EP 18: Imposter Syndrome Antidote

Need a clinical confidence boost? In this episode, our hosts get candid on imposter syndrome, and how you can combat feelings of inadequacy and self-doubt as an NP. We talk about leaning on your preceptor for support in times of growth, positive visualization for improving self worth, and ways to navigate toxicity in the workplace. 

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Transcript

Voiceover 0:01

Welcome to NP Launchpad, presented by Fitzgerald Health Education Associates, the podcast created for newly graduated nurse practitioners navigating the transition from school to clinical practice. Hosts Jason Gleason, Christopher Gleason, and Vanessa Pomearico-Denino deliver real talk, real experiences, and practical guidance to help you succeed from day one. So if you're ready, let's jump right in.

Vanessa Pomarico 0:43

I'm joined tonight by my two friends and colleagues, Dr. Christopher Gleason and Dr. Jason Gleason. Welcome, guys.

Jason Gleason 0:51

Hey, V. How's it going?

Vanessa Pomarico 0:53

Nice to see you both.

Jason Gleason 0:55

Good to see you as well.

Vanessa Pomarico 0:56

Thank you. All right. So just some quick housekeeping things. Um, we're gonna uh just ask you if you can uh send all of your questions to nplaunchpad @fhea.com. That is nplaunchpad@ fhea.com. Send us your questions and we might just answer them on air in a future episode. And just a quick disclaimer: this is for educational purposes only. Please make sure that you verify any of this information with your state and check with your employer as well, as well as your payer rules as well. We're here more as your friends and your colleagues, but any legal advice, you really need to contact the appropriate people for that. All right, so we're gonna dive right in tonight to the hot topic discussion about uh imposter syndrome. Why do you think imposter syndrome hits new grads so hard?

Christopher Gleason 1:49

I remember feeling imposter syndrome actually after I after I graduated. I knew I had a good knowledge base. I had practiced as an RN for 10 years. So, you know, I had that that general and that good knowledge base. However, when when I was transitioning into that NP role and taking on the responsibility of diagnosing, prescribing, and all and all that comes with it, I definitely felt like I was somewhat, somewhat in over my head and somewhat asking myself, how did I get here? What am I doing here? And, you know, am I truly an imposter in this role?

Vanessa Pomarico 2:23

And and that's exactly what imposter syndrome is. It's that psychological experience that really causes somebody to kind of fear that they're being exposed like a fraud or that they have this persistent self-doubt because they're constantly second-guessing their own abilities. Um, I I mean, I know for me, I kept waiting that first year, like you, Christopher. When I was a staff nurse, I don't remember having it when I was a staff nurse. And I think because as nurses, when we come out of school, they tend to, most organizations or hospitals tend to give you somebody that you're working with side by side for about, oh, ours was six weeks, but I now I hear it's up to six months or even a year now. So there was there was a lot of support there. But as a nurse practitioner, just like you did, I kept waiting for somebody to tap me on the shoulder and go, what are you doing? You can't do this.

Jason Gleason 3:12

Yeah, exactly.

Vanessa Pomarico 3:13

How about you, Jason? Did you feel like you had imposter syndrome?

Jason Gleason 3:16

Absolutely. Yeah, it can relate to both of what you're experiencing. You know, I I think I shared this in a previous episode, but that first time I wrote a prescription for a patient without a preceptor, it's like I double-checked everything because I was kind of nagging myself, like, oh, I just have this gut feeling like I'm gonna screw this up and do something wrong and kill this patient, when in fact the script was for Lacinoprel. And I looked it up like 10 different times, right? Yeah, but but and and I I think imposter syndrome to a certain degree, as long as it's controlled anxiety, is a good thing and it makes us double check ourselves. But tonight's topic, imposter syndrome, is where it can go horribly wrong for you, where you're second-guessing everything where you can't get anything done, right? Absolutely.

Vanessa Pomarico 3:57

Right, right. And you you mentioned the right word because imposter syndrome is a form of anxiety.

Jason Gleason 4:04

Oh, sure.

Vanessa Pomarico 4:04

And it really has to do with people who are over preparing, but they have they lack that ability to really like internalize or accept the fact that they are successful. And like you said, we don't have our preceptors there, and all of a sudden it's up to us. And so the imposter syndrome is a very real thing. And and there's so much out in the literature. So for those of our uh attendees tonight and our listeners, if there's something that you want to really take a look at, there are a myriad of articles that you can find on imposter syndrome, but we're gonna talk about it and talk about, excuse me, some of the anecdotes so that you don't really walk away feeling like there's nobody here to help me. So, really, when we think about imposter syndrome, even though we know as clinicians that we're doing the right thing, we always have to think about that transition stress response, right? We know that there's a huge responsibility being a nurse practitioner. The buck stops with us. You know, as a nurse, there's always, you know, a resident or a medical student and then a fellow and then the attending. So there's many layers of people, you know, above us as nurses, but as nurse practitioners, we're it. And so our responsibility really is so much heavier than the confidence that any of us are really feeling until we kind of get our feet underneath us. You know, there's so many things that play into imposter syndrome. I know one of the biggest things is the electronic health records. Oh, yeah. Um, really that right, that learning curve. Um, you know, trying to think, am I ever going to be able to get this right? And if I can't get through the computer, how am I going to be able to take care of a patient? Um, we have to think about new protocols. We have to think about that the culture, our work culture as nurse practitioners, especially in the outpatient setting, is so different than what we do as an inpatient, right? Um, and so there's a lot of very different expectations. And we know that um most of the people who suffer from imposter syndrome are really high achievers, like the superhumans, the perfectionists, right? But they're equally as vulnerable as anybody else. The problem is that when you're an overachiever, you tend to notice all of those gaps and you ignore the progress that you're making. And so, really tonight, hopefully the three of us are going to be able to make you feel a little bit better about not ignoring the progress, but acknowledging and accepting the fact that you really do know what you're doing. Okay.

Christopher Gleason 6:33

Right. Right.

Vanessa Pomarico 6:34

So one of the things that that I know um that helps with some of this is really when you normalize your stress response and then figure out what's the plan to help me work through this so I can minimize those feelings. So things like, you know, how do you measure your growth? So um things like fewer consults for the same problem. You're not going to the same person all the time to say, what was the first line of blood pressure medicine? You know, how do I do this I and D? Uh, getting a little bit faster with your notes. And we're going to talk about time management in an upcoming um episode. So we'll talk a little bit more about that in another episode. Um, and then being able to give our patients more education. And I know that that was one of the things that I felt good about, one of the areas that I felt good about. It was a very small area, was being able to do my patient education. And I finally was able to have the doc that I worked with that said, you know, look at the great job you're doing educating the patients on, I happen to be in a gynecology practice on safer sex and on birth control. You know, look at that as a win. And then let's work on all the other things. So one of the things, you know, you can always look for is asking your colleagues for some positive feedback. You know, what did I do well this week? Where can I improve? And really, we have to really celebrate our competence and stop thinking like we need to be so perfect. You know, medicine is not an exact science, right?

Jason Gleason 8:03

Right. Absolutely not.

Vanessa Pomarico 8:05

Yeah. So, so Jason, oh, go ahead.

Jason Gleason 8:08

Oh, no, go ahead. You have a question.

Vanessa Pomarico 8:10

I was just gonna ask you, how, what advice do you have for nurse practitioners to utilize their mentorship and and any peer support that might be around that can help them overcome their imposter syndrome?

Jason Gleason 8:22

You know what? I I look at imposter syndrome, I almost look at it from the viewpoint of preparing for your boards, for example. And every member of our audience out there has done that because they've hopefully have nailed their boards or they're preparing to. But if you think of preparing for your boards and the anxiety that you have around that, a lot of that is due to lack of confidence in yourself, in your skills, and not recognizing how brilliant you already are, right? And it's such a balancing act, I think, between recognizing that you are brilliant, that you've gotten to this point in your academic career, in your professional career, where you you know what you're doing, right? You're competent, otherwise you wouldn't have gotten this far. But also balancing that with you don't know what you don't know. It's like a a high wire act that you're trying to walk down, right? And so what I kind of visualize this as being is each of us have this balloon and it is blown up with all this air so tight. But if you imagine this balloon being filled with anxiety, and some of us, that anxiety, it's too much. It's about ready to pop, right? And so, whatever we can do to release some of that anxiety air out of this giant balloon filled with anxiety, we're gonna be able to function more effectively as an NP. So I would suggest, like if I was a new NP and I nail my boards, so I reduce some anxiety around my test, I nail my boards, I'm out in practice now, to continue that process of releasing some of that anxiety and flipping it around and using it in a positive way to stimulate curiosity and learning new skills and recognizing that you're competent is one of the best ways to do that, I believe, is communicating clearly with those around you, especially a mentor. And if you don't have a mentor, you should have a mentor in your in your clinic or your facility. If you don't have one, ask for one. Hopefully, everybody out there is assigned one. But talk to your mentor on a regular basis. That might be every day, it might be once a week. Set time aside, like five minutes, ten minutes. Hey, can you tell me what I can work on? But also key to that is telling me what am I doing right? What am I excelling at, right? That positive feedback is so, so important. And if you're not getting that, ask for that. And if you're still not getting that, maybe consider getting a different mentor. I think that's essential because you're laying the foundation, the groundwork for the rest of your practice, which can affect the entire trajectory of your entire career, but more importantly, the patient care that you're going to give to other people out there. And that can be a big safety issue. So that's how I kind of conceptualize, you know, the imposter syndrome and how to facilitate or get through it and really come out the other side a much better uh practitioner.

Vanessa Pomarico 10:45

I I love your analogy too.

Christopher Gleason 10:47

Um, I think it would add to that though, if you do have the luxury of having the mentor or the preceptor, um, one thing you can do as well is kind of do a check-in with them. You know, that they're gonna be they're gonna be following your progress, they're gonna be, you know, uh right by your side. So you can set up weekly, weekly meetings with them and say, hey, what am I doing right? What am I doing wrong? Where can I excel at? You know, and I think those those checkpoints with with your mentor or your preceptor could be crucial in in you know, excelling at your career.

Vanessa Pomarico 11:19

And especially that first year, oh yeah, you know, that sets the stage for the rest of your career. Like you said, like I love the analogy of the balloon, the anxiety balloon and letting some of that out. And and I think that when I read a lot of of the you know, social media chats and I see people are leaving, you know, because they don't like it. And it usually boils down to the fact that they don't have the confidence, they don't have the mentorship or the peer support, and they're frustrated and therefore they hate their job because again, as nurses, we're so used to being experts in our field that it's really hard to become a novice again. So I cannot impress upon our audience enough to say how important it is to embrace that novice role. That first year, we expect you to ask questions. And when you don't ask questions, we're gonna wonder why. But it's okay to not feel like you know everything, but celebrate the small wins. So instead of looking at your mistakes, you know, as a failure, think about it as your learning curve. Like I remember, you know, um not being able to find that spec, you know, doing a speculum exam and not being able to find the cervix, you know, the elusive cervix. And and that was just one of the things. And being in a gynecology practice, it was kind of important that I found the cervix. And the doc that I worked with said, okay, well, here's some of the things that you can do to find this. So rather than saying I'm a failure at doing this, she kind of just turned it around and said, Here's what you're gonna do the next time. And one of the suggestions she had was put your finger in, feel the cervix, and figure out where it's pointing. And that's where you point your speculum. And something little like that just made me feel like the next three pelvic exams I did, I was able to find the cervix, all because of that one little tip she gave me.

Jason Gleason 13:12

That's wonderful. Wow.

Vanessa Pomarico 13:13

You know, and thinking about like, you know, how many times have we done this? You know, you're in there with a patient and you forget to order a key lab. Is it the end of the world? No, because you can call the lab and add it on. You know, if you have to, you can call the patient and say, you know, can you go back? I'm sorry you have to get stuck twice, but I'd like to do a couple more labs on you. It's not the end of the world, you know. Um, not recognizing, let's say, an uncommon patient presentation. Let's face it, not everybody's gonna be textbook, right? And that's, I think, where that kind of decreases people's confidence is when they get a real life patient in there, that it doesn't look like what we learned in school. But you know, recognizing that, and like you said, trying to find a mentor. And if you don't have one, find one.

Jason Gleason 13:59

You have to.

Vanessa Pomarico 14:00

And that's gonna be really the most important thing to think about is being able to have somebody that will be there, whether it's at your job or whether you find it through, you know, um, one of our organizations, um, like A ANP. I had mentioned before for members of A ANP, they actually have a mentorship program and it's free to anybody who is a member. So there's other places that you can find mentors, even within your own um organization. They may have somebody that's not necessarily in your department, but in another department. I mean, I remember when I was a brand new faculty, they had me assigned to a mentor that worked in education. I was working in the nursing department, but she was just a faculty mentor. So it's really important that regardless of where we are in our careers, and you know, you could be somebody who's been a nurse practitioner for 10, 15 years and go into a different position. It's still important that you have somebody to mentor you. Absolutely.

Jason Gleason 14:54

It's so vital. You know, the population I really worry about, I'm concerned about like here in Montana and many other rural states, there might be some NPs out there that have just graduated from school. They're entry-level NP. They might have 30 years of RN experience, right? Which is wonderful, but it's not NP experience. It's still entry-level NP. And they might take a job in a rural community at a critical access hospital where they're it, and their mentor is maybe an older physician that's near retirement, that they're going to replace them as the provider in that community, you know, our smaller communities, and they don't have a lot of mentorship. So I love what you just said. It's so vital that if you don't have mentors around you, and if you don't have that opportunity to reach out to organizations such as ANP, who has a great mentorship program, just somebody to bounce ideas off of and give you that positive feedback and work through those hard cases. It's so important because often I think otherwise you feel like you're isolated, alone, that you're always screwing things up, that you're not doing good for anybody, and then you get deflated, discouraged. And that's where patients can die or get seriously injured. That's where you can lose your license, you know, because then you're running into that area of I'm doing things where I don't know what I don't know. And then that's a big deal. So it can be a disaster. So I love what you said about seeking out organizations, mentors, maybe not even in your facility if they're not there, but somebody you have to be attached to somebody as a mentor, make sure that it's a positive influence in your life. Have either of you had a mentor in your in your professional career that has been kind of the curmudgeon, like the the bane of your existence, so to speak. No positive feedback, just everything's negative, to the point where you almost second guess yourself, or maybe I could see even some new NPs out there kind of winging it and kind of faking through stuff and maybe not being completely honest with their mentor because they're afraid of the reaction. Have you ever had an experience like that?

Christopher Gleason 16:38

I did actually, but it wasn't af um it was while I was in school, not after I graduated. I had a uh a preceptor that I was following and I remember the case clearly. I was um examining the patient's ear. It uh she had just had it clean, so it was kind of uh bubbly still from the hydrogen peroxide. And, you know, I reported back to the the this uh particular provider and she went in and looked at the patient and she goes She was basically challenging me, asking me if, you know, do you even have any skills? She said, if you did, you would see that this person had a raging ear infection. Oh now, mind you, I'm a I'm a student still, so I have you know, I'm still learning everything. And I just remember how d disheartening that was and how it made me question, you know, should I be doing this? Should I become an NP? And then but on that contrast, I had this amazing preceptor. She's and she's been a m mentor of mine for many years, actually. Um, and she really encouraged me and she actually took over the hours that the the other preceptor was going to do for me. She actually took over all of those hours and finished my um uh semester out, which was amazing.

Jason Gleason 17:41

Well, look at the difference it made. Yeah, right night and day. Yeah. Right. So did you respond to her with her asking about a raging ear infection? Did you respond, well, you're a raging lunatic mentor for me? Sound like she was I would have.

Christopher Gleason 17:52

So V, going back to your um your story about finding the cervix, I have a very funny story about that. So I was working in uh primary care, it was my first primary care job, and I was doing a women's health exam. And you know how the women's health exams go, you have the curtain and everything. Um so I was down there look, you know, trying to trying to find the cervix, and of course my head's going like this and like this and like this. Yeah, like that too. And um eventually I did find the cervix and finish the exam. However, afterwards I had a conversation with the MA that was assisting me, and um she I was telling you, you know, I was having trouble finding the cervix, and she laughed and she goes, I could tell.

Jason Gleason 18:32

Nice. Where is that dang cervix, right? Right.

Vanessa Pomarico 18:36

The elusive cervix. You know, I have to say that I I I actually, one of my um early jobs, I had been a nurse practitioner for a few years, and I took a job working in a primary care office. I had left specialty practice, so I had been out for, you know, probably four or five years. And I have to say that one of the docs that I work with belittled me every single day. And it was just working on me hard like mentally. My mental health really started to suffer because he was always finding fault. You write too much. That was what he said in one of my notes. You write too much in your notes. Well, I don't know about the rest of you, but I learned that, you know, not documented, not done. So I I finally got up the courage to say, I'm not sure why it bothers you that I write so much. I mean, that's just my style. Or um he would pressure me into prescribing more of this particular antibiotic because one of his best friends was the drug rep for this particular company.

Jason Gleason 19:37

Wow.

Vanessa Pomarico 19:38

And he'd come in and he'd say, you know, you're not writing enough for this antibiotic. And I'm thinking, well, I kind of thought that that was a personal choice. He said, you know, my friend really needs this, and you need to start writing and, you know, with the finger in my face kind of thing. And it really started to work on my mental health. And this was way before we he'd even thought about getting mentors or getting a like a coach to kind of help you through it. And it got to the point where I almost left the profession.

Jason Gleason 20:07

Yeah.

Vanessa Pomarico 20:08

Because it was, you know, mentally, you know, he started working on me that everything I was doing was a weakness. And I remember I reached out to one of my former bosses who I absolutely adored. And he always said to me, you know, I had worked in this primary care office very part-time while I was working at the student health center. And when they decided they were going to go strictly GI, they were giving up all their primary care patients. I said, you know what, I really don't want to do GI. So I'm going to start looking for a job and I'll give you enough notice. And it was a lovely ending. You know, we parted ways, we stayed friends. And I remember I reached out to him and I called him one night and I was crying. And I said, I think I made a terrible mistake. And I remember him saying to me, I don't think you made a mistake. He said, You always have a home here if you want to come back. The door is always open. He said, But I could tell you weren't happy, you know, doing GI. He said, So let's talk about it. And he just kind of turned it around into a positive, so that he really made me realize that all the things that this particular doc was complaining about was not a weakness on my part, but was a threatening situation on their part, that they felt threatened by, you know, my completeness and my competency. And I also think a lot of it had to do with the fact that, you know, he was a bit of a misogynist and he did not like the fact that there was a strong woman in the practice and that patients wanted to see me. That could have very well done me in. And I might have even left the profession if it wasn't for the fact that my former boss took the time to kind of just turn it around a little bit and make me realize that I, you know, I was doing okay. And he reminded me of that. He said, You know, you worked for us for three years. He said, We never had a complaint. So he said, Don't let this bother you. And, you know, when you were talking about curmudgeonly, this was the the doc that I worked with that immediately popped into my head because it was just a curmogen was just a miserable person.

Jason Gleason 22:09

So it's a power trip for him, you know?

Vanessa Pomarico 22:11

It was a power trip. But you know, how do you think oh uh imposture syndrome works on people's mental health? What what do you have to say about that anything?

Christopher Gleason 22:19

I think the effect imposter syndrome has on mental health, especially if you let it go unchecked, is it can really affect your practice because it's really going to affect your anxiety. And by that it can uh eventually lead to depression because you're going to get get into that space where you're going to feel not good enough and that you you've made that mistake and that you know you're you're you're gonna potentially cause harm to patients and and things of that nature. So I I think it can definitely lead to issues with your uh with with your mental health not only the anxiety but the depression as well. What do you think Jason?

Jason Gleason 22:53

You know I when I think about that, I think about and I consider the people out there our listeners, our friends, our colleagues are listening in that may have experienced trauma in their life. And a lot of us have a lot of us have to some degree whether it's emotional physical sexual trauma over the years and and many of us have not even dealt with that. And you could you could maybe be a victim of emotional abuse in your childhood and still carry that baggage with you like a shackle around your your neck and weighing you down and then you you come into a situation where you know now you're working as an MP and this imposter syndrome takes hold and you don't have the confidence and you don't like confrontation and you're not standing up for yourself and you've been told you're a piece of garbage and trash throughout a an important part of your life when you're developing, all that stuff can come to the surface where it has not affected you for decades. So you have to be aware of that that even previous trauma can come right to the surface and hit you like a freight train and you're wondering what is going on. I thought I've dealt with all this stuff and now all of a sudden it's coming back to me because it's being triggered by this imposter syndrome issue that comes up when you launch it into new practice. And it's horrible because these NPs professionals are excited to get to work to help patients. That's why we're all into into the field we're into but you want to help all these people and you're excited about this new part of your life and yet your past comes to the surface again and holds you back. And so I think mental health is so important whether imposter syndrome is a trigger for previous trauma or your previous trauma set you up for imposter syndrome and not be ashamed of that. There's no shame in mental health but to seek the mental health that you need to get plugged into therapists and counselors and specialists that can help you work through some of those issues.

Vanessa Pomarico 24:28

Right. To recognize that is so important and again it's not we're not bringing this up to scare anybody away.

Jason Gleason 24:35

No, no.

Vanessa Pomarico 24:35

But just you know just to say that you know just be aware of your mental health and be aware that it is not a weakness if some of these things come back to haunt you later on in your career or early in your career things that maybe you thought you put to bed that it's okay to seek out therapy and coaching as a professional tool. Absolutely definitely so a couple of other things to think about too about overcoming imposter syndrome is is um skills practice. So I know for me, again having worked in GYN oncology as a nurse for so many years and then working in streak on ecology, we didn't get a good EKG course when I was in school we had like a one you know two hour session uh and the and the um person who came in taught to the rest of the class who happened to be ICU nurses um or cardiac nurses. And you know there's the three of us sitting in the back two of us were oncology nurses and one was a uh a psych nurse and we were completely lost. So EKGs were like the bane of my existence. So one of the things it was terrible one of the things that I ended up doing was is I actually took Dr. Fitzgerald's EKG course. And it was a two-part course and I was able to get my skills and so that was one skill that I knew that I was deficient in and I decided okay I'm gonna I'm gonna take this course and it was really the thing that kind of turned things around that I didn't have to go to this doc to say can you kind of help me with this because every time I went to him it was a derogatory comment. Yeah so I decided to take the bull by the horns and say okay I'm gonna learn how to do EKGs and I'm not gonna go to him anymore.

Jason Gleason 26:12

You know so just by picking a one skill even if it's once a month and kind of honing in on that and really you know uh really fine-tuning your skills and that's what's going to increase your confidence as well right but also too a I was gonna say and think about that if you focus on one skill a month over a year that's 12 skills that you can be very very well versed in and and skill death.

Vanessa Pomarico 26:38

Right. Right. So it's important that you kind of make a list you know where do I feel deficient and then kind of go and do a deep dive there.

Christopher Gleason 26:46

Yeah.

Vanessa Pomarico 26:46

The other piece of this we were talking about the mental health piece Jason and and Christopher but um burnout prevention you know it's so hard I I don't know about about both of you but I remember I don't think I slept through the night the first year I was a nurse practitioner because I was convinced that the CBC sitting on my desk was going to kill somebody.

Jason Gleason 27:05

Nice.

Vanessa Pomarico 27:06

You know, and that was before we had electronic health records not like you can get up in the middle of the night and log on to your computer.

Jason Gleason 27:11

Right.

Vanessa Pomarico 27:12

So sleep is so important. Self-care, you know, doing exercise because exercise we know increases the endorphins and really helps people to kind of you know just stay in a better frame of mind. But we have to think about not just our sleep, getting adequate sleep because let's face it, if you're sleep deprived, it's just gonna just roll right into like a really bad day. Making sure that you're exercising and eating healthy, but also setting boundaries we know that there have to be boundaries right as part of our toolkit to to really overcome imposter syndrome.

Christopher Gleason 27:45

Do you have anything else that you want to add to that I think I'd like to add with the burnout prevention especially the sleep and the exercise and the eating healthy if you if you cut back on that and you don't you don't meet those those goals it can affect not only you it can affect your family as well because we all know if you're if you're burned out from work, you're going to be burned out at home. And that can really kind of lead to um familiar discourse, discourse with your friends, d just discourse in your life in general to taking care of yourself first is key for for all of those relationships and your work as well.

Jason Gleason 28:20

Knowing your limits, your boundaries, all of that and I think you know in retrospect in my professional career I've been doing this for 20 years now over two decades. And when I look back on things one of the biggest regrets I have is not being able to say no, right? Over the years and I wish that there were opportunities where I would have turned them down because what that did it you know life is time right you only have so much time in the day to devote to whatever we have to devote to it. And so I often look back and one of the biggest regrets of my life is that I devoted too much time to my professional career and not enough time where it mattered the most to my family, my kids, you know, all the important stuff in life that's vital. And and we always hear it we always hear people telling us time slips by so quickly in our lives and we only have so much of it left. Choose wisely what you spend your time on I I loved Michelle Obama recently in an interview somebody asked her how do you decide what you're gonna spend your time on what are you going to prioritize? What boundaries do you set? Because we've noticed you don't attend all the activities that you're invited to obviously and she said you know what I think of it this way in my life I only have like estimated about 20 to 25 summers left in my life right in my lifetime this is her saying this. And I thought wow what a great perspective to think about that. I only have you know i if if you're 50 now and you want to live to be 75 or 80, you only have 25 to 30 more summers left. Are you going to spend your 30 summers with your family doing what you enjoy or are you going to spend it towards professional activities, right? Which are also very important, but you have to have a balance. And I thought that is such a great wake up call for so many people including myself it's it sparks something in me where I got to check myself and and put up more boundaries and really protect that time with my family.

Vanessa Pomarico 30:04

So true because it can be it can overtake you if you're not mindful of it, especially if and again we're going to talk about this in a future podcast about time management that you don't come home and you know do a lot of that but again really thinking about where your boundaries are and being able to to set them without feeling the least bit guilty about it. There should be you know no guilt whatsoever by setting a boundary.

Jason Gleason 30:30

Right. So such a snap of a finger time will fly by before you know it.

Vanessa Pomarico 30:35

It sure will it absolutely will. All right so we get to move into our my favorite part of our our program here is the fact or fiction. So Christopher you're up imposter feelings can coexist with real competence.

Christopher Gleason 30:48

We just say that's fact or fiction I think that's fact actually because I think you can be you can have a feeling of imposter syndrome regarding certain topics or certain skills but you can also have a confidence in other aspects of your of your work life as well so true.

Vanessa Pomarico 31:03

Right. Yeah all right Jason tracking small wins can change confidence faster than waiting to feel ready.

Jason Gleason 31:10

Yes that is a fact track those small wins it'll it'll uh get you through those tough days right and those small wins are what's really going to help you build that confidence you better Christopher mentorship is optional if you read enough guidelines.

Christopher Gleason 31:23

Absolutely false the the tips and tricks that you can learn from a mentor you'll never find in a in a guideline.

Jason Gleason 31:30

Well said that's so true yeah all right and Jason this one's for you perfectionism is the same thing as high standards fact or fiction that would be fiction right yeah perfectionism I think is very negative it's where you don't allow yourself to make any mistakes at all you're so tightly wound up everything has to be perfect. You can have high standards and not be a perfectionist. I think that's really important to delineate the two.

Vanessa Pomarico 31:55

So true all right so as an appreciation to our listeners we want to share some special savings with all of you you can go to the FHEA.com website and use the code launchpad20 for 20% off all of our CE library and our memberships and that's just as a thank you for supporting our show. So we're gonna move into the uh mailbag right now and again for any future uh questions that you have send them to us we might answer them on air you can send them to nplaunchpad at fa.com and we've got a couple of questions here today so Jason when do you feel imposter syndrome most? Is it with diagnoses, procedures, decision making or patient pushback?

Jason Gleason 32:40

That's a tough one I across the board I would say to some degree, but I would say I I think this changes as you gain more experience throughout your career, right? I I I would say early on in my career it was for decision making you know prescriptions and safety big time on meds right big imposter syndrome issues on medications just double checking everything which is to a certain degree is a good thing. You don't want to you know wing it but uh but overdoing it can certainly be uh negative on on your professionalism and your career and patient safety. And then as time goes on I would say um other aspects of decision making you know am I missing something in my differential? Because there's more complex conditions that we kind of pick up on as we uh gain our expertise and knowledge and just not to miss anything. That's the biggest issue I would I would have and I still have today. I have to double check things.

Christopher Gleason 33:29

How about you Christopher where do you feel um imposter syndrome the most I think um similar to what Jason had said at the beginning of my career it sounded a lot of you know the diagnoses the um and the decision making process but also to a certain extent the procedures as well be I remember doing um my first suture and thinking to myself what am I doing? You know, this I had practiced it with my mentor obviously but still I had that feeling of what am I doing? You know, here I am inserting a needle into this patient sewing them up and just feeling like I had no knowledge or you know a true understanding of what I was doing. But yeah I think that's those were the big ones for me. And now later on in my practice I think you know some some of that has eased up some, but I think it's there is some that's still there. And I think that's healthy to some extent as well because that's what's going to keep you kind of questioning things and and looking beyond and and and searching for those differentials.

Vanessa Pomarico 34:28

And you know for me I agree with both of you that depending on where we are in our careers, there's different things. But I would say that probably the hardest thing that I found in terms of imposter syndrome and I've been at this 28 years now was patient pushback. When all of a sudden patients started saying well but I Googled this and why are you not doing this or you know my neighbor is a nurse and she said that you should be doing this, this, and this. And I found that that for me be coming off as the expert was a little bit hard for me because now all of a sudden I wasn't waiting for the doc to come and say, you know, this is what we're going to do. It was me and say I'm not prescribing an antibiotic because you don't have any, you know, really reason to have an antimicrobial your symptoms are viral and here's how we're going to treat it. And that was hard for me to kind of come over that hump. But you're right, I think it it kind of waxed and wanes depending on where we are in our career for for feeling the imposter syndrome. So the next question is what's one win you have had this week that you're downplaying and why? Which one of you want to tackle that one?

Christopher Gleason 35:36

Go ahead Chris oh thanks well well considering that you're just coming off your defense in graduation that's a big win. That's a big win that's a big win I definitely admit to that the like you said earlier V I have um DNP post-DNP brain syndrome at this current state. But yes on Friday I graduated with my doctorate so I can officially call myself you know Dr. Gleason and that was a huge accomplishment for me. And it still feels very surreal to be done with that. So I think I'm still kind of adjusting to the you know the post-DNP phase of my life but it was a definitely a huge win.

Vanessa Pomarico 36:13

And I think that that's so important for our listeners is to then question yourself why are you downplaying this? Why are you not patting yourself on the back to say, you know what, I found that cervix. You know what I diagnosed somebody that had a really strange presentation and I diagnosed them that correctly and we have to really look at those wins absolutely I agree.

Jason Gleason 36:36

And I think when you're faced with those opportunities to look at yourself and analyze those kind of questions, think of it as an onion, right? And we have many layers to us as human beings and it unless you get down to the source of what's going on, why am I questioning myself like this? So keep asking yourself that question if you can't find the answer, I think that would be an important trigger to say, hey what you know what I need some help with my mental health and to seek out that care. Talk to a therapist they can help help you walk through that.

Vanessa Pomarico 37:03

And it's okay to go and seek care. Mental health there's so much stigma that's negative stigma that's that's surrounding you know uh what we, you know, any of us recognizing that, you know, maybe I'm not handling this as well as I should. And it's okay to seek out that help because it's just going to make you a stronger provider, but it's also going to make you a stronger person. So it's really important that we get rid of that stigma. All right so our wrap up uh checklist is one of three things I want you to do this week. I want you to track three micro wins weekly whether it's a skill, whether it's a case, whether it's a tough moment that you handled uh schedule a monthly debrief with somebody who might be your peer or your mentor. And that's really to kind of just sit down and talk about a tough case that you might have had or something that you really weren't sure of. It's really going to just help reinforce in a positive way that what you're doing is you're on the right trajectory and that it's just, you know, it's an uphill climb that first year, but it will, you'll reach the top and you'll you'll get there. And then track your micro wins weekly um you know trying to beat the I'm a fraud loop that's playing in your head. You really need to kind of get that change the chatter in your head and say, okay, I made it through the week I made it through the day I made it through the morning. Yes and and you know set really small goals. And sometimes a week might be too overwhelming. So maybe it's like I'm just gonna get through my morning session and see how I do. Write them down and on those days when you start to feel you know I I'm I'm not doing this look down write it down in a book or put it in a notes section in your phone and go over them and then say, you know what I really did okay. You know, look that I I did this, this, and this um and I was right on my diagnosis and the patient came back and they were feeling better. And those are going to be all the feedback that you need to really get rid of that chatter in your head that says I'm a fraud.

Jason Gleason 39:00

You know, in addition to that I I think writing things down like that, if you keep a journal throughout the year so to speak and write those positive things down, what you can also use that for is your annual evaluations. Exactly we're asked well what did you do this year? You can't think of the time well what did I do this year? You have it written down right yeah.

Vanessa Pomarico 39:18

And there's a lot of data out there that uh supports the fact that when we handwrite something, not type it, but when you handwrite something, it connects your brain and it really solidifies it so that people, you know you've heard about people who journal because you know when they handwrite something in their journal it helps them kind of work through difficult times in their life. Whenever you write something down it really helps to make that mind-body connection and it really does help to remodel that part of the brain to give you the confidence that you need. So all right well guys this has been a great session again um I would like to ask everybody in the audience I want to thank you again for being part of our audience if you wouldn't mind if you would drop us five stars if you think that we deserve it hit follow and then tap subscribe. And then most importantly please share this podcast with your friends, your colleagues, other students, your faculty and really help us to continue to put out podcasts that are of interest to all of you. So that's a wrap on this week's episode. Join us again for our next episode which is going to be on time management. So until next time everybody thank you for joining us.

Jason Gleason 40:29

See you later.

Christopher Gleason 40:30

Have a good week y'all.

Voiceover 40:33

You've been listening to NP Launchpad presented by Fitzgerald Health Education Associates. Like subscribe and share and for more tools to power your NP career visit FHEA.com