CRNA Perspectives
  • Tricking the Imposter: Struggles and Successes with Imposter Syndrome

    By H. Tammy McMannon, MAJ, USAF, NC, MSHS, CCRN, CEN

     

    Similar to other postgraduate nursing curricula, the first year of my program is front loaded with didactics, tests, and presentations. Afterwards, phase II continues with clinical rotations for the remaining two years. After a busy year of lectures and exams, I was nervous but excited to start applying this knowledge to patient care. However, one thought I couldn’t shake was, “what if my faculty and preceptors find out I’m really not as good as they think I am? What if I don’t belong in this profession?” I had done well during phase I, but felt my success was due to memorization rather than clinical thinking. What I thought was normal anxiety actually had a term attached it it…. imposter syndrome. Although imposter syndrome isn’t an official DSM diagnosis, it is a common concept amongst graduate students. Despite its commonality, students don’t publicly speak about their feelings for the fear of being found out.1 Like other psychological phenomenon, transparency and awareness are the first steps to escape imposter syndrome and move towards self-growth.


    What is Imposter Syndrome?

    Two psychologists named Pauline Rose Clance and Suzanne Imes coined the term in their article that was published in 1978.2 Although various definitions exist, it is broadly defined as difficulty internalizing success. For some, it could be an internal experience of intellectual phoniness, fear of being discovered, or a sense of being a fraud despite holding legitimate qualifications.2,4 This can impact mental health causing anxiety, depression, frustration, lack of self-confidence, and shame. Unfortunately, it often leads to difficulty in personal growth or professional advancement.

    How does this apply to CRNAs and SRNAs?
    Imposter syndrome is well-known in the non-healthcare professional setting with the term growing more popular within the nurse anesthesia community and its prevalence higher than expected. When nurses pursue an advanced degree, their professional roles changes. This transition also transforms professional standards, expectations, and responsibilities setting off an uncomfortable period of adjustment. Despite being equipped for the job, many in the nurse anesthesia community doubt their competency and qualifications as well as their ability to meet the expectations of their patients, colleagues, and themselves.3 Although they have a successful career, CRNAs are still afflicted by this syndrome. Additionally, SRNAs are experiencing unnecessary added stress and mental fatigue that may impede their studies or patient care.

    “It is more prevalent than we think, and students often don’t have a word to describe how they are feeling. Once I learned about imposter syndrome, it was like a weight lifted off of my shoulders.”

    K. T., third year SRNA, FL

    “I didn’t find out about this until several years after school. I felt really alone in my program, like I was waiting for someone to figure out that I was a fraud.”

    B.J., Retired CRNA

    “I experienced imposter syndrome when I started obtaining consent from patients. I couldn’t believe I was entrusted to explain risks/benefits. It was very awkward trying to be honest about risks while still getting patients to trust me and feel comfortable undergoing anesthesia.”

    K.G., second year SRNA, Algonquin, IL

    “I fear asking questions. I’m afraid the answer is so obvious, that everyone knows it and it will reveal my inadequacies.”

    H.R., CRNA, Facebook Group

    “I think imposter syndrome really started out as I graduated feeling that my training was not solid. I felt that some of my skills were not on the same level as other SRNAs. I was afraid that my colleagues and peers would realize that I was not a good hire since my skills were not on the same level as them.”

    M.Y., CRNA, Facebook Group

    How common is this?
    Recent studies show it can affect both men and women in professional settings and across multiple ethnic and racial groups. In a systematic review, the prevalence of imposter syndrome was as high as 82% in the professional population.2,5

    How do I get past it?

    1) Talk about it! Sufferers of imposter syndrome don’t want to admit their fraudulent feelings, but opening up to a supportive community can be a relief. Speaking with others show you aren’t alone with your thoughts and feelings.

    “Learning more about imposter syndrome helped improve my outlook and confidence in my program.”

    K.T., third year SRNA, FL

    “I think it really helps to talk it through with your peers. More often than not, they have had similar experiences.”

    M.Y., CRNA, Facebook Group

    2) Recognize your strengths and expertise. Make a mental list of your strengths as well as areas that need improvement. Pessimism is a conscious choice so choose to be proud of your accomplishments. Focusing on negativity can lead to depressive symptoms and generalized anxiety. An experiment on rhesus monkeys by Kyoto University’s Institute for Advanced Study of Human Biology showed pessimism demotivates the brain to endure hardship for reward.6 Reprogram your thoughts to positively reflect yourself and your achievements. Although this may be a simple step, it is an important step that is often overlooked.

    “Every day I tell myself, ‘you are prepared, you are ready.’ Thankfully, I remembered hearing other students discussing their feelings of imposter syndrome, especially while they were studying for boards. Because of this, I knew I wasn’t alone and that these feelings were not justified.”

    N.R., CRNA, Facebook Group

    3) Develop a healthy response to your failures. Take failure as an opportunity for professional and personal growth. If failure occurs, take a few deep breaths, and transform that frustration into a learning opportunity. Fear of failure and self-doubt have often prevented sufferers from moving forward causing them to avoid various opportunities. This can and will affect their overall job performance.

    Multiple times during sim lab and patient care, I have failed. I have inserted the epidural needle upside down in the training mannequin or I have “tubed the goose” during intubations. Changing my thought process reversed my feelings of defeat. After all, I’m a student learning how to become proficient and it’s ok if my classmates were successful with their skills and I’m batting below average. I can turn this into a positive experience and ask my classmates for pointers.

    “You always pass failure on your way to success.”

    Mickey Rooney

    4) Stop comparing yourself to others. Everyone has a different path and different timeline. Instead of comparing yourself to others, use them as motivation to improve yourself. You may not know this, but you are also inspiring someone else. I once heard a quote in high school that I find very fitting…

    “There will always be someone bigger and badder than yourself.”

    Thom Jones

    Better yet, compare yourself to a past version of yourself. Recognize the difficult moments and challenges you have overcome along the way.

    “There are people who have talent and strength I will never have. We all have limitations. I could train my whole life, but I may never be the faster sprinter in the world. Does that mean I quit? Not at all. It means I’m going to try to be the best I can be. It’s me versus me.”

    John Gretton “Jocko” Willink
    Retired U.S. Navy Seal officer

    5) Embrace the humility and pursuit for continuous personal growth. Acknowledge you will not know everything after graduation or even if you’ve been in the career field for a long time. Our profession is complex and always evolving. The information and skills out there are vast and the learning never stops.

    “The only person you can control is you. So focus on making yourself who you want to be: Faster. Smarter. Stronger. More humble. Less ego.”

    John Gretton “Jocko” Willink
    Retired U.S. Navy Seal officer

    6) Start validating your successes. At times, you may feel that you don’t deserve the compliments or felt luck was a part of your accomplishments. It’s time to change that tune and realize that no matter how basic your action was, it was still successful!

    A few years ago, I was selected for a highly competitive position that would provide me with great professional growth. I had doubts about myself and kept thinking I was selected because perhaps I was the sole applicant. Maybe I was selected because they wanted diversity in the office. I needed to change my thought process and acknowledge that my curriculum vitae listed many accomplishments. I was qualified for the position and that was why I was selected!

    “I get past imposter syndrome by remembering all of the accomplishments and sacrifices I’ve made to get to where I am now. I deserve to be where I am just as much as anybody else. I also remind myself that if I study, keep my eyes on the prize and apply myself, I’ll be able to say and do the smart things I hear my anesthesia providers say with time and patience.”

    S.N., second year SRNA, Seattle, WA

    Conclusion
    If you are reading this and feel like you fit the criteria for imposter syndrome, know you aren’t the only one in the boat. Reach out to your friends, classmates, and mentors. Be the one to open up that discussion. Talk therapy is a proven method and can help you and others move past these issues.7 If you aren’t comfortable opening up to your friends or family, social media is a great avenue. We all know this isn’t an easy process so tell yourself you are a CRNA or SRNA because you deserve it.

    Acknowledgements
    I would like to thank all of my fellow CRNAs and SRNAs who shared their imposter syndrome experiences for this article. I would also like to thank my phase II site directors at Wright-Patterson Medical Center and faculty at Uniformed Services University Graduate School of Nursing for their valuable input. Lastly, I would like to thank the AANA Education Committee in allowing me to spread the word on this topic in hope it helps someone in our community.

    References

    1. Weir K. Feel like a fraud? gradPSYCH Magazine. November 2012:24. Accessed October 12, 2021. https://www.apa.org/gradpsych/2013/11/fraud
    2. Clance PR, Imes SA. The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice. 1978;15(3):241–247. https://doi.org/10.1037/h0086006
    3. John S. Imposter syndrome: Why some of us doubt our competence. NursingTimes. January 28, 2019. Accessed November 13, 2021. https://www.nursingtimes.net/roles/nurse-educators/imposter-syndrome-why-some-of-us-doubt-our-competence-28-01-2019/
    4. Leonard J. How to handle imposter syndrome. MedicalNewsToday. September 29, 2020. Accessed September 2, 2021. https://www.medicalnewstoday.com/articles/321730#takeaway
    5. Bravata DM, Watts SA, Keefer AL, et al. Prevalence, predictors, and treatment of impostor syndrome: a systematic review. J Gen Intern Med. 2020;35(4):1252-1275. doi:10.1007/s11606-019-05364-1
    6. Bergland C. How pessimism can hijack the brain and subvert motivation. Psychology Today. August 2, 2021. Accessed September 2, 2021. https://www.psychologytoday.com/us/blog/the-athletes-way/202108/how-pessimism-can-hijack-the-brain-and-subvert-motivation
    7. Shalaby RAH, Agyapong VIO. Peer support in mental health: Literature review. JMIR Ment Health. 2020;7(6):e15572. Published 2020 Jun 9. doi:10.2196/15572