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The self-doubt began when I applied for nursing school. I’d think, “What makes you think you should have this sort of responsibility?” or “I can’t possibly do this— everyone says nursing school is so hard.” I’d been accepted into two different programs, but this only heightened my suspicion that there had been some mistake. I worried that once I was in school people would realize that I didn’t belong there.

These beliefs were hard to shake. I thought I was the only one with such doubts, but it turns out that I’m not alone and this phenomenon has a name. Imposter syndrome (IS) is the feeling of being a fraud. It often affects women and minorities, and it tends to occur at times of career transitions and in high-achieving individuals. Nurses can be particularly affected.

What is it?

In 1978, Pauline Rose Clance and Suzanne Imes published their study on what they called the imposter phenomenon. Now commonly called imposter syndrome, it is described as having deep feelings of unworthiness and doubt of one’s capabilities, coupled with the fear of being “found out” or exposed as a fraud. It’s accompanied by an inability to acknowledge one’s accomplishments.

People with IS are often afraid to speak about these feelings, as the fear of being exposed as a fraud can run deep. Such individuals tend to lean toward perfectionism as a compensation for their self-doubt. This can lead to overwork and unrealistically high expectations on tasks and assignments—or, conversely, it can lead to procrastination due to anxiety and fear.

People with IS also rarely ask for help and feel shame if they are exposed as falling short in any way. Imposter syndrome is not considered a mental illness and there is no official diagnosis for it, though research confirms that IS is very real and that many people struggle with it.

Who gets imposter syndrome?

Anyone can suffer from IS, and it can come and go at different times of life, but it tends to occur or become more intense around times of transition. Research suggests that it affects women and minorities more frequently, but any trait that sets a person apart from the majority of their peers can add to the feeling of being an imposter. Those traits can be gender, race, sexual orientation, gender identity, and others.

It is particularly prevalent among women due to cultural and societal expectations of their behavior in the workplace. Men may experience successes as a validation of their skills and intelligence, but as women make career advancements and gain skills and competency, some may feel it is due to luck or having “conned” those in authority.

What makes an individual susceptible?

Research has pointed to various causes. One premise put forth by Clance and Imes is that being raised by parents who have high expectations can set the stage. The child who is expected to be superior in all things starts to suffer when they realize they cannot do it all and are afraid to convey this and get the help they need. This mindset can carry into adulthood. Or conversely, the parents designate a sibling or another relative to be the “smart one,” leaving the child to feel they need to work harder for recognition.

Authors Tulshyan and Burey look at IS as a product of societal and historical contexts that manifest themselves in subtle ways. Sexism, racism and other forms of ingrained and unconscious bias can set the stage. They warn against the tendency of much published material on IS to point the finger at the people suffering from it and frame it as a personal problem. Instead, they highlight toxic work environments, such as those with overt or subtle bullying, that can exacerbate or cause IS, and suggest we focus on making systemic changes.

Are nurses more likely to have IS?

Some research has shown that IS may be more common among nurses and student nurses. Nursing school is a pressured situation with high-stakes goals. The profession has a steep learning curve, one that can feel particularly daunting because it often involves life and death situations. Once new nurses realize how much on-the-job learning will be needed to supplement what they learned in school, IS may set in. It may also contribute to the exhaustion, frustration, and lack of energy that characterize burnout in nursing.

In 1982, Patricia Benner laid out her framework for nurses’ paths from novice to expert. It takes many years to achieve expert status, but often people begin their nursing careers with high internal expectations, which can lead to a sense of failure. Even when a nurse has achieved a level of expertise, the feelings of being a fraud can remain.

Nurses at any stage of transition in their careers can fall prey: student nurse to employed novice, staff nurse to clinical leader, charge nurse to manager, career nurse to educator. Career changes always come with a period of adjustment and feelings of doubt, anxiety, and unease.

What can be a person do about IS?

Reaching out may be very difficult, as shame—the feeling that there is something wrong with oneself—is such a large component of IS. Learning that many people suffer with the same thoughts and doubts and gaining an understanding of where these feelings come from may empower people to make changes.

Talking with others is the first step. Seeing a therapist or engaging in group therapy will help dispel distorted internal views. Identifying compassionate peers and mentors in school or the workplace and cautiously opening up to them can be a way to gain feedback and perspective.

The person with IS could also keep lists of positive feedback to help dispel the negative self-talk. They could also share their knowledge and skills through tutoring, mentoring, or training to demonstrate to themselves as well as others their own capabilities.

Changing underlying systems that feed IS.

Researchers Tulshyen and Burey focus on the systems that create environments in which IS can flourish. They suggest women and minorities need to understand that the lack of supportive workplaces as well as cultural expectations are major factors that are not a product of their own failings.

They also point out that another’s displays of “confidence” do not automatically indicate competence. Blatant displays of confidence are often overcompensating for the person’s own fears, a product of arrogance, or just plain bullying. Look for more subtle and supportive forms of leadership in your organization and reach out to those individuals. Focus on people who work toward the improvement of all the members of the group.

Self-doubt, uncomfortable feelings, and anxiety at times of transition, both in the workplace and in school, are normal. Compounding factors such as societal expectations around achievement and achievement’s connection with a sense of self-worth, bias in the workplace and school, and poor messaging from important figures in childhood all add to the likelihood of IS. But there are many ways to counteract its effects and begin to feel more comfortable and engaged in life.

Eileen J Glover, RN, has been a psychiatric nurse for 12 years. She finds fulfillment in helping patients improve their lives from within. Eileen lives in southern Vermont. Eileen can be reached at eileenjglover1965@gmail.com.