Is Perfectionism in Nursing Students Healthy?

J.Adderton, BSN, MSN

I have always admired nursing students' ambition and drive for excellence. When I was in nursing school, I remember spending hours in the lab preparing for medication administration check-offs. My goal? It's simple...I wanted to perform the skill flawlessly. The goal of 'perfection" in nursing school can be both positive and negative. On one hand, it helps us to achieve goals that are demanding, but they are obtainable. On the second hand, not accepting anything less than perfect often leads to self-doubt, anxiety, and depression.

Is This You?

Do you recognize any of these unhealthy characteristics perfectionism in your own thinking?

Setting unrealistic high standards for yourself, and sometimes other people.
Using "all or none thinking" to evaluate yourself
Anything less than meeting your unrealistic goals would be considered a failure
Focusing on small mistakes or flaws instead of the overall progress being made

As a clinical instructor, I've had to remind many students to clean the skin with alcohol before administering their first injection on an actual patient. The skill caused high anxiety in most students and I expected missteps. But for some students, this one small reminder was absolutely demoralizing, and the entire clinical day would be a wash.

What is Your Self-Talk?

One way to determine your own level of perfectionism is to think about how you talk to yourself. It is common for nursing students to adopt thinking habits that distort the way they perceive reality in a negative way. Ultimately, these cognitive distortions will leave you with low confidence and feelings of inadequacy. Let's look at a few examples:

Self-Talk	Cognitive Distortion
"I never get true or false questions right.”	You overgeneralize by having a belief based on a single event.
"I turned in my care plan assignment, but it was all wrong.”	Jump to negative conclusions even when there's no evidence to support your thinking.
"My instructor must think I don't know what I am doing.”	You "mindread" and assume your instructor is thinking about you negatively.

Want to learn more about common cognitive distortions among college students? Check out this link and learn more about how they can limit your college success.

Irrational Beliefs

Nursing students often irrationally believe they cannot make any mistakes in nursing school. I have often wondered if this belief is the result of faculty bombarding new students about the grave consequences that may come from even a minor misstep. The truth is.... no one is perfect in nursing school and there's always improvements that can be made.

Focus on Positives

Perfectionist thinking habits ultimately lead to lower confidence and higher levels of anxiety. Fortunately, you can change your thinking by focusing on your successes instead of on your flaws.

Students often cancel out a positive thought or experience by adding "however" and "but". For example:

I had a fairly good day in clinical, but my instructor had to remind me to recheck a patient's blood pressure.
I feel good about the nursing diagnosis assignment, however, I already know I did one wrong.

"However" and "but" cancel out the positive statement in the above examples. Try reversing the order of your thoughts and use the positive to cancel out the negative. Or, just leave off the negative half. For example:

"My instructor had to remind me to recheck a blood pressure, but overall, I had good day."
- "Overall, I had a good day."
"I know I missed one nursing diagnosis, however, I feel good about the assignment."
- "I feel good about the assignment."

Setting Realistic Goals

We know being a perfect student is unattainable, so let's look at a few ways you can set realistic goals for yourself.

Set a goal like you normally do, but then reduce it somewhat. For example, if your goal is to make a 100 on a dosage and calculations exam, try reducing your goal grade to 90.
Avoid should and must thinking when setting goals. For example, "I must pass all my skill check-offs on the first try". A more realistic goal would be "I want to pass the majority of my skills check-offs on the first try.”

Think about what you would do if you were setting goals for another classmate. Sometimes we are more realistic when setting goals for other people.

Instead of using "perfectly" in your goals, try using "do well".
Focus on improving your own performance instead of doing better than others.

Wanting to be perfect in nursing school can be an effective motivator to help you perform at your best. But, setting unrealistically high standards can also raise stress levels and lower your confidence. The key is finding a balance between your best and learning from any mistakes along the way.

Let Us Hear from You

Do you have any words of wisdom or encouragement to share with today's nursing students?

References

Peurifoy, R. (2005). Anxiety, Phobias, & Panic: A step-by-step program for regaining control of your life. Lessons 5-6. Warner Books

NACADA- Impact of Perfectionism on Students- The good, the bad and the indifferent
https://nacada.ksu.edu/Resources/Academic-Advising-Today/View-Articles/Impact-of-Perfectionism-on-Students-The-Good-the-Bad-and-the-Indifferent.aspx

Perfectionism and Depression: Vulnerabilities Nurses Need to Understand
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169326/