Burnout and impostor phenomenon in nursing and newly licensed registered nurses: A scoping review

Impostor Phenomenon and Advanced Practice Registered Nurse Faculty

BACKGROUND

Impostor phenomenon (IP), or syndrome, is a behavioral health phenomenon where individuals discount personal accomplishments, success, and aptitude. It negatively affects high-functioning individuals in nursing and other health care professions.

PURPOSE

This study aimed to investigate IP in advanced practice registered nurse (APRN) faculty.

METHODS

This descriptive correlational study included the Clance Impostor Phenomenon Scale (CIPS).

RESULTS

The sample included 478 APRN faculty members representing 50 states and Washington DC. The majority (n = 324) of CIPS scores were moderate (n = 198) or frequent (n = 133), indicating that scores may be clinically relevant. Moderate levels were associated with an increased likelihood of experiencing negative sequelae, including decreased job satisfaction and increased burnout. Comparing CIPS scores yielded no statistically significant differences between APRN roles. Significant predictors included age, years of teaching, and rank of associate professor.

CONCLUSIONS

Findings can inform strategies to improve retention, recruitment, and job satisfaction.

Intensive care nurses' impostor phenomenon: Associations with narcissistic personality, shame-proneness, and guilt-proneness

BACKGROUND

Intensive care unit nurses commonly experience impostor phenomenon owing to constant exposure to urgent situations, high work pressure, and the demands of their professional roles. Impostor phenomenon may induce anxiety and self-doubt and adversely affect personal growth and career development. Therefore, identifying the severity of impostor phenomenon among intensive care unit nurses and its associated factors is important.

OBJECTIVES

The aim of this study was to investigate the associations between narcissistic personality, shame-proneness, guilt-proneness, and impostor phenomenon among intensive care unit nurses in tertiary hospitals.

METHODS

This cross-sectional study collected data from 251 nurses in tertiary hospitals in Korea, in July 2022, using an online questionnaire. Narcissistic personality was assessed using the Pathological Narcissism Inventory, and shame-proneness and guilt-proneness were measured using the Test of Self-Conscious Affect. Impostor phenomenon was assessed using the Clance Impostor Phenomenon Scale.

RESULTS

Multiple linear regression analysis showed that the most potent factors affecting impostor phenomenon in intensive care unit nurses was shame-proneness, followed by narcissistic vulnerability and guilt-proneness. The regression model explained 65.0% of the variance.

CONCLUSION

Nurse leaders can address impostor phenomenon among newly hired intensive care unit nurses with the goal of minimising adverse psychological outcomes. Shame-proneness, narcissistic vulnerability, and guilt-proneness require attention because of their relationship to impostor phenomenon. Additionally, it is necessary to plan and implement measures to promote awareness of self-conscious emotions, psychoeducation, and mental health intervention programs that focus on these factors.

Associations between stress, perfectionism, and imposter phenomenon among dental hygiene students

PURPOSE/OBJECTIVE

Imposter phenomenon (IP) depicts the feeling of being a fraud. Stress and perfection are associated with IP, impairing professional and academic performance and negatively impacting mental health. The purpose of this study was to explore the prevalence of IP and perfectionism in dental hygiene students and the relationship with stress.

METHODS

This study used cross-sectional survey research with a nonprobability sampling of dental hygiene students (n = 258). The study used three validated instruments: the Imposter Profile (IPP30) with six subscales, the Frost Multidimensional Perfectionism Scale Brief with two subscales, and the Perceived Stress Scale (PSS10). Descriptive, correlation, and linear regression were used for analysis.

RESULTS

The completion rate was 74.8% (n = 193). Linear regression analysis found the competence doubt (CD) subscale of the Imposter-Profile and perfectionistic striving (PS) were the only statistically significant predictors of stress (F = 10.01, p < .001, R2 = .16). CD (b = 0.36, p < 0.001) was twice as strong as PS (b = 0.15, p < 0.05) in predicting stress in dental hygiene students.

CONCLUSION

In this sample of dental hygiene students, the doubt about competence aspect of imposter phenomenon increased stress more than the striving for perfectionism. Faculty may minimize stress and support students by identifying the feelings associated with imposter phenomenon and highlighting student achievements to build confidence and feelings of self-efficacy.

Impostor Phenomenon Among Recently Graduated General Surgeons

BACKGROUND

Imposter phenomenon can occur in highly competitive fields causing internal feelings of fraud and self-doubt. Significant imposterism has been recently reported amongst general surgery residents.

STUDY DESIGN

We hypothesized that attending surgeons, navigating the transition into independent practice, would report a similar experience. We surveyed and collected Clance Imposter Phenomenon Scale (CIPS) scores from 24 Army general surgeons within 4 years of graduation.

RESULTS

Nearly all exhibited at least moderate imposterism, and over half reported significant or intense imposterism. Women reported statistically higher scores than men. Surgeons who engaged in off-duty employment or participated in mentorship were less likely to have significant or intense imposterism.

CONCLUSION

Transition to practice is a challenging and highly variable time for new surgeons. Identifying factors that attenuate these feelings could help with early career advancement.

Relationship between transition shock in novice emergency room nurses, quality of nursing care, and adverse patient events: The mediating role of emotional exhaustion

BACKGROUND

Transition shock, experienced during the first two years of employment, has been attributed to decreased clinical performance and an overall decrease in work productivity among newly graduated nurses, as well as compromised patient safety outcomes. This study tested the intermediary effect of emotional exhaustion on the association between transition shock in novice emergency room (ER) nurses, adverse patient events, and nursing care quality.

METHODS

A descriptive study was carried out involving 303 novice ER nurses from various emergency units in five different hospitals in Central Philippines, utilizing four standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

RESULTS

Transition shock in novice ER nurses was associated with an increased incidence of adverse patient events (β = 0.3897, p = 0.0005) and poorer nursing care quality (β = -0.2146, p = 0.0021). Furthermore, emotional exhaustion partially mediated the association between transition shock and the two patient-related outcomes: adverse patient events (β = 0.0477, 95 % CI = 0.0078-0.0997) and nursing care quality (β = -0.0142, 95 % CI = -0.0412 to -0.0095).

CONCLUSIONS

Transition shock in novice ER nurses contributed to heightened emotional exhaustion, which subsequently led to an increased incidence of adverse patient events and a decline in the quality of nursing care.

Gaining acceptance, insight and ability to act: A process evaluation of a preventive stress intervention as part of a transition-to-practice programme for newly graduated nurses

AIM

To investigate how NGNs perceived and applied an intervention for preventing stress-related ill health embedded in a transition-to-practice programme when entering their professional life.

DESIGN

A qualitative exploratory descriptive design was selected for this study to gain insights and perspectives on the adoption and utilization of the intervention.

METHODS

In this qualitative methodology process evaluation, semi-structured and audio-recorded interviews were conducted with a sample of 49 nurses. Data were collected between December 2016 and July 2017, and were sorted in NVivo 12 Plus, followed by thematic analysis.

RESULTS

The analysis resulted in three change processes stimulated by the intervention: (a) Building acceptance of being new; (b) Gaining insight into professional development and health and (c) Practical steps for skills development, healthy habits and better-organized work. In addition to the three themes, barriers that hindered the progression of the processes were also described. Each process influenced the development of the others by stimulating a deeper understanding, motivation to change and courage to act. Several barriers were identified, including the use of cognitively demanding intervention tools, fatigue, high work demands, inconvenient work hours and a hostile social climate on the ward.

CONCLUSION

This process evaluation showed that newly graduated nurses used knowledge from the intervention and adopted new behaviours largely in accordance with how the intervention was intended to work.

IMPACT

When entering a new profession, it is crucial to receive a well-thought-out, structured and targeted introduction to the new professional role, tasks and work group. Nurses stated that the intervention increased their understanding of the role as new nurses and their insight into how to develop skills that promoted better functioning and recovery. The intervention also stimulated the development of new health behaviour and some new learning strategies.

Impostor phenomenon traits in radiography students: Findings from a UK pilot survey

INTRODUCTION

Impostor Phenomenon (IP) includes feelings of being a fraud, which can be associated with high anxiety levels. Research suggests healthcare students on clinical placement report high levels of anxiety. This study aimed to explore radiography students' (diagnostic and therapeutic) IP traits within the United Kingdom (UK).

METHODS

The pilot study used a mixed-method online survey, applying the Clance Impostor Phenomenon Scale (CIPS). Internal student recruitment used the university virtual learning environment (VLE), and external UK recruitment used social media with a convenience sampling method. The survey included demographic questions (gender, age, year of study, course). The statistical analysis used the Kruskal-Wallis test for the quantitative responses and content analysis of the qualitative responses.

RESULTS

The survey received n = 92 responses; 77% were found to have frequent or intense IP traits. No significant differences were identified by age (p = 0.46) or radiography programme (diagnostic or therapeutic) (p = 1.00). The year of study demonstrated a significant difference (p = 0.01), with second-year students scoring a higher CIPS score (78.56) than first and third years (72.41 and 66.17, respectively). There was also a significant difference between males and females surveyed (p = 0.001). The thematic analysis highlighted that the clinical placement environment, prior IP knowledge, feelings of not belonging, and being an older/mature student increased IP feelings.

CONCLUSION

Both therapeutic and diagnostic students returned a high CIPS score >70, demonstrating that IP traits were present in the sample of survey responses. Although being an older/mature student was a subtheme in qualitative responses, the quantitative data displayed no statistical difference amongst the CIPS scores by age. A significant difference between males and females surveyed (p = 0.001) and year of study (p = 0.01) was found with second years students scoring higher (mean CIPS score of 75.56) than first and third-year students (72.41 and 66.17, respectively). The qualitative responses further suggested as clinical placement experiences increased, feelings of IP decreased.

IMPLICATIONS FOR PRACTICE

Educational intervention methods such as workshops may assist radiography students in identifying and coping with IP traits before their first clinical placement.

Leadership and Impostor Syndrome in Surgery

BACKGROUND

Impostor syndrome is an internalized sense of incompetence and not belonging. We examined associations between impostor syndrome and holding leadership positions in medicine.

STUDY DESIGN

A cross-sectional survey was distributed to US physicians from June 2021 to December 2021 through medical schools and professional organizations. Differences were tested with the chi-square test and t -test for categorical and continuous variables, respectively. Logistic regression was used to identify factors associated with holding leadership positions and experiencing impostor syndrome.

RESULTS

A total of 2,183 attending and retired physicians were included in the analytic cohort; 1,471 (67.4%) were in leadership roles and 712 (32.6%) were not. After adjustment, male physicians were more likely than women to hold leadership positions (odds ratio 1.4; 95% CI 1.16 to 1.69; p < 0.001). Non-US citizens (permanent resident or visa holder) were less likely to hold leadership positions than US citizens (odds ratio 0.3; 95% CI 0.16 to 0.55; p < 0.001). Having a leadership position was associated with lower odds of impostor syndrome (odds ratio 0.54; 95% CI 0.43 to 0.68; p < 0.001). Female surgeons were more likely to report impostor syndrome compared to male surgeons (90.0% vs 67.7%; p < 0.001), an association that persisted even when female surgeons held leadership roles. Similar trends were appreciated for female and male nonsurgeons. Impostor syndrome rates did not differ by race and ethnicity, including among those underrepresented in medicine, even after adjustment for gender and leadership role.

CONCLUSIONS

Female physicians were more likely to experience impostor syndrome than men, regardless of specialty or leadership role. Although several identity-based gaps persist in leadership, impostor syndrome among racially minoritized groups may not be a significant contributor.

Supporting new graduate nurses' transition to practice

ABSTRACT

How new graduate nurses are supported may determine whether or not they stay at the bedside. A strong preceptorship, mentoring, and support system can retain and grow this workforce. This article presents practical guidelines for experienced nurses when supporting colleagues new to clinical practice.

Burnout and Professional Engagement during the COVID-19 Pandemic among Nursing Students without Clinical Experience: A Cross-Sectional Study

Burnout affects many healthcare professionals, especially nurses, causing serious health problems and disrupting the work environment. Academic burnout may also be experienced, leading students to feel unable to cope with their education. As a result, they may lose interest and even consider abandoning their studies. Hence, burnout syndrome can affect both the mental health and the professional future of those affected. To evaluate academic burnout in nursing students who had no clinical experience before starting their practical training, a cross-sectional study involving 212 third-year nursing students at the University of Granada was conducted. Data were collected using the Granada Burnout Questionnaire, the Utrecht Work Engagement Scale, the NEO Five-Factor Inventory, the Hospital Anxiety and Depression Scale, and the Fear of CoronaVirus-19 Scale. High levels of burnout were present in 37.8% of the students. Moreover, 21.5% and 8.7% had borderline cases of anxiety or depression, respectively. Another 30.8% and 9.2%, respectively, were considered likely to present these conditions. According to the predictive models of burnout dimensions obtained, neuroticism is a predictor of all three burnout dimensions. Furthermore, anxiety, depression, extraversion, responsibility and engagement are predictors of some dimensions of the syndrome. Many nursing students present high levels of burnout, which is related to certain personality variables and to the presence of anxiety and/or depression. The level of professional engagement is inversely associated with the impact of burnout. The participants in this study have normalised their return to the pre-pandemic study routine (in-person classes), and fear of COVID-19 was not a significant predictor of any dimension of burnout.