The Impostor Phenomenon in New Nurse Practitioner Graduates

Feeling Like a "Fake": Challenges for New Nurse Practitioner Graduates

Nurse practitioner (NP) graduates often express feelings of being an "impostor" or "fake" as they move from the role of student to professional NPs. The purpose of this paper is to define the impostor phenomenon (IP) as it relates to the NP role and to discuss the challenges faced by new graduates during this transitional period. Strategies for managing these feelings of inadequacy will also be addressed.

IP is a concept that was first used to describe an "internal experience of intellectual phoniness" exhibited by a select sample of high-achieving women who were successful by external standards, but internally felt incompetent.^[1] They attributed their success to luck rather than to intelligence or ability.^[2]

IP is not an "abnormal" feeling, but instead a temporary, "normal" feeling that occurs when an individual experiences a transition such as a new role or job with subsequent changes in identities, relationships, and/or abilities. Clinical symptoms associated with IP include generalized anxiety, lack of self-confidence, depression, and frustration brought on by the inability to meet a self-imposed standard of achievement.^[3] Furthermore, disorientation and distress occur as an individual moves between 2 relatively stable states, culminating in a profound feeling of disconnectedness.

Overall, a search of the psychology and sociology literature yields much research on IP. One article focused on the clinical nurse specialist role, stating that IP may develop due to the clinical nurse specialist feeling unprepared "to be an expert," which results in depression, feelings of being uneducated, and loss of self-confidence.^[3]

Foremost is Benner's work on skill acquisition and professional development of nurses, based on the work of Dreyfus and Dreyfus.^[4,5] Benner's model describes the nurse as passing through 5 stages of career development: novice, advanced beginner, competent, proficient, and expert.^[4] Transition from novice to proficient takes between 3 and 5 years, with more than 5 years needed to become an expert.^[4]

One of the implications of Benner's research is that experts use intuition, which is grounded in the context of the nurse's clinical experience. Other researchers validated this assumption when they suggested that 1 of the 4 key components of expertise is familiarity.^[6,7]

Additional research identified that familiarity was not the only defining feature of expertise. For example, a novice may execute a skill without error yet not be able to perform it consistently in comparison to an expert. Novices' failure to perform consistently at the expert level resulted in feelings of anxiety during unfamiliar situations.^[8]

A model describing the transition to the NP role has been developed by Brown and Olshansky.^[9] This theoretical model is based on grounded methodology that examined the experiences of recently graduated NPs during their first year of primary care practice. The model consisted of a process called From Limbo to Legitimacy, and included the following 4 major categories: "Laying the Foundation," "Launching," "Meeting the Challenge," and "Broadening the Perspective."

The model shows progression over time, but the categories are not necessarily linear or mutually exclusive. Several authors described new graduates as being in the process of shedding their student role and beginning to take on the identity of a NP.^[10] Graduates were described as "being in limbo" because they had the academic credentials, but not the necessary license or employment to practice as an NP. During the transitional first year of practice, the new graduates faced many obstacles in establishing their identity in their new role.^[11]

Additional nursing literature on transition concluded that NP students are adequately socialized into the role during the educational period, but complete transition into the role may not always occur.^[12] Kelly and Mathews^[13] described how graduates from NP programs leave a comfort zone of nursing practice and enter a new position where feelings of insecurity and stress are common and are accompanied by disorganization, uncertainty, and insecurity.

Heitz and colleagues^[14] suggested that NPs used "optimistic self-talk" as a personal coping mechanism throughout transition; these NPs repeated to themselves comments such as "You've got to keep working" and "You're prepared to do this."^[14]

Topics in Advanced Practice Nursing eJournal. 2006;6(2) © 2006  Medscape

Cite this: The Impostor Phenomenon in New Nurse Practitioner Graduates - Medscape - Jun 07, 2006.