Imposter syndrome among Nurses and Healthcare Workers

Have you ever felt like you don’t belong?  Or are in the habit of second-guessing your education, training, fund of knowledge, and abilities? One moment you are a high achiever and the next thing you know; you begin to feel like a fraud, a pretender, an imposter…. As though your colleagues, managers and clients will soon discover that you don’t actually deserve your successes and accomplishments?

If your answer is yes, there is a possibility that you may be actually experiencing the imposter phenomena or the imposter syndrome as it is so commonly called. 

This is most common among people who have ventured into a new career, new graduates or those who just had a profession change.  Impostor syndrome is seen in people from all walks of life; men, women, healthcare professionals, nurses or managers, it does not discriminate

By writing this article I hope to educate and raise awareness of imposter syndrome among nurses and other healthcare professionals which will in turn allow them to recognize it in themselves. To know what it means, how it occurs and how often it occurs may help many of the new and seasoned nurses alike to overcome their self-doubt and move ahead in their chosen professions and careers.

My Experience…….

There was a brief period of time; when I was newly appointed into a managerial role at workplace, I often wondered if I actually belonged there.  Despite being a peer influencer and an over achiever at my previous role, I realized I was a minority there, in terms of my race, ethnicity and age.  Being a very young unit coordinator and continuously being reminded of my ethnicity fueled my sense of being a fraud.  My interests and style of leading a team were so different from those of my colleagues, which at times felt incredibly isolating thus fueling my feelings of inadequacy. 

So, what is impostor syndrome?

Imposter syndrome, also called as ‘imposter phenomenon’, or ‘fraud syndrome’ is described as intense feelings of fraudulence and self-doubt in the face of success.  Clance and Imes defined the term in 1978, where they attributed the term mainly to women who doubted their expertise and attributed their successes and achievements to some exterior causes.

 Nurses experiencing this may attribute any of their successes to luck, or being in the right place at the right time, knowing the right kind of people, or whatever they can think of to undermine their success.

New nurses may experience this when they have finally succeeded in doing complex procedures on their own or have begun taking individual patient assignments with minimal supervision. 

What could possibly cause an imposter syndrome?

Experts believe that imposter syndrome could be a result of certain personality traits combined with childhood experiences where they were constantly pressurized to maintain high standards set by their parents or caregivers.   These internalized ideas which grow and take root initially turn into self-perpetuating traits while they grow into adults.

Certain personality traits that make people compare themselves to others may be highly susceptible.   Other probable personalities may include:

 ‘perfectionists’ who think every task they tackle has to be done perfectly without receiving any help,

‘soloists’ or the ones who constantly work individually rather than in groups,

 ‘Experts’ who feel like they need to know everything before venturing into any projects,

 ‘Superman’ or the ‘Super caregiver’ persona; the nurses used to juggle a lot of tasks all at the same time or the

 ‘natural geniuses’ who constantly have the need to master new skills or obtain new knowledge without which they feel like frauds or imposters.

One of the studies conducted indicated that one of the biggest triggers of imposter syndrome could be   belonging to an under-represented minority group.    Modern healthcare settings are known to have diverse environments in terms of employees especially nurses belonging to various strata of society.  Any actual or perceived discrimination against such groups makes some people feel as though they are different from others and develop imposter like feelings or imposter traits.  These traits gradually make the nurses believe that they need to constantly prove themselves to feel belonged in a particular role.

These traits may further intensify when nurses switch specialties’ or are promoted to higher ranking positions, making them feel inadequate or undeserving of the bigger roles.   Therefore, when a nurse or healthcare worker feels different from his/her peers; because of race, gender, sexual orientation, or any other trait— they end up feeling like frauds or imposter who will soon be brought to shame.

The reality of imposter syndrome:

Imposter syndrome if and when left unchecked can cause terrible emotional turmoil and mental difficulties, giving rise to unpleasant emotions like shame, guilt, depression, anxiety, stress, and low self-esteem.   It may even change a person’s perspective about life; making him/her unable to view the positive aspects of life. 

The consequences could be:

1. Giving up opportunities for growth and advancement due to feelings of inadequacy or unworthiness
2. Downplaying one’s skills, knowledge and abilities
3. Take up innumerable courses and in-service education programs; not just for the sake of learning but because they feel insecure; thus, sabotaging their self esteem
4. Poor job satisfaction and eventually burn out
5. Nurses who lack self-confidence can end up making poor clinical decisions or mot trusting their clinical judgement or intuition which may have detrimental effects on their nursing care

On an organizational level:

Imposter syndrome among nurses can cause problems with nurse burnout, retention and turnover.  Therefore, it is essential that hospital administrators and managers adopt preventive strategies to make their work environments a safe place for nurses.

I learnt to let go…….

“I soon realized I did not have to be the perfectionist or the so-called ‘know all’ to be successful at my job or even at home.  I did not have to do it all alone.  I began learning to prioritize and delegate and ‘letting go’.

“I began to take constructive criticism in my stride, found every opportunity to better myself while at the same time telling myself that I was not an imposter.  My promotion was well deserved.  Instead of fearing the inevitable, I began asking questions and genuinely seeking help to perfect myself.    Belonging to a different ethnic group, I began to learn the local culture and all that it implicated.  Positive affirmations, reframing my thoughts and journal writing gave me a new found confidence to go on.  I actually began making lists of all things that I could and did well and the things that needed improvement.  That gave me a better perspective of how I needed to move forward. Once that was taken care of; there was no looking back….”

How to deal with impostor syndrome

1.  Stop comparing yourself to others

This reminds me of a very good quote of Dr.  Seuss

“Today you are you, that is truer than true. There is no one alive who is you-er than you. Shout aloud, I am glad to be what I am. Thank goodness I’m not a ham, or a clam, or a dusty old jar of gooseberry jam. I am what I am, what a great thing to be. If I say so myself, happy every day to me!”

Save yourself the torture of comparing yourselves to others.  It will do no good to you.  Is your companion better at giving presentations?  Is that colleague better at inserting IV’s?  If so, then approach them and learn from them.    Do not make unnecessary comparisons.  Do not tell yourself that they are better; or even worse, you are better than them.  Either way thinking can be injurious to you in the long term.   

• Don’t expect instant success

When you take up a new job in a different specialty or are promoted to a higher position; don’t expect immediate acceptance and success.  Infact expect the opposite.  Success comes from baby steps.  Work towards your goals.  Don’t be afraid to ask.   Don’t try going solo; instead be a team player. 

• Positive self-talk

Positive affirmations and self-talk have the power to heal.  Each time a negative thought creeps in tell yourself that you are worthy, you deserve your success, that you are special.  When you begin to feel insecure, tell yourself over and over, “I belong here”, “I deserve to be here”

• Journal writing:

Take out a diary, and start writing down the top three accomplishments that you are most proud of, the hard work that behind achieving these achievements and the sacrifices you had to make to make these things happen.  Each time you achieve something, each degree you gain, each promotion, or each procedure you succeed in, write it down.  Open this journal each time a nagging doubt begins to creep in.

• Talk to your mentor

It is often considered helpful to share what you feel with your trusted friends, colleagues or mentors. You may even discover that others have been in your position and that these feelings to some extent are common.   In case it is affecting your general mental well-being, seeking out a professional psychologist is the next best step to take.

The goal is to know that a few initial moments of doubt and hesitation are normal and there is nothing to worry about.  But when you develop an all-encompassing fear of being found out to not have what it takes is when a problem arises.

• Look at your achievements

Keep any positive feedback, any letters of accomplishment’s, awards and certificates in a place where you can constantly see it when you feel like a fraud or suffer from self-doubt.

Key takeaways:

• Imposter syndrome is real. The earlier you recognize it in yourself, the better your chances of improvement
• Unchecked imposter syndrome may effect your clinical practice and hinder your progress
• Overcoming imposter syndrome is the key. Positive self talk is critical
• Organizations that fail to recognize and act on imposter syndrome among their highly skilled and talented employees will ultimately face staff burnout and turnover.

References:

John S (2019) Imposter syndrome: why some of us doubt our competence. Nursing Times [online]; 115: 2, 23-24.