Overcoming the Phenomenon of Imposter Syndrome

(Part 2 of 3)

During the “Meet the Experts” panel at Elevate by Pysch Congress 2017, I mentioned experiencing “imposter syndrome” as a new nurse practitioner, and again, as a new teacher. This syndrome, first named by Pauline Rose Clance and Suzanne Imes in 1978 ¹ describes people who, despite high achievement and extensive preparation, inhabit their role fearful they are unprepared and terrified that others will discover them to be a fraud.

This passing remark about fearing that others would find out that I was unprepared and unqualified generated more questions and sidebar conversations than anything else I discussed at Elevate. Many of these conversations were with my fellow nurses. Clearly, I’d struck a chord. I would call the theme of these conversations “playing small”: the fear that Brene Brown so powerfully describes in her work on vulnerability and shame, that if we risk being seen, we risk the scorn of being judged as inadequate and when we are judged as such, we experience shame and it is this shame that makes us play small to protect ourselves².

PART 1: Responding to Not Knowing: Playing Big and Playing Small

I started to ask more questions about what it was that led my nurse colleagues to feel inadequate, I heard things like “Do the psychiatrists here understand all the science that the presenters are showing?” and “I don’t really get all of what (the presenter) is saying, but I’m just a nurse.” Others thanked me for representing the NP profession well. While I appreciated the compliment, I told them that they too could be up there, and next time, I wanted to share the stage with them.

When Clance and Imes identified the phenomenon of imposter syndrome, they found it was most prominent in women, particularly those who are high-achieving in academic and professional roles. While I don’t think that any one mental health profession has a monopoly on imposter syndrome, nurses—more than 90% of whom are women—could be especially vulnerable to this problem. The fairly recent history of nursing, in which poorly-paid nurses wore starched white uniforms and were expected to surrender their seats (and their opinions) to any doctor who entered the room, cannot be ignored in contextualizing this phenomenon. These experiences were and continue to be wounding to my profession.

In response to these wounds, the profession of nursing seeks to overcome inadequacy.  This is reflected in coursework which encourages us to reclaim our power within health care systems³; the need for condescending institutionalized acknowledgement (“Nurses week? Please…you don’t need to buy me lunch and give me a certificate of appreciation. Just pay me well and give me the autonomy and resources to do my job correctly.”) ⁴; and in the cumbersome alphabet soup of credentials that follows our names ⁵. I suspect some within my profession may see me as a heretic for dismissing these efforts, but I can’t help but see them as reflecting our wounds that have left us with a deeply held sense of inadequacy.

Now, I’d be remiss if I did not point out the irony that while I am a nurse, I am also a man, and a white one at that. I was born into privilege that many people in the world will never have, simply on account of my gender and my skin color. As a popular Internet meme quips, “Lord, grant me the confidence of a mediocre white man.” I have the privilege of working with this conference and the platform that this blog provides me.

Going forward with this blog series, I’ll explore the phenomenon of “playing small” as it relates to the imposter syndrome. I will also discuss the phenomenon of “playing big” and how it, too, can be an expression of fear while at the same time being wounding to those around them.

While I suspect imposter syndrome is endemic to nursing, I know that no one profession has a monopoly on this problem, so I encourage members of all the professions under the mental health umbrella to join me in understanding that which holds us back from our full potential. Where do you notice imposter syndrome in your own professional life?

References

1. Clance PR, Imes SA. The Imposter Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention. Psychotherapy: Theory, Research & Practice. 1978;15(3):241-247. 
2. Brown B. Daring Greatly. New York, NY: Avery Press; 2012.
3. Buresh B, Gordon S. From Silence to Voice: What Nurses Know and Must Communicate to the Public. Ithaca, NY, and London, England: Cornell University Press; 2013.
4. National Nurses Week 2017. American Nurses Association Web site. https://www.nursingworld.org/FunctionalMenuCategories/National-Nurses-Week-2017. Accessed July 10, 2017.
5. Fitzpatrick JJ, Carpenter R. The complexity of nursing credentials and how to present yourself. Nursing Education Perspectives. 2016; 37(1):2.

Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, California, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice