By Laura Ostrowsky, RN, CCM, MUP

I have been known to doubt myself. Should I, shouldn’t I is the first step in that process. Should I try? Should I speak up? Am I relevant? Is this a stupid question? I have to say with age has come a modicum of confidence. It’s not just age, though; it’s also hard work. It’s about taking the chances, but before that, it is discussion (sometimes internal, aka talking to myself). I lay awake at night rehearsing, mulling, rethinking, and, yes, second-guessing. No, before I go any further, I want you to know I don’t have a solution or easy fix. We all need to find our way; it is a process, often a journey. So, no solutions are provided, but I hope I can give you ample food for thought.

One form of doubting yourself is thinking that your success is luck. It rarely is. You may have been at the right place at the right time, but that doesn’t mean you haven’t earned your position/success. You worked for it, had the skills and talent, and got the degree, certification, and experience. Own your accomplishments. And as long as we are talking about owning, remember everything that doesn’t go right isn’t your fault. You may be familiar with the expression “if it’s not one thing, it’s your mother.” Women bosses often fall into this trap. We take responsibility for things that go wrong, even if it’s not our fault. Of course, I am responsible; I’m the boss, the parent, the caretaker, fill in the blank. There is nothing wrong with owning your mistakes; it’s an admirable trait, but you also need to learn to acknowledge your achievements. I used to keep a running list in a draft email (it could also be a file, electronic or written) of accomplishments, successes, etc. When It came time for me to provide my boss with info for performance improvement, I didn’t have to resort to memory.

Years ago, I worked on an interdisciplinary team to lower the length of stay in a few critical surgical services. The initiative was successful, and at an administrative meeting, they reviewed the results and thanked the doctors, the nurse managers, financial planning, and a few other areas. There was no mention of case management; believe me, we were vital in that success. Six months later, when the length of stay started trending up, my boss asked what the problem was. My response is to ask the doctors and the analysts from financial planning. If they are responsible for the decrease, they must also know why it has increased. My response took him aback. After some discussion, I pinpointed contributing issues, and we were able to turn things around. It would help if you took control of the narrative whenever possible (and I know it’s not always possible).

How many of you have been ignored at meetings or, worse, soon after you speak, someone else paraphrases what you just said, and everyone else finds it enlightening? This is common for many of us. I worked on my presentation skills and my confidence, and I also got older, and this happened less but never disappeared. I tried to turn weaknesses into strengths. I sought recognition and support outside of my institution, which helped me develop confidence and self-assurance. I conquered my fears and doubts with the help of mentors from CMSA and others in the healthcare industry. I began honing my writing skills and eventually published articles. I conquered my fear of public speaking and made presentations at conferences.
There is no easy answer or solution to overcoming self-doubt, but if you don’t challenge yourself and take chances, you will never change your narrative. You are a case manager and an advocate for others. Take the next step and advocate for yourself.

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Bio: Laura Ostrowsky, RN, CCM, MUP, spent 20 years from 1999-2019 as the Director of Case Management at Memorial Sloan-Kettering Cancer Center (MSKCC) and is currently teaching with the Case Management Institute and consulting on all things case management. Laura was the 2012 CMSA Case Manager of the Year. Her program at MSKCC was nominated by Case in Point for excellence in Utilization Management, Discharge Planning and Transitions in Care. She created a patient advocacy program to assist patients in obtaining access to specialty care despite network restrictions. The program has been featured in articles in Advance for Nursing, The Wall Street Journal, Case in Point, and Case Management Monthly. Laura holds a master’s degree in Health Planning and Policy from Hunter College. She has been a CMSA member since 2005, and has served on the Board of Directors of the NYC Chapter since 2011, and CMSA National from 2016-2018 and is a current board member of CMSA. Laura has over 30 years of health care experience, including time as a staff nurse, QA Coordinator, Director of UR and QA at Montefiore, followed by directorships in CM at New York Presbyterian(NYP) and Memorial Sloan Kettering Cancer Center. She also spent 3 years in information services at the NYP Network overseeing the selection, acquisition and implementation of an integrated hospital information application for UR, QA, Credentialing and Risk Management at 5 network hospitals. Laura has published articles on Case Management in CMSA Today, Professional Case Management, Case in Point, The Patient Flow Journal and other periodicals. She regularly presents at national conferences including CMSA, the Patient Advocate Institute and others on topics ranging from case management, patient flow and payer provider collaboration to advocacy, collaborative practice and case management’s role in the changing health care environment. She is also a past member of the Genentech speaker’s bureau where she presented on topics in oncology case management, palliative care and hospice.