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.

[DutchgirlRN, ASN, RN]

I am defineately a Type B person. With that said while working Med/Surg I can easily convert to a Type A nurse. In home health I'm my usual Type B person/nurse. My worst day in HH so far was running over a chicken. Poor chicken.

[DutchgirlRN, ASN, RN]

Total Type A, except for the part about IV sticks. Not only would trying that many times be against hospital policy (policy is 2 attempts/nurse), but it just wouldn't be smart. If you don't get it in the first couple of attempts, you probably are not going to get it anyway, so let someone else try. That is just common sense, IMO.

I understand the policy re 2 attemps/nurse but don't see why there is such a policy. 2 attemps per nurse can still add up to alot of sticks, way too many sticks. I personally never stick more than 3 times at most. If I can't get it in 3 sticks then I'm asking the doc for a PICC line order. I am the IV guru on the floor. I would refuse to let anyone combination of nurses stick me more than 3 times. I'll have a PICC thank you.

[UM Review RN, ASN, RN]

Ever since I've read this thread, I've been more aware of the difference between A's and B's.

Had a perfect example of the value of being a B just last night.

Long story short, when I made "small talk" with a patient, I found out that her niece brought in the medication list to the ER, and that was the list that the doc had gone by to order the patient's meds.

After a few more pointed questions, I discovered that the patient was a CHFer. She hadn't had any lasix in >48 hours because it wasn't ordered. She wasn't weighed, she wasn't getting her coumadin correctly, and also wasn't getting her stool softener.

Instead of questioning why the patient's meds didn't quite match her symptoms, the Type A's just gave the meds and got out of the room. The fact that the H&P hadn't come in was no excuse; this patient was alert and oriented X3, knew her meds, knew her dosages, and knew what they were for.

I asked her how this happened. She said, "I'm telling you, no one would listen to me! They all just told me that the doctor changed this or that, and no one would listen to me!"

I'm not writing this to chastise anyone; I'm writing this to serve as a warning. I understand how busy it gets; we all fall victim to that. But it's chilling to think that if this patient did not get a dose of Lasix that morning, she'd be in the ICU---or worse.

All because we've become so task-oriented that we don't take the time to listen.

[mtnmom]

My worst day in HH so far was running over a chicken. Poor chicken.

I love it!!!! :chuckle

[mtnmom]

I'm a B. and comfortable with that fact.

[Gompers, BSN, RN]

I understand the policy re 2 attemps/nurse but don't see why there is such a policy. 2 attemps per nurse can still add up to alot of sticks, way too many sticks. I personally never stick more than 3 times at most. If I can't get it in 3 sticks then I'm asking the doc for a PICC line order. I am the IV guru on the floor. I would refuse to let anyone combination of nurses stick me more than 3 times. I'll have a PICC thank you.

It doesn't work that way in the NICU though. Often, babies have PICC lines but they are pulled if they become septic - which unfortunately happens pretty often in immunosuppressed preemies. Where I work, they will not place another PICC line until the blood cultures are negative, because they just keep becoming a source of infection otherwise. In the meantime, the babies need peripheral IVs for fluids and antibiotics. We also don't give blood through PICC lines (they're extremely tiny bore lines) unless it's the only access we have in a very critical baby. So we always need a PIV to give transfusions.

So yeah, we deal with a lot of IV sticks in the NICU.

[leslie :-D]

i'm a definite B all the way.

works well in the hospice setting but still, there are plenty of times you need to be organized, focused and critically think your way through a situation. but often, i've left work late because of my gift of gab.

leslie

[veegeern, BSN, RN]

Interesting thoughts, but I'm going to agree with the poster that said that wouldn't be the sole explanation for complaints from 15-1900. Perhaps: staffing cut at 1500 (after all, it's not daytime anymore) and still all the hustle bustle of days? Doctors coming in after offices close and creating lots of orders to be done at the same time dinner trays hit the floor. Patients and visitors getting cranky at the end of the day because they're tired. I think boiling it down to "Type A" and "Type B" nurses is sometimes just another chance to blame staff for what is more of a system type problem.

My thoughts exactly. Our outpatient infusions/transfusions are usually completed by 1500, and we've usually discharged a couple by this time. This means we usually flex down - we lose a nurse and a PCA. Sometimes we even lose a ward clerk. We have a couple of MDs that make rounds from 1500-1900 (new orders), but the biggest problem is the admissions. It seems that the sickest people are the ones that call the MD's office for an appointment and are worked in at the end of the day. These are then sent to us for admission during the 1500-1900 time frame. And of course, you're trying to pass evening medications, feed patients, get them up to the toilet, etc...and deal with family members who just came by after work and need an explanation regarding that day's events. The other night we had 5 admissions arrive from the MD's office from 1550-1645. It was myself, the clinical coordinator, and 2 PCAs. The clinical coordinator is a type A, and I'm definitely a type B striving to be more like a type A with my "to do list." Staffing was flexed up at 1900, but she and I were there until 2100 finishing our work. I'd like to say that this is "the exception", but unfortunately it is more often "the rule." Hope this makes sense as it has been a long 2 days of 12 hour shifts.

[RN4NICU, LPN, LVN]

I understand the policy re 2 attemps/nurse but don't see why there is such a policy. 2 attemps per nurse can still add up to alot of sticks, way too many sticks. I personally never stick more than 3 times at most. If I can't get it in 3 sticks then I'm asking the doc for a PICC line order. I am the IV guru on the floor. I would refuse to let anyone combination of nurses stick me more than 3 times. I'll have a PICC thank you.

We can't put in our own PICCs in the NICU, the NNPs do it and they are not there at night. So if you can't get your PICC, then what do you do? The baby HAS to have the line, and as Gompers pointed out, if the baby needs blood products, you can't run them through a PICC anyway.

OF COURSE, we don't like to just keep trying and trying. After a couple of nurses have tried, we usually let the doc know what is going on. Some of them will go ahead and try for a central line at that point - some of them will say "keep trying". It depends on who is on call.

I agree that 2 sticks per nurse can still add up, but you are still getting someone with a fresh pair of eyes who is not already getting frustrated. Stopping after 3 sticks is not an option for us.

[veegeern, BSN, RN]

We can't put in our own PICCs in the NICU, the NNPs do it and they are not there at night. So if you can't get your PICC, then what do you do? The baby HAS to have the line.

OF COURSE, we don't like to just keep trying and trying. After a couple of nurses have tried, we usually let the doc know what is going on. Some of them will go ahead and try for a subclavian at that point - some of them will say "keep trying". It depends on who is on call.

I agree that 2 sticks per nurse can still add up, but you are still getting someone with a fresh pair of eyes who is not already getting frustrated. I say it is a good policy, because there are those nurses who would try every vein the kid had (even when they were clearly not going to get it), and after they had blown them all, not only would the baby be stressed, if not shocky, but there would be no veins left for someone else to try. "IV gurus" have off-nights too. I have often gotten one in after one of our "gurus" has already missed twice.

Our hospital policy for adults is that 2 floor nurses each attempt 2 times (or sticks). The nursing supervisor attempts 2 times. Then the MD is called. Don't know if this applies to our wee ones, though.

[Gompers, BSN, RN]

Our hospital policy for adults is that 2 floor nurses each attempt 2 times (or sticks). The nursing supervisor attempts 2 times. Then the MD is called. Don't know if this applies to our wee ones, though.

Well, usually the NICU staff nurses are the best IV sticks around - OB and Peds call US for IVs on their babies. Some of the NNPs are very good, too, but they only work day shift.

If we're really having a hard time getting an IV, we'll call the doc and go from there. Sometimes they'll decide to do IM antibiotics instead of IV if the baby is on full feeds. Other times they'll cut down the umbilical stump (if the baby still has a cord and is less than a week old) and place a UVC. And in those babies that are just impossible, they will place a PICC line even though blood cultures are still positive, or they'll place a second PICC in a baby that needs two lines (one for fluids and meds, one for tons of transfusions) and we'll give blood through that even though we really shouldn't.

[live4today, RN]

.......................many of us have certain traits that mark us as either a task-oriented or a nurture-oriented person.......................

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 meeting 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?.............................neither scenario is an example of "bad" nursing.................................

i would describe my style of nursing as more of a "type a minus" or "b plus".

the "type b" descriptions sounds wayyyyyyyy too lax- imo.

i agree that a good mix of a little of both type a and type b traits would make for a well-rounded nurse. i've never heard this study before, but in reading your post, i could picture nurses i've worked with who exhibited type a and type b traits.

i just prefer to work with staff who is both organized and people conscious. if they exhibit "lazy traits", that's not a good thing.