Letters to a Young Nurse

Doubt .𝕯ear Friend, You were an outstanding nursing student for four years, excelling in many ways. Now, three months into your first nursing job, you are questioning if you are good enough for this career. To me, there is no question. You are more than “good enough.” You are intelligent, skilled, and have a warm way with people. However, all is not well with you, far from it. Your letter I received today is an honest portrayal of your troubles and unrest. At a time when all “self-news” seemingly must be “good news,” I am grateful for your trust and humbled to receive it. You wrote, “I am filled with dread when I go to work, fearing that I will make a mistake.” You have so many virtues and carry so much light into the world, but now you are feeling only the darkness closing in around you. I am an old fool if I think I can identify a clear cause and a cure to what you described. Nevertheless, I have a thought. Do you remember something we chatted about after class one day while walking across campus last year? We spoke of how you wrestle with perfectionism. It is a time-tested truth that perfection is a wonderful guide but a terrible master. I am concerned that perfection has become your severe, brutal, unforgiving master. You began your career three months ago and you are still not yet “perfect.” Ninety days on the job does not make you a nurse of ten years’ experience. Can you forgive yourself for this? While a desire to be “perfect” is commendable, my experience teaches me that perfection is a trap that shackles much of the best a nurse has to offer; it is a crushing burden. Perfectionism is a strangle hold we put on ourselves causing the near paralysis you describe. Indeed, it seems that your drive to be perfect has now almost brought you to a halt. Perfectionism often destroys what it seeks to create. While reading your letter I felt that I was listening in on your own relentless interior conversation. Can you make room in that conversation for a voice other than your cruel inner critic? Doing so could help change the momentum of your life and career. Lighten perfection’s grip by dedicating yourself to progress each day. Though you only started your career three months ago, now is the moment for a new beginning. Analysis, measurement, and judgement are the perfectionist’s only tools. While these are certainly valuable, they are often misused or overused — especially on ourselves. Their sharp blades, when used with precision in conjunction with wisdom, gentleness, and kindness can extract the mistakes you fear. The unrelenting, reckless, and exclusive use of analysis, measurement and judgement wounds the spirit. Is this happening to you? If so, the world is poorer, less “perfect” for it. The paralyzing power of perfectionism is fueled by fear, often the fear of criticism which feeds the corrosive doubt. Your preceptor criticized you for not being efficient enough. Maybe she is right, I certainly do not know. Maybe she is “mean spirited” as you suggest. If, after candid reflection you feel some of her observations have merit, ask her to be your teacher instead of appointing her as your judge. Few things, situations, or people (including you and I) will be perfect. Forgive them and yourself. Forgiveness is the tremendous power you possess to be ever dedicated as a nurse. Forgiveness is the capacity delivering you the strength to go on growing, loving, flourishing, and being a healing presence in a world that is less than perfect and so dearly needs the best from you. As you will remember, students often focus more on their grades than on what they are actually learning. While the grades matter, in the end their importance fades in comparison to what is truly learned. At the end of your shift, talk with your preceptor about what you are learning, what you want to learn, and not just about your “grade” for the day. The work of caring for people is the work of a team that does not harshly compete against itself. Find the colleagues who understand that the triumph of one is a victory for all. We all knew this once and, like many important lessons, this is one that we need to be reminded of more often than we need to be informed about. Do not think that I am lowering standards of care. I am hoping to raise and improve the authentic delivery of that care. A student came to my office last week who was in a situation like yours in his clinical work. He was a casualty of perfectionism. I asked him to walk from one end of my office, located on the third floor, to the other while stepping only on a six-inch-wide strip of floor tile. He did it easily and smoothly. I asked him to do it again, but this time he was to imagine that there was only the six-inch wide row of tile, nothing else on either side, no surrounding support. If he wavered, he risked falling thirty-six feet. Those easy steps got a lot more difficult; he nearly froze in fear, getting the point, decided not to try. Can you relate to this? Has one person’s harsh criticism removed all the support—of knowledge, skill, and relationships that you have worked so hard to build around you? Are you feeling that you are about to fall? Perhaps it is not the work you dread, but the criticism. Do not grant that fear and dread the power to freeze the warmth and healing that the world is waiting for from you. I stand among a large gathering supporting you in these early days of your career. As you strive for the very best, hear our voices too. Hold appreciation and wonder in your heart for what you are doing with your life. On you go. John