It was my first day of clinical. I showed up at 4:30 a.m., put my little “SRNA” magnet on the board in the room I had been assigned to: robotic hysterectomies. I figured it would be a simple, straightforward day of general cases - a good time to get my first few intubations in, and sort of just get used to the flow of things. I had made my care plans the night before and had researched everything about the cases. I had been assigned to go with the chief CRNA of the anesthesia group at one of the largest hospitals in the country. Needless to say, I was excited, but super nervous.

I got to my room early and set up everything as I had learned in sim lab (we were a front-loaded program). When my preceptor finally showed up at 7, I expected him to have some critiques, tips, or some sort of pointers. Instead, he simply said, “There’s been a change, and our first case is now a port placement.” So there I am, scrambling through Vargo trying to figure out what in the world I’m supposed to do for that. I ask my preceptor and he just says, “Propofol.” He mainly just sits in the corner on his phone, and I’m thinking to myself, “You have no idea how much I do not know what I’m doing.” I felt so out of place, underprepared, clueless, and like I did not belong there. Was this even the right career choice for me?

When going through your clinical rotations while in CRNA training, it can often feel daunting and like you have no business being there. The imposter syndrome can be extremely overwhelming at times and even make you question if this is the right field for you. Don’t be discouraged; we have all been there! While there is no magic bullet to make those feelings go away, here are a few tips that can hopefully help you manage it and get the most from your clinical training.

You Aren’t Supposed to Know Everything

Despite some preceptors projecting on you or telling you that you should already know certain things, remember: the purpose of your clinical residency is to learn. You shouldn’t already know everything, or else you wouldn’t need to be there. Yes, there are some didactic things that you should absolutely know before going into clinicals, but most of everything else you just have to learn by doing it.

Part of the learning process is simply that - learning. One trick that I found gave me confidence and helped me grow is this: any time you find you don’t know something, write it down and research it at the end of the day. Don’t wait until the next week. Do a short debrief with yourself at the end of every day to go over things that you want or need to learn based on your day’s experience. Maybe it was a medication, or a surgery that you have no idea about (and yes, that is very common. I remember as a student, focusing so much on the anesthesia part that I had no idea what was happening on the other side of the drapes.) As your knowledge grows, your confidence will as well, and the imposter feelings will slowly fade.

You Know More Than You Think You Know

A few weeks before starting clinicals, while working on care plans for fictional cases that I had never actually witnessed, I remember my professor telling us, “You know more than you think you do.” That phrase really stuck with me and gave me the confidence to keep going, even when I felt clueless. There are times where you have no idea what to expect, and if you let those feelings take over, it can really overwhelm you. But remember, you wouldn’t be in clinicals if your faculty didn’t believe that you knew enough to do it.

You have years of experience working with critically ill patients. You know anatomy, physiology, pathophysiology, pharmacology, and patient care both from the classroom and experience. You have a whole library of learning in your brain, you just have to learn how to put the pieces together.

So don’t get sucked into the doubt. Start with what you know and work outwards from there. You will sometimes even surprise yourself with what you already know. Talk yourself through the things that you don’t understand, and eventually the light bulb will switch on, and it will all make sense.

Find Something to Do

I remember when I was in my first code as a brand-new ICU nurse. I remember feeling overwhelmed and like I had no idea what to do. As everyone else ran into the room and immediately started doing things, I really had no idea where to start. It was then that a more experienced nurse, realizing my conundrum, looked at me and said, “When you don’t know what to do, find something that you know you can do and do that until you find something else you can do.”

And that is honestly how your clinical experience will go. When you first start, start with the basics of what you know you need to do. No one expects you to have the perfect workflow down yet – that takes time. When you aren’t sure what to do, just do the next thing that you know, and over time you will learn to fill in the gaps. Don’t know the specifics of a certain case? Set up for a general, and then ask your preceptor when they get there. Don’t know the flow of a particular procedure or procedural area? Do your setup, research the patient, and ask questions. Do the things you know until you can figure out the things you don’t.

Get Comfortable Being Uncomfortable

My pharmacy professor in CRNA school gave us probably one of the most helpful pieces of advice as a student: “get comfortable being uncomfortable.” And the reality is, when you trust the process and know that you are there to learn, it makes the uncomfortableness way more tolerable. In a day and age where we prioritize comfort, we often lose the growth that comes from being uncomfortable. But uncomfortableness is what motivates us to change and be better.

If you haven’t figured it out yet, anesthesia will put you into a massive amount of uncomfortable situations. I have a colleague who has been a CRNA for 30+ years, and he says all the time, “If you don’t have something that scares you every once in a while, then you haven’t been doing this long enough.” The learning never stops, even when you graduate. If anything, it starts over again – and that’s the point. Always be learning, stay humble, accept help and critique, ask questions - get comfortable being uncomfortable.

You Will Make It

You are there for a reason, and despite what you may feel, you are fully capable and you really do know more than you think you do. When things get stressful, difficult, or you just feel like you have no idea what you are doing: stay calm, take a few deep breaths, talk yourself through things, and focus on the next thing that you can do. Imposter syndrome doesn’t go away because we wish it away or find some secret to overcome it. It goes away when we finally learn that we are right where we are supposed to be and that we are not an imposter at all. As I think back on that first day of clinicals, I remember the feelings of being overwhelmed, stressed, alone, out of place, directionless, but looking back I think my preceptor taught me one of the most valuable lessons: sometimes you just have to figure it out for yourself…and you will.