By Dr. Schola Matovu | Nursing Professor | Nurse Scientist | Director of Global Learning and Engagement
Redefining the Trenches
There is a phrase we use often in nursing: “nurses in the trenches.”
But I’ve been sitting with that phrase lately—and questioning what we actually mean by it.
What are the trenches?
Are we talking about rural clinics with no running water, no gloves, no electricity, and no support?
Are we talking about overstretched hospitals where nurses are expected to deliver miracles with limited resources?
Or are we also talking about something less visible—but equally damaging—like toxic work environments, internal rivalry, lateral violence, and systems that quietly pit nurses against each other instead of supporting collective strength?
Because the truth is: sometimes the trenches are not only physical.
Sometimes they are structural. Cultural. Emotional. Professional.
And sometimes, they are internalized.
The Myth of “Proving Ourselves”
There is another narrative that runs quietly beneath the surface of nursing:
That we are always trying to prove ourselves.
Prove our worth.
Prove our value.
Prove that we belong in spaces where decisions are made about us but rarely with us.
We raise our hands from the trenches, hoping someone will pull us up.
We ask to be included on medical mission teams.
We ask to be recognized in leadership spaces.
We ask to be seen as essential rather than optional.
But here is the uncomfortable question:
Why are we still asking to be included in what we already sustain?
Nurses are the largest segment of the global healthcare workforce, yet we continue to operate in systems where our presence is often secondary, conditional, or symbolic rather than structural.
This is not a workforce issue alone.
It is a power issue.
The Cost of the Trenches
We often romanticize “nurses in the trenches” as resilience. But we rarely ask what those trenches actually cost.
Across the world, nurses work in conditions that are nothing short of extraordinary—and often unjust.
Nurses like Agnes, whom I once interviewed on my Not Just a Nurse podcast, describe climbing long ladders in remote settings just to reach families in need of vaccines. In one moment, she shared, she fell from that ladder at 8 months pregnant—an image that is both heroic and heartbreaking at the same time.
Others deliver babies without gloves.
Care for patients during Ebola outbreaks without adequate protection.
Serve through pandemics like COVID-19 with insufficient support, resources, or staffing.
Many lose their lives in the very act of saving others.
And yet, these realities are often normalized as “part of the job.”
But we must ask: at what point does service become systemic neglect?
Trenches Exist in High-Income Systems Too
It would be a mistake to assume the trenches exist only in low-resource settings.
In well-funded hospitals and academic centers, the trenches look different—but they exist nonetheless.
They appear as:
- chronic understaffing masked as “efficiency”
- burnout normalized as “commitment”
- nurse-to-nurse rivalry replacing collaboration
- legitimate concerns dismissed as “complaining”
- advocacy reframed as disruption
In some settings, nurses advocating for safer staffing or improved working conditions are labeled as difficult. In others, unionized action leads to nurses being replaced with temporary staff—sending a subtle but powerful message: you are replaceable.
This is also a trench.
Just a quieter, more fancy-looking one.
Who Decides What Nursing Looks Like?
In many healthcare systems, there are still countries where senior nursing leadership positions—such as Chief Nursing Officer roles or representation at the Ministry of Health—are absent, underpowered, or symbolic at best.
And when leadership is absent, representation is absent.
And when representation is absent, policy is shaped without the very profession that carries most of the system’s burden.
This creates a dangerous paradox:
Nurses are expected to function at the highest level of care delivery—but are often excluded from the highest levels of decision-making.
So again, we must ask:
Are we in the trenches because of complexity?
Or because of design?
The Leadership We Need Is Not Individual—it Is Collective
We cannot leadership our way out of systemic problems individually.
We need something deeper:
Solidarity.
Not competition.
Not hierarchy among ourselves.
Not internalized oppression that reproduces the same systems we critique.
Because when nurses turn on each other, systems do not have to work as hard to suppress us.
And that is part of what must change.
“Good Trouble” and the Courage to Disrupt
The late U.S. Congressman John Lewis often spoke about the idea of “good trouble”—necessary disruption in the pursuit of justice.
Nursing needs that same courage.
Good trouble looks like:
- speaking up when systems are unsafe
- refusing silence in the face of injustice
- advocating even when it is uncomfortable
- demanding representation where it does not exist
- challenging narratives that diminish our profession
But good trouble also comes with risk.
Being labeled.
Being misunderstood.
Being isolated.
Fired.
And yet, silence carries its own risk too.
Because silence does not protect us.
It preserves the very systems that keep us in the trenches.
From Surviving Trenches to Transforming Systems
So, what do we do with all of this?
We do not abandon the language of struggle—but we must expand it.
If trenches represent hardship, then they must also represent a call to action—not permanence.
We must:
- demand nursing representation at every level of health systems
- invest in leadership development across all nursing roles
- strengthen mentorship instead of hierarchy
- eliminate toxic professional cultures that normalize harm
- and build global solidarity across regions, contexts, and systems
Because whether we are in the Global South or Global North, in rural clinics or major academic hospitals, the underlying challenges often echo the same themes:
inequity, invisibility, and underrepresentation.
Pulling Each Other Out
We are not meant to stay in the trenches forever.
And we are not meant to climb out alone.
If anything, the future of nursing depends on our ability to do something radically simple—but deeply difficult:
Pull each other out.
Not compete for the last position out.
Not crabs in a barrel.
Not silence those still inside.
But build ladders together that are strong enough for all of us.
Because when nurses are supported, patients are safer.
When nurses are represented, systems are stronger.
And when nurses are united, transformation becomes possible.
Closing Reflection
So, I leave you with this:
Maybe the question is not just “what are the trenches?”
Maybe the real question is:
Why have we accepted them as normal for so long?
And more importantly:
What would nursing look like if no nurse had to prove they belong in the system they already sustain?
Because we are not just nurses in the trenches.
We are nurses with the power to rebuild the ground beneath us.