Florence Didn't Fake It

[Esther Greenburg]

Beautiful article. I very much enjoyed reading it and your points were well said. Keep being authentic and awesome!

[pattithenurse]

I love this!  Beautifully written and so true!

[Feelgood RN]

I've heard this term pretty often. I feel like it's usually use to help nurses get out of their own head. We are the nurse, we care for our whole patient, but sometimes we get a patient/patients that have diseases/procedures/medications that we're not familiar with or we have to use equipment or do procedures that haven't recently been in our HealthStreams ?. Fake it until you make it is like saying, hey, show your patient you know what you're doing, you're in charge of them and their care and they expect that. We haven't been the most trusted profession for the last decade because we know every medication, every procedure, every obscure piece of equipment in the stockroom. I feel it's because we care for our patients and show them, as much as possible, that we know what we are doing...maybe even when we don't.

[OldEMTNurse, LPN, EMT-I]

On 6/10/2021 at 9:04 AM, Leah Mraz said:

When I became a registered nurse sixteen years ago, I had the healthy assumption my brains - chock full of textbook information from not only my bachelor’s in nursing but also ones in psychology and biology - would skillfully guide me through the nursing profession with ease. The minute I hit the floors of my first unit, I felt wholly unprepared. But before panic could set in, the commonly heard phrase was promptly thrown out to me as my only lifeline: “Fake it until you make it.” This became my mantra. As soon as I was making it in one area, I quickly and willingly re-entered the phase of faking it in another in order to climb the nursing ladder of success as I saw it.

Where did this advice to new nurses come from? I personally doubt Florence Nightingale, our esteemed founder of modern nursing, would have ascribed to this mantra. Following her service in the Crimean War, even after years of education as a person of wealth and privilege, Ms. Nightingale wrote in her book, Notes on Nursing: What it is and What it is Not, “it is impossible to learn [nursing] from any book, and that it can only be thoroughly learnt in the wards of a hospital.” She was interested in data and learning from mistakes. She was trailblazing her way into unchartered fields. Faking it was not an option as she tested theories through trial and error. Being true to oneself and to the needs of the patient were key attributes she wanted in a nurse. The increased comfort of her patient was often her only guide to success.

I do wonder when the push to "fake it" developed. Was it a push from above, hospital administrators wanting all their employees to appear highly skilled? Was it a push from within, the nursing profession fighting for respect as a highly-skilled, highly trained profession where no one starts off as a deer in the headlights? Or was it a product of “nurses eat their young” and throwing new grads to the wolves with a catchy phrase to see them through?

Once I actually gained confidence in my abilities from on-the-job training, I still was not fulfilled in my nursing career. I could start a difficult IV, provide critical thinking feedback to a physician, and show compassion to a belligerent patient, yet my purpose in nursing was ill-defined. If all I was supposed to do was “fake it until I make it” and now I supposedly made it, why was my purpose not clear?

The first decade of my nursing career was riddled with imposter syndrome that had been fostered by my mantra. I often questioned if I really knew what I appeared to be capable of doing. I was getting lost in the details of medical knowledge and healthcare politics, forgetting the concept of advocating for the patient as a whole. What Ms. Nightingale had prior to becoming a nurse that I lacked my first day as a nurse and continued to lack in the years that followed was an actual calling to be a nurse.

Florence Nightingale knew early on, the whole of the patient was her focus. This was the driving force behind her mission to transform nursing into a necessary and highly regarded profession. Someone needed to be looking out for the whole of the patient, not just the prescribed medicine, the infected wound, the fractured bone, or the imbalanced electrolytes. Over the years of my career, it became obvious to me that seeing the patient as a whole and guarding the well-being of that whole required a deeper understanding beyond the learned lessons of a lecture hall or the step-by-step instructions of a CRRT machine. There is no room for faking it when it comes to your heart. If your heart is not in it, the profession will chew you up and spit you out.

Today, I have found myself planted firmly among those nurses who have no interest in faking anything at all. I’m not here to impress physicians or families or administrators, I’m here for the patient. I am not here for the disease, for the cure to the disease, for the monetization of the disease. I am here for the patient. And through this simple, yet powerful mantra, I have found my calling. Ms. Nightingale also wrote in her book, Notes on Nursing: What it is and What it is Not, “It is often thought that medicine is the curative process. It is no such thing; medicine is the surgery of functions…. nature alone cures…. medicine, so far as we know, assists nature…. And what nursing has to do in either case, is to put the patient in the best condition for nature to act upon him.”

With modern medicine’s pharmaceuticals, technological advances, and intricate understanding of disease pathologies, it’s unfortunately not difficult to lose sight of the actual patient buried beneath it all. But fortunately, for the patient, they have a dedicated, professional advocate. If Florence Nightingale was here today, while she’d be duly impressed with how far the nursing profession has come, I am confident she would be quick to remind us, “Keep the nursing purpose centered on the patient.”

Neither did I, Thankfully

[Leah Mraz, BSN]

2 hours ago, Feelgood RN said:

I've heard this term pretty often. I feel like it's usually use to help nurses get out of their own head. We are the nurse, we care for our whole patient, but sometimes we get a patient/patients that have diseases/procedures/medications that we're not familiar with or we have to use equipment or do procedures that haven't recently been in our HealthStreams ?. Fake it until you make it is like saying, hey, show your patient you know what you're doing, you're in charge of them and their care and they expect that. We haven't been the most trusted profession for the last decade because we know every medication, every procedure, every obscure piece of equipment in the stockroom. I feel it's because we care for our patients and show them, as much as possible, that we know what we are doing...maybe even when we don't.

Definitely that too. There’s a reason and a place for it. You have to jump in, get your feet wet, and give it a go. But I think it might contribute to early burnout too as there’s this mistrust of not knowing, as if not knowing means you’re inadequate in your field. Inexperienced, perhaps, but not inadequate. And when new nurses learn early on to fake what they know, I believe they learn to mistrust their own intuition, believing they can’t possibly be seeing something that everyone else who is more “knowledgeable” than they are is missing. I think new nurses often have a strong sense of nursing intuition already inside, but there’s so much push to know it all and fake it if you don’t, that they’re own intuition gets silenced by their lack of experiential knowledge and trying to fake that they understand everything happening around them. At a risk of sounding stupid and asking a question, they might stay silent and assume everyone else knows the answer, going with the flow, or more accurately, getting swept away in the flow, missing the whole picture of the patient because they don’t understand the specialized area of something and are afraid to speak up. When orienting new nurses, if I see them hesitant, I tell them to follow that voice inside. That’s your nursing intelligence telling you something about your patient that requires clarification. Most often it is simply asking questions and gaining knowledge, but every now and then it’s that nurse seeing the whole of their patient and knowing something needed to be addressed further. 

[Feelgood RN]

Some of my best learning experiences I had as a new nurse were when I'd see some patients orders and be like "Crap, I forgot ALL the steps on how to do this." Feeling in adequate and not wanting to screw it up. Eventually Asking a co-worker our policy or steps just to find out "Yeah, I don't remember how to do that either!"  LOL  

[nitenurse]

Absolutely fake it till you make it -not for the reason of purposeful deception but to project confidence to someone that is not feeling their best. It's no different from taking your car to a mechanic or a technician installing cable; if they give you shrugged shoulders and the look of confusion, I doubt you would have any confidence in their abilities and likely request someone that knows what they're doing.

So, project strength, use your resources and get patients better with your healing hands.?

[SmilingBluEyes]

1 hour ago, nitenurse said:

Absolutely fake it till you make it -not for the reason of purposeful deception but to project confidence to someone that is not feeling their best. It's no different from taking your car to a mechanic or a technician installing cable; if they give you shrugged shoulders and the look of confusion, I doubt you would have any confidence in their abilities and likely request someone that knows what they're doing.

So, project strength, use your resources and get patients better with your healing hands.?

Agreed. It does nothing for your patient's faith in you if you go around acting all nervous and like you know nothing. It has nothing to do with being an imposter but bolstering your patient's confidence in your capability to care for them.

Now where we DO NOT fake it is when we don't  know the right way to do something or the answer to a question. That is when we ask our mentor/preceptor/charge nurse what policy states, or look it up ourselves.

There is room for both points of view.

[JBMmom, MSN, NP]

I totally agree with your sentiment that I would never fake anything in order to appease an administrator or manager, etc. I also have never faked more experience when asked directly. However, I did at one point have to place my first IV, first foley, first NG, etc. We all did. And I feel that acting with confidence is not really the same as faking it when it's in the best interest of the patient. I think the only time I was called out was for my first foley on a female patient. She half jokingly asked if I had done it before and I responded that while it was my first time I did well in anatomy class and there weren't all that many holes, so I should be able to find it. Fortunately, she laughed and I think it put us both a bit more at ease. 

Thank you for your well written piece.

[Leah Mraz, BSN]

17 hours ago, nitenurse said:

Absolutely fake it till you make it -not for the reason of purposeful deception but to project confidence to someone that is not feeling their best. It's no different from taking your car to a mechanic or a technician installing cable; if they give you shrugged shoulders and the look of confusion, I doubt you would have any confidence in their abilities and likely request someone that knows what they're doing.

So, project strength, use your resources and get patients better with your healing hands.?

I totally understand what you’re saying. However, in my experience the encouragement to fake it until you make it was not about confidence. I know plenty of very experienced nurses who know a ton and still enter a room with a lack of confidence as that’s more a personality trait. A shrug of the shoulders and look of confusion shows more indifference than lack of confidence to me. If I have someone ready to learn and soak it all in but fully admitting they don’t have all the answers, I’m trusting that they are going to stop at nothing to get the answers they need to do the job right. I go with that person every time. If I have a bullsh*tter telling me they know everything and to not worry, I’m worried. I, too, am an excellent bullsh*tter, and in my experience, this approach always distances me from true compassion. Authenticity always brings me closer to it. The confidence my patients have in me when being authentic always soars above any approach I take to act like I’m an expert in all things. 
100% agree to project strength/confidence and use your resources. This to me does not mean fake it, however. 

[Leah Mraz, BSN]

11 hours ago, JBMmom said:

I totally agree with your sentiment that I would never fake anything in order to appease an administrator or manager, etc. I also have never faked more experience when asked directly. However, I did at one point have to place my first IV, first foley, first NG, etc. We all did. And I feel that acting with confidence is not really the same as faking it when it's in the best interest of the patient. I think the only time I was called out was for my first foley on a female patient. She half jokingly asked if I had done it before and I responded that while it was my first time I did well in anatomy class and there weren't all that many holes, so I should be able to find it. Fortunately, she laughed and I think it put us both a bit more at ease. 

Thank you for your well written piece.

Yes! I remember being told to tell people I’ve started a ton of IVs when I hadn’t successfully started one. And it’s so unnecessary to be successful and gain your patient’s trust. I have learned, for myself personally, that if I create a wedge between my patient and myself, however small and forgivable, the gap of patient vs. healthcare system becomes more defined. And I always want to be the bridge between that gap, the advocate the patient needs to keep them informed (or their healthcare surrogate if they are incapacitated). The phrase “fake it until you make it” obviously has different meanings for different people. But I’m in the mindset that authenticity fosters whole patient care more than anything else. I found it especially true during the pandemic.