"I Keep Waiting for Someone to Find Out": Professional Identity Formation and the Impostor Phenomenon in a New Psychiatric Mental Health Nurse Practitioner
[Student Name]
University of Phoenix
NSG/506: Transition to Advanced Practice Nursing
Week 3 Assignment
[Instructor Name]
[Date]
The nurse practitioner described is a composite written for a model paper.
Six months into her first position at a community mental health center, a composite psychiatric mental health nurse practitioner (PMHNP) sat in her car after a day of eleven medication management visits and wrote in her journal: "I keep waiting for someone to find out I don't really know what I'm doing." That day she had started a patient with bipolar disorder on lithium, adjusted an antidepressant for an adolescent and declined to prescribe a benzodiazepine to a patient who became angry. Her decisions were reviewed by her collaborating psychiatrist and found sound. The gap was not between what she knew and what the role required; it was between what she did every day and who she believed herself to be. This paper examines that gap through the concepts of professional identity formation and the impostor phenomenon and proposes practices for building an advanced practice identity.
Professional Identity Formation
Professional identity is the way a person understands himself or herself as a member of a profession, including its values, responsibilities and ways of thinking. Cruess et al. (2014), writing about physicians, described professional identity formation as a process in which a person's identity is transformed through socialization into a community of practice, shaped by role models, clinical experiences, reflection and the attitudes of colleagues, and in which the person gradually comes to think, act and feel like a member of the profession. Although developed in medical education, the framework describes the advanced practice transition well: a registered nurse who already has a strong nursing identity must integrate a new set of responsibilities, especially diagnosis and prescribing, into that identity.
For advanced practice nurses the process has a particular tension. The role draws on the nursing tradition of holistic, relationship-centered care while taking on diagnostic and prescriptive authority historically associated with medicine. A PMHNP who defines herself only as a prescriber risks losing the nursing perspective that distinguishes her practice; one who defines herself only as a nurse may hesitate to exercise the authority her license grants. The competencies for advanced nursing education address this by placing personal, professional and leadership development alongside clinical domains, treating identity as part of what graduate education must build (American Association of Colleges of Nursing [AACN], 2021).
The Impostor Phenomenon
Clance and Imes (1978) described the impostor phenomenon in high-achieving women who, despite objective success, believed they were not truly intelligent and feared being exposed. The pattern includes attributing success to luck or effort rather than ability, discounting praise and working harder to avoid discovery. Bravata et al. (2020), in a systematic review, found that impostor feelings were common across many professional groups, were associated with anxiety, depression and burnout, and appeared frequently during transitions and among people in new roles.
The PMHNP's journal entry fits this pattern. She attributed the psychiatrist's approval to his kindness rather than to her reasoning, and she spent evenings rechecking decisions she had already made correctly. The phenomenon is not simply a lack of confidence; it is a misreading of evidence about one's own competence, and it can drive exhaustion.
How Common the Experience Is
Evidence suggests that her experience is typical. Hart and Bowen (2016) surveyed new nurse practitioners about their preparation and transition and found that many felt only somewhat or not well prepared for practice when they began, with particular concerns about managing complex patients and prescribing, and that formal orientation and mentoring were associated with a smoother transition. Knowing that most new nurse practitioners feel underprepared at first helps reframe the feeling as a stage of identity formation rather than evidence of personal inadequacy.
Practices That Build Identity
If professional identity forms through socialization, role modeling and reflection, then a new PMHNP can take deliberate steps rather than waiting to feel like an expert.
First, structured reflection with evidence. Instead of reviewing her day for mistakes, the PMHNP will keep a brief weekly log of decisions she made, the reasoning behind them and the outcomes when known. Over months, the log becomes a record of competence that is harder to dismiss than a feeling.
Second, mentorship from an advanced practice nurse. Her collaborating psychiatrist provides clinical oversight, but identity is also shaped by role models from one's own profession. She will seek a senior PMHNP mentor, through her state nurse practitioner association if none is available at her agency, with whom she can discuss not only medications but how to hold the nursing perspective within a prescribing role.
Third, naming the phenomenon. Reading about the impostor phenomenon and discussing it with peers reduces its power; recognizing a thought as a familiar pattern makes it easier to question.
Fourth, professional engagement. Joining a professional organization, attending a psychiatric nurse practitioner conference and later precepting students connect her to a community of practice, which Cruess et al. (2014) identify as central to identity formation.
Identity Within the Team
Professional identity also forms in how others treat the new practitioner, and here the PMHNP has less control. Some clinic staff still route questions about her patients to the psychiatrist, and one therapist introduced her to a patient as "the nurse who helps the doctor." These moments matter because identity is partly conferred by a community, not only claimed by an individual (Cruess et al., 2014). The response is not to insist on a title but to act consistently in the role: signing her own prescriptions and notes as the prescriber of record, answering questions about her patients directly, explaining her reasoning in team meetings and correcting role descriptions calmly when patients are misinformed. Over time, a team's expectations tend to follow a practitioner's steady behavior, and her colleagues' recognition becomes part of the identity she is building. Her collaborating psychiatrist can help by redirecting questions about her patients to her, a small act of sponsorship that tells the rest of the team whose decision it is.
My Professional Identity Plan
Writing as the PMHNP, the plan for the next twelve months is specific:
1. Keep the weekly decision log and review it monthly with my mentor.
2. Meet with a PMHNP mentor at least monthly, beginning within 60 days.
3. Present one case at the agency's interdisciplinary case conference by month nine, speaking as the prescriber of record.
4. Join the state nurse practitioner association and attend one professional meeting.
5. Precept one PMHNP student in my second year of practice.
Each step is meant to replace the question "when will I feel like a real nurse practitioner?" with actions that make the identity real.
Conclusion
A new psychiatric mental health nurse practitioner who performed competently while feeling like a fraud illustrates the gap between role and identity that marks the transition to advanced practice. Professional identity formation explains that the gap closes through socialization, role models and reflection, and the impostor phenomenon explains why competent people often discount their own success. The evidence shows her experience is common. Deliberate practices, reflection on real decisions, mentorship within the profession, naming the phenomenon and professional engagement, can help her build the identity her license already assumes.
References
American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials
Bravata, D. M., Watts, S. A., Keefer, A. L., Madhusudhan, D. K., Taylor, K. T., Clark, D. M., Nelson, R. S., Cokley, K. O., & Hagg, H. K. (2020). Prevalence, predictors, and treatment of impostor syndrome: A systematic review. Journal of General Internal Medicine, 35(4), 1252-1275. https://doi.org/10.1007/s11606-019-05364-1
Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241-247. https://doi.org/10.1037/h0086006
Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2014). Reframing medical education to support professional identity formation. Academic Medicine, 89(11), 1446-1451. https://doi.org/10.1097/ACM.0000000000000427
Hart, A. M., & Bowen, A. (2016). New nurse practitioners' perceptions of preparedness for and transition into practice. Journal for Nurse Practitioners, 12(8), 545-552. https://doi.org/10.1016/j.nurpra.2016.04.018
How this NSG 506 Week 3 example is structured
The University of Phoenix library guide for NSG/506 lists Week 3 as Professional Identity of the Advanced Practice Nurse. The paper opens with a lived moment so identity is discussed as an experience before it is defined. Professional identity formation is then explained from its source literature, the impostor phenomenon is placed within it and the evidence on new nurse practitioner preparedness shows how common the experience is. The final sections turn the analysis into practices and a plan, which is what separates an identity paper from a reflection. Students search this week as NSG 506 Week 3, NSG506 Wk 3 or NSG/506 Wk 3; all three are the same assignment.
NSG/506 Week 3 questions, answered
What does NSG/506 Week 3 usually ask for?
The University of Phoenix library guide for NSG/506 lists Week 3 as professional identity of the advanced practice nurse. Many sections ask for a paper on what defines the advanced practice nursing role and identity, how it differs from the registered nurse and physician roles, and how the writer will develop it. Check your instructions for required elements.
Is the impostor phenomenon a diagnosis?
No. Clance and Imes described it in 1978 as an internal experience of intellectual fraudulence among high achievers, not a psychiatric diagnosis. It is common during role transitions, including the move into advanced practice.
Should a professional identity paper be personal?
Most prompts invite some personal reflection, but the strongest papers anchor it in sources and end with specific actions. The sample uses a composite nurse practitioner so that the analysis can be detailed without exposing anyone.
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