Nurses are trusted, knowledgeable, and present at every point of patient care. Yet their voices are often missing from leadership discussions, public education, and system-level decision-making. In Speak Up, Start Now, Rosa Hart, BA, BSN, RN, SCRN, challenges that reality by reframing speaking up as an essential part of nursing practice, not an optional or risky act.

Written for nurses and others with lived healthcare experience, the audiobook positions advocacy, ethical storytelling, and leadership as skills nurses already possess. The message is direct and grounded in clinical reality: nurses do not need permission to lead conversations that directly affect patients, families, and healthcare systems.

What is Speak Up, Start Now About?

Speak Up, Start Now is an audiobook that encourages nurses and healthcare professionals to use their lived experience to advocate for patients, influence healthcare culture, and reduce burnout. Drawing from her work as a stroke-certified nurse, Hart offers practical guidance on ethical storytelling, leadership, and speaking up in clinical care, policy, and public education, even for those who do not yet see themselves as leaders.

A Book Written for Nurses Who Do Not Yet See Themselves as Leaders

Hart wrote Speak Up, Start Now primarily for nurses because, as she explains, “we are the largest and most trusted segment of the healthcare workforce, and yet one of the most underutilized when it comes to leadership, advocacy, and storytelling.”

While nurses are the primary audience, the audiobook also speaks to other healthcare professionals, patient advocates, and individuals with lived experience in healthcare systems who recognize their potential to improve. At its core, the book serves as a roadmap for people who want to use their voice to improve patient care, influence healthcare culture, and create meaningful change, even if they do not yet identify as leaders.

Hart emphasizes that the book validates lived experience as expertise. It gives nurses permission, along with practical tools, to stop waiting for someone “more qualified” to lead conversations that directly affect patients and communities.

Listening as the Catalyst for Change

The idea for Speak Up, Start Now emerged from years of listening. Hart describes hearing the same concerns repeatedly in exam rooms, hallways, conferences, and quiet side conversations. Patients were seeking clear and trustworthy information. Nurses were searching for purpose. Healthcare professionals across disciplines felt disconnected from one another and from systems meant to support care.

These recurring themes revealed a gap between what nurses know and who feels empowered to say it out loud. The audiobook was created to address that gap by helping nurses recognize their authority and use their voice responsibly.

What Speaking Up Looks Like in Healthcare

Hart makes clear that speaking up in healthcare is not a one-size-fits-all approach. In patient care, it may mean advocating for safety, clarity, or dignity. In policy or leadership settings, it can involve attending meetings or writing an op-ed. On social media, speaking up may take the form of ethical storytelling and education that counters misinformation with compassion.

At its core, speaking up is using one’s perspective responsibly to improve the quality of life for patients, families, and healthcare workers.

How Stroke Care Shaped the Book

Hart’s experience as a stroke-certified nurse strongly informs the audiobook’s message. Working in stroke care, particularly during transitions of care, exposed how easily patients fall through the cracks when communication breaks down. She witnessed how siloed specialties, outdated information, and time constraints left patients confused and caregivers overwhelmed.

These bedside experiences shaped the foundation of Speak Up, Start Now. As Hart learned through clinical practice, education saves time, advocacy saves lives, and nurses are uniquely positioned to bridge gaps across the healthcare continuum.

Moving Beyond the Bedside and Facing Impostor Syndrome

Transitioning from bedside nursing to writing, speaking, and media work brought significant challenges. Hart identifies impostor syndrome as one of the most persistent barriers. Nursing culture often teaches professionals to defer, wait, and stay in their lane. Stepping into public-facing roles required questioning deeply ingrained beliefs about who gets to be seen as an expert.

She also faced skepticism regarding legitimacy, particularly in podcasting and media. Through that experience, Hart learned that curiosity, integrity, and clinical grounding matter more than titles. The audiobook addresses these internal and external barriers directly, so nurses navigating similar paths do not feel isolated.

Translation and Amplification as a Throughline

Across her roles as nurse navigator, podcast host, media consultant, and author, Hart identifies a single unifying purpose: translation and amplification. Her work focuses on translating complex healthcare information into human language and amplifying voices that are often ignored.

Speak Up, Start Now represents the clearest expression of that mission. Hart emphasizes that a nurse’s voice is not an extra contribution. It is essential.

From Voice Notes to Audiobook

The audiobook began as voice notes recorded between work, family life, and everyday moments. This process kept the tone conversational, accessible, and honest.

Because the book originated from Hart’s own voice, it reflects the way she speaks: direct, encouraging, and grounded in lived experience rather than theory. She hopes nurses take away a key lesson from this process. Perfect conditions are not required to begin. Honesty, consistency, and permission are enough, and nurses can give themselves that permission.

Why Starting Before You Are Ready Matters

A central theme of the audiobook is starting before feeling fully prepared. Hart challenges the belief that nurses must wait for the right timing, more credentials, or external validation. Through stories from her own experience and others, she shows that growth happens because you start, not after.

Readiness, she emphasizes, is built through action.

Advocacy, Vulnerability, and Professional Credibility

Healthcare culture often prioritizes care delivery over visibility. Hart reframes vulnerability as trust-building rather than self-promotion. When clinicians share thoughtfully and ethically, it humanizes healthcare and strengthens credibility.

The audiobook also addresses three common misconceptions:

• • I’m not qualified enough to speak up.

• • Using my voice is risky or unprofessional.

• • Advocacy has to be loud or confrontational.

Speak Up, Start Now reframes voice as ethical, strategic, and aligned with nursing values.

Real-World Impact and System Change

Hart has already seen the impact of speaking up through her podcasting work. Nurses have launched education initiatives, patients across more than 90 countries have gained access to niche stroke information, and local nonprofits have received increased visibility and support.

The audiobook builds on this momentum by showing readers what is possible when nurses stop minimizing their influence. Hart hopes healthcare systems will begin to see frontline clinicians not only as implementers but also as strategic partners. When nurses are heard early, care improves, and burnout decreases.

Speaking up also plays a role in addressing burnout itself. Hart notes that burnout thrives in silence, while speaking up restores agency, meaning, and connection to the reasons many nurses entered the profession.

A Message for the Future of Nursing

Hart hopes the legacy of Speak Up, Start Now is that nurses begin to see themselves as thought leaders, educators, and architects of healthier systems, not just participants within them.

Looking ahead, she sees workshops, speaking engagements, consulting, and community-building as natural extensions of the book’s message, with the goal of sustained impact rather than a single conversation.

Her closing message to nurses is clear and deeply personal: “You don’t have to burn your scrubs as I did, or have the whole plan figured out. Pay attention to what lights you up and what breaks your heart. That’s where your innovation lives. Your voice is already enough. Start now.”