From the Bedside to the Boardroom:

Imposter Syndrome in Nursing Leadership

Karen R. Fowler, PhD, RN, CENP, and Lizette Villanueva, PhD, RN, CNE, CHW

Nurse leaders have a complex role in patient and staff outcomes. Nurses graduate
from nursing schools clinically proficient but may lack leadership and team-building
skills. This may lead to an imbalance in the executive suite and result in nurse
leaders developing imposter syndrome. Imposter syndrome can occur at times of
career transition, and emerging nurse leaders may be particularly affected. Edu-
cation focused on topics such as peer-mentoring, reflection, and identification of
attributes can help combat feelings associated with imposter syndrome and in-
crease authentic leadership capabilities in nurse leaders.

T
he nursing leadership role is pivotal in organi- cultivates self-doubt, diminishes well-being and resil-
zational success. Often described as frontline ience, impacts the ability to receive feedback, and can
leaders, nurse leaders have a complex role in negatively affect success.4 A previous study found IS to
patient and staff outcomes. Clinical nurses who are be negatively impacted by resilience,5 which mediated
engaged and demonstrate sound clinical skills are often the relationship between IS and a sense of belonging.
offered opportunities to be promoted into leadership This indicates that those with IS may be less resilient
positions; however, they may be ill-prepared for the and lack a strong sense of belonging. Alrayyes et al.6
role. Although competency training can help prepare found that adults experiencing IS had higher levels of
new nurse leaders for the task of management, it burnout and depersonalization, but a lower sense of
cannot prepare them for all areas of business man- accomplishment. Echoing this, Maftei et al.7 found that
agement, negotiation, and advocating for nurses in the those who scored higher on IS scales had higher levels
boardroom. Nurses are clinically proficient upon of depression and anxiety and a greater tendency to-
graduation, but may lack leadership and team-building ward procrastination, compared with those who scored
skills. Health care executives (non-nurses) are primarily lower. In a systematic review, Bravata et al.8 reported
trained in leadership functions, which may create an that IS tends to be discussed more frequently in lay
imbalance in the executive suite and result in nurse literature as a behavioral component influencing per-
leaders developing imposter syndrome (IS). IS, also formance and that most studies on IS were conducted
known as “imposter phenomenon,” was first used to with students, minority groups, and women with a
describe high-achieving women who felt less capable or focus on nurses, physicians, managers, teachers, and
knowledgeable than their male counterparts and sub- accountants.
sequently felt as if they were “faking it” when inter-
acting with executives in their organization.1 A nursing
literature review generates a more conceptual defini-
tion of IS, indicating that it is subjective, involves KEY POINTS
inaccurate self-assessment, and includes feelings of  Transitioning emerging nurse leaders from
incompetence (professional, intellectual) despite evi- the bedside to the boardroom should occur
dence to the contrary.2 to avoid imposter syndrome.
 Nurse leaders’ success depends on
PROMINENCE OF IMPOSTER SYNDROME understanding the effects of imposter
Current Literature and Background syndrome.
IS is not limited to one group of individuals. An esti-  Strategies to combat imposter syndrome
mated 70% of the population has experienced IS at include mentorship programs, workshops,
some point.3 In much of the population, these feelings and fostering a positive work environment
are limited and transient. However, when pervasive, IS for nursing leadership.

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 Gender been identified between racial and ethnic identity and
IS exerts subtle effects on performance that accumulate IS. Further, IS has been linked to a lack of a sense of
over time. Historically, IS research has conceptualized belonging experienced in various fields, particularly
“imposterism” as being experienced by high-achieving those in science, technology, engineering, and math.20
women, although recent studies have found equal Although IS often affects women and ethnic minor-
levels of IS across genders.2 Undeniably, IS affects all ities, it can also occur at times of career transitions, and
genders, including women and men, although multiple emerging nurse leaders may be particularly affected.
studies have found greater IS among women.8
Compared with men, women are significantly more Nursing
likely to report IS-related beliefs, which are significantly Individuals experiencing IS often feel inadequate
related to mental health outcomes and perfectionism.9 despite evidence to the contrary.21 Although IS is not
Bernard et al.10 found that women who reported a an official diagnosis in the Diagnostic and Statistical
high frequency of racial discrimination had higher levels Manual of Mental Disorders, its existence is undeniable. IS
of IS and reported greater fear of success and fear of can evolve and lead to burnout, depression, and
failure, as well as lower self-esteem, compared with anxiety.21 Nurse leaders promoted to executive posi-
men.11 Cultural and societal expectations for workplace tions become acutely aware of the differences between
behavior make IS particularly prevalent among women, the bedside and administrative roles. While the over-
some of whom may feel that their career advancements arching goal of providing excellent patient care is the
and gained skills are attributable to luck rather than same in both roles, other components of a manage-
their own competence.12 Confidence in one’s abilities ment or leadership role may be unfamiliar to many
enhances one’s competence; therefore, IS plays a role in newly promoted nurse leaders. Differences between the
maintaining unjust inequalities. Women are especially bedside and the boardroom, such as the attire (business
more likely to experience IS when marginalized in the attire), language (e.g., return on investment, covered
workplace.13 Self-doubt layered with IS impacts lives, market share), and forms (e.g., financial state-
women’s careers and makes them “push less often than ments, reports), can increase the risk of IS in newly
male counterparts for a raise or promotion.”14 IS can promoted nurse leaders.
lead to psychological distress, emotional suffering, and
serious mental health conditions.15 Strikingly, IS is IMPLICATIONS FOR NURSE LEADERS
experienced by not only by members of historically The good news for nurse leaders is that IS can be
disadvantaged groups and women in particular but also ameliorated through education, mentorship, and a
those with traits that set them apart from the majority, supportive culture. The literature suggests several
such as gender identity, sexual orientation, race, and strategies, and Table 1 presents an amalgamation of
ethnicity.10 the strategy and information found to reduce IS. The
first step in decreasing IS is based on a nurse leader’s
Ethnicity ability to reflect. Farrell22 highlights several paradoxes
As IS has become more prevalent in higher education related to leadership. Specifically, new nurse leaders
and the workplace, theories surrounding the phenome- must be decisive yet allow participatory decision-
non has expanded to studies related to gender, envi- making, be cognizant of the overall organization yet
ronmental surroundings, culture, and race.16 IS has know details related to patient care, engage others yet
been studied across genders, with most studies con- control outcomes, and simultaneously focus on both
ducted on college students. However, scholars first organizational health and individual patient outcomes.
examined IS among racial and ethnic minority samples. While the paradoxes are not mutually exclusive, nurse
A growing body of research indicates that Black leaders need higher levels of reflection and emotional
emerging adults are particularly vulnerable to percep- intelligence. In the context of IS, nurse leaders must be
tions of intellectual incompetence17 related to simulta- cognizant of their feelings in “executive boardroom”
neous stressors resulting from expectations, societal situations and recognize their discomfort.
roles, relationships, and negative race-related experi- Nurse leaders are problem-solvers. IS can be
ences. Several people competing for limited resources recognized a potential issue through self-reflection.
creates additional challenges, and those with diverse Understanding of the complexities of IS will assist in
ethnic backgrounds may sense a “prestige hierarchy minimizing its destructiveness. Previous research
with unclear and shifting rules,” leading to persistent conducted with nursing students has linked poor
self-doubt and the emergence of IS.18 Afran et al.19 professional self-concept with IS.23 Through mentor-
reported that feelings of insecurity and self-doubt are ship, new nurse leaders can increase their sense of self-
characteristic of IS among Black, indigenous, and other care, self-knowledge, and self-leadership, thereby
people of color. IS results from the inevitable effect of reducing IS.23
working in a white-dominated economy and learning in In a study on transitioning to a leadership position,
a white-dominated education system. A connection has nurses perceived a lack of support or adequate

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Table 1. Counteracting Imposter Syndrome
Reflect on feelings and emotions in high- Have you felt this way in the past? Are there
stress executive situations. situations that make these feelings worse?
Do you leave meetings wishing You had said
something but were too timid to speak up?
Acknowledge and label what your self- Do you have a difficult time admitting you
reflection reveals. may have imposter syndrome?
Read information on the topic; knowledge What is in the literature? Is it possible you are
can be liberating. not alone in my feelings and anxieties?
Choose a mentor who has experience in the Who is someone you admire in the
executive suite and will offer you advice. organization? Would they be willing to be a
mentor?
Identify the strengths and accomplishments Why were you promoted? What are your
that have allowed you to advance. accomplishments?
Change or reframe your mindset through Tell yourself, “I have a role in executive
positive affirmations. administration. I have voice and owe it to
those who report to me to use it.”
Prepare for setbacks; you may need to Are you feeling anxious? What do you need
periodically reframe your mindset. to do to be the leader you are capable of
being?

succession planning and mentoring.24 Further, succes- requesting inclusion in important professional meetings,
sion planning, mentorship, and support were shown to and designing a “hero” wall in the workplace with
ease transition discomfort for newly promoted nurse certificates, photos, and accomplishments.28 A study on
leaders. Transitioning plans were identified as a coping mechanisms in health care faculty found that
component to minimize frustrations and disillusion- social support, positive affirmations, and validation of
ment with nurse leadership.24 Formal mentorships can accomplishments reduced symptoms of IS.29
increase a mentee’s self-efficacy, raise leadership Educational programs on IS have been proven to aid in
awareness, and promote the acquisition of leadership remediating symptoms, and several studies note the ability
qualities, which will reduce the occurrence of IS.25 of leadership training to increase self-efficacy and decrease
Self-efficacy theory posits that beliefs and self- IS.4,8,30 Feenstra et al.16 stated that many IS-related in-
appraisals regarding one’s own abilities impact out- terventions attempt to “fix” the individual without
comes, expectations, and behaviors.26 Nurse leaders considering their environment. Organizations and leaders
with high self-efficacy value their strengths and must understand the concepts behind IS and the mediating
recognize the importance of their contributions. Thus, factors that can make new nurse leaders prone to experi-
enhancing new nurse leaders’ self-efficacy is vital for encing it. Thus, instructional programs should focus on all
reducing the impact of IS. Cziraki et al.27 found that leadership staff, not only those deemed to have a tendency
increasing nurses’ opportunities to develop leadership toward developing IS. To ensure the successful transition of
skills increases their self-efficacy and motivation for new nurse leaders, focus must be placed on aspects of
career advancement. Nurse leaders serve as a voice for organizational culture, interpersonal relationships, and
nursing in the executive boardrooms; thus, their ability everyday interactions among leadership teams.16
speak with confidence and make their voices heard is
essential. IS can be a limiting factor in a new nurse SUMMARY
leader’s ability to speak with the necessary confidence. Evidence demonstrates that successful adaptation to the
If IS has been identified as a barrier, reframing and nurse leader role improves when assistance with the
cultivating positive micro-affirmations can potentially transition to leadership practice is available.31,32 How-
foster individual growth and confidence.28 Dissolving ever, Winter30 found that competency-based training
deeply rooted feelings of inadequacy requires targeted may not be enough to overcome pervasive feelings of self-
actions that increase self-confidence. These actions, doubt and insecurity in volatile, uncertain, complex, and
called “reframing,” can include actions such as appre- ambiguous environments. A scoping review by Gottlieb
ciative inquiry, recognition, validation of experiences/ et al.33 suggests that mentorship programs, workshops on
feelings, reinforcing/rewarding positive actions, IS, and fostering a positive work environment can reduce

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 the incidence of IS. Education focused on peer- ethnic minority college students. J Couns Psychol.
mentoring, reflection, identification of attributes, and 2017;64(2):141.
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ership has also been found to reduce IS in new leaders.16 econ Lab. 2020;11(2):1-17.
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ences of imposter phenomenon in STEM. CBE Life Sci Educ.
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