Bonnie Castillo, 60, is executive director of National Nurses United, the largest union and professional organization of registered nurses in the country, and of California Nurses Association/National Nurses Organizing Committee.

If you were running one of the federal task forces or the Centers for Disease Control and Prevention, what would you do to protect nurses and the public?

Day One, I would direct that the Defense Production Act immediately get mobilized to produce [personal protective equipment]. Because it needs to get to the front line now. Why didn’t we do that to protect as many people as we could get protected, save as many lives as we possibly can?

To what do you attribute the insufficient response or preparation?

The hospitals and our health-care industry subscribe to what is known as “just in time.” Just-in-time staffing. Just-in-time purchasing of supplies. They’ve taken a calculated risk because we have a profit-driven health-care system. They actively monitor the bottom line. And they took a gamble relative to how much to have and how much to be prepared. We see this all the time in the day-to-day running of hospitals where we are struggling for safe staffing or have insufficient supplies and/or equipment. But this is something that is very serious and spreads like wildfire. Obviously, at the federal level they were quick to dismiss it. And the CDC came out with guidelines shifting commensurate to what the hospitals are complaining of. The lower standard is cheaper. So they just kept lowering and lowering, all the way down to bandannas. There was this moment of: We’re expendable. They’re looking at us like fodder.

When was that turning point?

Probably mid-February is when we started seeing what these employers were willing to do — and could see that at the federal level they were going to pretty much sign off on anything our hospitals wanted to do or not do. Someone had to take a stand.

Our nurses took it upon them[selves] and their neighbors to bring in their own N95s [masks] from their garages and basements. Initially the hospitals responded with: Take those off. You will be disciplined. You will be suspended. But the N95 just became where we drew the line in the sand. We said: We cannot go in there with a surgical mask or bandanna. We are here to take care of the patients. And not only the covid patients, but all the other patients. You’re essentially making us become vectors of this virus, which goes against our very fiber of why we became a nurse to begin with.

So we pushed back and had hundreds of change-of-shift actions in front of the hospitals. And as soon as we started to shame them, a lot of them developed a mechanism to take community-acquired PPE. They never would have done that if we hadn't protested, if people wouldn't have looked at them like, You're sending these nurses to battle with no armor, no tools. We're a female-dominated profession and believe that this is gender-based. Would you do that with firefighters? With oil and chemical workers?

You know, we just had a situation [in a hospital] in Southern California just this past week where there were some floors where nurses had N95s, and another floor where they didn’t but the physicians had [them]. The doctors even told the nurses: Oh, don’t go in there with just a surgical mask — these are positive covid patients. But the hospital told them no. So what ended up happening is those nurses said: Well, then we can’t take these patients. And the hospital suspended them and then tried to accuse them of doing a walkout. That was even under doctors’ orders. Now, since then, we’ve been out in the public, the press covered it, and we have those nurses back to work. But will it be an ongoing battle? Yeah, I think it will.

Where do you think the biggest breakdown in leadership has been?

At the federal level, without a doubt. It should start there, and obviously that has been chaotic. And it has rippled down. The thing that is so frustrating is we know what we need. It's not like, Well, we can't figure out what's going on. We know we've got an infectious disease, and we know how to protect ourselves and how to actually try to save as many lives as possible. But what's happening now is, because we don't have these protections, this is just out of control. And waiting for the season to change is not good enough — not for the richest industrialized nation in the world that we pride ourselves to be, to have this level of failure.

We need to have a fundamental structural change in the delivery of health care. We can't have the motivation being maximizing profits for the shareholders. It doesn't work. How many people's lives are we willing to sacrifice to keep this business model of health care in place? This pandemic has shown what it is and what it isn't. And it can't even begin to deal with crises. We can do better. We have to do better. As nurses, we know that life has to go on, and we have to save as many lives as possible, but we are nowhere near the end of the tunnel.

There must be days you just want to just bang your head against the wall and say, “We can’t do this.”

I think what keeps me going, actually, is my training as a critical care nurse, knowing that my sisters and brothers are in there and the sacrifices that they're making every day. They have families and loved ones and friends. And I know the fear and the terror that they feel when they're putting on their scrubs and getting ready to go in. They're more than willing to do this; they're simply asking for this basic level of protection. So I feel very compelled to fight. And I'm going to back them up with every breath that I have.

There are parallels, I think, to firefighters after 9/11. And I wonder, do you feel like the public may come to better understand and appreciate the role that nurses play, coming out of this?

Yes, I do. So many people have come to interface with health care in ways that they never expected to. You know, whenever a disaster happens, we always say the way you can tell a nurse is, we run into the disaster. We’re compelled to go in and help. We feel so honored to be with our patients at the most intimate times of their life — from birth to death. There’s not a lot of other professions where you’re there with people at their most vulnerable. And I do think that people are looking at nurses in a way that, you know, it’s something to behold the sacrifices that they’re willing to make. And we know that we can build a society that actually values what we do and what our work provides everyone.

This interview has been edited and condensed.
KK Ottesen’s latest book is “Activist: Portraits of Courage.”