Imposter Syndrome in Nursing: A Barrier to Personal Growth

What is imposter syndrome?

Imposter syndrome has been defined as the persistent inability to believe that one’s success is deserved or has been legitimately achieved as a result of one’s own efforts or skills. Bravata and colleagues reviewed 62 studies with 14,161 participants, finding a prevalence of 9% to 82%, largely dependent on the screening tool and cutoff to assess symptoms. Both men and women experience this phenomenon with a wide range of age groups from adolescents to late-stage professionals. For nursing, it can potentially range from new graduate nurses to executive leaders.

Who might be most at risk for imposter syndrome?

• This phenomenon can impact anyone in a new role. A recent blog, “Imposter Syndrome and New Leaders,” notes the impact on new nurse managers and even new chief nursing officers.
• Another blog, “Imposter Syndrome Is Common in Healthcare - How Can You Combat It?” shares that imposter syndrome may be higher in underrepresented groups, including ethnic minorities, women, the LGBTQ+ community, racial minorities and religious minorities.
• Imposter syndrome can be exacerbated by previous experiences where someone felt quite confident and competent in their established role, but moving to a new role brings the imposter syndrome to life. Earning a new degree, obtaining a certification, being promoted to a leadership role, transferring to a unit providing a higher level of care, or changing specialties may trigger the feelings of self-doubt associated with imposter syndrome.
• Edwards and colleagues found that role ambiguity, lack of self-compassion, transitions and minimal clinical experience can also contribute to this phenomenon.

In a profession where you are constantly on the go, critically thinking and implementing lifesaving measures, it is understandable that new nurses may feel unworthy, unprepared or incapable. Imposter syndrome can lead to stress, low self-esteem, anxiety and depression. Interestingly, Bravata et al. noted there were no published studies that evaluated treatments for this condition. The development of multiple screening tools, including the Clance Impostor Phenomenon Scale (CIPS), Harvey Impostor Phenomenon Scale (HIPS), Leary Impostor Syndrome Scale and the Young Imposter Syndrome Scale, show the commitment to better understand this phenomenon.

What does this syndrome mean for me as a nursing professional?

Despite the passage of time, experiences gained, and the development of an extensive curriculum vitae (CV) as healthcare professionals, when and how will many nurses understand that their accomplishments or level of achievement are good enough to move past the manifestations of imposter syndrome?

A Personal Experience

Personally, I have felt some degree of self-doubt and fear as my career progressed. As a new nurse, do I know everything that I need to keep my patients safe? Can I perform technical skills at the same level as my peers? I had to learn to overcome my feelings of self-doubt. Being selected to treat the more challenging patient as well as transitioning to preceptor and charge nurse roles helped to build my confidence.

Then, as my nurse manager started challenging me to take on additional leadership roles, I was still comparing myself to more experienced colleagues. There were times when I wondered, ‘Why me? Am I really the most qualified person for this position?’ I took the Graduate Record Examination (GRE) very soon after completing a Bachelor of Science in Nursing. However, I waited to apply to graduate school until my scores were about to expire. Yes, my confidence had grown, but there was a fear of leaving the unit and position where I felt I had conquered my fear and was now the role model. When I went back to graduate school for my master’s as a clinical nurse specialist (CNS) and then a doctoral degree, my fear was amplified by the idea of moving to a new role and becoming the less experienced individual again. ‘Am I as qualified as the other applicants in my program? How do I continue to prove my value to my organization?’

Even after becoming a CNS, I wondered if I had progressed as quickly or accomplished as much as other CNS colleagues at this point in their careers. Simply, am I enough? After a few small wins, fortune was on my side when I was selected to lead an evidence-based project to address rising Clostridium difficile rates. I shifted my focus to the task at hand and excelled. Most importantly, I learned to accept positive feedback and see the value of the work that I was completing. The positive outcomes as a result of this quality intervention were a result of my time and effort. In addition, I had a wonderful senior nurse leader who took me under her wing. She helped me see our healthcare facility in a different light. I was not alone in the projects that I was undertaking, as she introduced me to a number of amazing resources across multiple departments that increased collaboration and the number of projects where I could share my specific expertise. This transformational leader was also my biggest cheerleader, making sure that the fruits of my labor were seen by other senior nurse leaders in my facility and healthcare system. In the process, I was forced to see the broad impact and value that I was creating.

Embracing my talents, my next adventure was to mentor CNS students and individuals new to the role. My experiences allowed me to better notice the same signs of fear and uncertainty in others. As a mentor, I was able to remove the stigma that nurse leaders were unapproachable by ensuring that my students were provided with face-to-face introductions and invitations to meetings with the senior nurse leader team. I could also share my personal experiences as well as tips and tricks to successfully move forward. For example, presentations and speaking up in meetings can be quite challenging. With each project completed by my CNS students, I ensured they had multiple opportunities to share details and outcomes both verbally and in writing with leaders at all levels.

Whether presenting to a nurse manager on the fly in a hallway or to a senior leader in a boardroom, how do you organize yourself to make sure that you hit all of the key points? The instinct is to write out your presentation, but this approach can be hard to follow. My students always had a bulleted list of their key points, especially required actions being requested from their particular audience. Give your mentee the opportunity to practice as much as needed to be confident. Also, leading a project can be intimidating. Allowing your mentee to take the lead with you as a safety net is instrumental to success. New learners need the opportunity to use a plan-do-study-act mindset to face a quality improvement initiative, with an experienced mentor to bounce ideas around with.

Personal Solutions – What can I do to address imposter syndrome?

• Be patient with yourself. Practice grace and self-compassion.
• Share your feelings with a trusted colleague or mentor. You are not alone.
• Accept positive feedback from peers and nurse leaders at all levels, to build your confidence.
• Recognize that your accomplishments are a result of hard work and not luck.
• Recognize your own expertise and how much you have grown by working with new nurses as a mentor or preceptor.
• Celebrate your successes, no matter how big or small. Consider keeping a file of your accomplishments, recognitions and notes of support, and use this information to help refocus your thinking if you feel challenged when you take on a new challenge.
• Resist the temptation to compare yourself to others; instead, focus on your own achievements.
• Do not sacrifice great strides for perfection. Rome was not built in a day, as the saying goes.
• Seek a mentor who inspires you.
• Consider reaching out to a therapist if needed. Focus on your mental health, and do not allow yourself to burn out.

Structural solutions – What can others do to help address imposter syndrome?

• Academic Institutions
  • Incorporate imposter syndrome content into nursing courses, provide emotional education for students, and establish mentoring relationships with students.
  • Educate faculty, especially clinical instructors, on the signs of imposter syndrome in their students, and develop strategies to help build students’ self-confidence.
• Healthcare Employers
• Implement strong mentoring programs at all levels of practice.
• Build and maintain well-being programs to support the needs of nurses.
• Create a culture that supports collegiality and teamwork, where all healthcare professionals feel empowered to share and overcome their fears, and learn from one another.
• Focus on positive performance and address performance improvement.

From both academic institutions and healthcare employers, further research is needed to better understand contributing factors as well as methods to overcome imposter syndrome.

The Challenge – Where do I go from here?

My challenge to every nurse – whether a new graduate, considering going back to school, or taking on a new role – is to not undervalue yourself. Focus on the evidence of your contributions and successes.

• Face your fear or doubt, and then step up to the challenge.
• Let your knowledge, experience and clinical expertise speak for themselves. Be sure to highlight your achievements on your CV.
• Use your fear as an opportunity to become the best version of yourself and to pursue opportunities to advance professionally!
• Look for academic institutions and healthcare employers who embrace a culture that supports your individual needs through mentorship and well-being programs. In an environment that supports you, flourish and seek or accept the right opportunities.
• Take the additional step to recognize signs and symptoms of imposter syndrome in newer nurses and help them see the light and move forward to greatness, especially as the nursing profession moves out of the pandemic and faces unprecedented nursing shortages.

What steps do you take to address imposter syndrome in yourself? Also, how do you help others, to ensure their longevity in this rewarding profession?