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The Q Word Podcast

"Imposter Syndrome"

Welcome to the Q word, a podcast about the tips, trends and taboos of emergency nursing, where we pull the hospital curtain back on issues that emergency nurses and their patients often think about, but seldom talk about.

Lisa: Hi Nyssa! 

Nyssa: Hi Lisa! 

Lisa: So, Nyssa, you told me that you had a story to tell me and our listeners today. Tell me a story nurse Nyssa.

Nyssa: So, Sharon and I went to an event that was hosted by Frank Warren. He is a blogger at and he writes books. And he started over a decade ago a project. It's an art project/social experiment/internet sensation, all those things rolled into one. And basically what he did is he went all over Washington DC and passed out self-addressed stamped postcards, and asked people to anonymously mail him their deepest, darkest secrets. People did. And still are.

Lisa: People expose their deepest, darkest secrets? 

Nyssa: Yes. 

Lisa: And it has to be postcard size. So longer than a tweet but shorter than a Facebook rant.

Nyssa: Yes. 

Lisa: Okay. 

Nyssa: And people, people send silly things and they send intensely painful things and everything in between. And they sometimes will just scrawl it on a piece of paper, and sometimes it's a beautiful, intricate piece of artwork. So he did a presentation in Atlanta. And Sharon and I went to this probably 10 days before I graduated from nursing school. So all that stood between me was time and NCLEX, and then I was a registered nurse. So I bought his book. And at the end, there was an opportunity to get him to sign the book and to actually meet him and speak with him for a minute. And so as is very common, I got to my turn to speak with Frank Warren. And I said, "Do you want to know my secret?" And he said, Yes. And he's a very tall guy, and he bent down so that I could whisper in his ear. And I said, "I graduate from nursing school in about two weeks and I don't know anything". And he laughed and turned to me and he said, "Oh, I get photographers tell me I don't know what half of the settings on my camera are. And I have, you know, singers tell me they can't read music". And he, you know, he kind of like laughed it off and told me these two stories and I thought to myself, dude, you're totally invalidating what I just said to you. Like, whether you take a bad picture or a good picture accidentally, whatever.  Whether you sing off-key or or not, whatever, but I will have people's lives in my hands. Like that's not the same thing.

Lisa: Yeah, those are inconsequential. Relatively speaking compared to what you're doing,

Nyssa: Right. And so I thought he wasn't understanding me. And he was invalidating and taking what I was saying this deep, dark secret of mine and making it very flip. But in fact, what he was doing is he was teaching me that this is not an uncommon sentiment, and I later learned that it has a name and the name is Imposter Syndrome. 

Lisa: So that's what we're talking about today? Imposter syndrome?

Nyssa: Yes. 

Lisa: Imposter syndrome and the emergency nurse nurses who fear they don't know what the hell they're doing. 

Nyssa: That's right. So the definition of imposter syndrome is the fear of being found out that you're not as competent as people think you are, that you are a fake or a fraud. And according to an article in Forbes in 2014, that this impacts top executives. It impacts actors, athletes, all across industries, even people who are wildly successful and famous and wealthy, feel imposter syndrome.

Lisa: I see it here, Harvard, we just started bringing the new freshmen in, right? They just arrived to school. And half of these kids get here, having been the smartest kid in their high school, always excelled more than any other student academically. And then they get to Harvard. And they're surrounded by every other kid who was the smartest person in the room their whole lives. And suddenly they think, Oh my god, they made a mistake. What am I doing here? I don't know what I'm doing. I don't. . . I've never worked in a lab. I don't know how to write a paper. I don't belong at Harvard.

Nyssa: And Forbes goes on to say that apart from serial narcissists, super low achievers, and outright crazies, no one is immune from the self-doubt of imposter syndrome. 

Lisa: Okay, so how do you know if you are suffering from this? 

Nyssa: Well, here's some hints. One is: Do you ever feel like you got where you are by charm or good luck? Or connections or by accident? Or like you fooled the boss? About 70% of all people have felt this way at some point in their careers.

Lisa: Yes. That makes perfect sense. Okay, point number two?

Nyssa: So if you are a woman you may have been more likely to suffer from imposter syndrome. So the phrase was actually or the name of this was actually coined in 1978 by two female psychologists, Dr. Pauline Clance and Dr. Suzanne Imes. And they were right here at Georgia State University in Atlanta. And they discovered that women more often feel like a fraud. That if a woman is to apply for a job, she has to fit every single criterion, whereas a man will apply for a job if he only meets about 60% of the required criteria.

Lisa: Well, certainly they're not immune to it.

Nyssa: Men are not immune to it, but women are more likely to feel imposter syndrome.

Lisa: Okay, so what's the third point?

Nyssa: So the third point is if you have received compliments from people about your work performance, and you just brush them off, even excuse them, you reject the compliment, you may be suffering from impostor syndrome. So you'll make an excuse like, well, anybody could have taken care of that patient. And this is not a display of false modesty. These people really don't believe that they deserve the credit because they feel fraudulent. They brush off the compliment.

Lisa: Okay, I see that with my kids here at Harvard to a lot of them. I'm like, wow, you're doing so great. I mean, look at your grades. Geez, you got a 3.98 GPA, and they're like, yeah, my block mate has a 4.0. They feel seriously dejected, that somehow that isn't proof that they learned the material or that they're good at the material. It's proof that somebody wasn't paying attention to how they grade that they're going to that that that they're going to get their comeuppance later when they fail the next exam.

Nyssa: And this is a weakness of high achievers. High achievers are the ones that are the most difficult on themselves and that have this negative self-talk in their head saying you don't know what you're doing. You don't know what you're talking about. Someone's going to find you out.  So Dr. Valerie Young has written a book called The Secret Thoughts of Successful Women about imposter syndrome and she breaks it down into five different personality types that are prone to feeling this way. They are the perfectionist, the superwoman or man, the natural genius, the rugged individualist, and the expert.

Lisa: Okay, I'm visualizing like five people standing at a line up with like, little signs over their heads. 

Nyssa: Yes. 

Lisa: All right. So we're going to look at the perfectionist. 

Nyssa: Yes. 

Lisa: That's somebody who has ridiculously high expectations of themselves and of the people around them. Is that about right? 

Nyssa: Yes. 

Lisa: Okay, so if I am that ER nurse, what do I act like?

Nyssa: Yeah, so this is a nurse who's a micromanager. They have a difficult time delegating to their tech or to their fellow teammates. So that means that they are reluctant to hand off their patients to go to lunch. When they do they say "I have my phone call me if there are any problems". Or when they do delegate to another nurse, a teammate, or a tech, they come back and they're disappointed with the job that was done because they feel like they could have done it better. Or they redo the job that was done to do it their way because their way is the best.

Lisa:  That makes them feel like an imposter when they don't do it as well as somebody else? Clearly, something has to break that self-image in order to be flooded with this sense of inadequacy, right?

Nyssa: The perfectionist, they feel like their work has to be 100% all of the time. And in emergency nursing and nursing in general, just when you think you've got everything done or just when you think you're about to get caught up and ready to hand off at shift change, the Code Blue comes rolling in the door and now everything's behind and everything's a disaster and everything's a mess. So perfectionists are very frustrated emergency nurses.

Lisa: All right, so the Superwoman or the Superman. That's a person that's working harder, faster, longer than anybody else. They don't need rest. . .

Nyssa: And they wear a cape.

Lisa: Yeah. 

Nyssa: So you know this nurse, this is the nurse that stays till eight or 830 or nine, not on the occasional crazy ridiculous shift but every single shift. They're there an hour, hour and a half past quitting time trying to get 12 hours of work done in 13 or 14. This is the nurse that regularly clocks no lunch. They work right through lunch. This is a nurse who feels like an imposter. And so they work harder and longer and faster and more sacrifices. They've given up their hobbies, they give up their lunch, they give up their bathroom break, they turn a 12 hour shift into a 14 hour shift in an attempt to make themselves indispensable or or  make themselves look like they are working harder and they are. They're working harder and longer than everybody else. And that's their way of combating the imposter syndrome.

Lisa: I see that that's just not sustainable nor is it practical or healthy.

Nyssa: No, that's right. That's right. So their reward is that they, they feel like well, I put in more hours than anyone. I skipped my, my lunch and I, so therefore, I must be a legitimate emergency nurse.

Lisa: I see. It's a. . . almost an overcompensation? 

Nyssa: Yes. 

Lisa: The natural genius that was the third one, right? That's somebody who never had to study for that math test. Facts and figures just fell into their head and everything comes really easy. So how does that show up in the nursing field? What kind of nurse is a natural genius?

Nyssa: So I went to nursing school with this dude, he sat there and never cracked a book. I'm not even sure the cellophane came off of his book, and he would sit in lectures with his feet kicked up on the table crossed and the rest of us would be furiously notetaking and studying our brains out and this guy would sail through with minimal effort and get really great grades.

Lisa: If his legs has been uncrossed would it have been better? That was a very specific detail.

Nyssa: I left out the part where he was wearing cowboy boots with the kicked up on the table crisscrossed.

Lisa: Okay, this guy was just like he never had to study got it. 

Nyssa: So you know anatomy and physiology is not an easy set of classes. Microbiology, not easy. Nursing school, not easy. There are people who have an easy time and get through them relatively easily based on their natural ability, their natural genius. But when those people get out into the actual nursing world, there are some things that you can't just rely on your natural genius or your photographic memory. It doesn't make you a compassionate person who can interact well with a variety of different patients. It doesn't make you automatically a fantastic IV stick. So when they come across something that they are not naturally gifted at a skill set, for example, or interpersonal reaction or interpersonal relations that you can't be taught in a book. Then they think well, they start to panic. This has never happened to them before. They start to question whether or not they deserve to be there or question their, their abilities. In the emergency setting when patients come in, we don't know their diagnosis necessarily. Some of them, their symptomology is more obvious than others. Sometimes we have to really hunt and do a Dr. House on them. When you don't have a diagnosis that you can turn to in your photographic Rolodex, then you start to question like, I don't know what's going on with this patient. That's not uncommon in the emergency room.

Lisa: And then that may snowball. I don't know what's going on with this patient. Oh my God, what am I doing here? I don't belong here. I'm a terrible nurse. Because I can't figure this thing out. Everything is always coming naturally to me, and suddenly it doesn't, right. I'm faking it. How did I get here? Just because everything is always come naturally up to this point doesn't mean that everything always will.

Nyssa: And the natural genius resist having a mentor or even a preceptor. They want to just go in and do things themselves. And just figure it out for themselves. And it's not always something that you can just figure out. These patients don't always read the textbooks. And so sometimes the way that their disease or injury progresses is not the way that the majority of patients does. And so therefore, you you have to be really flexible and not, you know, taken by surprise when they're not following exactly what the textbook said they would do. 

Lisa: People are reading the textbook, I mean, they are all reading Web MD. So clearly, they know exactly what's wrong with themselves when they show up in your ER. But you know, I can see how the natural genius might have trouble adapting. 

Nyssa: That's right. That's right.

Lisa: Oh, this one- this one sounded really appealing. The rugged individualist is a lumberjack with an ax in one hand, a flannel coat and a stethoscope.

Nyssa: That's what they look like.

Lisa: So there's a little, I'm hearing, this little cross pollination between these terms, but this is someone who probably always has done things on their own. Who never asked for any help; is very stubbornly independent.

Nyssa: Right. And we've talked before that the ER is an environment of teamwork and even a family kind of an atmosphere. There's not a lot of room for people who are loners or individualistic in an emergency setting of any kind. These folks are afraid to ask for help or ask questions because they feel like it will show weakness. And there's an interesting thing that I want to point out about rugged individualists and about emergency nursing. And, you know, we hear the little phrase all the time about the only dumb question is the one that doesn't get asked. And we say that over and over to one another. We say there's no such thing as a dumb question. And that's fine, but in reality, you know, we we will give you a pass when you are a new nurse of about a year. You can ask anything you want to. Once you get to that two-year mark or so though, there's an underlying sense that if you ask a question, people are going to be like, What's wrong with her? She's been a nurse for two years. She should know this. Or Why is he asking that? So there, there's not really this thing about you can ask any questions safely that you want to. And this is the other thing about emergency nursing, when you are on your orientation, or when you have done your first year of nursing, there's no possible way that you're going to see every patient that you might ever encounter in your career. And so it's very reasonable that in your second year of nursing, you come up against something that's common, but you haven't seen yourself. So, you know, for example, maybe you haven't accessed a port-a-cath and you know, 18 months that you've been a nurse, and now all of a sudden you have a patient that needs it. And you're thinking, well, do I ask someone? They're going to think well, she's, you know, what's wrong with her? That's something you should know. But in fact, this was just a hole in your orientation, and everyone has that. And as a former educator, you can't plan what patients these folks are going to see. And so there are definitely going to be holes in their experience and in their orientation. And they have to feel like they can come forward and ask questions when when they see those even in their second, third, fifth, 10th year. It should be okay. And so a rugged individualist is someone who thinks if I ask this, you know, they're going to know I don't belong. They're going to think well, you know, they're going to find me out. And this can be really, really dangerous in an emergency setting or any setting when you think, well, I'm just going to power through on my own without asking this. This can be really dangerous for patients.

Lisa: Of the ones we've talked about so far, this one worries me the most. In some ways, I feel are the most compassionate for that personality type who finds themselves in an emergency nursing situation. 

Nyssa: I agree. 

Lisa: I would think the consequences of not asking for help when you need it could be dire. 

Nyssa: Yeah, I agree with you. 

Lisa: The last type is the expert. That's somebody who thinks they know everything about everything. 

Nyssa: So the expert actually feels like they know nothing about nothing. And so what they do. . .

Lisa: Well, I got that all wrong.

Nyssa: To compensate is they go to every class and every conference and they take every certification exam and get all the alphabet soup behind their name. And every time they do that they feel like okay, I have another certification I am, I'm legitimizing myself and Okay, I took another non-mandatory inservice. Okay, I went to another non-mandatory class and I'm just going to eat up all this information. In the attempt to cope with this, I don't belong, I am an imposter. And so what happens is they do become extremely knowledgeable. But if you say, Oh, so and so is the expert on XYZ, they're going to quickly correct you and they're going to panic and say, No, no, no, I'm not an expert. I just went to that one class at one time. So they shudder when someone calls them an expert. This one kind of hits home for me because I want to know everything about everything.

Lisa: But do you feel like an imposter when you don't know something?

Nyssa: Oh, yeah, absolutely.

Lisa: Really because here I was thinking, yeah, I'm not so worried about those experts. I think they could dig it. They're fine. And we're worried about the rugged individualists but I'm sorry, Nyse. 

Nyssa: No, I don't, I don't think I'm dangerous as an expert, but I definitely think that you know, I when someone asks me something that I don't know, I feel like okay, here it is. The jig is up. I've been found out.

Lisa: Oh, okay. I see how that works. Because you're not an expert on something that somebody asked you about. You feel as if it invalidates the rest of your knowledge?

Nyssa: Yes, that's right. All the other things that. . . if I can't answer that question, every other question I've answered before is null and void. That's right. That's right. 

Lisa: Very interesting. So what do you do about it? How do you combat this imposter syndrome? It's like a bad guy in a Batman comic book imposter syndrome.

Nyssa: Right? So you know, this is negative self-talk in your head and say you've got to develop some positive of self-talk in your head. There are some other things that you can do outside of that. But first of all, just remember you did make it through anatomy and physiology. You did make it through nursing school, there are a lot of people who don't. You passed in NCLEX. You got hired. You got through orientation, or wherever you are along that continuum. Those are not easy tasks, and you succeeded in those. And and not everyone does. So remind yourself of that.

Lisa: There are not that many accidents, there's not that much charm, there's not that many mistakes, and there's not that many personal favorites that could get you through every single level. 

Nyssa: That's right.

Nyssa: The second one is if you are feeling overwhelmed about a patient, ask for help. This is to protect you, your license, and most importantly, your patient. Don't BS your way through it, because when you do, it's going to make you feel even more like a fraud because you're behaving like one. 

Lisa: Asking for help is kind of like a muscle. The more you learn to do it, the easier it becomes, the less you'll have to do it and down the line. But ask when you need it. Ask now. Don't fight it. You'll learn to ask better questions later. It will help you in the long run. 

Nyssa: That's right. And the question that you ask and the answer that you get is a building block to the next one and the next one which does develop your knowledge and your experience. 

Lisa: That's right. 

Nyssa: There's an article about nurse imposter syndrome by Linda Lampert. And she says, keep in mind that everyone struggles at first. So that super nurse that you watch and you set up as your idol? They struggled. Your nurse manager? Struggled. Your preceptor? They struggled too. They were all new at one point. And guess what? They probably still do struggle on certain things. So remind yourself that even those people that you have up on a pedestal, who are leadership or who are your nursing idol, they struggle, struggled and probably still do on certain things.

Lisa: It's it's the pattern and they're fitting into the pattern that they're supposed to. It's a healthy natural course of action.

Right. And the difference is to be scared about having a patient turned over to you and being responsible for a patient's well being, that is a scary place to be. And to feel like you don't know what to do or you're unprepared is normal. But staying in that place and not doing something about it is not normal. That's how you move past this. So over and over and over again in these imposter syndrome articles I saw on the list of how to resolve this "Find yourself a mentor." And I feel like in nursing, that's a solution to a lot of problems is- find a mentor, you know, get a mentor. I agree to a point that a mentor can be beneficial in this case. But a mentor is someone who cheers for you and who is pulling for you. But a mentor is also meant to challenge you and push you and to critique you even. And so when you are feeling that you don't have a lot of competence and maybe there's not a lot of basis for that, then maybe what you need is actually a cheerleader. So if you are winging it, maybe you need a wingman. That's different than a mentor. A wingman is someone who's going to be there for you and say, You're doing a great job, you are figuring this out. They don't do the challenging part. They don't do the pushing part. And they don't do the critique part. That's not their role. 

Lisa: A mentor's role is the building up the part. 

Nyssa: That's right, and you go to them when you need the building up. And when you're ready for a challenge. And when you're ready to be critiqued and you've kind of moved over that hump, you go to your mentor, and I mean, it's, it's possible that it could be the same person. It's possible that you can have a wingman inside of nursing and you can have a wingman that's not in nursing profession that can say, "wow, what you do is amazing. I don't know how you do that every single day." And they pump you up in that way. And that's really important and can help you. The other thing about this one that can help imposter syndrome is to actually be a mentor yourself. So, if you're a new grad nurse, find a nursing student, Find someone who's just starting A&P 1. Mentor them through that. You already succeeded in that and they are trying this really hard thing that you know about. So be a mentor to them. That can help set aside a lot of self-doubt when you are helping someone else. 

Lisa: One of the things you learn when you start teaching is how much you learn about your subject matter when you have to teach it to other people, guiding people through the things that you just recently went through, helps you really learn that material over and over and over again. And that is how you become an expert about it. That is how you get a really good solid base of knowledge. And that does combat your sense of being an imposter because you're like, now I do know this stuff. Not only do I know it, I learned it and I've learned enough to teach it to somebody else.

Nyssa: Yes. And the nursing version of that would be, you can become a superuser in your unit for the thing that you feel weakest on. Or we have annual skills where we teach stations that are different skill things. Different things that we need to know. Find the one that you're weakest at and volunteer to teach that. So you teach it 6-8-10 times in a two or three-day period. By the end you have immersion therapy'd yourself right into being comfortable with it. So that's a great way to overcome. Like, I feel nervous around LVADs or I don't love the rapid infuser. So I'm going to volunteer to teach and be the content expert for a couple of days on the rapid infuser. And by the time it's over, you have taught it so much that you now have a new comfort level with it and you're ready to go the next time you're called on. 

Lisa: Makes perfect sense. 

Nyssa: There's a cool quote from Christine Lagarde. She is the International Monetary Fund director and she says when they attack a specific task, they attack it "inside, outside, sideways, backward, historically, genetically and geographically'. They leave no stone unturned and she says that they don't do it until they get it right, they do it until they can't get it wrong. This is a style of over learning that we like to talk about. And it's my favorite.

Lisa: I like that. That's very interesting.

Nyssa: I think. . . I don't know that she really studies monetary stuff genetically. I mean maybe. I think it's, you know, just metaphorically speaking. They metaphorically attack it from every possible angle.

Lisa: Right, right.

Nyssa: I remember when I went to company in doc for my flight role. I remember them telling me "get comfortable with being uncomfortable". So what they were saying is you're going to be in some positions that you've not been in before. You're going to be experiencing things that are going to stretch your skillset, stretch, stretch your experience. Why would you want to be in a job that you are qualified for? Don't you want to be pushing yourself and reaching and stretching? And that's sort of when we also feel like an imposter is when we are pushing ourselves past the boundary of our comfort, okay, but if you stay in the comfort zone you will stagnate, right? So get comfortable with being uncomfortable.

Lisa: I like that.

Nyssa: And then the last suggestion that I have is kind of interesting. In these generic imposter syndrome articles they suggest having something like a happy file or a kudos file, where you collect nice things that people have written about you or nice comments that people have made to you. I have a very close friend of mine who's a teacher. And she showed me in her classroom, she literally has a happy drawer and she pulled that drawer out.  Inside of it were letters from little children and parents. And it's a beautiful little drawer filled with colorful pieces of paper and artwork and glitter and crayons and markers and paint and it really makes you happy just peeking in there. And that is her drawer to remind her when she stumbles on a situation that she doesn't know how to handle and she feels like an imposter because she's handling something new. She remembers that she has all these letters from children who love her and parents who've praised her for the job that she has done. So it's a great idea. So here, here's the problem with that and emergency nursing. If you are hoping to set aside a file full of love letters that your patients and their families have sent you, it's going to be a slim file with cobwebs on it. Because the nature of what we do, we don't see our patients for very long. They are at their worst when we see them, they're hurting, they're unresponsive. Their families are frantic. Honestly, getting a letter in an emergency setting is such a rare. . . it's like a beautiful unicorn because you just rarely rarely ever get it. 

Lisa: Emergency nursing. Other nurses who spend more time with their patients. . .

Nyssa: Those nurses in labor and delivery that bond with those women and get to share the most special day of their life. Those pediatric nurses who care for people's precious precious little children. Those oncology nurses who see people through their cancer and see the same patients over and over again- They establish rapport. They share special times. They get lots of love letters. Emergency nurses, we just don't. What do we do about our kudos folder then? We got crickets, right? So you are going to have to find your, your compliments and your love notes elsewhere. And so we'll keep that in mind with your employees and your co-workers. So when they do a great job, tell them. Even better- write it to them where they can look at it again. When you have a patient or family member that compliments you make a note in your phone. Send yourself an email and tuck it aside in a folder so that you can look at it. There's some articles that suggest that you read it every single day. If you're really battling with imposter syndrome, set an alarm on your phone and read through your kudos file and your happy file every single day. And when it comes to ER nursing we don't often get praised. Wow, your charting is immaculate or Wow, the care that you gave was really really good. But if we miss a core measure, or if we fail to chart something important, we're definitely going to hear about it. So mistakes are often the things that get pointed out. It's just the nature of what we do. And so it's a little bit harder for us to come up with this, this kind of this kind of praise. And your emergency physicians, your patient care techs, your pre hospital providers, they're all in the same boat. So when they do a great job, tell them write it to them.

Lisa: Spread the love.

Nyssa: Yea. Spread the Love. It's a beautiful unicorn, I'm telling you. So rare.

Lisa: Well, if I ever have to go to the ER, I will try to remember this and send a nice note to my nurse.

Nyssa: Yes, if you have been treated and cared for by an emergency caregiver, nurse or otherwise, and you had a great experience and you take the time to write it, it is a very big deal. It's a very big deal.

Lisa: Alright, so that's how you combat imposter syndrome. Those are some techniques that nurses can use. We're talking still now your boots on the ground nurses. What about when you get promoted to a leadership role, and now you're suddenly a nurse leading a battalion of nurses. I think that that would ramp up the stress and anxiety even more. What do you do about that?

Nyssa: Anytime that there's a role change that you have in nursing or in any other industry, you are at risk for imposter syndrome because you have gone right down to novice again. So even if it's not a promotion, even if you've just decided to leave the emergency department and go, for instance, to the OR all of a sudden, now, you're a novice OR nurse and you're starting out at the bottom again, and you have to learn all of those skills. And you're going to go through it much more quickly than you would if you were a new grad nurse, for instance. But nonetheless, you still have a novice mentality. So some examples that you you know, you kind of alluded to- so let's say that tomorrow I start a new job as the charge nurse. Today I am a staff nurse, I'm going to go to sleep and wake up as a charge nurse. Nothing has changed my experience or my knowledge base. But now all the sudden people are going to be calling me to put out fires, and they're going to call me to go and quell the discontent in the waiting room. They're going to call me to bed patients. And I'm going to be expected to do all these things. But nothing has changed in me, but my role. So I'm at high risk for imposter syndrome. Certainly people who get promoted to management, to the education role in the department, even just someone who is newly precepting. All of a sudden, you're in a new role that that's different for you. 

Lisa: So is there no training involved? I mean, when you get a new job, and you suddenly shift from staff nurse to a charge nurse, how does it work? 

Nyssa: It goes both ways, depending on the facility. So there are courses that you can take as a charge nurse. There are preceptor classes that you can take. Other times you just show up to work and you're the charge nurse now or you show up to work and you have a preceptee and figure it out. You may get a little bit on-the-job training. You may get a classroom experience. You're getting nowhere close to the eight or 10 weeks of orientation you had as a new grad, or two years' worth of nursing school. And so we spend two years learning how to assess and intervene on patients' care. But then you do really well at that. And you may be promoted to a nurse manager. And so now, we assume that because you are a great bedside nurse, that means that you can now do all of a sudden do schedules and budgets and payroll and purchasing and supply ordering. . .

Lisa: Right, all the administrative stuff.

Nyssa: Right, and there's nothing in nursing school that teaches us how to do those things. But those things are hugely important. People's schedules, people's payroll, that's a really big deal. And sometimes managers are thrown into that with a very little opportunity to succeed or at least at first.

Lisa: Got it. 

Nyssa: So when you have been thrown into one of these leadership positions, and you are feeling like an imposter, you're feeling like a fraud or even if you're just feeling like a novice, there are a few things that you can do. One is instead of thinking about I'm not good for this, think about you know, I have a lot to offer this position. In other words, you're not going to step into the charge nurse role and be the best charge ever the first day. But you can think "I have a lot to offer this charge nurse position" and "give me a little time and I'll be on it. I'll have it". So reframe your thinking to that. What about when you interviewed for this position? You sold yourself, remember? And they picked you. Remember, you sat in an interview somewhere and said, you know, this is what I can do for this position, and they believed you and now believe yourself. Also, when you're stepping into one of these leadership or management roles, don't step into the shoes of the person who was in it before you. They may be ridiculously huge shoes to fill. They may have had the position for 20 years, they had 20 years experience and now you are putting yourself into. That's unfair, right? You have no experience. You're brand new to this and you're comparing yourself to the person who did it for 20 years, of course, you're going to feel like a fraud, right? Additionally, do it your way, don't do it their way. This is an important thing that my nurse manager taught me is: I want you to do it your way, not the way that the previous person did it. 

Lisa: Do it your own way. That sounds a little dangerous to me. Because all the people who are relying on you are used to the way things have been done up for 20 years. I guess you don't want to burn the house down and rebuild it from scratch, right? When you walk in the door the first time. So there have been a sort of transition that nurses need to go through in order to bring the rest of the people who rely on them along with them. 

Nyssa: Yeah, and I think doing it your way doesn't necessarily mean let's do a complete 180.  Just means I want your spin on it. I want your experience and your brainpower on this.

Lisa: Your personality. . .

Nyssa: I'm not asking you to redefine the entire role. I'm just asking you to do it in your own way. 

Lisa: Got it. All right. That makes sense too. Now that you know how to combat your own sense of imposter syndrome, I have a good sense of how to combat mine, which I do feel on a regular basis. . . 

Unknown Speaker  
Nyssa: Which was your favorite sort of imposter syndrome intervention? 

Unknown Speaker  
Lisa: I like the happy wall. I like the happy drawer. I do that too. 

Nyssa: Really?

Lisa:  I do keep a collection of happy things around me to remind me of the reason why I do what I do. But I also have the benefit of all of the students who have graduated from Harvard, who I've advised in one way or another for the last seven or eight years. And I have the pleasure of seeing them go on to medical school, graduate school, FBI agents, Hotel and Restaurant managers, successful happy people running their own businesses. That's my sort of happy collection of all right, what am I doing here my really giving good advice, then I can go okay, I've had several thousand kids pass through my doors and cry on my shoulder and they're doing great.

Nyssa: And not only did they go out and achieve and do these really high-performing things, but you have some really dear friends out of those students. 

Lisa: Absolutely. Yes. Some of my my favorite people and some of my best friends are kids that went through the program and that I've, you know, been lucky enough to collect along the way.

Nyssa: Yeah. 

Lisa: Is that your best coping mechanism to?

Nyssa: I like the idea of if you're winging it, find a wingman. I like wingmen. I like mentors. And I like wingmen. 

Lisa: Out of the types you said you thought that you suffered the most from being the expert. 

Nyssa: Yeah, I am a conference nerd. I have a lot of alphabet soup behind my name. And it's because I need that validation. I can definitely feel that one for sure.

Lisa: I guess we can sum this up by saying that if you suffer from imposter syndrome, you're in good company. It's not an unexpected consequence of what you do. You literally as a nurse have other people's lives in your hands. So don't beat yourself up about it. 

Nyssa: That's right. 

Lisa: Well, thanks for this one Nyssa. Folks, if you like what you hear, we'll say the same thing we always do. Check us out on Facebook, Twitter, Instagram, email us at or go to our website,

Nyssa: Do you want to tell us about your episodes of imposter syndrome?

Lisa: Please do! Hit us up on Facebook with us so we can start a nice conversation. 

Nyssa: Love it. 

Lisa: Thanks Nyssa. We'll talk to you next time. 

Nyssa: Okay, bye Lisa!




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