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.”