Unearthing the Impact of Impostor Syndrome on Decision Self-Efficacy Among Nurse Managers

Abstract

Introduction

The psychological phenomenon known as “impostor syndrome” is characterized by ongoing self-doubt and a dread of being revealed as a fraud can subtly erode nurse managers’ confidence and hinder their capacity to make prompt and wise judgments. Strong decision-making self-efficacy is essential for nurse managers, who are frontline leaders in charge of crucial clinical and operational results. But the unseen weight of impostor syndrome could undermine this crucial leadership skill.

Objective

This study aims to unearth the impact of impostor syndrome on decision self-efficacy among nurse managers.

Methods

A cross-sectional descriptive design following STROBE guidelines was used to unearth the impact of impostor syndrome on decision self-efficacy among nurse managers. 95 nurse managers from Minia University Hospitals were included. Data was collected using the Clance Impostor Phenomenon Scale (CIPS) and a researcher-developed Decision Self-Efficacy Scale (DSES).

Results

The findings revealed that 57.9% of nurse managers had a high level of impostor syndrome, while 71.6% exhibited low decision self-efficacy. A significant negative correlation was found between impostor characteristics and decision self-efficacy (r = −0.81, p = .050*). Years of experience were the only demographic factors significantly related to decision self-efficacy (r = −0.398, p = .001).

Conclusion

Impostor syndrome was negatively associated with decision-making confidence among nurse managers. Interventions to address impostor feelings and enhance self-efficacy may support effective leadership and organizational performance in healthcare settings.

Keywords

decision self-efficacy impostor syndrome confidence effective leadership organizational performance nurse manager

Introduction/Background

Nurses are essential to providing high-quality patient care, yet they often experience significant occupational stress and burnout. One psychological factor gaining increasing attention in nursing research is the impostor phenomenon. Impostor syndrome (IS) refers to the ongoing belief that one's success and capabilities are not genuine, even when there is clear evidence of competence, knowledge, and achievement (Qureshi et al., 2017). This condition has been associated with impaired decision-making, increased self-doubt, and a tendency toward harsh self-criticism, which can lead to indecisiveness, hesitation, and an aversion to taking risks—ultimately undermining effective leadership (KH & Menon, 2022).

Managers experiencing impostor syndrome may struggle with anxiety and feelings of hopelessness, which can hinder their ability to make important decisions and negatively affect organizational performance (Mount & Tardanico, 2014). Therefore, the impostor phenomenon poses a dual challenge for both individuals and organizations—it can motivate some to pursue perfection, but it can also stifle risk-taking and innovation. Fear of making mistakes may lead individuals to avoid opportunities that are essential for personal development and professional advancement, such as proposing new ideas (Halim et al., 2023).

Literature Review

Nurse managers hold a complex position that significantly influences both patient care and staff performance. While nurses often graduate with strong clinical skills, they may be underprepared in areas such as leadership and team-building. This gap can create instability within management roles and may contribute to the development of impostor syndrome among nurse leaders. Impostor syndrome often emerges during career transitions and can particularly affect highly capable nurse leaders (Gómez-Morales, 2021; Siddiqui et al., 2024). If it persists, IS can lead to ongoing self-doubt, reduced well-being and resilience, difficulty accepting feedback, and a negative impact on professional success (Edwards-Maddox et al., 2023; Fowler & Villanueva, 2023).

Self-efficacy, or the belief in one's own ability to succeed and achieve goals, plays a vital role in influencing decision-making, the level of effort exerted, and emotional reactions. People with strong self-efficacy are more likely to take on difficult tasks, encouraging innovation and creative thinking. For example, a recent study found that 59 critical care nurses with high self-efficacy delivered excellent patient care and demonstrated strong confidence in their abilities, enabling them to manage challenging situations more effectively and contributing to positive outcomes (Konduru et al., 2024; Siraj et al., 2024). Conversely, individuals experiencing impostor syndrome frequently demonstrate diminished self-efficacy, which may impede their professional performance. However, supportive workplace environments can help buffer the effects of impostor syndrome and reduce the negative consequences associated with low self-efficacy (Haar & De Jong, 2024).

Impostor syndrome can cause individuals to make less effective decisions or even avoid specific career paths altogether out of fear of failure or being perceived as incompetent. Despite its significance, the influence of impostor syndrome on career decision-making has been largely neglected in existing research. Addressing this gap is crucial for promoting a healthier and more supportive work environment. Emotional attributes like self-efficacy, hope, optimism, and resilience—key components of psychological resilience—are vital in enabling individuals to navigate career challenges effectively, as emotional well-being plays a central role in decision-making and coping mechanisms (He et al., 2024; Khalil et al., 2024).

Theoretical Framework

Bandura's Social Cognitive Theory (SCT), which highlights how cognitive processes influence behavior, self-belief, and emotional reactions, serves as the foundation for this investigation. The idea of self-efficacy, or the conviction that one can plan and carry out the behaviors necessary to handle potential circumstances, is fundamental to SCT. Nurse managers’ confidence in their capacity to make wise, prompt, and efficient decisions in intricate clinical and organizational situations is reflected in their decision self-efficacy in the context of nursing leadership (Bandura, 1997).

The self-regulatory processes emphasized in SCT can be disrupted by imposter syndrome, which is characterized by persistent emotions of intellectual fraudulence despite evidence of ability. People who experience imposter syndrome tend to accentuate their self-doubt and internalize accomplishment as luck, which can lower their perceived self-efficacy, especially in high-stakes leadership situations. This theoretical viewpoint offers a basis for comprehending how imposter syndrome-related cognitive distortions can impede confidence in decision-making and leadership efficacy (Klassen & Usher, 2010).

This study uses SCT to investigate how internal belief systems impact management behavior, providing a lens through which to view the psychological obstacles that could impair the professional performance of nurse managers. The framework aids in the identification of psychological variables that can be changed and provides guidance for the creation of treatments meant to improve healthcare systems’ leadership capabilities (Vaughan-Johnston & Jacobson, 2020).

Significance of the Study

Impostor syndrome is notably prevalent among nursing staff, with reported rates ranging from 36% to 75% (Li et al., 2025). It is particularly common among early-career nurses, nurse researchers, and advanced practice nurses, often hindering both personal and professional growth by triggering anxiety, self-doubt, and feelings of inadequacy. As such, it is important to assess the extent to which intensive care nurses experience impostor phenomenon and to identify the contributing factors. Nurses experiencing impostor syndrome may also feel heightened shame in response to perceived failures (Kehagias et al., 2025).

This is especially concerning in the healthcare field, where professionals operate in complex, high-pressure environments. Nurse managers, who balance both clinical and administrative responsibilities, require strong decision-making and leadership capabilities. The presence of impostor syndrome in these roles can significantly affect their confidence and effectiveness. Therefore, the current study aims to investigate the relationship between impostor syndrome and decision self-efficacy among nurse managers. By exploring the psychological and professional impact of impostor syndrome, this research seeks to offer insights into how nurse managers can strengthen their leadership and decision-making skills through improved awareness and management of impostor-related challenges.

The Study Aim

The current study aims to unearth the impact of impostor syndrome on decision self-efficacy among nurse managers.

Research Questions

To fulfill the aim of the current study, the following questions were formulated:

What is the level of impostor syndrome characteristics among nurse managers?

What is the level of decision self-efficacy among nurse managers?

Does impostor syndrome affect decision self-efficacy among nurse managers?

Methods

Study Design

A cross-sectional descriptive research design was approved following STROBE guidelines.

Setting

The study was conducted at Minia University Hospitals, affiliated with the Ministry of Higher Education, provides free healthcare services to a wide range of patients. The study location was chosen because it plays a crucial part in providing comprehensive, free healthcare services to a wide range of patients. The hospital system, a major academic healthcare institution, has a sizable number of nurse managers who oversee clinical care, allocate resources, and supervise personnel in high-demand settings. This environment provides a relevant scenario for studying leadership dynamics, especially the psychological issues, like impostor syndrome, that can influence nurse managers’ decision-making. The generalizability of findings among comparable public healthcare institutions in Minia and comparable low- and middle-income nations is improved by the diversity of clinical departments, patient acuity, and managerial duties. The context also fits with the study's goal of guiding capacity-building tactics in healthcare settings with limited resources.

Sample

A convenience sample was used, including all available nurse managers at Minia University Hospitals (N = 95). Inclusion criteria: All nurse managers working at Minia Hospitals who had at least one year of management experience and were willing to participate. Exclusion criteria: Assistant nurses, newly appointed nurse managers with less than one year of experience, and those on extended leave during data collection. Although the required sample size was calculated as 75 based on the formula provided by Althubaiti (2023), all 95 authorized nurse managers were included to ensure comprehensive representation.

Sample Size Calculation

n = \frac{{(z / d)}^{2} \times {(p)}^{2}}{1 + (1 / N) [{(z / d)}^{2} \times {(p)}^{2} - 1]}

where n is the Sample size (75); N is the Total population (95); Z is the Confidence level at 95% (1.96); d is the Error proportion (0.05); and p is the Probability (50%).

Study Tools

A structured questionnaire was employed to gather the data. The questionnaire consisted of three sections, as follows:

Tool (1): Personal Characteristics Data Sheet:

It was developed by the researcher to collect data on the personal and professional characteristics of nurse managers. The information gathered included nurse manager code, age, gender, marital status, place of residence, educational qualifications, and years of experience (Appendix A).

Tool (2): Clance Impostor Phenomenon Scale (CIPS):

The Clance Impostor Phenomenon Scale, modified by the researchers guided by Clance (1985) to help individuals determine whether they have IP syndrome characteristics or not and, if so, to what extent they are suffering.

Justification and Scoring: The original 5-point scale was modified to a 3-point scale primarily to simplify responses and improve comprehension among participants whose primary language was not English. Because the scale was modified, new cut-offs were derived. The total possible score range (20 to 60) has a width of 40 points. This range was trisected into three groups of approximately equal width resulting in the ‘Low’ (20–33), ‘Moderate’ (34–47), and ‘High’ (48–60) categories.

Validation and Reliability: A content validity review was conducted by seven experts. After their advice was taken into consideration, a confirmatory factor analysis confirmed a single-factor structure explaining 64.2% of total variance. The scale demonstrated excellent internal consistency (Cronbach's α = .93). Item-total correlations ranged from .56 to .82, and all factor loadings exceeded .70, supporting construct validity. The complete 20-item scale is provided in Appendix (b).

Tool (3): Decision Self-Efficacy Scale (DSES):

This 25-item scale was structured by the researchers based on a review of the literature (Bandura, 2007; O'Connor, 1995) to assess the degree of confidence in making decisions. It uses a 3-point Likert scale (3 = agree to 1 = disagree).

Item Development and Content Validity: The scale items are classified into five dimensions: Confidence in Decision-Making (5 items), Problem-Solving Abilities (5 items), Handling Complex Situations (5 items), Ethical Decision-Making (5 items), and Collaboration and Feedback (5 items). An expert panel of seven nursing Administration and psychometrics specialists assessed content validity, confirming it with a scale-level CVI = 0.89.

Validity and Reliability: An Exploratory Factor Analysis (EFA) using Varimax rotation was conducted. The EFA yielded the five hypothesized dimensions, which explained 68.4% of the total variance. The model fit indices were strong (CFI = 0.94, TLI = 0.91, RMSEA = 0.05, SRMR = 0.04). Reliability for the five subscales was strong (Cronbach's α ranged from .86 to .93). The total 25-item scale demonstrated excellent overall reliability (Cronbach's α = .87).

Scoring: The scoring system is divided into three levels: Poor decision self-efficacy (25–41), Moderate (42–58), and Excellent (59–75). These performance bands were established based on the tertile (33rd and 67th percentile) distribution of the sample data. The complete 25-item scale is provided in Appendix (c).

Translation and Pilot Study

To ensure linguistic and cultural equivalence, the authors employed a comprehensive translation and back-translation process for both scales. Initially, the instruments were translated into Arabic by two multilingual experts. A third independent translator, who was blind to the Arabic versions, then back-translated them into English. Differences were analyzed and resolved by consensus. Following the expert review and translation, a pilot study was conducted with 10% of the total sample (n = 9 nurse managers) to assess the clarity, feasibility, and applicability of the tools. The pilot also confirmed the time required for completion. No changes were needed, and these participants were excluded from the final study sample.

Ethical Consideration

Approval from the Ethical Committee of the Faculty of Nursing, Minia University, was obtained to conduct the current study (REC202512). Additionally, official permission was secured from the administrative personnel of the selected hospital. Informed consent was obtained from all participants after explaining the purpose and nature of the study, as well as their right to withdraw at any time. Anonymity and confidentiality were ensured by assigning a unique code number to each participant, and the data will not be accessed by any unauthorized individuals without the participants’ permission. The study posed no risk to the participants.

Statistical Analysis

The collected data were coded, analyzed, and tabulated using appropriate statistical tests. Statistical analysis was performed using Microsoft Excel and the SPSS software package, version 24. Quantitative data were described using mean ± standard deviation (SD), while qualitative data were presented as frequencies and percentages. Data interpretation involved testing for statistically significant differences between groups, with a p-value considered significant if ≤ .05 at a 95% confidence interval. For quantitative data comparisons between two groups, a paired sample t-test was applied.

Data Collection Procedure

Before data collection began, official permission was obtained from the Research and Ethical Committee as well as the Dean of the Faculty of Nursing, Minia University. Subsequently, approval was secured by the medical and nursing directors of Minia University Hospital. After receiving hospital directors’ consent, the researcher contacted each department manager to request permission, explained the study's nature and purpose, invited voluntary participation, and obtained formal written consent.

The questionnaires were then distributed by the researcher to nurse managers in their respective units during break times. Nurse managers were given instructions on how to complete the questionnaires, which were collected the following day. Completing the questionnaires took approximately 20 to 30 minutes. Data collection spanned three months, from January to March 2025. After data collection was completed, the information was entered, analyzed, and organized into tables. Any queries from the nurses were answered during this time, and further clarifications were given as needed.

Results

Table 1 shows that, the majority (77.9%) were aged 22 to 32 years, and 22.1% were 33 to 43 years old., the mean age of nurse managers was 32.8 ± 5.7 years, with a median (IQR) of 31 (28–37). Regarding gender, 89.5% of the participants were female. Additionally, 69.5% of the nurse managers were from rural areas. In terms of experience, the table indicates that about 69.5% had between 1 and 10 years of nursing experience.

Table 1.

Percentage Distribution of the Nurse Manager Socio-Personal Data (no. = 95).

Items	Nurses’ manager's data (no. 95)
Age
22–32 years	74	77.9
33–43 years	21	22.1
Mean ± SD	32.8 ± 5.7
Median (IQR)	31 (28–37)
Gender
Male	10	10.5
Female	85	89.5
Residence
Urban	29	30.5
Rural	66	69.5
Years of experience
1–10 years	66	69.5
11–20 years	29	30.5
Mean ± SD 8.6 ± 4.6
Marital status
Married	79	83.2
Single	16	16.8

Table 2 and Figure 1 show that 57.9% of nurse managers reported a high overall level of impostor characteristics. Specifically, the dimensions of “Fake,” “Discount,” and “Luck” were reported at rates of 54.8%, 59%, and 50.5%, respectively.

Figure 1.

Percentage distribution of total Impostor characteristics among nurse managers at selected hospitals (no. = 95).

Table 2.

Percentage Distribution of Impostor Characteristics Dimensions Among Nurse Managers at Selected Hospitals (no. = 95).

Items	Low		Moderate		High
Items	no.	%	no.	%	no.	%
Fake	11	11.5	32	33.7	52	54.8
Discount	9	9.5	30	31.5	56	59
Luck	13	13.6	34	35.8	48	50.5

Table 3 and Figure 2 show that 71.6% of nurse managers reported a low overall level of decision self-efficacy. The specific dimensions—Confidence in Decision-Making, Problem-Solving Abilities, Handling Complex Situations, Ethical Decision-Making, and Collaboration and Feedback—were reported at rates of 77%, 73.6%, 59.5%, 71.5%, and 69.5%, respectively.

Figure 2.

Percentage distribution of total decision self-efficacy at selected hospitals (no. = 95).

Table 3.

Percentage Distribution of Decision Self-Efficacy Dimensions at Selected Hospitals (no. = 95).

Items	Low		Moderate		High
Items	no.	%	no.	%	no.	%
Confidence in Decision-Making	73	77	11	11.5	11	11.4
Problem-Solving Abilities	70	73.6	16	16.8	9	9.5
Handling Complex Situations	66	59.5	16	16.8	13	13.6
Ethical Decision-Making	68	71.5	12	12.6	15	15.7
Collaboration and Feedback	66	69.5	12	12.6	17	17.8

Table 4 reveals that there were no statistically significant differences between nurse managers’ data and their impostor characteristics.

Table 4.

Relationship Between Nurse Managers^, Personal Data and Impostor Characteristics (n = 95).

Variable	Mean ± SD	t	p-Value	Significance
Age
22–32 years	50.54 + 7.99	0.29	.76	NS
33–43 years	49.95 ± 7.95
Gender
Male	49.80 ± 8.59	0.45	.652	NS
Female	50.63 ± 7.73
Residence
Urban	50.92 ± 7.65	0.657	.513	NS
Rural	49.84 ± 8.30
Years of experience
1–10 years	51.17 ± 7.92	0.386	.701	NS
11–20 years	50.30 + 8.29
Marital status
Single	52.62 ± 7.65	1.82	.072	NS
Married	49.39 ± 7.84

NS = not significant (p > .05); * = significant (p ≤ .05).

Table 5 shows a statistically significant relationship between nurse managers’ years of experience and their decision self-efficacy.

Table 5.

Relationship Between Nurse Managers, Personal Data and Decision Self-Efficacy Characteristics (n = 95).

Variable	Mean ± SD	t	p-Value	Significance
Age
22–32 years	25.82 + 19.15	0.08	.934	NS
33–43 years	25.42 + 19.63
Gender
Male	22.19 + 16.09	1.10	.27	NS
Female	27.07 + 20.13
Residence
Urban	24.62 + 18.07	0.53	.59	NS
Rural	26.74 + 20.20
Years of experience
1–10 years	22.73 + 19.54	0.81	.50	*
11–20 years	30.35 + 21.36
Marital status
Single	26.37 ± 20.8	0.21	.83	NS
Married	25.44 ± 16.3

NS = not significant (p > .05); * = significant (p ≤ .05).

Table 6 demonstrates a significant negative correlation between impostor characteristics and decision self-efficacy (r = −0.398**, p = .001).

Table 6.

Correlation Between of Impostor Characteristics & Decision Self-Efficacy at Selected Hospitals (no. = 95).

Variable		Impostor Characteristics	Decision Self-Efficacy
IP characteristics	RP	1	.398–**.001.
Decision Self-Efficacy	RP	.398–**.001	1

Discussion

Impostor syndrome (IS) involves persistent feelings of inadequacy, ongoing self-doubt, and a fear of being revealed as a fraud (Bravata et al., 2020). It can negatively impact professional growth and career satisfaction. Individuals experiencing IS often struggled to recognize their abilities and instead credited their achievements to external factors such as luck or assistance from others (Emas et al., 2024). This tendency to attribute success to outside influences rather than personal competence can weaken self-efficacy and perpetuate feelings of being an impostor (Chatterjee, 2024).

However, the quality and supportive nature of the initial nursing training is the foundation for the development of strong decision self-efficacy. The literature indicates that the high-stress training environment can expose students to psychological risks, such as perceived impostorism and anxiety (Bhardwaj et al., 2024). These psychological obstacles have the potential to damage one's sense of self and, as a result, impede the confidence necessary for making wise clinical decisions. Given the established advantages of strong self-efficacy, cultivating this confidence is crucial. High decision self-efficacy lowers turnover, enhances professional identity, and promotes efficient career planning and adaptability (Jung & Yoo, 2022). Strong decision-making self-efficacy enables nurses to prioritize care interventions, effectively identify patient requirements, and collaborate with other members of healthcare teams (Shorey & Lopez, 2021).

Individuals with impostor syndrome frequently experience low self-efficacy because their self-doubt weakens their confidence in making decisions. This may result in hesitation, reluctance to take responsibility, or excessive overcompensation in decision-making situations. In turn, diminished self-efficacy can intensify feelings of impostorism, creating a cycle of doubt and lowered confidence (Pákozdy et al., 2024). Therefore, it is important to explore the impact of impostor syndrome on decision-making self-efficacy among nurse managers.

The current research's findings of personal data for nurse managers show that most nurse managers were between the ages of 22 and 32 years old, and the least percentage were between the ages of 33 and 43 years old. Speaking about gender, it was found that most nurse managers were female, and the highest percentage of them are married. In addition, more than half of them were from rural areas. Concerning the years of experience of nursing managers, it was discovered that more than half of them had 1 to 10 years of experience.

Regarding the level of impostor syndrome among nurse managers, it was unearthed that more than half of nurse managers have a high level of impostor syndrome. This might be due to the perpetual striving of nurse managers for perfectionism and social comparison with their peers, as well as the work in high-pressure environments like hospitals, which contributes to the development of impostor syndrome.

This is supported by the study of Bravata et al. (2020), which found that impostor syndrome is significantly associated with individuals’ desire to maintain their social status and avoid showing imperfections to others. However, social support and a strong sense of self-worth were strongly negatively correlated with impostor symptoms. Additionally, impostor feelings were closely associated with pessimism, perfectionism, and low self-esteem. Similarly, Rosenthal et al. (2021) reported that individuals with low self-esteem and self-compassion, as well as those experiencing intense pressure and competition, were more likely to experience the impostor phenomenon. In contrast, Feenstra et al. (2020) argued that impostor syndrome is often viewed as a personal issue, overlooking the influence of environmental and systemic factors that contribute to these feelings.

Regarding the level of decision self-efficacy among nurse managers, it was found that more than half of nurse managers reported a low level of total decision self-efficacy, and it was also noted that most nurse managers have a low percentage in the “Confidence in Decision-Making” dimension, which explains the main reason behind low decision self-efficacy: most nurse managers have poor confidence, which makes them more hesitant in making decisions.

This aligns with the findings of Wang et al. (2023a), who demonstrated that self-doubt is negatively correlated with self-efficacy and decision-making, emphasizing that individuals with persistent self-doubt often hesitate or avoid making decisions due to a lack of confidence in their abilities. However, this contrasts with Stone's study (1994), which found that overconfidence can result in poor decision-making, indicating that confidence alone does not ensure high decision self-efficacy. Similarly, Pignault et al. (2023) argued that psychological flourishing, rather than confidence, plays a more crucial role in overcoming decision-making difficulties.

Regarding the relation between nurse managers’ data and impostor syndrome, it was found that there were no statistically significant differences between nurse managers’ personal data and impostor characteristics. This is in harmony with the study of Batur et al. (2024) and Holden et al. (2024), who revealed that socio-demographic factors, such as age and gender, were not significantly tied to IS scores.

Regarding the relation between nurse managers’ personal data and decision self-efficacy, it was found that there were only statistically significant differences between nurse managers’ years of experience and their decision self-efficacy. This might be due to the lack of years of experience of participating nurse managers, in which the highest percentage of them have only 1 to 10 years of experience, which affects their interaction with diverse management scenarios needed to arm them with the skills needed to make decisions with high self-efficacy; moreover, it negatively coincided with their ability to make effective decisions.

This is consistent with the study by Chang et al. (2025), who emphasized that self-efficacy develops through specific learning experiences, noting that nurses with more years of experience build confidence through repeated successful decision-making. Similarly, Ellison (2023) found that years of experience are positively reflective of confidence in decision-making, which aligns with Reddan's findings (2015) that practical exposure and frequent decision-making tasks over time significantly enhance confidence levels.

However, this view is challenged by Wang et al. (2023b) who reported that although age and experience often correlate positively with self-efficacy, this relationship is influenced by other factors such as social support and personality traits, suggesting that experience alone is not a definitive predictor. Likewise, Bullock-Yowell et al. (2014) demonstrated that decision-making self-efficacy is more strongly predicted by access to consistent career information and social support than by the duration of decision-making experience.

Regarding the correlation between impostor syndrome and decision self-efficacy, it was found that there was a negative correlation between impostor syndrome and decision self-efficacy. This might be due to the poor consequences of impostor syndrome on persons’ personalities, in which increases their self-doubts and causes them to see themselves as impostors that not deserve that success or authority and have continuous fear from being exposed as impostors to others which disrupt their self-confidence and make them hesitate in making decisions and consequently lead to poor decision-making self-efficacy.

In the same line with, Batur et al. (2024) investigated the relationship between impostor syndrome and self-efficacy among healthcare professionals and found a strong negative correlation, showing that higher levels of impostor syndrome were linked to lower confidence in decision-making, particularly among nurses early in their careers. This underscores the influence of psychological factors on professional performance and decision-making effectiveness. Similarly, Pákozdy et al. (2024) examined university students and reported that impostor syndrome impairs self-efficacy, resulting in hesitation and avoidance during decision-making. However, Behmanesh et al. (2025) found that in environments with robust support systems, the poor consequences of impostor syndrome on decision self-efficacy were significantly reduced. This emphasizes the critical role of supportive environments in mitigating the impact of impostor syndrome.

Moreover, there are no specific strategy can be used to resolve IS. There are multifactorial issues require a comprehensive and layered approach spanning individual awareness to institutional reform. Some interconnected strategies may guide the study subjects to achieve a meaningful changes; improving awareness and provide education programs to raise awareness of this issue, accessible and consistent mentorship, providing psychological training and support personnel development, promoting a positive work environment, recognition, feedback, and team-building, changing of organizational Policies such as regulated working hours to prevent excessive workloads, safeguard designed break times to promote well-being, and extend parental leave policies to support work-life balance are essential for overcoming the IS (Erul, 2025).

Strengths and Limitations

By examining the psychological effects of impostor syndrome on nurse managers’ decision self-efficacy, this study tackles a crucial and little-studied aspect of nursing leadership. It adds to the expanding corpus of research on leadership effectiveness and mental health in the healthcare industry, especially in low- and middle-income nations. The results are more contextually relevant when a well-defined sample from a sizable public university hospital is used. To further guarantee the quality and dependability of data gathering, the study makes use of validated instruments. Its ramifications are beneficial for nursing practice and policy formation, providing a basis for focused interventions.

The study has several limitations despite its contributions. The cross-sectional design limits the capacity to conclude the causal relationship between choice self-efficacy and impostor syndrome. Additionally, the study is restricted to a single institution, which could limit its applicability to different healthcare environments or geographical areas. Furthermore, response bias may affect self-reported assessments, especially when it comes to delicate psychological concepts like impostor syndrome. Longitudinal designs, multi-site samples, and qualitative methods should be considered in future research to expand comprehension and validate the results in larger contexts.

Implications for Nursing Practice

The results of how impostor syndrome affects nurse managers’ decision-making self-efficacy have important ramifications for nursing practice. Impostor syndrome might cause nurse supervisors to question their judgment, shirk leadership duties, or put off important choices, which could jeopardize staff morale and patient safety. Thus, it is crucial to create a supportive workplace that encourages psychological safety. Nurse managers can improve their decision-making skills, normalize impostor syndrome, and gain confidence with regular mentorship, peer support groups, and leadership development programs. To train future leaders, nursing schools should also include material on self-awareness and coping mechanisms for impostor syndrome. In the end, early detection and focused actions can enhance team performance, leadership efficacy, and healthcare results.

Implications for Policy Makers

These findings underscore the necessity for policymakers to incorporate psychological well-being into leadership competency frameworks and healthcare leaders’ professional growth pathways. Policies that acknowledge impostor syndrome as a hindrance to successful leadership and establish uniform evaluations and interventions across organizations should be required by national nursing bodies and healthcare facilities. Policies ought to encourage the use of mental health services, ongoing leadership development, and the incorporation of self-efficacy and emotional intelligence into performance reviews. Healthcare systems may enhance leadership capabilities, guarantee secure clinical governance, and foster a resilient and self-assured nursing workforce by establishing policy-level accountability and support frameworks.

Conclusion

One profession that stands out for its human-centeredness and caring comforts is nursing. Only nurses use certain values when interacting with patients and their families (Abou Hashish & Ghanem Atalla, 2023). This implies that fostering a culture of support that encourages lifelong learning and skill improvement should be a top priority for healthcare companies. To encourage nurses’ participation in committee meetings and decision-making, hospital administrators should support the organized communication networks of nursing leaders and subordinates (Ghanem et al., 2023).

The current study reveals a significant negative relationship between impostor syndrome and decision self-efficacy among nurse managers. Most participants exhibited high levels of impostor traits, which were closely linked to reduced confidence in their decision-making skills. These results highlight the considerable psychological burden impostor syndrome places on nursing leaders, potentially hindering effective leadership and overall organizational performance. While demographic variables had minimal effect, greater years of experience were found to enhance decision self-efficacy. These findings underscore the critical need for targeted support, training, and mentorship programs aimed at boosting nurse managers’ self-efficacy and mitigating the prevalence and associate of impostor syndrome within clinical leadership.

Ethics Approval and Consent to Participate

Every technique used in this investigation closely followed the relevant guidelines provided in the Declaration of Helsinki (DoH-Oct2008). The present study was carried out with permission from Minia University's Faculty of Nursing's Ethical Committee (REC 202512). Furthermore, formal approval was obtained from the chosen hospital's administrative staff. All participants gave their informed consent after being fully informed about the nature and goal of the study, as well as their ability to discontinue participation at any moment. Each participant was given a unique code number to maintain anonymity and confidentiality, and without the participants’ consent, no unauthorized individuals will be able to access the data. Participants were not at risk from the study.

Supplemental Material

sj-doc-1-son-10.1177_23779608251413343 - Supplemental material for Unearthing the Impact of Impostor Syndrome on Decision Self-Efficacy Among Nurse Managers

Supplemental material, sj-doc-1-son-10.1177_23779608251413343 for Unearthing the Impact of Impostor Syndrome on Decision Self-Efficacy Among Nurse Managers by Aziza Ibrahim Abd El Kader Mohamed, Amal Diab Ghanem Atalla, Rasha Mohamed Nagib Ali, Alzahraa Abdel Aziz Omar Abdel Rahman and Maaly Zayed Mohammad, Marwa Mohammad Abd Elbaky, Samar Hussien Khalaf Alah Mohamed in SAGE Open Nursing

Supplemental Material

sj-docx-2-son-10.1177_23779608251413343 - Supplemental material for Unearthing the Impact of Impostor Syndrome on Decision Self-Efficacy Among Nurse Managers

Supplemental material, sj-docx-2-son-10.1177_23779608251413343 for Unearthing the Impact of Impostor Syndrome on Decision Self-Efficacy Among Nurse Managers by Aziza Ibrahim Abd El Kader Mohamed, Amal Diab Ghanem Atalla, Rasha Mohamed Nagib Ali, Alzahraa Abdel Aziz Omar Abdel Rahman and Maaly Zayed Mohammad, Marwa Mohammad Abd Elbaky, Samar Hussien Khalaf Alah Mohamed in SAGE Open Nursing

Footnotes

ORCID iDs

Aziza Ibrahim Abd El Kader Mohamed

Amal Diab Ghanem Atalla

Author Contributions

Aziza Ibrahim Abd El Kader Mohamed and Amal Diab Ghanem Atalla did conceptualization, methodology, research, producing the first draft, and manuscript revision and editing. Alzahraa Abdel Aziz and Rasha Mohamed Nagib Ali did conceptualization, data gathering, statistical analysis, data curation, writing the first draft, reviewing it, and revising it are all done by Omar Abdel Rahman. Samar Hussien Khalaf, Maaly Zayed Mohammad, and Marwa Mohammad Abd Elbaky Alah Mohamed did data gathering, research, methodology, manuscript revision, and editing. The material of this manuscript has been reviewed and approved by all authors.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Upon reasonable request, the corresponding author will make the datasets created and examined during the current work available.

Supplemental Material

Supplemental material for this article is available online.

References

Abou Hashish

E. A.

Ghanem Atalla

A. D.

(2023). The relationship between coping strategies, compassion satisfaction, and compassion fatigue during the COVID-19 pandemic. SAGE Open Nursing, 9, 1–11. https://doi.org/10.1177/23779608231160463

Althubaiti, A. (2023). Sample size determination: A practical guide for health researchers. Journal of General and Family Medicine, 24(2), 72–78. https://doi.org/10.1002/jgf2.600

Bandura

(1997). Self-efficacy: The exercise of control. W.H. Freeman. https://doi.org/10.1891/0889-8391.13.2.158

Bandura

(2006). Guide for constructing self-efficacy scales. In Pajares

Urdan

(Eds.), Self-efficacy beliefs of adolescents (Vol. 5, pp. 307–337). Information Age Publishing.

Batur

Arslan

Turan

(2024). Analysis of the relationship between medical achievement self-efficacy perception and impostor phenomenon in the postgraduate education process: A cross-sectional study. BMC Medical Education, 24(1), 1536. https://doi.org/10.1186/s12909-024-06591-9

Behmanesh

Jalilian

Heydarabadi

A. B.

Ahmadi

Khajeali

(2025). The impact of hidden curriculum factors on professional adaptability. BMC Medical Education, 25(1), 1–10. https://doi.org/10.1186/s12909-024-06618-1

Bhardwaj

Kumar

Bahurupi

(2024). Influence of perceived impostorism on self-esteem and anxiety among University Nursing Students: Recommendations to implement mentorship program. Journal of Family Medicine and Primary Care, 13(12), 5745–5751. https://doi.org/10.4103/jfmpc.jfmpc_1030_24

Bravata

D. M.

Watts

S. A.

Keefer

A. L.

Madhusudhan

D. K.

Taylor

K. T.

Clark

D. M.

, et al. (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

Bullock-Yowell

McConnell

A. E.

Schedin

E. A.

(2014). Decided and undecided students: Career self-efficacy, negative thinking, and decision-making difficulties. NACADA Journal, 34(1), 22–34. https://doi.org/10.12930/NACADA-13-016

10.

Chang

Zhong

(2025). Sources of self-efficacy in career contexts: Aa longitudinal perspective. Current Psychology. Advance online publication. https://doi.org/10.1007/s12144-025-07699-x

11.

Chatterjee

(2024). Impostor syndrome and its relationship with self-efficacy and achievement of success [Unpublished manuscript]. Available at SSRN: https://ssrn.com/abstract=4815409

12.

Clance

P. R.

(1985). The impostor phenomenon: Overcoming the fear that haunts your success. Peachtree Publishers.

13.

Edwards-Maddox

(2023). Burnout and impostor phenomenon in nursing and newly licensed registered nurses: A scoping review. Journal of Clinical Nursing, 32(5–6), 653–665. https://doi.org/10.1111/jocn.16475

14.

Ellison

D. J.

(2023). The relationship between self-efficacy, years of experience, and stress scores for special education teachers in Central Tennessee [Doctoral dissertation]. Liberty University. Liberty University Digital Commons. https://digitalcommons.liberty.edu/doctoral/4784

15.

Emas

Dolamore

Jones

P. A.

Lovell

Whitebread

Chordiya

(2024). Impostor phenomenon & belonging in master of public administration students in the US context. Journal of Public Affairs Education, 30(4), 560–587. https://doi.org/10.1080/15236803.2024.2397942

16.

Erul

(2025). A call for action to prevent Impostor syndrome and burn-out among medical oncologists. Cancer Control, 32, 10732748251347045. https://doi.org/10.1177/10732748251347045

17.

Feenstra

Begeny

C. T.

Ryan

M. K.

Rink

F. A.

Stoker

J. I.

Jordan

(2020). Contextualizing the impostor “syndrome”. Frontiers in Psychology, 11, Article number 1410452. 575024. https://doi.org/10.3389/fpsyg.2020.575024

18.

Fowler

K. R.

Villanueva

(2023). From the bedside to the boardroom: Impostor syndrome in nursing leadership. Nurse Leader, 21(3), e7–e10. https://doi.org/10.1016/j.mnl.2022.10.003

19.

Ghanem Atalla

A. D.

Sharif

L. S.

Katooa

N. E.

Kandil

F. S.

Mahsoon

Elseesy

N. A. M.

(2023). Relationship between nurses’ perception of professional shared governance and their career motivation: A cross-sectional study. International Journal of Nursing Sciences, 10(4), 485–491. https://doi.org/10.1016/j.ijnss.2023.09.016

20.

Gómez-Morales

(2021). Impostor phenomenon: A concept analysis. Nursing Science Quarterly, 34(3), 309–315. https://doi.org/10.1177/08943184211010462

21.

Haar, J., & De Jong, K. (2024). Imposter phenomenon and employee mental health: What role do organizations play? Personnel Review, 53(1), 211–227. https://doi.org/10.1108/PR-01-2022-0030

22.

Halim, S. K., Hidayat, D., Eni, Y., & Fernando, E. (2023). What is Entrepreneurial Fear of Failure? Binus Business Review, 14(1), 73–84. https://doi.org/10.21512/bbr.v14i1.8658

23.

Cai

Cheng

Liu

(2024). The relationship between impostor phenomenon and career decision-making difficulties among nursing interns: The mediating role of psychological resilience. Frontiers in Psychology, 15, Article number 1484708. https://doi.org/10.3389/fpsyg.2024.1484708

24.

Holden

C. L.

Wright

L. E.

Herring

A. M.

Sims

P. L.

(2024). Impostor syndrome among first-and continuing-generation college students: The roles of perfectionism and stress. Journal of College Student Retention: Research, Theory & Practice, 25(4), 726–740. https://doi.org/10.1177/15210251211019379

25.

Jung

Y. M.

Yoo

I. Y.

(2022). Development and testing of the career decision-making self-efficacy scale for nursing students: A methodological study. BMC Nursing, 21(1), 231. https://doi.org/10.1186/s12912-022-01017-7

26.

Kehagias

Giannouchos

T. V.

Lampropoulos

Bellou

Kehagia

Kehagias

(2025). Exploring the impostor phenomenon in the field of general surgery—A systematic review of the literature. Current Problems in Surgery. Advance online publication. https://doi.org/10.1016/j.cpsurg.2025.101766

27.

Menon

(2022). Impostor syndrome: An integrative framework of its antecedents, consequences and moderating factors on sustainable leader behaviors. European Journal of Training and Development, 46(9), 847–860. https://doi.org/10.1108/EJTD-07-2019-0138

28.

Khalil

A. I.

Alharbi

Al Qtame

Al Bena

Khan

M. A.

(2024). Investigating the association between resilience and impostor syndrome in undergraduate nursing and medical students: A cross-sectional study. Journal of Medical Life, 17(9), 868. https://doi.org/10.25122/jml-2024-0160

29.

Klassen

R. M.

Usher

E. L.

(2010). Self-efficacy in educational settings: Recent research and emerging directions. In Urdan

T. C.

Pajares

(Eds.), The decade ahead: Theoretical perspectives on motivation and achievement. (Vol. 16, pp. 1–33). Emerald Group Publishing Limited. https://doi.org/10.1108/S0749-7423(2010)000016A004

30.

Konduru

R. K.

Manikandan

Purty

A. J.

(2024). Impostor phenomenon among the final year (part 1 and 2) medical students of a private medical college in the union territory of Puducherry: A cross-sectional study. Indian Journal of Community Health, 36(2), 215–221. https://doi.org/10.47203/IJCH.2024.v36i02.010

31.

Qiu

Luo

Y. X.

Fang

(2025). The relationship between impostor phenomenon and emotional exhaustion among Chinese nurses: The mediating role of bi-directional work-family conflict. Frontiers in Public Health, 12, Article number 1410452. https://doi.org/10.3389/fpubh.2024.1410452

32.

Mount

Tardanico

(2014). Beating the impostor syndrome. Center for Creative Leadership.

33.

O'Connor

A. M.

(1995). Validation of a decisional conflict scale. Medical Decision Making, 15(1), 25–30. https://doi.org/10.1177/0272989X9501500105

34.

Pákozdy

Askew

Dyer

Gately

Martin

Mavor

K. I.

, et al. (2024). The impostor phenomenon and its relationship with self-efficacy, perfectionism and happiness in university students. Current Psychology, 43(6), 5153–5162. https://doi.org/10.1007/s12144-023-04672-4

35.

Pignault

Rastoder

Houssemand

(2023). The relationship between self-esteem, self-efficacy, and career decision-making difficulties: Psychological flourishing as a mediator. European Journal of Investigation in Health, Psychology and Education, 13(9), 1553–1568. https://doi.org/10.3390/ejihpe13090113

36.

Qureshi

M. A.

Taj

Latif

M. Z.

Zia

Rafique

Chaudhry

M. A.

(2017). Impostor syndrome among Pakistani medical students. Annals of King Edward Medical University, 23(2), 106–110. https://doi.org/10.21649/akemu.v23i2.1647

37.

Reddan

(2015). Enhancing students’ self-efficacy in making positive career decisions. Asia-Pacific Journal of Cooperative Education, 16(4), 291–300.

38.

Rosenthal

Schlussel

Yaden

DeSantis

Trayes

Pohl

Rucker

(2021). Persistent impostor phenomenon is associated with distress in medical students. Family Medicine, 53(2), 118–122. https://doi.org/10.22454/FamMed.2021.799997

39.

Shorey

Lopez

(2021). Self-efficacy in a nursing context. In Al-Otaibi

N. H. M. Y.

Abdullah

M. K.

(Eds.), Health promotion in health care—Vital theories and research (pp. 145–158). IntechOpen.

40.

Siddiqui

Z. K.

Church

H. R.

Jayasuriya

Boddice

Tomlinson

(2024). Educational interventions for imposter phenomenon in healthcare: A scoping review. BMC Medical Education, 8(1), 43. https://doi.org/10.1186/s12909-023-04984-w

41.

Siraj

R. A.

Aldhahir

A. M.

Alzahrani

Y. R.

Alqarni

A. A.

Alanazi

T. M.

Alruwaili

Algarni

S. S.

Alghamdi

A. S.

Alahmari

M. A.

Baogbah

A. A.

AlQahtani

A. S.

(2024). The impact of impostor syndrome on self-esteem and intention to quit among respiratory therapy (RT) students in Saudi Arabia. SAGE Open Medicine, 12, https://doi.org/10.1177/20503121241260149

42.

Stone

D. N.

(1994). Overconfidence in initial self-efficacy judgments: Effects on decision processes and performance. Organizational Behavior and Human Decision Processes, 59(3), 452–474. https://doi.org/10.1006/obhd.1994.1069

43.

Vaughan-Johnston

T. I.

Jacobson

J. A.

(2020). Self-efficacy theory. In Levesque

R. J.

(Ed.), The Wiley encyclopedia of personality and individual differences: Models and theories (pp. 375–379). John Wiley & Sons, Inc. https://doi.org/10.1002/9781119547143.ch62

44.

Wang

Zhou

Zhu

Shang

(2023a). The effect of social reference points on self-other risk decision-making. Current Psychology, 42(7), 5986–5995. https://doi.org/10.1007/s12144-021-01954-7

45.

Wang

Luan

Zhao

(2023b). The antecedents of career decision self-efficacy: A meta-analysis on 20 years of research. Career Development International, 28(6/7), 633–648. https://doi.org/10.1108/CDI-04-2023b-0092

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