Are You A Type "a" Nurse Or Type "b"

[kellbell1]

Many years ago, when I was director of nursing at a hospital in east San Gabriel Valley, I was confronted by patients and patient's families expressing grievances during the 1500-1900 shift. This shift had a disproportionate number of complaints. Yet, I knew that the nursing staff on this shift was both competent and efficient, so I wondered what was the problem could be. I set about observing the nurses as they worked. It didn't take long to realize that the problem wasn't so much the nurses's skills, but how they executed their work. For some reason, this shift had a disproportionate number of nurses who were task-oriented and it was this behavior that was at the heart of the problem.

Individuals exhibit both a variety and a continuum of behaviors, but many of us have certain traits that mark us as either a task-oriented or a nurture-oriented person. It is one of these two modes that defines how we organize and execute our work. Being aware of your predilection can help you work more smoothly with your fellow nurses, customize your interaction with patients and their families, and even be more effective as a nurse.

The task-oriented (Type A) nurse will usually have a To Do list, with an idea of how much time each task will take. This nurse will plan breaks and meal times around a schedule of work responsibilities. She is usually praised for her organizational skills.

The nurture-oriented (Type B) nurse is more focused on the interpersonal aspects of her work. Her focus is on meet ing the emotional/spiritual needs of her patients. The task itself is secondary. Problems generally arise when the ratio of Type A and Type B nurses are out of sync, as this can lead to subtle and not so subtle conflicts among the nursing team, as well as complaints from patients and their families.

A "Type A" nurse may:

* Fight to get one of the limited number of scales available to weight her baby, rather than wait until later, when there is less demand;

* Get that patient out of bed and sitting up in the chair at the designated time, even if the patient is engaged in some other activity;

* Change the dressing of the patient's open wound, even though housekeeping is in the room vacuuming and doing other cleaning tasks;

* Arrive 15 minutes or more before the shift is set to begin;

* Collect all the necessary equipment for the lab tests ordered, even if the labs don't need to be sent in until end of shift--twelve hours later; or,

* Stick a patient to get that IV started even if it means trying 13 times.

A "Type B" nurse may:

* Arrive late for the start of your shift because she is busy talking to everyone in the nursing office, cafeteria, hallway, and parking lot;

* Know the entire life story of each and every one of her patients;

* Leave the bay supplies more depleted, or in more chaos, than when she arrived;

* Be looking for the supplies needed to draw the labs that were due in the lab 20 minutes ago;

* Know that it just isn't her day to start a patient's IV if by the third attempt she has still been unsuccessful;

* Be overhead saying, "but it's an organized mess."

So, which "type" makes the perfect nurse? If your answer is both and neither then you'd be right. A strictly "Type A" nurse is the nurse caricature that we all dread and hate--this is the Nurse Ratched stereotype that dogs our profession to this day. Meanwhile, the "Type B" nurse is the one we all dread to work with because she is so busy with the "touchy-feely" side that no tasks get done. Nursing teammates are often left to do her work in addition to their own.

The best nursing model is a blend of the two types. Most of us shift between the two types, adjusting our style as needed. Problems arise when we become stuck in one style of behavior. We may not always be aware of our proclivities, but our fellow coworkers generally are.

Any NICU nurse, especially those who work the night shift, knows of the mad dash to get all babies weighed at the start of shift. When Type A nurses make up the majority on the shift, there is an almost comic, and sometimes stressful, ballet as each nurse tries to secure one of the few scales that are available for this function. A Type B nurse would generally choose to wait a little later in the shift to do the weigh-in (especially if it is not a time-sensitive task) and let the Type A's "duke it out" over the limited number of scales.

When Type B nurses make up a large percentage of your nursing team, things like restocking the bay or calling in all the labs, etc., might not get done in a timely manner, since they may focus most of their work time interacting with other nurses, the patient, or the patient's family.

Neither scenario is an example of "bad" nursing. The solution lies in a strong manager who can identify the traits of her nurses and try the following solutions:

* Redistribute the "mix" of personality types, ensuring that one type does not dominate.

* Hold in-services for the nursing teams so they can learn to identify and integrate their styles into their work.

* Help an over-strong Type A or Type B personality learn how to moderate the behavior so that it does not continue to overwhelm the other nurses, patients, and themselves.

Good and competent nursing leadership, from both the nursing management and from the nurses themselves, is a critical element in a nursing team that excels in its work and provides the best of patient care.

Knowing what personality trait you are likely to exhibit, especially in moments of stress, can help you to be a better nurse. No one style is always superior to the other. However, knowing when and how to shift from one style of behavior to the other can help you perform in an even more effective manner, and interact better with the other members of the nursing team.

[marie4]

Very insightful food for thought. Thank you!

[Gompers, BSN, RN]

Here in the NICU, almost everyone is a Type A personality! We have to be - everything is so completely detail-oriented. We joke all the time that we are the most anal nurses in the hospital, and the other services that work with us agree!

The thing about the IV sticks bothered me though - isn't it a general rule of thumb EVERYWHERE that if you don't get an IV in two sticks, you have to find someone else to try? I thought that was basic nursing ettiquite.

[Nella]

I must be a cross over. I exhibit qualities of both types. I'm fairly organized, I do the thing about getting my IV, blood draw supplies lined up. Same for dressing changes etc. I use a clipboard to track all my pt's I&O, vitals, IV fluids etc

But I'm flexible about my tasks and when I take my breaks and lunches. I can recognize when the shift isn't going the way I planned and I make the needed adjustments.

I'd never ever change a dressing while the housekeeper was in the room. But I know the housekeepers ( and I know their life stories too) and so can ask them to skip the room and come back to later when I'm done.

And I'd never ever stick someone more than 3 times for an IV start, that's just sadistic. ( Luckily I'm very good w/ IV starts, usually don't need 3 times to start with).

And I'm good with patients. I talk to them and let them talk to me. They are more than a set of tasks waiting to be done.

You might think about whether the pts receive more visitors on second shift, therefore generating more complaints.

[UM Review RN, ASN, RN]

Thanks so much for that post! I'm such a Type B that I now understand why I and other Type B's have so much trouble with a couple of the day shift staffers.

They just don't get it when you tell them that your line draws were a little late because you were discussing a patient's new cancer dx at 0400 or sitting at the bedside of a confused patient, holding her hand until she fell asleep.

One of those highly-driven types actually had one of our night shift nurses in tears. We all dread having to pass our assignments on to her because she's gotten such great feedback about her Type A behavior that she's turned into quite the little bully.

But that's gonna stop now. :)

[LeesieBug]

As a student, I thought this was interesting. I'd like to mention that my school is breeding Type A's. :chuckle There is no room for a type B in most our clinicals...they'll beat it out of you!

Even during our senior year, most of the instructors are very rigid in their expectations of how we do things....the only time I had some breathing space was during preceptorship. While our clinical evaluation tool is based on Benner's Domains, which includes much more than "tasks" and time management, the instructors are primarily concerned with.... tasks and time management. Type A's are praised as being clinically strong, so that's what we all have to strive for.

Hopefully, once I'm off on my own I can return to some sort of balance.

Thanks for the interesting thread.

[healer27]

Hi, I agree with LeesieBug I'm a student as well and I think in my school as well the focus is more on "getting the tasks" done at this point. I think for a new grad it probably takes some time and work (at least I foresee it will for me) to merge A&B together. I'm going to strive to do this. :wink2:

[Mississippi_RN]

I think I am a Type AB...a mix of the two. I do have a mental "list" of things I need to do in the day, but I am open to being somewhat flexible if things come up in the meantime, or if the patient needs to do something else first. Also, I am one of those people doing stuff before it needs to be done, but mostly only to be sure I remember to get it done...lol.. I can be somewhat forgetful. I know I will go through my charts at least twice to make sure I closed them all. And my general rule on IVs are that I will stick twice and then get someone else to try. The only time I have only broke that rule is when I think I have a very good chance of getting it the third time, especially if the first or second time was only messed up because of patient movement, vein that detoured unexpectantly or etc. But almost 99.9% of the time, if I dont get it 2nd try, then I get someone else.

[Judee Smudee, ADN, RN]

Alas, the high tech nature of health care is tipping the scales more and more in favor of the type A. They are terrific in this enviroment. The Alas is for me a B. In the acute setting I was having more and more trouble keeping up. I even did a thread about how the doctors were complaining I was to slow. The patients I believe, want to know how much you care much more than the care how much you know. I am currently working in LTC and it fits my B personality better.

[VivaLasViejas, ASN, RN]

I appreciate this information so much!! Now I know why management was often frustrated with me.......I'm so type B it's not even funny (although I am ALWAYS early for work, and I can be organized when I absolutely must) and I worked with practically all type A's. Day shift is made for them, and management looooves them---they get all the props and the promotions, while we type B's must content ourselves merely with the love and respect of our patients.

No wonder I gravitate towards evenings and nights........days just drove me crazy. Now I know why. Thank you to the OP for posting this!!:)

[LPN1974, LPN]

I think I'm type A. On my job we have such a large amount of work to do if you don't get started on time and get done on time, you ain't going home on time.

Our medication loads are heavy and take a long time, we have many things to do besides administering the meds. We do self administration programs on our people and some of them require alot of time and patience.

And of course there are the treatments that have to be done, and we are going to electronic med sheets soon, so that's going to take even longer in my opinion.

On dayshift our people go to training classes, so the nurses have to get done on time for the people to leave the residence.

On evenings they're wanting to get their bathing done and go to bed so the nurses have to get finished.

We are just rushed to do what we have to do.....very task oriented.

[RENAISSANCE RN]

I am not a nurse yet, but as a student I am a-/b+.