. In contrast, the careers that actually sustain nurses in Canada are far quieter and far more radical. They double back. They stall. They are rerouted by grief, by curiosity, by political awakening. They are shaped by patients who stay with us and by systems that both constrain and invite our courage.

My own career trajectory, in acute mental health and substance use inpatient work, then clinical nurse specialist and educator roles, documentation and informatics, and professional practice, board work and historical scholarship, is one example of a life in nursing that refuses the single bedside story. It is less a ladder than a series of intentional risks in a landscape where nurses are still routinely depicted as peripheral. Using those moves as a thread, this reflection explores some of the opportunities and risks that nurses in the Canadian health care system might consider as they decide how they want to live their own careers.

Staying close to crisis

Many Canadian nurses begin in the places where the system’s fractures are most visible: acute medicine, acute mental health, substance use, emergency, medical units caring for people living with poverty, trauma, and chronic illness. The first real risk is often just staying. Staying in nursing. For me this meant staying in spaces where seclusion rooms, code whites, and constant risk assessments make it impossible to pretend that care is neutral. Staying long enough to see how certain bodies are more likely to be restrained, how particular ways of speaking are more likely to be charted as “non‑compliant,” and how policy can become a blunt instrument when staff are scared and stretched.

The opportunity in this choice is depth and moral clarity. Nurses who remain in these settings learn to hold tension between safety and autonomy, between what they are required to do and what they know will land in a patient’s nervous system as violence. They become exquisitely skilled at reading distress, de‑escalating conflict, and creating tiny pockets of dignity inside deeply coercive structures. The risk is cumulative moral injury and burnout, particularly when staffing, leadership, and larger policy decisions do not align with the kind of care nurses are trying to provide. Without spaces for reflection, advocacy, and collective meaning‑making, the very sensitivity that makes a nurse good at this work can become unbearable.

Becoming a specialist or educator

Leaving a familiar unit to become a clinical nurse specialist, educator, or a clinical lead is often framed as a “step up,” but from the inside it can feel more like a sideways move into a liminal space. Patients become populations. Individual crises become trends and dashboards. Days fill with meetings, guideline development, consults, and quiet negotiations about what is “realistic” this fiscal year.

The opportunity here is leverage. A CNS or educator who knows inpatient mental health or substance use from the inside can see exactly where a pathway fails patients, where an assessment tool entrenches stigma, or where a “behavioural expectation” policy is really a comfort policy for staff. From that vantage point, it becomes possible to re‑write admission processes, embed trauma‑ and violence‑informed principles, and build education that acknowledges structural racism, sanism, and colonialism as clinical issues, not side topics. The risk is becoming a buffer rather than a bridge, absorbing frustration from the direct care space and pressure from leadership, smoothing over fissures instead of naming them. It takes deliberate practice to notice when a role meant to advance nursing practice is being used to protect the institution from discomfort.

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Walking into the chart: clinical documentation and informatics

Choosing to focus on clinical documentation and informatics is another kind of career risk. Many nurses experience electronic health records as something done to them: another screen, another audit trail, another way their work is surveilled, managed, monitored, and fragmented. Stepping into informatics roles means moving toward that discomfort instead of away from it.

The opportunity is profound. Decisions about flowsheets, problem dictionaries, risk tools, and default phrases encode particular narratives about patients and about nursing itself. A nurse who has cared for people in acute distress is uniquely positioned to see how a suicide risk tool might miss context, or how a violence flag can follow someone for years without offering any explanation of what actually happened. In that role, documentation can be reclaimed as a site of advocacy: building spaces in the record for patient voice, for social determinants, for nuance that resists purely biomedical or carceral framings. The risk is distance. It becomes easier, over time, to think in objects (forms, builds, workflows) rather than in human beings. Staying connected to practice, through relationships, site visits, or clinical shifts, is essential to keep the work grounded.

Stepping into governance and history

Moving into governance, professional advocacy, or historical research is a further step away from any single clinical microsystem and deeper into the structures that authorize or constrain nursing. Serving on boards, policy tables, or regulatory committees places nurses within decision‑making architectures that have often marginalized nursing voices. Historical scholarship, meanwhile, asks nurses to look backward: to trace how psychiatric nursing, harm reduction, or community practice evolved, and whose stories were erased along the way.

The opportunities here are about narrative and power. In governance spaces, nurses can insist on asking which patients are missing from the room, which nurses are missing from leadership, and how decisions will play out on night shift in a locked unit, not just on a slide deck. In archives and oral histories, researchers recover legacies of resistance and care that challenge the idea that the current system is the natural endpoint of progress. These stories can strengthen contemporary advocacy by showing that nurses and service users have long contested harmful practices, often at great personal risk. The personal risk in this work is a sense of in‑between‑ness: being seen as “too political” by some clinical colleagues and “too clinical” or “too activist” in academic or policy circles.

Choosing which risks are yours

Across all of these journeys, my journeys, staying in acute MHSU, becoming a CNS or educator, entering informatics, moving into governance and history spaced, is not a linear red carpet walk toward prestige. This journey is a series of questions: What risks am I willing to take, and for whom? Sometimes the risk is material: giving up a permanent line to do something new, to do project work, or to join a needed initiative. Sometimes it is relational: stepping out of a tight-knit unit, challenging a respected colleague, or occupying a leadership role that will inevitably disappoint someone. Sometimes it is interior: allowing your understanding of “good nursing” to be unsettled by patients’ stories, critical scholarship, or your own shifting capacities over time.

Not every nurse will, or should, take the same risks. For some, the most ethical choice is to stay, and work on making a single unit. Play it safe. For others, it is to leave and use a different platform, like education, policy, research, digital health, to try to move (shift? change? reconstruct?) the larger system. In a context where nurses are already asked to be endlessly flexible, refusing certain risks can also be protective: saying no to a badly designed promotion, to a committee that tokenizes rather than listens, or to work that contradicts one’s values is its own kind of courage.

What your career illuminates is that when nurses in Canada do take risks. And because we are nurses, these are grounded in relationships, ethics, and a clear memory of the bedside. These risks can reverberate far beyond a single job description. A redesigned assessment, a reworded policy, a more honest documentation standard, a board motion, a historical article: each is an opportunity to cause a shift in how the system understands nursing and how nursing understands itself. Not all nurses wear scrubs. Not all leadership comes with a formal title. Sometimes, the most consequential act is to refuse the single story of the bedside supporting character and to live, instead, as the main character in a nursing life that keeps changing shape.

Peace,

Michelle D.