DIALOGUE IMAGE welcomes letters in response to previously published articles. Letters should be addressed to the Editor, should be typed double-spaced and should not exceed two typed-pages. The Sigma Theta Tau Intenuztional afiliation (if applicable) of the letter writer should be noted, Anonymous letters will not be considered for publication, but names may be withheld upon request. In general, letters in response to articles published more than two issues previously will not be considered. The original authors may be asked to respond to letters.
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To the Editor: I read “The Imposter Phenomenon in the Clinical Nurse Specialist Role” (Arena and Page, Spring, 1992) with great interest, recognizhg in the quotations from the literature and the authors’ “recognition of the phenomenon” a picture I first saw documented early in the 195Os, in a completely different context, while working with undergraduate students in a general medical clinic. Although our focus was an entirely different one (why, in a teaching program which emphasized to students of medicine and nursing that there was no such thing as an “uncooperative patient” were a small minority of patients in that busy clinic identified by a good professional staff as “uncooperative”? What was responsible for this labeling? Our finding was that a patient became labeled as “uncooperative” when hisher behavior caused a professional staff member of any health discipline to feel ineffective. A small number of patients seemed to have a special ability (like an eye for color, or an ear for music) which caused a staff member who believed herself (and who usually was) above such childish behavior to respond with sudden anger. The worker then regretted this reaction and felt @ty because hisher self image was of a professional generally able to deal objectively with a wide range of human problems and responses. This is an area, which combined with the descriptive research Arena and Page recommend, could well use further investigation. If done by nurses who were epidemiologists, the search would try to identify “causative factors,” “susceptible hosts” and the “mode of transmission” to track down an explanation. If a similar problem engaged the attention of an agriculturist, he would probably say he was about to look at “the seed” “the soil” and “the method of husbandry” in tracking the solution. But the search in either case would be a challenging one as the hunt proceeded. More power to the researcher who tackles it! Is it the same feeling of frustrationthat is responsible for the overuse of restraints?
Doris Schwartz, RN, FAAN (Retired) Gweynedd, PA 246
To the Editor: Re: Arena and Page, “The imposter phenomenon in the CNS role” (Summer, 1992): So that is what’s been bugging me! I feel as if a lo00 lb. weight has been lifted from my shoulders! What a relief -knowing that it’s not just me! Although I have known, in my heart-of-hearts, that it’s not possible for a CNS to become an expert in administration, education, research, consultation and clinical nursing in two short years of graduate school, I have somehow felt that I was supposed to. A point on which the article doesn’t elaborate: not only does the CNS expect her/himself to be a walking, breathing encycloma of nursing knowledge, so do her co-workers. In my first CNS position, I functioned beautifully as an inservice education director; of course, there was almost always enough time to research and analyze each new issue. But when I moved to another town and began working as a staff nurse in critical care (after a seven-year absence from bedside nursing), I was more than a little rusty, a fact that was frequently brought to my attention with negative feedback from my co-workers. The reinfomment of my own feelings of incompetence was very detrimental to my self esteem. It was only my love of nursing that made me perservere, and with time and experience I have continued to learn and grow. My growth has taken a giant leap forward with what I’ve learned by reading the article. Thanks to Arena and Page for writing it and to IMAGE for publishing it!
Betty Sorrentino, RN, MS, CCRN San Luis Obispo, CA To the Editor: I read with much interest the study by Arena and Page. I have worked as a CNS for the VA now for three years, and I know first-hand what these authors have so eloquently described, only now I have a label for it. I came on board with no mentor, charged with the clinical nursing responsibility for two units in Long Term Care (LTC), over 200 patients. As a new graduate and CNS, 1 immediately faced a situation where our facility was undergoing a JCAHO review. Our LTC unit lacked a comprehensivebowel and bladder program, for which it had been cited the year before. I “white-knuckled” it through that first year, taking refuge in the support I was offered by my fellow CNSs, and in the literature that assisted me in developing and adapting a program to meet our needs (and JCAHO’s requirements). Other budding CNSs did not fare so well. One, a CNS in Psychiatric Nursing, quit after three short months because “management” did not embrace the suggestions she offered about care of difficult patients, even though these recommendations were well-based in the current literature. I underscore the loss to the profession because CNSs bring with them an ideal of what nursing is, and should continue to be, regardless of the setting. However, we are not experts at all things, and I, for one, IMAGE:lournal of Nursing Scholarship
would never attempt to direct the managerial aspects for care, not having had the requisite academic preparation. My preparation as a CNS focused on the clinical aspects of Geriatric care and on case management, bioethics, nursing theory and research. A thesis was required of all candidates. I was ill-prepared as a consultant or manager, expect in case management. Graduate CNS programs differ in their curricula. The point here is that we are all “imposters” if we are so arrogant as to profess that we are experts in every content area unless our experiences have been so comprehensive. As a nurse and as an individual, I believe all of us need to respect and trust each other and regard each other as colleagues striving to achieve mutual goals for our patients. Until we are able to do that, we will continue to “eat our young,” even before some of them have hatched!
John C. Woody, RN,M S , CS Alpha Gamma Long Beach, CA
To the Editor: I am writing to express my concern and disappointment regarding the article by Arena and Page (“The Imposter Phenomenon in the Clinical Nurse Specialist Role,” Summer, 1992). The article did little to add to the body of knowledge available to clinical nurse specialists and did much to tarnish the professional image of an exceptional group of advanced practice nurses. The “imposter phenomenon” is not unique to the clinical specialist role, advanced practice nursing, nor even nursing in general. The idea that clinical specialists use ‘‘charm, friendliness, looks, humor, sexuality, and astute perceptiveness to win the approval of superiors” is absurd. The imposter phenomenon belongs in the psychology and sociology literature, as the authors point out it has been. It does not belong in the nursing literature associated with such an achieving and leading groups as are clinical specialists. Please note that there was no research evidence in this article to support that clinical specialists in any number experience this phenomenon, much less a great number. Let me also remind the authors that while they stated other master’s prepared nurses are hired as clinical specialists, the title “clinical nurse specialist” is not a job title, but rather one which has been attained by receiving a master’s in nursing in a clinical specialty area. Anyone who has graduated with a master’s in administration, for instance, and takes a position which was designed for a clinical nurse specialist should feel like an imposter. The problem here rests not with the role, but with the unqualified people assuming the role. Without research to support that this phenomenon exists within nursing and with clinical nurse specialists in particular, this article did not belong in the literature. The difference between a learning curve of any new nursing graduate at any level has been confused with feelings of being an imposter. As the authors conclude, the Volume 24, Number 3, Fall 1992
phenomenon may affect other roles, but investigation is warranted, not “may be warranted” before such information appears in the literature unsupported.
M.K. Gaedeke Norris, RN, MSN, CCRN Clinical Nurse Specialist The Children’s Hospital of Buffalo Buffalo, NY
The Authors respond: Although we expected our article on the Imposter Phenomenon to spur scholarly debate and controversy we do notfeel we have in any way, “tarnishedtheprofessionalimage of advancedpracticenurses.” On the contrary, we are strong advocates of both the nursing profession and the CNS role, attempting to deal with our perception of the realities of CNS practice. We were also alerting other CNSs to feelings that may occur during role implementation, in an effort to potentially avoid their exodusfrom this vital position. We do agree with Ms.Norris that the Imposter Phenomenon is not unique to the CNS role. It effects many professional people. The characteristics of “charm,friendliness, looks, humor, sexuality and astute perceptiveness... was a quote in the literature review from Clance and Imes (1978), the originators of the concept. Wepropose that these traits are neutral human characteristics used by all people at some time or another. To deny that nurses use at least some of these traits seems slightly unrealistic. Nursing has always drawnfrom the body of literature and knowledge base of other disciplines including psychology, sociology and medicine. We believe that there are no “sacred cows,” and that controversy fosters discussion and debate which ofien lead to research and change. To avoid an issue because it originates in another field would seriously limit the growth of nursing as a profession. This article was an exploratory effort to see if seasoned CNS colleagues shared ourfeelings or if we were alone in our sentiments. rfwe were alone, thenfiture research would not be indicated. Since we are both experienced CNSs, Ms.Norris ’s suggestion that these emotions relate to a new graduate’s learning curve rather than feelings of imposture is inapplicable, at least to us. Since IMAGE provides a forumfor literature review and discursive pieces, as well as completed research, we felt it was an appropriate vehicle to attempt to validate our feelings and beginformulating the research question. From the responses we received there is now evidence that some CNSs do relate to the phenomenon indicating that immediate research is necessary. We appreciate the feedback and the opportunity to dialogue with colleagues who could identify with the phenomenon, as well as with those who could not. We have certainly broadened our perspective on the topic and we welcome continued critique. ”
Donna M. Arena, MS, RN Nancy E. Page, MS,RN 241
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To the Editor: I read “The Imposter Phenomenon in the Clinical Nurse Specialist Role” (Arena and Page, Spring, 1992) with great interest, recognizhg in the quotations from the literature and the authors’ “recognition of the phenomenon” a picture I first saw documented early in the 195Os, in a completely different context, while working with undergraduate students in a general medical clinic. Although our focus was an entirely different one (why, in a teaching program which emphasized to students of medicine and nursing that there was no such thing as an “uncooperative patient” were a small minority of patients in that busy clinic identified by a good professional staff as “uncooperative”? What was responsible for this labeling? Our finding was that a patient became labeled as “uncooperative” when hisher behavior caused a professional staff member of any health discipline to feel ineffective. A small number of patients seemed to have a special ability (like an eye for color, or an ear for music) which caused a staff member who believed herself (and who usually was) above such childish behavior to respond with sudden anger. The worker then regretted this reaction and felt @ty because hisher self image was of a professional generally able to deal objectively with a wide range of human problems and responses. This is an area, which combined with the descriptive research Arena and Page recommend, could well use further investigation. If done by nurses who were epidemiologists, the search would try to identify “causative factors,” “susceptible hosts” and the “mode of transmission” to track down an explanation. If a similar problem engaged the attention of an agriculturist, he would probably say he was about to look at “the seed” “the soil” and “the method of husbandry” in tracking the solution. But the search in either case would be a challenging one as the hunt proceeded. More power to the researcher who tackles it! Is it the same feeling of frustrationthat is responsible for the overuse of restraints?
Doris Schwartz, RN, FAAN (Retired) Gweynedd, PA 246
To the Editor: Re: Arena and Page, “The imposter phenomenon in the CNS role” (Summer, 1992): So that is what’s been bugging me! I feel as if a lo00 lb. weight has been lifted from my shoulders! What a relief -knowing that it’s not just me! Although I have known, in my heart-of-hearts, that it’s not possible for a CNS to become an expert in administration, education, research, consultation and clinical nursing in two short years of graduate school, I have somehow felt that I was supposed to. A point on which the article doesn’t elaborate: not only does the CNS expect her/himself to be a walking, breathing encycloma of nursing knowledge, so do her co-workers. In my first CNS position, I functioned beautifully as an inservice education director; of course, there was almost always enough time to research and analyze each new issue. But when I moved to another town and began working as a staff nurse in critical care (after a seven-year absence from bedside nursing), I was more than a little rusty, a fact that was frequently brought to my attention with negative feedback from my co-workers. The reinfomment of my own feelings of incompetence was very detrimental to my self esteem. It was only my love of nursing that made me perservere, and with time and experience I have continued to learn and grow. My growth has taken a giant leap forward with what I’ve learned by reading the article. Thanks to Arena and Page for writing it and to IMAGE for publishing it!
Betty Sorrentino, RN, MS, CCRN San Luis Obispo, CA To the Editor: I read with much interest the study by Arena and Page. I have worked as a CNS for the VA now for three years, and I know first-hand what these authors have so eloquently described, only now I have a label for it. I came on board with no mentor, charged with the clinical nursing responsibility for two units in Long Term Care (LTC), over 200 patients. As a new graduate and CNS, 1 immediately faced a situation where our facility was undergoing a JCAHO review. Our LTC unit lacked a comprehensivebowel and bladder program, for which it had been cited the year before. I “white-knuckled” it through that first year, taking refuge in the support I was offered by my fellow CNSs, and in the literature that assisted me in developing and adapting a program to meet our needs (and JCAHO’s requirements). Other budding CNSs did not fare so well. One, a CNS in Psychiatric Nursing, quit after three short months because “management” did not embrace the suggestions she offered about care of difficult patients, even though these recommendations were well-based in the current literature. I underscore the loss to the profession because CNSs bring with them an ideal of what nursing is, and should continue to be, regardless of the setting. However, we are not experts at all things, and I, for one, IMAGE:lournal of Nursing Scholarship
would never attempt to direct the managerial aspects for care, not having had the requisite academic preparation. My preparation as a CNS focused on the clinical aspects of Geriatric care and on case management, bioethics, nursing theory and research. A thesis was required of all candidates. I was ill-prepared as a consultant or manager, expect in case management. Graduate CNS programs differ in their curricula. The point here is that we are all “imposters” if we are so arrogant as to profess that we are experts in every content area unless our experiences have been so comprehensive. As a nurse and as an individual, I believe all of us need to respect and trust each other and regard each other as colleagues striving to achieve mutual goals for our patients. Until we are able to do that, we will continue to “eat our young,” even before some of them have hatched!
John C. Woody, RN,M S , CS Alpha Gamma Long Beach, CA
To the Editor: I am writing to express my concern and disappointment regarding the article by Arena and Page (“The Imposter Phenomenon in the Clinical Nurse Specialist Role,” Summer, 1992). The article did little to add to the body of knowledge available to clinical nurse specialists and did much to tarnish the professional image of an exceptional group of advanced practice nurses. The “imposter phenomenon” is not unique to the clinical specialist role, advanced practice nursing, nor even nursing in general. The idea that clinical specialists use ‘‘charm, friendliness, looks, humor, sexuality, and astute perceptiveness to win the approval of superiors” is absurd. The imposter phenomenon belongs in the psychology and sociology literature, as the authors point out it has been. It does not belong in the nursing literature associated with such an achieving and leading groups as are clinical specialists. Please note that there was no research evidence in this article to support that clinical specialists in any number experience this phenomenon, much less a great number. Let me also remind the authors that while they stated other master’s prepared nurses are hired as clinical specialists, the title “clinical nurse specialist” is not a job title, but rather one which has been attained by receiving a master’s in nursing in a clinical specialty area. Anyone who has graduated with a master’s in administration, for instance, and takes a position which was designed for a clinical nurse specialist should feel like an imposter. The problem here rests not with the role, but with the unqualified people assuming the role. Without research to support that this phenomenon exists within nursing and with clinical nurse specialists in particular, this article did not belong in the literature. The difference between a learning curve of any new nursing graduate at any level has been confused with feelings of being an imposter. As the authors conclude, the Volume 24, Number 3, Fall 1992
phenomenon may affect other roles, but investigation is warranted, not “may be warranted” before such information appears in the literature unsupported.
M.K. Gaedeke Norris, RN, MSN, CCRN Clinical Nurse Specialist The Children’s Hospital of Buffalo Buffalo, NY
The Authors respond: Although we expected our article on the Imposter Phenomenon to spur scholarly debate and controversy we do notfeel we have in any way, “tarnishedtheprofessionalimage of advancedpracticenurses.” On the contrary, we are strong advocates of both the nursing profession and the CNS role, attempting to deal with our perception of the realities of CNS practice. We were also alerting other CNSs to feelings that may occur during role implementation, in an effort to potentially avoid their exodusfrom this vital position. We do agree with Ms.Norris that the Imposter Phenomenon is not unique to the CNS role. It effects many professional people. The characteristics of “charm,friendliness, looks, humor, sexuality and astute perceptiveness... was a quote in the literature review from Clance and Imes (1978), the originators of the concept. Wepropose that these traits are neutral human characteristics used by all people at some time or another. To deny that nurses use at least some of these traits seems slightly unrealistic. Nursing has always drawnfrom the body of literature and knowledge base of other disciplines including psychology, sociology and medicine. We believe that there are no “sacred cows,” and that controversy fosters discussion and debate which ofien lead to research and change. To avoid an issue because it originates in another field would seriously limit the growth of nursing as a profession. This article was an exploratory effort to see if seasoned CNS colleagues shared ourfeelings or if we were alone in our sentiments. rfwe were alone, thenfiture research would not be indicated. Since we are both experienced CNSs, Ms.Norris ’s suggestion that these emotions relate to a new graduate’s learning curve rather than feelings of imposture is inapplicable, at least to us. Since IMAGE provides a forumfor literature review and discursive pieces, as well as completed research, we felt it was an appropriate vehicle to attempt to validate our feelings and beginformulating the research question. From the responses we received there is now evidence that some CNSs do relate to the phenomenon indicating that immediate research is necessary. We appreciate the feedback and the opportunity to dialogue with colleagues who could identify with the phenomenon, as well as with those who could not. We have certainly broadened our perspective on the topic and we welcome continued critique. ”
Donna M. Arena, MS, RN Nancy E. Page, MS,RN 241
