AACN News—March 2001—Opinions

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Vol. 18, No. 3, MARCH 2001


President's Note: Make Waves: Have the Courage to Not Be Perfect

By Denise Thornby, RN, MS
President, American Association of Critical-Care Nurses

One trait that many critical care nurses struggle with is perfectionism. As my family and friends are quick to point out, it is also a tendency of mine. However, I have come to realize that perfectionism is not a healthy pursuit of excellence.

The differences between perfectionists and healthy achievers are numerous. Perfectionists believe that mistakes must never be made and that the highest standards of performance must always be achieved. Although those who strive for excellence in a healthy way take pride in trying to meet high standards, perfectionists often experience self-doubt and fears of disapproval
or criticism. While the healthy striver has drive, the perfectionist is driven.

Are you a perfectionist? Ask yourself the following questions:
• Do you ever feel as if what you accomplish is not quite good enough?
• Do you put off projects or tasks until you believe you can get them just right?
• Do you hang on to standards that you measure yourself against, when circumstances make such standards impossible to reach?
• Do you experience guilt or frustration because you do not perceive yourself as the ideal critical care nurse?
• Do you feel impatient and intolerant watching someone else tackle what you ordinarily do best?
• Do you avoid new experiences because you are afraid you won’t be good enough?

Does this sound familiar? To some extent, most of us have an issue with perfectionism. Whenever I ask nurses what their idea of a “perfect nurse” is, they describe an individual who is truly phenomenal. In fact, I have collected an entire list of suggested strategies that any “perfect critical care nurse should be able to achieve.” Some of these idiosyncrasies might lead you to wonder whether these perfectionists would go so far as to use “white out,” of all things, to cover small drops of blood on the bedding! Some of the following perfectionist “quirks” might be more familiar.
• Only wanting their handwriting on the bedside flow sheet or chart
• Not only using colored tape to label IV lines and pumps, but also specifically insisting that dopamine lines be labeled with pink tape and epinephrine with blue tape
• Changing tape and dressing, because the way they were taped bothers you
• Changing the bedding of an extremely unstable patient, because the sight of messy linens drives you crazy

I am sure you can add to this list. I began to question myself after my patient arrested during a linen change and I realized I was changing the bed to meet my needs, not the patient’ s needs. Now, please understand that I know how important clean and neat beds are to the comfort of patients and the reassurance of their families. However, this should never be done if it places the patient at risk because of increased oxygen consumption, simply because it will make you feel better.

Perfectionism may be one of the barriers preventing us from achieving our vision. How can you have a healthcare system driven by the needs of patients, when your actions are driven by perfectionism instead of excellence? When people are driven by perfectionism, they often experience:
• Fear of failure. Many perfectionists equate failure to achieve their goals with a lack of personal value or worth.
• Fear of making mistakes. Mistakes are often equated with failure. Yet, in orienting their lives around avoiding mistakes, perfectionists miss opportunities to learn and grow.
• Fear of disapproval. If they let others see their faults, then perfectionists fear that they will no longer be accepted. It then becomes important to protect yourself from criticism, rejection
and disapproval.

• All-or-none thinking. Perfectionists frequently believe that they are worthless if their accomplishments are not perfect. They often have difficulty keeping their view of a situation
in perspective.

• Over-emphasis on “shoulds.” Perfectionists are driven by a list of shoulds that they have adopted both professionally and personally. As a result, perfectionists rarely take into consideration
their own wants, desires or judgments.

• A belief that others achieve success easily. Perfectionists tend to perceive that others achieve success with minimal effort, few errors, great self-confidence and little stress. At the
same time, perfectionists view their own efforts as never enough.


Overcoming perfectionism requires courage, because it means accepting our imperfections and humanness. The first step is to practice the act of self-awareness and determine whether you have issues with perfectionism and how they impact your effectiveness as a critical care nurse. The second step in changing from perfectionism to healthy achieving is to realize that perfectionism is undesirable. You must then challenge self-defeating thoughts and behaviors that fuel perfectionism. Professionally, I have found that asking myself a series of questions can help me overcome this perfectionist trait. Is this going to help me toward a vision of a healthcare system driven by the needs of patients and their families where critical care nurse can make their optimal contribution? Is this the right thing for this patient? Whose need am I meeting? Am I supporting and empowering others?

To be seen by others as a credible, influential leader, each of us must become a healthy striver for excellence. Challenge yourself to discern whether you are driving for excellence, instead of being driven by perfectionism. I hope you will take this opportunity to pause in your day and reflect on the many roles you play in your life—and to ask: Is it excellence or is it perfectionism?
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