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The perils of perfectionism in nursing

By: Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Don’t let perfectionism derail your leadership career.


  • Perfectionism is a weakness masquerading as a strength.
  • A perfectionist approach can cause even the best and brightest people to feel unmotivated, devalued, dependent, disempowered, frustrated, and ultimately disengaged.
  • Perfectionism may contribute to career success, it can result in leadership derailment.

Jackie* is a director of quality management at her organization. She prides herself on being a perfectionist in every aspect of her life, so she’s surprised when feedback on a recent 360-degree evaluation indicates that her direct reports and peers find her difficult to work with. Their observations include “She edits all written work done by others (often with comments that don’t add value)” and “She rarely fully delegates projects to her staff without a significant amount of micromanagement.” Jackie also has been tagged as indecisive; she believes her deliberative decision-making approach avoids errors. Jackie’s supervisor asks her to review the evaluation and develop an action plan to dial down some of the perfectionist tendencies that are impeding her effectiveness.

Jackie’s challenges aren’t unusual for those who pride themselves on being perfectionists. Perfectionists usually can’t see that a threshold exists to adding value to conversations, projects, or written work. Beyond a certain point, their ideas aren’t value-added and their behavior becomes frustrating to others who are trying to complete a task. Ultimately, perfectionism can derail a leader’s success. Jackie’s exacting standards make it hard for her to let others do their job. She frequently decides to do the work herself so that it will be “done right.” The outcome is that she’s overloaded with work, and her team members aren’t growing in their roles.

Perfectionists like Jackie have the mistaken belief that every job or project has a perfect outcome. They set an unrealistically high bar for themselves and others. No matter how much work has been done on a project, they may feel that it’s not good enough and continue revising their work and that of others. In a chaotic and rapidly changing healthcare environment, maintaining this level of control is an illusion.

By their nature, perfectionists want to make the very best decision and frequently believe that even better alternatives exist. Failing to act in a timely manner may mean forgoing critical strategic opportunities and can result in turnover of frustrated staff. Jackie’s supervisor is wise to push her to examine the perils of her behavior and to dial down her perfectionism. But behavior change will be challenging because perfectionism may be deeply rooted in feelings of anxiety and insecurity.

Perfectionist behaviors

Researcher Brené Brown, PhD, LMSW, has noted that shame is the birthplace of perfectionism. Perfectionism is a mistaken belief that if we live a perfect life, act perfect, and look perfect, we can minimize the pain of blame, judgment, and shame. Perfectionism can begin in childhood as a pattern of behavior developed to earn the approval and acceptance of parents and other adults. Most of us have some perfectionism traits, but others, like Jackie, are on the far end of the continuum. When taken to an extreme, perfectionism can become self-destructive because it’s an unattainable goal. And it doesn’t happen in a vacuum. Jackie’s perfectionism affects everyone around her because she’s setting impossibly high standards not only for herself, but also for her staff.

Jackie should begin her path to reducing perfectionism with a reflective look at some of her behaviors. (See Are you a perfectionist?)

Are you a perfectionist?

Perfectionistic traits that might derail your leadership career include:

  • a continuous drive to do more, be more, and prove yourself
  • a strong need for control
  • setting impossibly high standards for yourself and others
  • fear of failure
  • excessive rumination and overthinking when things don’t go well
  • checking and redoing others’ work
  • the inability to delegate work to others
  • an orientation to detail versus the bigger picture
  • a focus on flaws and mistakes made by others
  • a strong association of self-worth with career accomplishments
  • a preoccupation with your appearance and status in others’ eyes
  • frequent criticism of others when they don’t meet your expectations
  • excessive need for cleanliness and order
  • a need to present an external picture of the “perfect life” to others
  • thinking in terms of absolutes and an inability to live with ambiguity
  • a belief that only one best way exists to goal achievement
  • a focus on individual weaknesses versus strengths
  • the inability to be decisive if the “perfect” decision isn’t evident
  • a need to add value even when it’s not necessary
  • a high stress level during setbacks.

Source: Martin 2019

Dialing down perfectionism

Because perfectionist leaders don’t empower their staff and don’t practice transformational leadership, they’re rarely confronted about the impact their behavior has on others. Instead, they try to maximize results by using a pace-setter management style. This approach is characterized by impatience, lack of empathy, negative stretch (stretching people well beyond their comfort zone with insufficient or no support), and harsh judgments about others’ performance and capabilities. When staff fail to meet expectations, the leader is disappointed and staff feel micromanaged.

Like many perfectionists, Jackie may justify her behavior by contending that her standards are just higher than others’; she wants excellence. But striving for excellence isn’t the same as perfection. For staff, excellence is attainable and allows them to appreciate their accomplishments. Perfection can be crippling because enough is never enough. A perfectionist approach can cause even the best and brightest people to feel unmotivated, devalued, dependent, disempowered, frustrated, and ultimately disengaged. When the leader’s behavior is left unchecked, staff may feel they have no safe way to push back on the leader’s perfectionism, so they leave.

Dialing down her perfectionism will require a radical change from Jackie. She’ll need to carefully evaluate her current work habits and move to change destructive behaviors. To travel the road to reform, Jackie should embrace these five steps:

  1. Recognize perfectionism is a weakness masquerading as a strength. To successfully conquer perfectionism, Jackie must recognize that it doesn’t drive her success; instead, it’s a barrier. She’s achieved her career goals because she’s capable and motivated despite her issues with perfectionism. She won’t be able to change her perfectionist ways without accepting they’ve become a liability that could derail her. This recognition will require Jackie to practice self-compassion and reframe how she thinks about herself.
  2. Identify key problematic perfectionist behaviors and triggers. After Jackie recognizes that her perfectionism is problematic, she’ll need to identify the key behaviors to change as well as what triggers her criticism and nagging. This will require reflection and a willingness to embrace her imperfections. Jackie’s lack of decisiveness is a good example. She needs to pay attention to when she doesn’t make timely decisions but instead keeps exploring options, hoping for something better. Jackie must recognize that this is flawed thinking.
  3. Differentiate excellence from perfection. Setting high standards for excellence is the right approach in leadership, but Jackie will need to differentiate excellence from perfection. She should consider the risks of something being imperfect and that at some point “done” is better than perfect.
  4. Accept that a goal can be achieved in multiple ways. Perfectionists often see their way of doing things as the only path to goal achievement. Jackie will need to shift her thinking and accept that different approaches can lead to successful outcomes. Her inability to fully delegate projects costs the organization because she’s not meeting other responsibilities. She’ll need to reduce her unnecessarily high expectations of others and recognize that criticism isn’t a motivator.
  5. Find an accountability partner. Changing deeply rooted behaviors can be extremely difficult. After Jackie develops her action plan, she should find a trusted colleague who can observe her new behaviors and offer feedback. This will require vulnerability when seeking help to avoid reverting to destructive behaviors.

Perfectionism rehab

If you’re a perfectionist like Jackie, recognize that it’s a double-edged sword. While perfectionism may have contributed to your career success, it can result in leadership derailment. Pay attention to your perfectionist tendencies and work hard to moderate them. Recognize the difference between excellence and perfection and acknowledge that a goal can be achieved in many ways; your approach may not be the best option. Practice patience and recognize that perfectionism is likely to emerge when you’re under stress. An accountability partner can help you when you’re being unrealistic. Strive to be a recovering perfectionist.

Rose O. Sherman is adjunct professor at the Marian K. Shaughnessy Nurse Leadership Academy, Case Western Reserve University in Cleveland, Ohio, and author of the book The Nurse Leader Coach: Become the Boss No One Wants to Leave. You can read her blog at emergingrnleader.com.

*Name is fictitious.


Brown B. The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are. Center City, MN: Hazelden Publishing; 2010.

Goldsmith M. What Got You Here Won’t Get You There: How Successful People Become Even More Successful. London: Profile Books; 2010.

Martin S. The CBT Workbook for Perfectionism: Evidence-Based Skills to Help You Let Go of Self-Criticism, Build Self-Esteem, and Find Balance. Oakland, CA: New Harbinger Publications; 2019.

Roger D, Petrie N. Work without Stress: Building a Resilient Mindset for Lasting Success. New York, NY: McGraw-Hill Education; 2017.

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